Contextual interlinkages and authority levels for strengthening coordination of national food safety control systems in Africa.

Africa is the greatest contributor to the burden of foodborne diseases in the world. The problem is associated with the weak food safety control systems in many countries of Africa. Africa's national food control systems are based on fragmented legislation which provide for multiple jurisdictions resulting in weaknesses in coordination, inspection and enforcement of food safety measures mandated to different sectors such as agriculture, trade, and health. It was hypothesized that the weak food safety legislation is a result of inability to contextualize and appreciate the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) guidelines for strengthening national food control systems. Raising awareness and knowledge on interlinkages and authority levels among the sectoral food safety actors can foster appreciation of the FAO and WHO recommendations and inform food safety policy reforms in the continent. This article highlights the interlinkages in food safety activities of the actors along the food chain. It also contextualizes the roles of each agency or ministry and proposes institutional arrangements to be considered in strengthening national food safety control systems in Africa.

Aflatoxin Contamination, Exposure among Rural Smallholder Farming Tanzanian Mothers and Associations with Growth among Their Children.

Recently, aflatoxin exposure especially through maize and groundnuts has been associated with growth impairment in children. Infants and children are considered to be more susceptible to toxins because of their lower body weight, higher metabolic rate, and lower ability to detoxify. On the other hand, for women of reproductive age, aflatoxin exposure may not only affect their health but also that of their foetus in the case of pregnancy. This study focused on investigating AFB1 contamination in maize and groundnut from respondent households, exposure among women of reproductive age and associations of aflatoxin contamination with growth retardation among children in Mtwara region, Tanzania. The highest maximum AFB1 contamination levels from all samples obtained were in maize grain (2351.5 µg/kg). From a total of 217 maize samples collected, aflatoxins were above European Union (EU) and East African Community (EAC) tolerable limits in 76.0% and 64.5% of all samples. Specifically, maize grain had the highest proportion of samples contaminated above tolerable limits (80.3% and 71.1% for EU and EAC limits). Groundnut had 54.0% and 37.9% of samples above EU and EAC maximum tolerable limits. The lowest proportion of contaminated samples on the other hand was for bambara nut (37.5% and 29.2% for EU and EAC limits, respectively). Aflatoxin exposure in our surveyed population was much higher than previous observations made in Tanzania and also higher than those observed in Western countries such as Australia and the USA. Among children, AFB1 concentration was associated with lower weight for height z scores and weight for age z scores in the univariate model (p < 0.05). In summary, these results indicate the seriousness of aflatoxin contamination in foods commonly consumed in the vulnerable population assessed. Strategies both from the health, trade, and nutrition sectors should therefore be designed and implemented to address aflatoxin and mycotoxin contamination in diets.

Complementary feeding in Kongwa, Tanzania: Findings to inform a mycotoxin mitigation trial.

Complementary feeding of 6- to 24-month-old infants and young children with adequate, safe and developmentally appropriate food is essential to child health. Inappropriate complementary foods and feeding practices are linked to the high incidences of undernutrition among infant and young children in most developing countries, including Tanzania. Mycotoxin risk is an additional concern, given the documented presence of aflatoxin and fumonisin in food systems of Africa, especially maize and groundnut. In preparation for a trial of mycotoxin mitigation, we conducted focus group discussions and recipe trials to explore complementary foods and feeding practices in Kongwa, a rural district of central Tanzania. Sixty mothers of infants from 6 to 18 months of age in five villages across the district were purposefully sampled. During focus group discussions, mothers reported to mostly feed their children with cereal and groundnut-based foods as thin or thick porridges. The most common porridge preparations contained cereal (mostly, maize) ranging from 66.7% to 80.0% by weight and groundnuts from 7.7% to 33.3%. The ratio of cereal to groundnut ranged from 3:1 to 4:1. For the recipe trial sessions, mothers chose similar ingredients reported during discussions to prepare complementary foods. The reliance on maize and groundnuts in complementary foods predisposes the children to undernutrition and exposure to aflatoxins and fumonisins. These formative research results suggest multiple intervention points to improve complementary feeding and reduce mycotoxin exposure in this population, including education messages package on feeding practices, mycotoxin control practices and complementary food formulation.

Estimating the risk of aflatoxin-induced liver cancer in Tanzania based on biomarker data.

