Conclusions

Over a 20-year period of research in West Africa we have demonstrated, by using biomark-ers, the ubiquitous nature of high level exposure to aflatoxins throughout life. One cannot help but speculate as to what the reaction would be if continued exposure to high levels of a potent carcinogen was to be left unaddressed in Europe or North America. Indeed it is ironic that aflatoxins have evoked the most interest recently in the context of the slim risk of their use as chemical weapons by the late Saddam Hussein (http://www.publications.parlia-ment.uk/pa/cm200203/cmselect/cmfaff/813/813we31.htm) or the relatively limited numbers of acute aflatoxicosis outbreaks, such as that in Kenya, rather than in terms of the major public health problems of hepatocellular carcinoma and, potentially, of child morbidity and mortality (Table 3). The scale of the former consequences of aflatoxin exposure is dwarfed by the impact of these toxins if they truly impair growth and immunity in children and thereby make a significant contribution towards the 4.5 million deaths annually of children aged five years and younger in sub-Saharan Africa. The development of affordable and acceptable intervention strategies, such as that demonstrated for peanuts in Guinea, should be a high priority together with further etiologic studies of aflatoxins and child health. These parallel approaches collectively provide the foundation and rationale for effective prevention strategies in affected countries.

Table 3. The wrong emphasis on aflatoxin and human disease.

Health Effect

Possible number

Relative

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