We conducted surveys in Ghana in 1999 and 2003 to assess the level of awareness of afla-toxins and their relevant harmful effects. The first survey was of peanut farmers, poultry farmers, retailers, processors, feed millers and consumers. It found very poor awareness of the problem, with only 8% of the 1983 respondents indicating knowledge of the word "aflatoxin". The second survey was of medical doctors, nurses, agriculturists, pharmacists, biologists and other professionals. This survey found a much higher knowledge of the words "mycotoxin" or "aflatoxin," > 70% for most categories of interviewed persons, and, to a lesser extent, < 40%, of the relevant adverse effects. The level of awareness depended on education, profession and position. Thus, awareness of aflatoxins among health, agricultural and some other professionals in Ghana is fair, but the general Ghanaian population is mostly unaware of the problem or its implications. The general lack of awareness, together with the inability of most of the responding professionals to accurately identify the harmful effects of aflatoxins suggests that the menace posed by the toxin is not well appreciated in Ghana.
Aflatoxins are potent mycotoxins produced by the fungi, Aspergillus flavus and Aspergillus parasiticus. These toxins are involved in several human and animal health conditions (Di-mitri and Gabal, 1996; Obasi et al, 1996; Ramos et al, 1996; Sahoo et al, 1996; Oyelami et al., 1997). In acute doses, aflatoxin is toxic and can be lethal (Chen, 1992). In Ghana, aflatoxins occur in peanut (Beardwood, 1964; Mintah and Hunter, 1979; Kpodo, 1995; Awuah and Kpodo, 1996) and some of its processed products (Kpodo, 1995), and in maize and kenkey, a maize-based food (Kpodo et al., 1996).
In 1998, a news item with the sensational banner headline, "Shocking Scientific Report: Kenkey Causes Cancer" appeared in the August 17-18 edition of the Ghanaian Chronicle, a Ghanaian newspaper. The author of the article, who at the time also was the editor of the newspaper wrote, "Scientific studies from major processing sites and markets in Accra have concluded comprehensively that there is widespread occurrence of the strain (italics mine) that causes cancer, particularly liver cancer in Ga kenkey" (Koomson, 1998a). The writer based his report on a publication by Kpodo et al. (1996), that documented the occurrence of mycotoxins in fermented maize products. Koomson (1998a) showed some lack of understanding of the matter when, for example, he wrote "According to the report, maize which is a major dietary staple has been identified as the 'villain'. The molds which develop on the maize particles, because of delayed or poor drying process, contain a bacteria called aflatoxin (italics mine), a proven cause of cancer." In a related report (Koomson, 1998b), confused the issue further by referring to aflatoxin as a fungi (italics mine) that can cause certain types of cancer.
Many Ghanaians eat kenkey and the Ghanaian Chronicle, at that time, was one of the most widely read newspapers in Ghana. The article on the carcinogenicity of kenkey was, therefore, read by many Ghanaians. Naturally the publication attracted a lot of rejoinders and counter rejoinders some with headlines such as "The Kenkey Palava" (Odei, 1998), "The Kenkey Debate: Must We Tell the People" (Koomson, 1998c), and "The Battle of the Kenkeys" (Season, 1998). In the weeks following publication of the initial news item (Koomson, 1998a), panelist after panelist discussed the issue on several radio stations in Ghana. Phone-in callers, mostly lay persons, contributed to the discussions. The impression from most of these discussions and from some of the newspaper rejoinders pointed to a lack of understanding by Ghanaians of aflatoxin and its harmful effects. Thus, we decided to determine the level of awareness of aflatoxin and its associated problems in Ghana. Such a study would be useful in the formulation of aflatoxin management strategies.
In 1999, 331 peanut farmers, 727 peanut consumers, 372 peanut retailers, 400 peanut processors, 18 feed millers and 135 poultry farmers from three broad geographical zones in Ghana were surveyed with a pre-tested, structured questionnaire. This survey was part of a USAID Peanut Collaborative Research Support Program (Peanut CRSP) project titled "Economic effect of aflatoxins on the well being of Ghanaian peanut producers and consumers". The Upper East region, Upper West region and the Northern region comprised the Northern Zone. The middle Zone was comprised of the Ashanti and Brong Ahafo regions. The Central, Greater Accra, Western, Volta and Eastern regions constituted the southern zone. Participants were interviewed individually, usually in the relevant local language. Information on socioeconomic variables, awareness of the word "aflatoxin", health effects of aflatoxin, and on several issues linked to aflatoxin awareness was obtained from respondents.