Evidence about the magnitude of the aflatoxin menace can help policy makers appreciate the importance of the problem and strengthen policies to support aflatoxin mitigation measures. In this study, we estimated aflatoxin-induced liver cancer risk in 2016 for Tanzania and used the information to estimate the health burden due to the aflatoxin exposure in the country. The burden of aflatoxin-induced liver cancer was assessed based on available aflatoxin biomarker data from a previous epidemiology study, hepatitis B virus infection prevalence and population size of Tanzania in 2016. The health burden due to aflatoxin-induced liver cancer was estimated using disability adjusted life years (DALYs). The aflatoxin exposures ranged from 15.0-10,926.0 ng/kg bw/day (median, 105.5 ng/kg bw/day). We estimated that in 2016 there were about 1,480 (2.95 per 100,000 persons) new cases of aflatoxin-induced liver cancer in Tanzania and assumed all of them would die within a year. These morbidity and mortality rates led to a total loss of about 56,247.63 DALYs. These results show, quantitatively, the cases of liver cancer and related deaths that could be avoided, and the healthy life years that could be saved, annually, by strengthening measures to control aflatoxin contamination in Tanzania.

Estimating the health burden of aflatoxin attributable stunting among children in low income countries of Africa.

Numerous population-based studies have documented high prevalence of aflatoxin associated childhood stunting in low income countries. We provide an estimate of the disease burden of aflatoxin related stunting using data from the four African countries. For this empirical analysis, we obtained blood aflatoxin albumin adduct biomarker based exposure data as measured using ELISA technique and anthropometric measurement data from surveys done over a 12-year period from 2001 to 2012 in four low income countries in Africa. We used these data to calculate population attributable risk (PAR), life time disease burden for children under five by comparing two groups of stunted children using both prevalence and incidence-based approaches. We combined prevalence estimates with a disability weight, measuring childhood stunting and co-occurrence of stunting-underweight to produce years lived with disability. Using a previously reported mortality, years of life lost were estimated. We used probabilistic analysis to model these associations to estimate the disability-adjusted life-years (DALYs), and compared these with those given by the Institute for Health Metrics and Evaluation's Global Burden of Disease (GBD) 2016 study. The PAR increased from 3 to 36% for aflatoxin-related stunting and 14-50% for co-occurrence of stunting and underweight. Using prevalence-based approach, children with aflatoxin related stunting resulted in 48,965.20 (95% uncertainty interval (UI): 45,868.75-52,207.53) DALYs per 100,000 individuals. Children with co-occurrence of stunting and underweight due to exposure to aflatoxin resulted in 40,703.41 (95% UI: 38,041.57-43,517.89) DALYs per 100,000 individuals. Uncertainty analysis revealed that reducing aflatoxin exposure in high exposure areas upto non-detectable levels could save the stunting DALYs up to 50%. The burden of childhood all causes stunting is greater in countries with higher aflatoxin exposure such as Benin. In high exposure areas, these results might help guide research protocols and prioritisation efforts and focus aflatoxin exposure reduction. HEFCE Global Challenge Research Fund Aflatoxin project.

Protocol for the trial to establish a causal linkage between mycotoxin exposure and child stunting: a cluster randomized trial.

BACKGROUND: The number of stunted children has fallen globally but continues to increase in Africa. Stunting is estimated to contribute to 14-17% of child deaths under 5 years of age and is a risk factor for poor cognitive and motor development and educational outcomes. Inadequate dietary intake and disease are thought to be the immediate causes of undernutrition and stunting. However, improving infant diets through complementary feeding interventions has been shown to only modestly reduce stunting. Multiple observational studies demonstrate a dose response relationship between fetal and post-natal aflatoxin exposure and reduced linear growth. METHODS: This community-based cluster randomized trial will measure the effect of a reduced aflatoxin diet on length-for-age Z scores at 18 months in central Tanzania. All 52 health facilities in the Kongwa District of Dodoma Region were randomized into two groups. Starting at 6 months of age, participants in the intervention group receive a low-aflatoxin pre-blended porridge flour containing maize and groundnut (ratio 4:1 respectively) and low-aflatoxin groundnut flour, whereas in the control group the same porridge mix and groundnut flour are promoted through education but acquired by the household. Both groups will receive the same infant and young child feeding education and a thermos flask. A total of 3120 infants between 6 weeks and 3 months of age will be recruited into the study over 1 year. Data will be collected four times - at recruitment and when the infants are 6, 12 and 18 months of age. In a cohort of 600 infants, additional data will be collected at 9 and 15 months of age. The primary outcome is length-for-age at 18 months. Secondary outcomes include the Z scores for weight-for-age, middle upper arm circumference and head circumference, and the blood biomarker aflatoxin-albumin in the full sample, with the urine biomarker aflatoxin M1 analyzed in the cohort only. DISCUSSION: Better understanding the etiology of childhood stunting can lead to more appropriate interventions and policies to further reduce linear growth faltering and meet the Sustainable Development Goals. TRIAL REGISTRATION: NCT03940547, (April 24, 2019).

