1. 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

2. The Relationship Cycle
Food Security

3. Aflatoxin effects

4. 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

5. 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

6. 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)

7. 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)

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

9. 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

10. 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

11. 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

12. 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.

13. 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

14. 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

15. Thank you!