In 2003, a similar study was conducted, but with a focus on people involved in the delivery of agricultural and health services in the country. The second study involved 385 agriculturists, 103 health professionals, 17 biologists and 69 other professionals.
The Statistical Package for Social Sciences (SPSS) for Windows XP version 11.0 was used to analyze the data. Analytical tools were descriptive, e.g., means, frequencies and percentages, as well as inferential, e.g., x2 tests.
In the 1999 study, 331 peanut farmers, 727 consumers, 372 peanut retailers, 400 peanut processors, 18 feed millers and 135 poultry farmers participated. Feed millers and poultry farmers were not included in the northern zone because the feed milling and commercial poultry industries are generally absent from these areas. Eighty-three percent of the respondents were male. Other than the feed millers, 50% of whom indicated knowledge of the word "aflatoxin", knowledge of the word by farmers, poultry farmers, retailers, processors and consumers, respectively, were 6.0, 18.5, 6.5, 2.8 and 6.9% (average 8.1%). For the various groups, indication of knowledge of the word "aflatoxin", except for peanut farmers, was significantly dependent (p < 0.01) on education. Thus, feed millers in Ghana, most of whom are well educated, have a better appreciation of aflatoxins than do the other groups in this survey. Indication of awareness of the word "aflatoxin" by geographic zone was 10.4, 6.7 and 8.0%, respectively, for the northern, middle and southern zones.
The overall low awareness of the word "aflatoxin", among the general Ghanaian population probably results, in part, from the highly technical nature of the subject and, in part, because aflatoxin has never been considered a serious enough issue in Ghana to merit an urgent awareness campaign. This low level of awareness may result in recommended management not being seriously implemented.
A large number of farmers and food processors in Ghana became aware of aflatoxin through interactions with personnel from the Ghana Ministry of Food and Agriculture. This education was not surprising since some of the Ministry of Food and Agriculture staff had previously attended a workshop on aflatoxin in peanuts held in Kumasi, Ghana and had gone back to their communities and were disseminating the knowledge they had acquired. Amongst all of the survey participants, only 2.5% of the respondents became aware of afla-toxin through workshops, which is probably because workshops on aflatoxin are not common in Ghana. The low level of education resulting from these workshops is undesirable, as they are important fora for the dissemination of technical and scientific information.
Ninety-one percent of the total respondents indicated that they sorted their nuts prior to consumption, with 53% indicating that the sorting was thorough. The fate of the sorted bad nuts depended on the geographic zone. In the northern zone, half of the respondents used the "bad" nuts while 16% and 29% of respondents in the middle and southern zones, respectively, did so. Uses for the bad nuts included feeding to backyard poultry and processing into peanut butter after adding some good nuts. More respondents in the northern zone use the bad nuts because of the chronic food insecurity and poverty problems that occur there.
In 2003, we surveyed personnel involved in the delivery of agricultural and health services in Ghana because aflatoxin is, among others, both an agricultural and a medical issue. Thus, personnel in the agricultural and health services delivery sectors and policy makers in both sectors need to play lead roles in the dissemination of aflatoxin information in Ghana. To do so effectively, they must be well apprised of the subject. More agriculturists (67% of the respondents) participated in the study, while relatively few health personnel (18% of the respondents) did. Of the medical personnel, physicians were the most under-represented, with an ~ 20% response. The other personnel were mainly social scientists, physical scientists, etc., associated with agricultural and medical establishments and they constituted about 15% of the sample. Seventy-eight percent of the respondents were male.
Amongst the professionals (Table 1), physicians, with 61% positive responses, were the most aware of aflatoxins/mycotoxins and their potential complications, followed by pharmacists (49%), biologists (47%), agriculturists (40%), nurses (34%) and the other physical/social scientists (32%). Although many of the health and agricultural professionals said they knew of the term "mycotoxins" (Issue 1, Table 1), relatively few of them could correctly identify the organisms that produce them (Issue 4, Table 1). Similarly, most professionals were aware of the term "aflatoxin" (Issue 2, Table 1), but only a few of them could
Table 1. Positive responses (%) by professionals in Ghana to mycotoxin/aflatoxin issues (2003 survey).
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