Harmful algal bloom and associated health risks among users of Lake Victoria freshwater: Ukerewe Island, Tanzania.

There is a global concern regarding the occurrences of harmful algal blooms (HABs) and their effects on human health. Lake Victoria (LV) has been reported to face eutrophication challenges, resulting in an increase of bloom-forming cyanobacteria. This study is aimed at understanding the association of HABs and health risks at Ukerewe Island. A cross-sectional study conducted on 432 study subjects and water samples for cyanobacteria species identification were collected at LV shores. The results reveal that concentrations of cyanobacteria cells are beyond (WHO) acceptable limits; species of Microcystis aeruginosa range from 90,361.63 to 3,032.031.65 cells/mL and Anabaena spp. range from 13,310.00 to 4,814,702 cells/mL. Water usage indicates that 31% use lake water, 53% well water and 16% treated supplied pipe water. Vomiting and throat irritation was highly reported by lake water users as compared to wells and pipe water (P < 0.001). Gastrointestinal illness (GI) was significantly elevated among lake water users as compared to pipe and well water users (P < 0.001). Visible blooms in lake water were associated with GI, skin irritation and vomiting as compared to water without visible blooms (P < 0.001). The concentration of cyanobacteria blooms poses greater risks when water is used without treatment.

Efficacy of Different Doses of Multiple Micronutrient Powder on Haemoglobin Concentration in Children Aged 6-59 Months in Arusha District.

In Tanzania's Arusha District, anaemia is a significant public health problem. Recently, home fortification with multiple micronutrient powder was recommended, and daily use of one sachet has shown to be effective. However, it is a challenge for deprived families with low income to afford the daily sachet. The aim of this study was to compare the efficacy of different administration frequencies of micronutrient powder in reducing anaemia in children aged 6-59 months. This research used a community-based, randomized longitudinal trial design with the intent to treat anaemia. Children aged 6 to 59 months (n=369) were randomly assigned to one of four intervention groups which received, on a weekly basis, either five sachets (n=60), three sachets (n=80), two sachets (n=105), or one sachet (n=124) for six months; 310 children completed the study. Using the HemoCue technique, a finger-prick blood was taken at baseline, middle, and end points of the intervention to determine haemoglobin levels. The effect of treatment on haemoglobin was assessed with analysis of covariates with Bonferroni post hoc to test group difference (p > 0.05) from each other. At the end, haemoglobin levels were significantly higher in participants who received three or five sachets of micronutrient powder per week compared to those who received one or two micronutrient powder sachets per week (p < 0.05). The prevalence of illnesses was reduced from 65% to 30.5% in all groups. This finding indicates that economically challenged families may opt for three times per week sachet administration rather than a more costly daily administration. This trial is registered with PACTR201607001693286.

Prevalence and predictors of undernutrition among underfive children in Arusha District, Tanzania.

Childhood undernutrition is a global health challenge impacting child growth and survival rates. This deficit in nutritional status contributes to the increasing chronic disease prevalence and economic burden in individuals and throughout developing contexts. A community-based cross-sectional study was conducted in Arusha District of Tanzania to determine the prevalence and predictors of undernutrition in 436 children. A structured questionnaire was used to collect data on demographic and socio-economic factors as well as feeding practices and prevalence of preventable childhood diseases. Anthropometric data were collected through the measurement of length/height and weight of all children. The prevalence of undernutrition was estimated based on Z-scores indices below -2SD of the reference population for weight for age (underweight), height for age (stunting), and weight for height (wasting). Fifty percent, 28%, and 16.5% of the children were stunted, underweight, and wasted, respectively. The age above 2 years and being a male were associated with stunting. The age above 2 years, nonexclusive breastfeeding children, and living at Seliani and Oturumeti were associated with being underweight. Similarly, morbidity, none exclusively breastfed children, living at Oturumeti, and being born to a mother 35 years and above were associated with wasting. In this study, we found the prevalence of child undernutrition in Arusha District is high in comparison with national and regional trends and appears to be associated with being a male. It is recommended that nutritionists and health planners should focus on these key predictors when planning nutrition interventions to address the problem of undernutrition among underfive children in Arusha District.

