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...

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.
  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.
  3. World Health Organization, 2001. Iron deficiency anaemia: assessment, prevention and control. A guide for programme managers. WHO/NHD/01.3.
  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.
  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.
  6. Allen LH, , 2000. Anemia and iron deficiency: effects on pregnancy outcome. Am J Clin Nutr 71: 12801284.
  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]
  8. Dim CC, Hyacinth EO, , 2007. The prevalence of anemia among pregnant women at booking in Enugu, south eastern Nigeria. MedGenMed 9: 11.
  9. Abouzahr C, Royston E, , 1991. Maternal Mortality: A Global Factbook. Geneva: WHO.
  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.
  11. Nils M, , 2008. Prepartum anaemia: prevention and treatment. Ann Hematol 87: 949959.[Crossref]
  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.
  13. West KJ, , 2002. Extent of vitamin A deficiency among preschool children and women of reproductive age. J Nutr 132 (Suppl): 2857S2866S.
  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.
  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.
  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.
  17. Fung F, Clark R, , 2004. Health effects of mycotoxins: a toxicological overview. J Toxicol Clin Toxicol 42: 217234.[Crossref]
  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.
  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]
  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]
  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]
  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]
  23. Verma RJ, Raval PJ, , 1991. Cytotoxicity of aflatoxin on red blood Corpuscles. Bull Environ Contam Toxicol 47: 428432.[Crossref]
  24. Verma RJ, , 2004. Aflatoxin cause DNA damage. Int J Hum Genet 4: 231236.
  25. CIA, 2005. The World Factbook. Available at: www.cia.gov/library/publications/the-world-factbook/index.html. Accessed September 28, 2009.
  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.
  27. Beardwood CJ, , 1964. Detection of aflatoxin in groundnut Accra. Ghana Med J 3: 8788.
  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]
  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.
  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.
  31. Cellabs, 2005. Malaria antigen Celisa. Brookvale, Australia. Available at: http://www.cellabs.com.au/profiles/PP-M2v05.pdf. Accessed October 29, 2009.
  32. World Health Organization, 1991. A guide for programme managers. Parasitology 103: 291298.[Crossref]
  33. Garcia L, , 2001. Diagnostic Medical Parasitology. Washington, DC: ASM Press.
  34. Tijen T, Diler A, Yusuf K, Nalan G, Kamil K, , 2000. Comparability and reliability in chemical measurement. Accred Qual Assur 5: 383387.[Crossref]
  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]
  36. UAB, University of Alabama at Birmingham, 2002. UAB Laboratories Bulletin of Information. Birmingham, AL: UAB (University of Alabama at Birmingham).
  37. Hosmer D, Lemeshow S, , 2001. Applied Logistic Regression. Wiley Series in Probability and Statistics. Second Edition. New York: Wiley and Sons.
  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]
  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.
  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.
  41. Verma RJ, , 2004. Aflatoxin cause DNA damage. Int J Hum Genet 4: 231236.
  42. Wild CP, Turner PC, , 2002. The toxicology of aflatoxins as a basis for public health decisions. Mutagenesis 17: 471481.[Crossref]
  43. Park DV, Williams TV, , 1969. Metabolism of toxic substances. Br Med Bull 25: 256262.[Crossref]

Data & Media loading...

  • Received : 18 Dec 2010
  • Accepted : 19 Apr 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