title: Association between Aflatoxin M₁ and Liver Disease in HBV/HCV Infected Persons in Ghana.
abstract: Aflatoxins are produced by the fungi Aspergillus flavus and Aspergillus parasiticus and are common food contaminants in tropical developing countries. Extensive aflatoxin consumption has been shown to be highly associated with liver disease. A case-control study was conducted to determine the association between aflatoxin and liver disease in Kumasi, Ghana. A questionnaire was administered to examine socio-demographic characteristics and food storage and consumption practices, and urine samples were collected to measure levels of the aflatoxin metabolite (AFM₁). Two hundred and seventy-six people participated in the study; 38 had liver disease (cases), 136 had neither hepatitis B/C nor liver disease (negative controls), and 102 were hepatitis B/C positive without liver cancer (positive controls). A much higher percent of participants in each group was male (76% of cases, 88% of negative controls and 65% of positive controls). Multivariate analysis showed that age was a significant predictor for being a case when cases were compared to negative controls. The odds of being a case was 70% less for participants aged 25-34 years (odds ratios (OR) 0.30; 95% confidence interval (CI) 0.10-0.88) compared to those ≥45 years. For cases; Akans were seven times more likely to have AFM₁ levels below the median when compared to other ethnic groups (OR 7; CI 1.41-34.68). When cases were compared to positive controls, they were 2.29 times more likely to report awareness of aflatoxin contamination of groundnuts (95% CI 1.06-4.91). Cases were also two times more likely to report awareness of aflatoxin contamination of maize than all controls combined (95% CI 1.02-4.11). However, most cases reported that aflatoxin contamination does not cause sickness in humans. This shows that there is awareness of aflatoxin contamination without proper understanding of the serious potential adverse health impacts among these study participants. These findings indicate that educational interventions that stress the harmful health effects of aflatoxin in food, with an emphasis on the higher risk for males, are urgently needed. The reasons for lower aflatoxin levels among Akans need to be determined, and the findings used to design interventions that benefit other ethnic groups in the society.
authors.affiliation: Department of Epidemiology, School of Public Health, Ryals Public Health Building, University of Alabama at Birmingham, 1665 University Boulevard Birmingham, Birmingham, AL 35294-002, USA. clarrisaafum@gmail.com.
authors.forename: Clarrisa
authors.initials: C
authors.lastname: Afum
authors.affiliation: Department of Epidemiology, School of Public Health, Ryals Public Health Building, University of Alabama at Birmingham, 1665 University Boulevard Birmingham, Birmingham, AL 35294-002, USA. lorenecudjoe@gmail.com.
authors.forename: Lorene
authors.initials: L
authors.lastname: Cudjoe
authors.affiliation: Department of Epidemiology, School of Public Health, Ryals Public Health Building, University of Alabama at Birmingham, 1665 University Boulevard Birmingham, Birmingham, AL 35294-002, USA. jlhills14@gmail.com.
authors.forename: Justin
authors.initials: J
authors.lastname: Hills
authors.affiliation: Department of Epidemiology, School of Public Health, Ryals Public Health Building, University of Alabama at Birmingham, 1665 University Boulevard Birmingham, Birmingham, AL 35294-002, USA. rbhunt@cchs.ua.edu.
authors.forename: Raymond
authors.initials: R
authors.lastname: Hunt
authors.affiliation: Department of Epidemiology, School of Public Health, Ryals Public Health Building, University of Alabama at Birmingham, 1665 University Boulevard Birmingham, Birmingham, AL 35294-002, USA. apadilla@uab.edu.
authors.forename: Luz A
authors.initials: LA
authors.lastname: Padilla
authors.affiliation: Veterinary Medicine & Biomedical Sciences, Texas A & M University, College Station, TX 77845, USA. SELmore@cvm.tamu.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Elmore
authors.affiliation: Department of Epidemiology, School of Public Health, Ryals Public Health Building, University of Alabama at Birmingham, 1665 University Boulevard Birmingham, Birmingham, AL 35294-002, USA. aafriyie09@gmail.com.
authors.forename: Abena
authors.initials: A
authors.lastname: Afriyie
authors.affiliation: School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. oparesem@hotmail.com.
authors.forename: Ohene
authors.initials: O
authors.lastname: Opare-Sem
authors.affiliation: Veterinary Medicine & Biomedical Sciences, Texas A & M University, College Station, TX 77845, USA. tphillips@cvm.tamu.edu.
authors.forename: Timothy
authors.initials: T
authors.lastname: Phillips
authors.affiliation: Department of Epidemiology, School of Public Health, Ryals Public Health Building, University of Alabama at Birmingham, 1665 University Boulevard Birmingham, Birmingham, AL 35294-002, USA. jollyp@uab.edu.
authors.forename: Pauline E
authors.initials: PE
authors.lastname: Jolly
mesh_terms: D000328:Adult; D016607:Aflatoxin M1 / Q000652:urine*; D010367:Arachis; D016022:Case-Control Studies; D005260:Female; D005506:Food Contamination; D005869:Ghana / Q000453:epidemiology; D016174:Hepacivirus; D006515:Hepatitis B virus; D006801:Humans; D008107:Liver Diseases / Q000453:epidemiology / Q000652:urine*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D055815:Young Adult; D003313:Zea mays
chemical_list: D016607:Aflatoxin M1
keywords: Ghana; aflatoxin M1; hepatitis B/C virus; hepatocellular carcinoma; liver disease