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

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)

Clinical Trials Aflatoxin Prevention Studies

Primary Prevention Chemoprevention

Reduction in aflatoxin exposure

Africa and China

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

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%)

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%)

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

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

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

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