Comprehensive assessment of maize aflatoxin levels in Eastern Kenya, 2005-2007.

BACKGROUND: Aflatoxin, a potent fungal toxin, contaminates 25% of crops worldwide. Since 2004, 477 aflatoxin poisonings associated with eating contaminated maize have been documented in Eastern Kenya, with a case-fatality rate of 40%. OBJECTIVE: We characterized maize aflatoxin contamination during the high-risk season (April-June) after the major harvests in 2005, 2006 (aflatoxicosis outbreak years), and 2007 (a non-outbreak year). METHODS: Households were randomly selected each year from the region in Kenya where outbreaks have consistently occurred. At each household, we obtained at least one maize sample (n = 716) for aflatoxin analysis using immunoaffinity methods and administered a questionnaire to determine the source (i.e., homegrown, purchased, or relief) and amount of maize in the household. RESULTS: During the years of outbreaks in 2005 and 2006, 41% and 51% of maize samples, respectively, had aflatoxin levels above the Kenyan regulatory limit of 20 ppb in grains that were for human consumption. In 2007 (non-outbreak year), 16% of samples were above the 20-ppb limit. In addition, geometric mean (GM) aflatoxin levels were significantly higher in 2005 (GM = 12.92, maximum = 48,000 ppb) and 2006 (GM = 26.03, maximum = 24,400 ppb) compared with 2007 (GM = 1.95, maximum = 2,500 ppb) (p-value < 0.001). In all 3 years combined, maize aflatoxin levels were significantly higher in homegrown maize (GM = 17.96) when compared with purchased maize (GM = 3.64) or relief maize (GM = 0.73) (p-value < 0.0001). CONCLUSIONS: Aflatoxin contamination is extreme within this region, and homegrown maize is the primary source of contamination. Prevention measures should focus on reducing homegrown maize contamination at the household level to avert future outbreaks.

Laboratory epidemiologist: skilled partner in field epidemiology and disease surveillance in Kenya.

Although for over 20 years the Field Epidemiology Training Programs (FETPs) have provided a model for building epidemiology capacity in Ministries of Health worldwide, the model does not address laboratory training and its integration with epidemiology. To overcome this, Kenya added a laboratory management component in 2004, creating the first field epidemiology and laboratory training program (FELTP) to train both medical and laboratory epidemiologists. Laboratory management and epidemiology candidates were recruited from among degree-holding scientists at the Ministry of Health and trained in both applied epidemiology and laboratory management using a combination of short courses and extensive field placements. The course generated a cohort of laboratory epidemiologists with demonstrated capacity in disease surveillance and management of outbreaks. Early indicators suggest programmatic success: the start of laboratory-based disease reporting and better laboratory involvement in outbreak responses.