Aflatoxicosis outbreak and its associated factors in Kiteto, Chemba and Kondoa Districts, Tanzania

Abstract

Tanzania had experienced hundreds of cases of aflatoxicosis in the districts of Kiteto, Chemba, and Kondoa for the three consecutive years since 2016. Cases may end up with liver cancer. Aflatoxin-induced liver cancer had resulted in the demise of roughly three persons per 100,000 in the country during the same year, 2016. We investigated to characterize the latest outbreak of 2019 and identify its risk factors. This case-control study enrolled all patients presented with acute jaundice of unknown origin and laboratory test results confirmed an acute liver injury with or without abdominal pain, distension, vomiting, or fever during the period of June to November 2019 and had epidemiological link with cases confirmed with Aflatoxin-B1-Lysine. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were used to identify independent factors associated with aflatoxicosis. We analyzed 62 cases with median age of 7 years (0.58–50 years) and 186 controls with median age of 24 years (range 0.42–55) with onset of symptoms ranging from 1st June 2019 to 16th July 2019. Case-parents had higher serum aflatoxin-B1–lysine adduct concentrations than did controls; 208.80 ng/mg (n = 45) vs. 32.2 ng/mg (n = 26); p<0.01. Storing foods at poor conditions (AOR 5.49; 95% CI 2.30–13.1), age <15 years (AOR 4.48; 95% CI 1.63–12.3), chronic illness (AOR 3.05; 95% CI 1.19–7.83) and being male (AOR 2.31; 95% CI 1.01–5.30) were significantly associated with the disease, whereas cleaning foods before milling decreased the risk of getting the disease by 88% (AOR 0.12; 95% CI 0.05–0.29). According to the results, the outbreak resulted from a globally highest-ever recorded aflatoxin-B1-lysine that originated from a common source. To prevent future outbreaks, it is crucial to store and clean food crops safely before milling. We recommend strict regulations and enforcement around aflatoxin levels in food products.