An In Vitro Evaluation of the Capacity of Local Tanzanian Crude Clay and Ash-Based Materials in Binding Aflatoxins in Solution.

Aflatoxins in feeds cause great health hazards to animals, and thus eventually to humans as well. The potential of clays from Arusha (AC), Kilimanjaro (KC), the Coast (CC), and Morogoro (MC), as well as volcanic ash (VA) and rice husk ash (RA), were evaluated for their capacity to adsorb aflatoxins B1 (AFB1), B2 (AFB2), G1 (AFG1), and G2 (AFG2) relative to a commercial binder Mycobind® (R) using in vitro technique. On average, CC, VA, KC, MC, AC, RA, and R adsorbed 39.9%, 51.3%, 61.5%, 62.0%, 72.6%, 84.7%, and 98.1% of the total aflatoxins from solution, respectively. The capacity of AC and RA was statistically (p < 0.05) better in binding aflatoxins next to R. The adsorption capacity seemed to follow the trend of the cation exchange capacity (CEC) of these materials. The CEC (meq/100 g) of CC, MC, KC, VA, AC, RA, and R were 7.0, 15.4, 18.8, 25.4, 27.2, 27.2, and 38.9, respectively. On average 96.3%, 42.7%, 80.8%, and 32.1% of AFB1, AFB2, AFG1, and AFG2 were adsorbed, respectively. The binding capacity of the clays and ashes relative to Mycobind® was about 100% for AC and RA, 50% for KC, MC, and VA, and 33.3% for CC. The AC and RA seem to be promising resources in binding aflatoxins in solution.

Water, Sanitation, and Hygiene Practices Associated with Nutritional Status of Under-Five Children in Semi-Pastoral Communities Tanzania.

Undernutrition among under-five children is a public health concern in developing countries and has been linked with poor water, sanitation, and hygiene (WASH) practices. This study aimed at assessing WASH practices and its association with nutritional status of under-five children in semi-pastoral communities of Arusha. The study was cross-sectional in design. Mother-child pairs from 310 households in four villages of Monduli and Longido were involved. Weight and height of children were measured using weighing scale and length/height board, respectively. Children's age was recorded using clinic cards. Hemoglobin level of each child was tested using Hemo Cue® Hb 201 + photometer (HemoCue AB, Ängelholm, Sweden) machine. Structured questionnaire was used to gather information on WASH, child morbidity, demographic, and sociocultural characteristics. Prevalence of stunted, underweight, wasted, anemia, and diarrhea were 31.6%, 15.5%, 4.5% 61.2%, and 15.5%, respectively. Children with diarrhea 2 weeks preceding the survey (P = 0.004), children using surface water for domestic purposes (P < 0.001), and those with uneducated mothers (P = 0.001) had increased risk of being stunted and underweight. Children introduced to complementary foods before 6 months of age (P = 0.02) or belonging to polygamous families (P = 0.03) had increased risk of being stunted. Consumption of cow's milk that is not boiled (P = 0.05) or being a boy (P = 0.03) was associated with underweight. Prevalence of undernutrition among under-five children in the population under study was alarming and it could be associated with poor WASH practices and other sociocultural factors. This study underlines the importance of incorporating WASH strategies in formulation of interventions targeting on promotion of nutrition and disease prevention in pastoral communities.

Prevalence and predictors of anemia among children under 5 years of age in Arusha District, Tanzania.

