Abstract/Details

Reducing the risks of aflatoxin through public health interventions


2011 2011

Other formats: Order a copy

Abstract (summary)

Aflatoxin, produced by the fungi Aspergillus flavus and A. parasiticus, is the most potent naturally occurring human hepatocarcinogen. Food crops colonized by these fungi, especially maize and groundnut, are the major sources of dietary aflatoxin exposure. Aflatoxin and chronic hepatitis B virus (HBV) infection, two liver cancer risk factors that synergize with each other, are prominent in sub-Saharan Africa and certain parts of Asia. Furthermore, increasing evidence from epidemiological studies suggests that aflatoxin may cause child growth impairment, which can increase risks of premature deaths. A broad range of aflatoxin control strategies, developed to reduce aflatoxin exposure or its toxicity, include preharvest, postharvest, and dietary interventions; as well as the HBV vaccine, which does not reduce aflatoxin exposure but reduces the risk of aflatoxin-induced liver cancer.

We compared the efficacy and the cost-effectiveness of four aflatoxin risk-reduction strategies: HBV vaccine, biocontrol (preharvest), a postharvest intervention package, and NovaSil clay (dietary) in preventing liver cancer and stunting in Nigeria. Aflatoxin and chronic HBV infection are attributable for 8-27%, and 59-62%, respectively, of total liver cancers in Nigeria. We found that the HBV vaccine provides the greatest health-based efficacy and the lowest cost to avert one disability-adjusted life year (DALY) in Nigeria, compared with the selected aflatoxin control interventions. The prospective burden of aflatoxin-related stunting in Nigeria varies depending on aflatoxin exposure levels, which can vary substantially by year and location. At higher levels of aflatoxin exposure, the burden of aflatoxin-associated stunting is significant. Preventing stunting by any of these interventions would greatly reduce the cost per DALY and turn these interventions from non-cost-effective to very cost-effective. Our technical feasibility assessments of these four interventions suggest some advantages and disadvantages of each intervention over the others. These data are crucial components in a decision making process to effectively allocate public health resources, and to position interventions for further development of public health interventions to prevent some aflatoxin-related public health problems, especially in high risk populations.

Indexing (details)


Subject
Toxicology;
Surgery;
Environmental Health;
Public health;
Health risk assessment;
Intervention;
Fungi;
Carcinogens
Classification
0383: Toxicology
0383: Surgery
0470: Environmental Health
0573: Public health
Identifier / keyword
Health and environmental sciences; Aflatoxin; Health interventions; Liver cancer; Stunting
Title
Reducing the risks of aflatoxin through public health interventions
Author
Khlangwiset, Pornsri
Number of pages
213
Publication year
2011
Degree date
2011
School code
0178
Source
DAI-B 73/03, Dissertation Abstracts International
Place of publication
Ann Arbor
Country of publication
United States
ISBN
9781267030993
Advisor
Wu, Felicia; Barchowsky, Aaron
University/institution
University of Pittsburgh
University location
United States -- Pennsylvania
Degree
Ph.D.
Source type
Dissertations & Theses
Language
English
Document type
Dissertation/Thesis
Dissertation/thesis number
3485840
ProQuest document ID
909517149
Copyright
Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works.
Document URL
http://search.proquest.com/docview/909517149
Access the complete full text

You can get the full text of this document if it is part of your institution's ProQuest subscription.

Try one of the following:

  • Connect to ProQuest through your library network and search for the document from there.
  • Request the document from your library.
  • Go to the ProQuest login page and enter a ProQuest or My Research username / password.