Challenges and Response

Challenges

The initial epidemiological investigations found that the outbreak posed several challenges:

• There was an upsurge of patients with acute hepatitis of unknown etiology presenting at poorly equipped local hospitals with few, if any, adequately trained personnel.

• There was an apparent widespread contamination of maize grain in the local maize distribution system with more than 55% of maize samples from markets having levels greater than the regulatory limit of 20 ng/g. About 7% of the samples were exceedingly highly contaminated (> 1,000 ng/g; Lewis et al., 2005).

• In addition to the contamination problems, there was a general shortage of maize forcing starving families to consume overtly contaminated maize. Farmers usually sort and sell clean maize with what remains being consumed in the household.

• The community did not as yet associate the high number of deaths with the maize they were consuming. Awareness campaigns were needed to educate the public on the dangers associated with the consumption of contaminated maize.

• The affected area has rough terrain with a poor road network that generates distribution and other logistical problems. Thus, in the affected areas, households will consume more of the locally grown contaminated maize, as what is sold in the local market and consumed may be of poor quality as well.

Responses

The immediate efforts in rapid response focused on:

• Providing support to the local health facilities to strengthen their capacity to manage the large number of admitted cases. This support needs to be followed up with routine training of personnel to familiarize them with the symptoms of aflatoxin poisoning.

• Education of the public on the causes of the prevailing ill health and death.

• Sampling and analysis of grain stocks and the destruction of condemned contaminated grain.

• Replacement of condemned and destroyed grain. This intervention presents enormous logistical problems ranging from aflatoxin testing of a large number of samples, inadequate stocks of replacement grain, to informing vulnerable groups who often live in areas with a poor communication network of the problem, and distributing the available replacement grain over a minimal and rough road network.

• Due the general shortage of maize, some of the grain destined for the affected households was diverted to other, less needy, households.

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