Investing in the first 1000 days of an Infant- Need to address Aflatoxins Africa Day for Food and Nutrition Security – 26 October 2016 Prof. Archileo Kaaya and Ms. Wezi Chunga-Sambo

The Relationship Cycle Food Security

Aflatoxin effects

Health Effects of aflatoxins Toxicity → Aflatoxicosis: Both humans and animals Lethal doses →Acute toxicity: cases in Tanzania, Kenya, West Africa Sub-lethal doses → Liver cancer (HCC), mutagenicity Nutritional illnesses → growth reduction due to binding protein and micronutrient (vit A, B12, C, D & E; Zn, Ce, Fe and Ca) : Stunting, kwashiorkor in children Suppression of the immune system: CD4 cells, T-lymphocytes → suppress phagocytic activity: HIV, Malaria

Aflatoxin Exposure in 1,000 Days of Life Complementary/weaning foods (450 – 1000 days; AFB1, AFG1 & AFM1) Cereal, tubers and nut-based foods Cow milk and other milk-based products Neonatal and infant exposure Premature introduction (360 – 450 days) - Low birth weight - Impaired growth, cognitive development - Impaired immune function - Impaired GIT function - Stunting Trans-placental exposure (0 – 270 days; AFB1) AF exposure can occur throughout the first 1000 days of life AF can cross the placental barrier, with varying degrees of maternal exposure being passed on to the fetus throughout this time of critical development for the infant. Reports of high exposure levels during pregnancy in Kenya AFM1, a toxic metabolite of AFB1, can be excreted in breast milk, continuing the maternal-child exposure route after birth. Levels of AF in infants also known to be high during the complementary feeding period, as traditional complementary foods such as maize-and milk-based porridges are often highly contaminated. Breastmilk (270 – 450 days; AFM1) Maternal exposure Nutrition: consumption of aflatoxin contaminated foods

Evidence on Association of Aflatoxin Exposure and Child Growth Geography Findings (correlation) Reference Ghana, The Gambia Exposure during pregnancy and smaller babies during the first weeks of life Barett (2005), Review Tanzania Exposure and reduced weight and height among breast fed infants under 6 months Magoha et al. (2014) Benin, Togo Between higher levels of aflatoxins and lower growth rates Gong et al. (2002) Togo, Iran, Kenya, UAE Exposure and stunting in children Uganda In SW region, every adult & all but four children had detectable AF-alb adduct, including five babies reported to be exclusively breastfeeding Children who consumed soya, had levels of AF-alb adduct almost twice as high as those who did not eat soya Gershim et al (2014)

How can we address the Problem? African Union established a flagship program focusing on aflatoxins, PACA (endorsed by the AU Joint Conference of Ministers of Agriculture and Ministers of Trade in 2012) PACA’s mission: - To support agricultural development, safeguard consumer health and facilitate trade by - Catalyzing, coordinating and increasing effective aflatoxin control along agricultural value chains in Africa Recognizing the complexity of the aflatoxin challenge and magnitude of its impact, African Union established a flagship program focusing on aflatoxins “improving the effectiveness and efficiency of governments to tackle the aflatoxin challenge in Africa” while forging strong partnerships and work jointly with other key stakeholders involved in aflatoxin control (e.g., RECs, private sector actors, NGOs, development partners)

PACA pilots evidence based model in 6 countries and further scaling Phase 1 Pilot Countries: Gambia, Malawi, Nigeria, Senegal, Tanzania, Uganda Maps are illustrative

Country-level Activities: driven by country plan approach Prepare Country Plans: Year 1 Execute Country Plans: Year 2 - 5 Stage 1: Gather evidence to inform plan The Secretariat will enhance capacity to implement the plan and monitor progress Stage 2: Validate & finalize country plan Stage 3: Support gov’t capacity to implement plan Stage 4: Monitor progress and advocate

Uganda Case Support Government of Uganda to forge strong partnerships with other stakeholders –UMMSC, ATWG Generate evidence to inform policies and interventions for aflatoxin control, feeding into national plans - CSAAP Mainstream aflatoxin control plans into existing strategies and frameworks –UG NACAP into ASSP Business meeting to mobilize resources to implement the plan

Policy Recommendations Stemming from NACAPs and RACAPs for addressing aflatoxins in the first 1000 days Infant and Young Child Nutrition guidelines to be developed and to contain aflatoxin avoidance measures on Infant and Young Child Nutrition Train all district nutrition officers on aflatoxin issues and aflatoxin measures contained in the infant and young child Nutrition Nutrition Units advocating for aflatoxin safe rehabilitation foods for Malnourished Children

Policy Recommendations Stemming from NACAPs and RACAPs for addressing aflatoxins in the first 1000 days Include aflatoxin control activities in SUN, SDGs, and other food security and nutrition policies and programs Targeted awareness for pregnant women and lactating mothers Mainstream aflatoxin control into NAIPs Promote exclusive breastfeeding for the first six months of life Design and implement beneficiary-specific nutrition education modules Exclusive breast feeding - to minimize and delay the premature introduction of harmful and higher levels of aflatoxin found in complementary foods  period working with ministries of health, and particularly to reach midwives, trained birth attendants, community health workers, nurses, nutritionists and doctors who are primary care givers for pregnant and lactating women and their young children Dietary diversification - as an affordable and rapid response mechanism to reduce the transmission of aflatoxin to infants and unborn children.

Policy Recommendations Stemming from NACAPs and RACAPs for addressing aflatoxins in the first 1000 days Conduct national reviews of the current dietary recommendations and nutrition programs advocating the consumption of aflatoxin prone foods. Promote dietary diversity for pregnant and lactating women Ensure standards for food and feed adequately address the special needs of the 1000 days

Take Home Messages Unsafe food is not food at all Need to invest in Aflatoxin mitigation in order to start achieving nutrition and food security targets Need for more partnerships – SUN, One Health, etc. Mainstream aflatoxins into NAIPs/RAIPs and all nutrition and food security interventions More countries to uptake the PACA Model which is proving successful in the 6 Pilot Countries October 2016 | Slide 14

Thank you!