Aflatoxin Exposure Among Mothers and Their Infants from the Western Highlands of Guatemala.

OBJECTIVES: We examined breast milk of mothers and urine of infants before and after introduction of supplementary foods for aflatoxin M1 (AFM1) and the association between AFM1 with maternal and infant diet. METHODS: A prospective cohort study was conducted among mothers and infants ages 0-6 months and 7-12 months from June-October 2014. Sociodemographic, dietary, birth, and health data were collected. A breast milk sample was collected from each mother and a urine sample from each infant at baseline (time point 1) and monthly for 2 time points thereafter; samples collected at baseline and time point 3 were tested for AFM1. RESULTS: Almost 5% of breast milk and 15.7% of urine samples tested AFM1-positive. The median AFM1 in breast milk was 0.020 ng/mL and in urine 0.077 ng/mg creatinine. At time point 3, infants of 5 of the 6 mothers in each group who were AFM1-positive in breast milk were also AFM1-positive in urine. Mothers' consumption of cooked maize/maize dough ≥ 3 days per week (OR 2.96, 95% CI = 1.19-7.34) and mothers' consumption of tamales made from maize ≥ 3 days per week (OR 0.28, 95% CI = 0.10-0.73) were significantly associated with AFM1 in infant urine. CONCLUSION: This is the first study in Guatemala documenting aflatoxin exposure in both breast milk of lactating mothers and infants´ urine during the first year of life. This may have important implications in understanding the multicausality of the high rates of stunting among children < 5 years old in Guatemala.

Sociodemographic factors, health seeking behaviors, reproductive history, and knowledge of cervical screening among women in Swaziland.

BACKGROUND: Cervical cancer is the leading cause of cancer among women in Swaziland; however, a low rate of cervical screening in this population has led to high rates of morbidity and mortality from cervical cancer. OBJECTIVE: To identify factors associated with lack of cervical screening among women in Swaziland. METHODS: A cross-sectional study was conducted among 300 women aged 18-69 years attending clinics in three regions of Swaziland from May to August of 2014. An investigator-administered questionnaire was used to collect data on socioeconomic factors, health-seeking behaviors, reproductive history, and cervical screening history and knowledge from the women. RESULTS: Adjusted multivariable logistic regression analysis revealed that women < 30 years of age were less likely to receive a cervical exam compared to women ≥30 years of age (Odds Ratio 0.06, 95% Confidence Interval 0.01-0.67). Women who had a tertiary education were almost 6 times more likely to receive a cervical screening (OR 5.83, 95% CI 1.11-30.50). Women who said that they did not know when to receive cervical screening were 73% less likely to have a cervical exam (OR 0.27, 95% CI 0.01-0.74). CONCLUSIONS: Younger age, lower educational level, and lack of knowledge about when to receive a cervical screening affected whether women obtained a cervical screening. This indicates the need for educating women, particularly younger women, about the importance of cervical examinations. Addressing these barriers to screening should lead to a decrease in cervical lesions and cancer, especially in this high HIV-positive population.