Abstractobjectives The fungal metabolite aflatoxin is a common contaminant of foodstuffs, especially when stored in damp conditions. In humans, high levels can result in acute hepatic necrosis and death, while chronic exposure is carcinogenic. We conducted a pilot study nested within an existing population cohort (the General Population Cohort), to assess exposure to aflatoxin, among people living in rural south-western Uganda.methods Sera from 100 adults and 96 children under 3 years of age (85 male, 111 female) were tested for aflatoxin-albumin adduct (AF-alb), using an ELISA assay. Socio-demographic and dietary data were obtained for all participants; HIV serostatus was available for 90 adults and liver function tests (LFTs) for 99.results Every adult and all but four children had detectable AF-alb adduct, including five babies reported to be exclusively breastfed. Levels ranged from 0 to 237.7 pg/mg albumin and did not differ significantly between men and women, by age or by HIV serostatus; 25% had levels above 15.1 pg/ mg albumin. There was evidence of heterogeneity between villages (P = 0.003); those closest to trading centres had higher levels. Adults who consumed more Matooke (bananas) had lower levels of AF-alb adduct (P = 0.02) than adults who did not, possibly because their diet contained fewer aflatoxin-contaminated foods such as posho (made from maize). Children who consumed soya, which is not grown locally, had levels of AF-alb adduct that were almost twice as high as those who did not eat soya (P = 0.04).conclusions Exposure to aflatoxin is ubiquitous among the rural Ugandans studied, with a significant number of people having relatively high levels. Sources of exposure need to be better understood to instigate practical and sustainable interventions.
SummaryChanges in agriculture and rural livelihoods in Africa are often attributed to the HIV epidemic. While acknowledging that the epidemic has devastated many families and communities because of excess morbidity and mortality, this review explores other causes of change in agriculture practices and production in southern Uganda. Over the past 20 years labour shortages, because of labour migration and changing aspirations (as well as HIV), crop and livestock pests and diseases, declining soil fertility, changes in commodity markets and a growing off-farm sector have contributed to the changes seen in rural southern Uganda. Policy interventions outside agriculture and health have also had an impact on households. The HIV epidemic has not happened in isolation. The perceived impacts of the epidemic cannot be addressed in isolation from these other drivers of change.
Kenya has enshrined the right to sanitation in the 2010 constitution. Achieving this requires scaling up infrastructure and models of delivery beyond sewer networks that have previously been the focus. In Kenya, two enterprises, Sanergy and Sanivation, have been providing new forms of off‐grid services with container‐based sanitation (CBS). This paper uses a political economy analysis to understand the incentives, institutions and power dynamics that are enabling or constraining the potential for such off‐grid sanitation models. The paper outlines six core problems to be addressed in the pursuit of scaling up: fragmented governance; sustainability of CBS enterprise models; service delivery planning in informal settlements; personal power rather than institutions in decision‐making; vested local interests; and land tenure and political connection. It discusses how stakeholders might work collaboratively to progressively address or recognise these issues.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.