Volume 83, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Aflatoxins are fungal metabolites that contaminate staple food crops in many developing countries. Up to 40% of women attending a prenatal clinic in Africa may be anemic. In a cross-sectional study of 755 pregnant women, Aflatoxin B-lysine adducts (AF-ALB) levels were determined by high-performance liquid chromatography. Participants were divided into quartiles “low,” “moderate,” “high,” and “very high.” Anemia was defined as hemoglobin levels < 11 g/dL. Logistic regression was used to examine the association of anemia with AF-ALB. The mean AF-ALB level was 10.9 pg/mg (range = 0.44–268.73 pg/mg); 30.3% of participants were anemic. The odds of being anemic increased 21% (odds ratio [OR], 1.21, = 0.01) with each quartile of AF-ALB reaching an 85% increased odds in the “very high” compared with the “low” category (OR, 1.85; confidence interval [CI], 1.16–2.95). This association was stronger among women with malaria and findings were robust when women with evidence of iron deficiency anemia were excluded. This study found a strong, consistent association between anemia in pregnancy and aflatoxins.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. UNFPA, 2007. State of the world population 2007. Geneva. Available at: http://www.unfpa.org/swp/2007/english/notes/indicators.html. Accessed October 26, 2009. [Google Scholar]
  2. World Bank Bank W, , 2006. Maternal mortality. , ed. Public Health at a Glance. Washington, DC: The World Bank Group. Available at: http://go.worldbank.org/UQXMKI6L30. Accessed October 26, 2009. [Google Scholar]
  3. World Health Organization, 2001. Iron deficiency anaemia: assessment, prevention and control. A guide for programme managers. WHO/NHD/01.3. [Google Scholar]
  4. Kesa H, Oldewage-Theron W, , 2004. Anthropometric indications and nutritional intake of women in the Vaal Triangle, South Africa. J R Inst Public Health 119: 294300. [Google Scholar]
  5. Khusun H, Ray Y, Werner S, Drupadi HS, , 1999. World Health Organization hemoglobin cut-off points for the detection of anemia are valid for an Indonesian population. J Nutr 129: 16691674. [Google Scholar]
  6. Allen LH, , 2000. Anemia and iron deficiency: effects on pregnancy outcome. Am J Clin Nutr 71: 12801284. [Google Scholar]
  7. Khan K, Wojdyla D, Say L, Gulmezeglu A, Van Look P, , 2006. WHO analysis of causes of maternal death: a systematic review. Lancet 367: 10661074.[Crossref] [Google Scholar]
  8. Dim CC, Hyacinth EO, , 2007. The prevalence of anemia among pregnant women at booking in Enugu, south eastern Nigeria. MedGenMed 9: 11. [Google Scholar]
  9. Abouzahr C, Royston E, , 1991. Maternal Mortality: A Global Factbook. Geneva: WHO. [Google Scholar]
  10. WHO G, , 1997. Coverage of Maternity Care: A Listing of Available Information. Maternal and Newborn Health/Safe Motherhood Unit. Document: WHO/RHT/MSM/96.28. [Google Scholar]
  11. Nils M, , 2008. Prepartum anaemia: prevention and treatment. Ann Hematol 87: 949959.[Crossref] [Google Scholar]
  12. Yatich NJ, Jiang Y, Agbenyega T, Turpin A, Rayner JC, Stiles JK, Ellis WO, Funkhouser E, Ehiri JE, Williams JH, Jolly PE, , 2009. Malaria and intestinal helminth co-infection among pregnant women in Ghana: prevalence and risk factors. Am J Trop Med Hyg 80: 896901. [Google Scholar]
  13. West KJ, , 2002. Extent of vitamin A deficiency among preschool children and women of reproductive age. J Nutr 132 (Suppl): 2857S2866S. [Google Scholar]
  14. Williams J, Phillips T, Jolly P, Stiles J, Jolly C, Aggarwal D, , 2004. Human aflatoxicosis in developing countries: a review of toxicology, exposure, potential health consequences, and interventions. Am J Clin Nutr 80: 11061122. [Google Scholar]
  15. United States Department of Agriculture Smith T, , 2005. A focus on aflatoxin contamination. , ed. Washington, DC: United States Department of Agriculture. Available at: http://fsrio.nal.usda.gov/document_reslist.php?product_id=69. Accessed October 25, 2009. [Google Scholar]
  16. Cornell University DoAs, 2008. Aflatoxins: occurrence and health risks. Plants poisonous to livestock. New York: Cornell University. Available at: http://www.ansci.cornell.edu/plants/toxicagents/aflatoxin/aflatoxin.html. Accessed October 25, 2009. [Google Scholar]
  17. Fung F, Clark R, , 2004. Health effects of mycotoxins: a toxicological overview. J Toxicol Clin Toxicol 42: 217234.[Crossref] [Google Scholar]
  18. International Society For Infectious Diseases, 2000. Aflatoxin, Maize-Africa. Benin, Ghana, Togo. Available at: http://www.promedmail.org/pls/otn/f?p=2400:1001:57555:F2400_P1001_BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:1001,20000826.1425,Y. Accessed September 20, 2009. [Google Scholar]
  19. Turner P, Sylla A, Gong Y, Diallo M, Sutcliffe A, Hall A, Wild C, , 2005. Reduction in exposure to carcinogenic aflatoxins by postharvest intervention measures in west Africa: a community-based intervention study. Lancet 365: 19501956.[Crossref] [Google Scholar]
