Aflatoxin exposure in developing countries: the critical interface of agriculture and health.
BACKGROUND
Aflatoxins are common contaminants of staple foods in sub-Saharan Africa. These toxins are human liver carcinogens, especially in combination with chronic infection with hepatitis B virus. However, in an agricultural setting, the effects on growth, immune status, and susceptibility to infectious disease in farm animals are also well recognized. These latter effects have been far less explored in human populations.


OBJECTIVE
To review some of the more recent work on aflatoxins where the health outcomes seen in the agricultural setting, including growth impairment and immune suppression, have been investigated in human populations. The paper draws largely on examples from West Africa. The paper also sets out how knowledge gained about aflatoxins in the agricultural setting can be used to design intervention studies in human populations.


METHODS
A review of the relevant literature.


RESULTS
Human exposure to aflatoxins begins early in life, and recent studies in West Africa have demonstrated an association between exposure and growth faltering, particularly stunting, in young children. At present the underlying mechanisms for the latter effects are unknown but may include impairment of immunity and increased susceptibility to infections. Simple postharvest intervention strategies were successful in reducing aflatoxin exposure in a subsistence farm setting, providing a rationale for prevention of aflatoxin-related disease.


CONCLUSIONS
There are potential benefits to public health from intervention strategies combining expertise in the agricultural and health settings to address the aflatoxin problem.
Wild
Christopher Paul
CP
Molecular Epidemiology Unit, Centre for Epidemiology and Biostatistics, Leeds Institute of Genetics, Health and Therapeutics, Faculty of Medicine and Health, University of Leeds, Leeds, UK. c.p.wild@leeds.ac.uk
D000348:Aflatoxins / Q000008:administration & dosage / Q000009:adverse effects*; D000354:Africa, Western; D000367:Age Factors; D000383:Agriculture; D001827:Body Height / Q000187:drug effects; D002273:Carcinogens / Q000032:analysis; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D005506:Food Contamination / Q000032:analysis* / Q000517:prevention & control; D006128:Growth / Q000187:drug effects*; D006801:Humans; D007223:Infant; D008297:Male; D011634:Public Health
D000348:Aflatoxins; D002273:Carcinogens