1. RESEARCH REPORT
© 2014

2. 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

3. 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.

4. Aflatoxin Contamination
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:
*Recommended limit = 10µg/kg
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.
Food Item
Aflatoxin Contamination
% of Samples
Levels* (ng/kg)
Maize kernels 45
Muthokoi 20
Maize 30
6000–30000

5. 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.

6. Aim of the study Purpose 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.

7. 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
To describe the demographic and socio-economic status of the lactating mothers in the study.
To determine the food consumption patterns and dietary diversity of the lactating mothers in the study.
To determine the breast feeding practices of the breast fed children between 0 to 6 months

8. 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.

9. 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.

10. LITERATURE REVIEW 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

11. METHODOLOGY Study Design Study Setting
Kikumbulyu Location, Kibwezi District, Makueni County.
Makueni County is located in Eastern region of Kenya and covers an area of sq Km
Study Design
A descriptive and analytical cross-sectional study.

12. 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% = % attrition rate N=399≈ paired lactating mothers and breastfeeding children below 6 months of age

13. Sampling Procedure: Multistage

14. 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

15. 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

16. 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.

17. 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.

18. 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 .

19. 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

20. Data entry into SPSS version 20 is still on progress.
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)

21. Descriptive statistical analyses.
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 .

22. 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.

23. Descriptive statistical analysis.
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.

24. Generate a predictor model of aflatoxin levels in breast milk from independent variables which significantly contribute to the influence of aflatoxin in breast milk.

25. Thank You