© 2014
INFLUENCE OF DIETARY AFLATOXIN
CONTAMINATION ON AFLATOXIN
LEVELS IN BREAST MILK AMONG
LACTATING MOTHERS IN
KIKUMBULYU LOCATION, KIBWEZI
DISTRICT OF MAKUENI COUNTY
PRESENTER:OTIENO ISAAC OGALLO
REG:A56/83054/2012
SUPERVISORS: DR.ALICE M. MWANGI
MR.P.LAMUKA
PROF.G.CHEMININGWA
INTRODUCTION
Aflatoxins is of fungal origin (mycotoxins).
Geographic, climatic, agricultural and susceptibility
of food commodities.
Passed to body tissues and fluids eg breast milk,
urine and blood.
Dietary exposure of lactating mothers also puts
breast feeding infants at equal risk of aflatoxin
exposure.
Severe outbreaks have been reported in eastern
region of Kenya, hence selected study area.
PROBLEM STATEMENT
Eastern region of Kenya prone to aflatoxin contamination.
Makueni County reported the highest and severest
incidences of contamination in maize, Kenya’s main staple
Kilonzi, 2011 found the following in Kibwezi:
Food Item
Aflatoxin Contamination
% of Samples
Levels* (ng/kg)
Maize kernels
45
18000 - 480000
Muthokoi
20
12000-123000
Maize*Recommended limit = 10µg/kg
30
6000–30000
Little still known on aflatoxin contamination in human
breast milk in Kenya.
And the influence of these high levels of dietary
contamination on the levels in human breastmilk is not clear
Hence dietary maternal to child aflatoxin exposure through
breast milk could be an under-evaluated risk factor in Kenya.
JUSTIFICATION
Recurrent incidences of aflatoxin contamination, outbreaks
of aflatoxicosis in Eastern region of Kenya.
There is severe toxicity even when taken at lower levels both
in diet and milk.
As a consequence, deleterious health effect such as
carcinoma, hemorrhage, stunting, and immune-suppression
has been reported in children.
Hence the need to carry out the study.
Aim of the study
 To contribute towards improvement of food safety as
well as maternal and infant and young child health
during the lactation period.
Purpose of the study
 To generate information on the current situation on the
levels of aflatoxins in food and breast milk among lactating
mothers from Makueni County as a basis for emphasizing
the constant need of monitoring aflatoxin occurrence in at
risk regions.
Main objective
 To determine the influence of dietary aflatoxin
contamination on aflatoxin levels in breast milk among
lactating mothers in Kkumbulyu Location, Kibwezi
District of Makueni County.
SPECIFIC OBJECTIVES
1. To describe the demographic and socio-economic status
of the lactating mothers in the study.
2. To determine the food consumption patterns and dietary
diversity of the lactating mothers in the study.
3. To determine the breast feeding practices of the breast fed
children between 0 to 6 months
Cont’d
4.To determine the levels and types of aflatoxins in
foods susceptible to aflatoxin contamination and
are mostly consumed by the lactating mothers in
the study.
5.To determine the types and levels of aflatoxins in
the breast milk of lactating mothers, and in the
urine of the breast fed children between 0-6
months in the study.
Study Hypotheses
No significant association;
 Socio-demographic characteristics of the lactating
mothers and the levels of aflatoxin in the breast milk.
 Food consumption pattern and dietary diversity of
the lactating mothers and the levels of aflatoxin in
the breast milk and urine of breastfeeding children.
 Levels of aflatoxin among foods that are susceptible
to aflatoxin contamination.
LITERATURE REVIEW
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
General overview of aflatoxins
Types, Structures and Properties of Aflatoxins
Factors Promoting Aflatoxin Occurrence in the
World
Incidences of Aflatoxin Outbreak
Global Occurrence
Aflatoxin Occurrence in Kenya
Food, Dietary Diversity and Aflatoxin
Aflatoxin in Human Breast Milk
Maximum Set Levels for Aflatoxins
Nutritional and Health Consequences Related to
Aflatoxin Contamination
METHODOLOGY
Study Setting
Kikumbulyu Location, Kibwezi District, Makueni
County.
Makueni County is located in Eastern region of
Kenya and covers an area of 8008.9 sq Km
Study Design
 A descriptive and analytical cross-sectional study.
