Public health status

The general health situation and our knowledge of it also conditions perceptions of aflatoxin contamination. In countries with high medical and hygiene standards and where the benefits of good nutrition have added years to survival, cumulative toxicities assume greater significance than they do in countries where life expectancy is not as great due to the high incidence of infectious diseases, environmental hazards and unsafe water.

Statistics generally attribute to the presently recognized risks of aflatoxins (liver cancer) a small fraction of the burden of disease, and on this basis aflatoxin is rated a lower priority for Ministries of Health in developing countries than are many other more pressing problems. Hopefully this position will change, as it is based on untenable assumptions about the levels of exposure and toxicities occurring in developing countries.

Another factor that strongly influences the perception of aflatoxin is the presence of the hepatitis B virus, with which aflatoxin interacts synergistically. When these two agents are combined, the potency of aflatoxin as a carcinogen is increased 30 fold (Henry et al., 2002). This synergism means that institutions concerned for people with hepatitis B should perceive aflatoxin as a much more dangerous toxin than they currently do. Although there are campaigns to inoculate people against hepatitis B, there currently are 80 million people with the disease for whom any aflatoxin exposure is an increased concern.

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