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EFFECT OF MATERNAL AFLATOXIN EXPOSURE THROUGH DIET ON GROWTH OF INFANTS 0 - 3 MONTHS IN KISUMU COUNTY, KENYA
Obade, MI; Andang’o, P; Obonyo, C & Lusweti, F
Abstract
Aflatoxins are naturally occurring carcinogenic toxins associated with poor growth
outcomes in young children. Although evidence supports mother-to-infant exposure
during pregnancy and breastfeeding, evidence of its effect on growth is limited to the
period after introduction of complementary foods. It is, therefore, unclear whether early
maternal exposure to aflatoxins affects infant growth right from birth. Prevalence of
aflatoxin levels of 40% has been observed in Nyanza region, Kenya, and 22.7% of
children under 5 years are stunted. The purpose of this study was to determine the
effect of maternal aflatoxin exposure on growth of infants 0-3 months old in Kisumu
County, Kenya. Specific objectives were to: establish association between maternal
baseline characteristics and aflatoxin exposure; establish association between infant
baseline characteristics at birth and maternal aflatoxin exposure; determine effect of
maternal aflatoxin exposure on infant growth indicators at 3 months of age. Out of 553
pregnant women who were screened for aflatoxin exposure, 137 exposed and 137 nonexposed
women, matched for age and household income, participated in an 8-month
cohort study. The women were followed up to delivery and their infants up to 3 months
after delivery. Infant length and weight data was collected monthly. Length-for-age
(LAZ), weight-for-length (WLZ)) and weight-for-age (WAZ) z-scores were generated.
Aflatoxin levels were analyzed using Enzyme Linked Immunosorbent Assay (ELISA)
in parts per billion (ppb). Effects of aflatoxin on infant growth outcomes were assessed
using multi-variate linear and logistic regression. Effect of maternal aflatoxin exposure
on infant length, weight, LAZ, WLZ, WAZ was determined using Cox regression with
constant time at risk. Infants of exposed women had lower weight (95% CI:-0.85,-0.53), length (95% CI: -4.08, -3.36), LAZ (95% CI: -1.93, -1.16) and WAZ (95% CI:-1.03, -0.54) at 3 months of age, but there was no difference in WLZ (95% CI:-0.03,
0.74). Risk for stunting was higher in infants of exposed women (RR=4.08; 95% CI:
1.35, 12.29). There was no difference in the risk for underweight (RR=6.61; 95% CI:
0.80-54.33) and wasting (RR=0.37; 95% CI: 0.40, 3.39, P=0.38).These results underpin
the need to reduce aflatoxin exposure in infants and young children who are very
vulnerable.
Keywords
Aflatoxin; maternal; infant; growth; z-scores; ELISA; stunting; underweight
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