Study Population
Lactating mothers and breastfeeding children below 6
months old
Sample size
Fischer et al.(1992) formula N=Zpq⁄d
where; Z=1.96, p= 50.0%, d=5%
=384 + 4 % attrition rate
N=399≈400
200 paired lactating mothers and breastfeeding
children below 6 months of age
Sampling Procedure: Multistage
MAKUENI COUNTY
Purposive Sampling
KIBWEZI DISTRICT
Purposive Sampling
KIBWEZI DIVISION
Purposive Sampling
KIKUMBULYU LOCATION
Random Sampling
MIKUYUNI
SUB-LOCATION
NGANDANI
KATHYAKA
NDETANI
SUB-LOCATION
SUB-LOCATION
SUB-LOCATION
5
5
VILLAGES
VILLAGES
5
VILLAGES
5
VILLAGES
Random Sampling
10 HH
10 HH
10 HH
10 HH
LACTATING
LACTATING
LACTATING
LACTATING
MOTHERS
MOTHERS
MOTHERS
MOTHERS
Inclusion Criteria
 Available and willing lactating mothers with children
between 0-6 months
Exclusion Criteria
 Lactating mothers with disease of the breast or with
breast complications such as breast pain, breast
engorgement, nipple pain, milk stasis, mastitis and an
overactive let down
 Eligible but unavailable and/or unwilling mothers
Data Collection Tools and Equipment
 The main study tool used was a semi-structured
questionnaire
 Equipment for aflatoxin analysis ;
 MaxSignal ® ELISA kit
 High Performance Liquid Chromatography (HPLC).
Data Collection
 Recruitment and training of research assistants
 Pretesting of the data collection tools and equipment
Data Collection Procedure
Demographic and socio-economic status
 Semi-structured pretested questionnaire administered
to 200 lactating mother. This was done through
interview.
Dietary diversity, food consumption patterns,
consumption levels and breast feeding practices
 Semi-quantitative food frequency questionnaires
administered.
 24 hour Dietary Diversity for the lactating mothers
was also done.
Sample collection
 Food samples
 Purposive sampling .
 Foods susceptible to aflatoxin contamination (maize
ugali, githeri, muthokoi and maize porridge) collected.
 Available during data collection were collected.
 A total of 400 food samples were collected.
Cont’d-Sample collection
Breast milk samples
 100 Breast milk samples .
 Hand expressed 10ml of breast milk.
 Urine samples
 100 Urine samples collected from breast feeding
children between 0-6 months belonging to mothers’
whose breast milk samples were collected.
 Mainstream urine, wet their under wrappings (napkins
or clothing).
 wrung the under-wrappings, let the urine drip into
plastic urine containers
.
Data Management and Analysis
Data Quality Assurance
 Data quality assurance across all the stages of study
 Adequate training of field assistants (community
health workers)
 Pretesting of data collection tools and standardizing
data collection procedures.
 Close supervision of field assistants.
 Contamination was minimized during sample and
specimen collection by using sterilized gloves and air
tight cryovial tubes.
 Strict hygiene observed during specimen collection
 Statistical Analyses
 Data entry into SPSS version 20 is still on progress.
 Objective 1: Socio-demographic characteristics of
the lactating mothers
 Descriptive statistical analyses will be done.
 ANOVA
 Chi-square
 Regression test (inference statistical analysis)
 Objective 2/3: Food consumption patterns and
dietary diversity of the lactating mothers, and
breast feeding practices of children between 0-6
months in the study
 Descriptive statistical analyses.
 Multiple –ANOVA .
 Regression analysis .
 Objective 4: Types and levels of aflatoxin in foods
that are mostly consumed and are likely to be
contaminated with aflatoxin among lactating
mothers in the study.
 Descriptive analysis.
 ANOVA.
 One sample t-test/one way ANOVA.
 Multiple correlations between food and corresponding
aflatoxin levels.
Objective 5:Types and levels of aflatoxins in breast
milk of lactating mothers and urine of
breastfeeding children below 6 months of age.
 Descriptive statistical analysis.
 ANOVA.
 One sample t-test/one way ANOVA.
 Correlations.
 Generate a predictor model of aflatoxin levels in breast
milk from independent variables which significantly
contribute to the influence of aflatoxin in breast milk.
Thank You