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Guinea: Low Cost Approaches to Reducing the Disease Burden from Contaminated
Groundnuts
Paul C. Turner
Maryland Institute for Applied Environmental Health
THIS WORK WAS SUPPORTED BY A GRANT FROM THE NIEHS, USA ES06052
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Aflatoxins in Foods from 4 Villages in Lower Guinea - Nov/Dec
Food samples
Village no. positive (%)
Peanuts Rice Corn
Bangouya 9/13 (69) 0/15 1/3 (33)
Sougueta 5/9 (56) 0/14 1/3 (33)
Kolente 8/9 (89) 0/19 0/3
Friguiagbe 6/15 (40) 0/18 0/0
Total 28/46 (61) 0/66 2/9 (22)
Other foods all negative for aflatoxins (soup, sorghum, manio, fonio, milk, potato leaves)
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Clinical Trials Aflatoxin Prevention Studies
Primary Prevention Chemoprevention
Reduction in aflatoxin exposure
Africa and China
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Oct 1999 Dec 1999 Feb 2000
HarvestGroundnut sample Groundnut sample Groundnut sample
Protocol for Primary Prevention Study to Reduce Aflatoxin Exposure in Guinea, Conakry
Blood 130 subjects
Blood 230 subjects
Blood 330 subjects
Intermediate visits to villages 1) check compliance , 2) short dietary questionnaire on foods consumed in previous 24 hours , 3) check humidity in storage facilities
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Guinea Intervention Study
Intervention Control
Groundnut drying Mat 150 (100%) 10 (7%) Ground 79 (53%) Mixed 61 (41%)
Hand sorting 150 (100%) 52 (35%)
Type of bag Natural fibre 150 (100%) 4 (3%) Plastic 107 (71%)
Mixed 39 (26%)
Wood pallet 150 (100%) 6 (4%) Other 70 (47%) None 74 (49%)
Insecticide use 150 (100%) 19 (13%)
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Guinea Intervention Study
Intervention Control
Groundnut drying Mat 150 (100%) 10 (7%) Ground 79 (53%) Mixed 61 (41%)
Hand sorting 150 (100%) 52 (35%)
Type of bag Natural fibre 150 (100%) 4 (3%) Plastic 107 (71%)
Mixed 39 (26%)
Wood pallet 150 (100%) 6 (4%) Other 70 (47%) None 74 (49%)
Insecticide use 150 (100%) 19 (13%)
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Multivariable models of serum AF-albuminat the two follow-up surveys
Survey 2 Survey 3GM ( 95% CI ) GM ( 95%
CI ))Individual level
intervention 12.7 ( 7.8, 20.7) 8.0 (6.1,10.5)**
control 15.5 (9.5,25.0) 18.4 (14.2,24.0)
Village mean levelintervention 12.3 (11.2,13.5)** 8.2
(7.8,8.5)**control 17.6 (16.1,19.3) 18.7
(17.8,19.5) Approx 60% reduction ** p<0.001
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Are there any issues / problems
Focus on ground nut – Maize? JIFSAN et al collaborations
Whilst cost is low it is not insignificant What is / are the most effective components?
What happens to any discarded food items
Sustainability Are any INTERVENTION components lost from the
system Large educational components
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What else?? From year to year will there be added benefit from
the previous success?
What about co-exposures – AF and FB in maize
Are interventions that demonstrate etiology in the child health arena needed – are such interventions different in nature to sustainable interventions of a more global nature
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Acknowledgements
Institut Pasteur de Guinée, Kindia, Republic of Guinea Sylla, A. Diallo M
University of Leeds, UK Gong, Y, Sutcliffe A.E.
IARC, France Wild CP
London School of Hygiene & Tropical Medicine, UK Hall AJ