Anemia is a global health problem affecting most developing countries. We examined the prevalence of anemia and its predictors among children under 5 years of age in Arusha District, Tanzania. Random sampling technique was used to identify 436 children aged 6-59 months. Anemia status was assessed by measuring hemoglobin concentration from blood sample obtained from a finger prick and HemoCue® Hb 201+ photometer. Demographic information and dietary intake data were collected using a standardized questionnaire. Anemia cut-off points were defined according to World Health Organization standards for children aged 6-59 months. Logistic regression using backward procedure was used to estimate odds ratios (ORs) at 95% confidence intervals (CIs). Prevalence rate of anemia among under-fives was found to be 84.6% (n=369). Multivariable logistic regression identified the following predictors of anemia; low birth weight (adjusted OR (AOR): 2.1, 95% CI: 1.1-3.8), not consuming meat (AOR: 6.4, 95% CI: 3.2-12.9), not consuming vegetables (AOR: 2.1, 95% CI: 1.1-4.1), drinking milk (AOR: 2.5, 95% CI: 1.1-5.2), and drinking tea (AOR: 4.5, 95% CI: 1.5-13.7). It was concluded that low birth weight and dietary factors (ie, low or nonconsumption of iron-rich foods like meat, vegetables, and fruits) were predictors of anemia among under-five children living in this rural setting. Community education on exclusive breastfeeding and introduction of complementary foods should be improved. Mothers and caretakers should be educated about nutrition, in general, as well as potential use of micronutrient powder to improve the nutritional quality of complementary foods.

Control of Fusarium verticillioides (Sacc.) Nirenberg and Fumonisins by Using a Combination of Crop Protection Products and Fertilization.

Fusarium verticillioides is the most common fungal pathogen associated with maize ear rot in Tanzania. In a two-year trial, we investigated the efficacy of crop protection (insecticide and/or fungicide) and fertilizer (nitrogen and/or phosphorus) treatments in reducing the occurrence of F. verticillioides and its mycotoxins in maize grown in Tanzania. Seasonal differences were seen to have a substantial influence on the incidence and severity of insect infestation, Fusarium ear and kernel rot, biomass of F. verticillioides and contamination with fumonisins. With regard to the application of fertilizers, it was concluded that the impact on maize stalk borer injury, Fusarium symptoms and fumonisin levels was not significant, whereas crop protection significantly reduced maize damage. The application of an insecticide was most effective in reducing insect injury and as a result of the reduced insect injury the insecticide treatment also resulted in a significant decrease in Fusarium symptoms. In 2014, fumonisin levels were also significantly lower in maize treated with an insecticide. Additionally, significant positive correlations between insect damage and Fusarium symptoms were observed. In conclusion, this study clearly shows that application of an insecticide alone or in combination with a fungicide at anthesis significantly reduces insect damage and consequently reduces F. verticillioides infection and associated fumonisin contamination.

Comparison of urinary aflatoxin M1 and aflatoxin albumin adducts as biomarkers for assessing aflatoxin exposure in Tanzanian children.

PURPOSE: To determine levels of urinary aflatoxin M1 (AFM1) in children and correlate the concentrations with previously reported aflatoxin albumin adduct (AF-alb) levels in these children. MATERIALS AND METHODS: Matched urine and blood samples were collected from 84 Tanzanian children aged 6-14 months old. From 31 children in one village (Kigwa), samples were collected at three time points six months apart. Samples were collected from 31 and 22 children from two different regions at the second time point only. Urinary AFM1 was measured using a commercial enzyme-linked immunosorbent assay (ELISA) kit with a modified protocol to improve sensitivity. AF-alb was measured using an established ELISA method. RESULTS: The relative ranking of the three villages for exposure to aflatoxin based on either AFM1 or AF-alb biomarker measurements was the same. In Kigwa village, both AFM1 and AF-alb levels were higher at six months post-harvest compared to baseline. However, at the next visit, the AFM1 levels dropped from a GM (interquartile range) of 71.0 (44.7, 112.6) at visit two to 49.3 (31.5, 77.3) pg/ml urine, whereas AF-alb levels increased from 47.3 (29.7, 75.2) to 52.7 (35.4, 78.3) pg/mg albumin between these two visits, reflecting the fact that AFM1 measures short-term exposure, whereas AF-alb measures longer term exposure. There was a correlation between AFB1 intake and AFM1 excretion (r= 0.442, p ≤ 0.001). CONCLUSIONS: Urinary AFM1 is a good biomarker for AFB1 exposure in Tanzanian children, reflecting geographical and temporal variations in exposure to this foodborne toxin.

Influence of Water, Sanitation, and Hygiene Practices on Common Infections among Under-Five Children in Longido and Monduli Districts of Arusha, Tanzania.