  20. Kpodo K, Thrane U, Hald B, , 2000. Fusaria and fumonisins in maize from Ghana and their co-occurrence with aflatoxins. Int J Food Microbiol 61: 147157.[Crossref] [Google Scholar]
  21. Awuah R, Kpodo K, , 1996. High incidence of Aspergillus flavus and aflatoxins in stored groundnut in Ghana and the use of a microbial assay to assess the inhibitory effects of plant extracts on aflatoxin synthesis. Mycopathologia 134: 109114.[Crossref] [Google Scholar]
  22. Jolly P, Jiang Y, Ellis W, Awurah R, Nnedu O, Phillips T, Wang J-S, Afriyie-Gyawu E, Tang L, Person S, Williams J, Jolly C, , 2006. Determinants of aflatoxin levels in Ghanaians: sociographic factors, knowledge of aflatoxins and food handling and consumption practices. Int J Hyg Environ Health 209: 345358.[Crossref] [Google Scholar]
  23. Verma RJ, Raval PJ, , 1991. Cytotoxicity of aflatoxin on red blood Corpuscles. Bull Environ Contam Toxicol 47: 428432.[Crossref] [Google Scholar]
  24. Verma RJ, , 2004. Aflatoxin cause DNA damage. Int J Hum Genet 4: 231236. [Google Scholar]
  25. CIA, 2005. The World Factbook. Available at: www.cia.gov/library/publications/the-world-factbook/index.html. Accessed September 28, 2009. [Google Scholar]
  26. Ghana Districts, 2006. Ashanti Region, Kumasi cosmopolitan. Kumasi: Ministry of Local Government and Rural Development. Available at: http://www.ghanadistricts.com/districts/?news&r=2&_=6. Accessed June 24, 2009. [Google Scholar]
  27. Beardwood CJ, , 1964. Detection of aflatoxin in groundnut Accra. Ghana Med J 3: 8788. [Google Scholar]
  28. Borghi J, Hanson K, Acquah AC, Ekanmian G, Filippi V, Ronsmans C, Brugha R, Browne E, Alihonou E, , 2003. Costs of near-miss obstetric complications for women and their families in Benin and Ghana. Health Policy Plan 18: 383390.[Crossref] [Google Scholar]
  29. Roll Back Malaria, World Health Organization, and United Nations Children’s Fund, 2004. Guidelines for Core Population Coverage Indicators for Roll Back Malaria: To Be Obtained From Household Surveys. Calverton, MD: MEASURE Evaluation. [Google Scholar]
  30. Qian G, Tang L, Xu L, Johnson NM, Tietze D, Rodriguez M, Kaufman L, Cunningham K, Wittmer J, Guerra F, Donelly KC, Phillips TD, Wang J-S, , 2009. Serum level of aflatoxin B1-lysine adduct in a US population compared to a high risk population in China. Toxicologist 104: 755. [Google Scholar]
  31. Cellabs, 2005. Malaria antigen Celisa. Brookvale, Australia. Available at: http://www.cellabs.com.au/profiles/PP-M2v05.pdf. Accessed October 29, 2009. [Google Scholar]
  32. World Health Organization, 1991. A guide for programme managers. Parasitology 103: 291298.[Crossref] [Google Scholar]
  33. Garcia L, , 2001. Diagnostic Medical Parasitology. Washington, DC: ASM Press. [Google Scholar]
  34. Tijen T, Diler A, Yusuf K, Nalan G, Kamil K, , 2000. Comparability and reliability in chemical measurement. Accred Qual Assur 5: 383387.[Crossref] [Google Scholar]
  35. Phiri KS, Calis JC, Siyasiya A, Bates I, Brabin B, van Hensbroek BM, , 2009. New cut-off values for ferritin and soluble transferrin receptor for the assessment of iron deficiency in children in a high infection pressure area. J Clin Pathol 62: 11031106.[Crossref] [Google Scholar]
  36. UAB, University of Alabama at Birmingham, 2002. UAB Laboratories Bulletin of Information. Birmingham, AL: UAB (University of Alabama at Birmingham). [Google Scholar]
  37. Hosmer D, Lemeshow S, , 2001. Applied Logistic Regression. Wiley Series in Probability and Statistics. Second Edition. New York: Wiley and Sons. [Google Scholar]
  38. Engmann C, Adanu R, Luc T-S, Bosea C, Lozoff B, , 2008. Anemia and iron deficiency in pregnant Ghanaian women from urban areas. Int J Gynaecol Obstet 101: 6266.[Crossref] [Google Scholar]
  39. Bommakanti AS, Waliyar F, , 2009. Importance of aflatoxins in humans and livestock health. International Crops Research Institute for the Semi-Arid Tropics. Available at: http://www.aflatoxin.info/health.asp. Accessed October 25, 2009. [Google Scholar]
  40. University of Maryland Medical Center Dugdale DC I, Chen YB, Zieve D, , 2008. Hemolytic Anemia Caused by Chemicals and Toxins: Overview. , eds. Baltimore, MD: University of Maryland Medical Center. Available at: http://www.umm.edu/ency/article/000590.htm. Accessed October 8, 2009. [Google Scholar]
  41. Verma RJ, , 2004. Aflatoxin cause DNA damage. Int J Hum Genet 4: 231236. [Google Scholar]
  42. Wild CP, Turner PC, , 2002. The toxicology of aflatoxins as a basis for public health decisions. Mutagenesis 17: 471481.[Crossref] [Google Scholar]
  43. Park DV, Williams TV, , 1969. Metabolism of toxic substances. Br Med Bull 25: 256262.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 18 Dec 2009
  • Accepted : 29 Apr 2010
  • Published online : 05 Nov 2010

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error