The study aimed at assessing water, sanitation, and hygiene practices and their influence on infectious diseases among under-five children in semipastoral communities of Arusha. The study was cross-sectional in design. Prevalence of infectious diseases among under-five children was derived from patients' attendance register. Mothers randomly sampled from households were interviewed using questionnaire. Information regarding child morbidity and sociodemographic and WASH characteristics was gathered. Hospital data revealed that 2/3 of under-five patients visited the hospitals annually were suffering from infectious diseases. Mean percentage of diarrhea prevalence for years 2013-2015 in Longido was higher than the mean of the respective years prevalence in Monduli (p = 0.02). Households' survey showed that 15.5% of under-five children were suffering from diarrhea. Children who consumed foods kept in kibuyu (p < 0.001) or used unboiled cows' milk (p = 0.01) or were drinking surface water (p = 0.04) or born to uneducated mothers (p = 0.01) had increased risk of developing diarrhea compared to their counterparts. Storing complementary foods in kibuyu was strongly associated with diarrhea among under-five children. To address the problem, communities under study need to be motivated through health education on food hygiene, proper handling of food storage containers, and domestic water treatment at the household level.

Risk of Exposure to Multiple Mycotoxins from Maize-Based Complementary Foods in Tanzania.

This study estimated exposure to multiple mycotoxins in 249 infants aged between 6 and 12 months in three agro-ecological zones of Tanzania. Maize-based complementary food intakes were estimated using two 24 h dietary recalls. Using @Risk software, probabilistic exposure assessment was conducted by modeling maize intake data (kg/kg body weight/day) with previously determined multiple mycotoxin (except for ochratoxin A (OTA) and zearalenone (ZEA), present in only a few samples) contamination data (µg/kg) in maize. Maize intakes ranged from 0.13 to 185 g/child/day (average = 59 ± 36 g/child/day). The estimated mean exposures were higher for aflatoxins (6-fold), fumonisins (3-fold), and deoxynivalenol (2-fold) than health-based guidance values of 0.017 ng/kg body weight/day, 2 µg/kg body weight/day, and 1 µg/kg body weight/day, respectively. The population at risk of exposures above the limits of health concern ranged from 12% for HT-2 toxin through 35% for deoxynivalenol to 100% for aflatoxins. The exposure varied among the agro-ecological zones. Strategies targeting multiple mycotoxins in maize are urgently needed to minimize exposures in Tanzania.

Local post-harvest practices associated with aflatoxin and fumonisin contamination of maize in three agro ecological zones of Tanzania.

A survey was undertaken of a total of 120 farmers, 40 from each of the three studied agro-ecological zones of Tanzania, to determine local post-harvest management practices associated with aflatoxin (AF) and fumonisin (FB) contamination of maize. Data on practices (collected using a structured questionnaire) and maize samples were obtained from each of the 120 farmers. FB and AF contamination in the samples were analysed by HPLC. A total of 45% and 85% of maize samples were positive for AF and FB respectively, with levels ranging from 0.1 to 269 µg kg(-1) for AF and from 49 to 18 273 µg kg(-1) for FBs. Significant differences in contamination level were observed among the three agro-ecological zones. Farmers in the three agro-ecological zones practised similar practices in varying degrees. Drying, sorting and protecting maize against insect infestation are practices that showed significant association with AF or FB contamination of maize. Drying maize on mat/raised platform, sorting (damaged, discoloured and moulded grains) and application of synthetic insecticides during storage are practices that were associated with less contamination of maize with AF and FB. The results can be used to advise on effective post-harvest strategies for prevention of AF and FB contamination of maize in rural Tanzania.

Risk of dietary exposure to aflatoxins and fumonisins in infants less than 6 months of age in Rombo, Northern Tanzania.

Infants less than 6 months of age receiving foods other than breast milk are at a high risk of exposure to mycotoxins. We surveyed food intake and estimated the risk of exposures to aflatoxin and fumonisin mycotoxins for infants less than 6 months of age in Northern Tanzania. A total of 143 infants were progressively recruited and three follow-up visits were made at 1, 3 and 5 months of age. A 24-h dietary recall technique was used to estimate flour intake of infants who had been introduced to maize foods. Aflatoxins and fumonisins in the flours were analysed using high-performance liquid chromatography technique. Exposure to aflatoxins or fumonisins was estimated using the deterministic approach. By the age of 3 months, 98 infants had started taking food; 67 of them, maize flours at levels ranging from 0.57 to 37.50 g per infant per day (average 8 g per infant per day). Fifty-eight per cent of 67 maize flour samples contained detectable aflatoxins (range 0.33-69.47 µg kg(-1) ; median 6 µg kg(-1) ) and 31% contained detectable fumonisins (range 48-1224 µg kg(-1) ; median 124 µg kg(-1) ). For infants who consumed contaminated flours, aflatoxin exposure ranged from 0.14 to 120 ng kg(-1) body weight (BW) per day (all above the health concern level of 0.017 ng kg(-1) BW per day as recommended by the European Food Safety Agency) and fumonisin exposure ranged from 0.005 to 0.88 µg kg(-1) BW per day. Insignificant association was observed between exposure to fumonisins or aflatoxins and stunting or underweight. Reducing aflatoxin and fumonisin contamination of maize and dietary diversification can prevent infants and the public, in general, from exposure to the toxins.

Feeding practices and nutrient content of complementary meals in rural central Tanzania: implications for dietary adequacy and nutritional status.

BACKGROUND: Stunting and micronutrient deficiencies are significant health problems among infants and young children in rural Tanzania. Objective of the study was to assess feeding practices, nutrient content of complementary meals, and their implications for dietary adequacy and nutritional status. METHODS: A cross-sectional study was conducted in six randomly selected villages in Mpwapwa District, Tanzania during the post-harvest season. Information on feeding practices, dietary consumption and anthropometric measurements of all infants below the age of one year were collected. Forty samples of common meals were collected and analysed for proximate composition, iron, zinc and calcium. Results were expressed per 100 g dry weight. RESULTS: Energy, protein and fat content in porridge ranged from 40.67-63.92 kcal, 0.54-1.74% and 0.30-2.12%, respectively. Iron, zinc and calcium contents (mg/100 g) in porridge were 0.11-2.81, 0.10-3.23, and 25.43-125.55, respectively. Median portion sizes were small (porridge: 150-350 g; legumes and meats: 39-90 g). Very few children (6.67%) consumed animal-source foods. Low meal frequency, low nutrient content, small portion size and limited variety reduced the contribution of meals to daily nutritional needs. CONCLUSIONS: Findings of the study highlight inadequate feeding practices, low nutritional quality of meals and high prevalence of stunting. Feasible strategies are needed to address the dietary inadequacies and chronic malnutrition of rural infants.

A prospective study of growth and biomarkers of exposure to aflatoxin and fumonisin during early childhood in Tanzania.

BACKGROUND: Aflatoxin and fumonisin are toxic food contaminants. Knowledge about effects of their exposure and coexposure on child growth is inadequate. OBJECTIVE: We investigated the association between child growth and aflatoxin and fumonisin exposure in Tanzania. METHODS: A total of 166 children were recruited at 6-14 months of age and studied at recruitment, and at the 6th and 12th month following recruitment. Blood and urine samples were collected and analyzed for plasma aflatoxin-albumin adducts (AF-alb) using ELISA, and urinary fumonisin B1 (UFB1) using liquid chromatography-mass spectrometry, respectively. Anthropometric measurements were taken, and growth index z-scores were computed. RESULTS: AF-alb geometric mean concentrations (95% CIs) were 4.7 (3.9, 5.6), 12.9 (9.9, 16.7), and 23.5 (19.9, 27.7) pg/mg albumin at recruitment, 6 months, and 12 months from recruitment, respectively. At these respective sampling times, geometric mean UFB1 concentrations (95% CI) were 313.9 (257.4, 382.9), 167.3 (135.4, 206.7), and 569.5 (464.5, 698.2) pg/mL urine, and the prevalence of stunted children was 44%, 55%, and 56%, respectively. UFB1 concentrations at recruitment were negatively associated with length-for-age z-scores (LAZ) at 6 months (p = 0.016) and at 12 months from recruitment (p = 0.014). The mean UFB1 of the three sampling times (at recruitment and at 6 and 12 months from recruitment) in each child was negatively associated with LAZ (p < 0.001) and length velocity (p = 0.004) at 12 months from recruitment. The negative association between AF-alb and child growth did not reach statistical significance. CONCLUSIONS: Exposure to fumonisin alone or coexposure with aflatoxins may contribute to child growth impairment.