Aflatoxin exposure and mortality in acutely ill children: results from the CHAIN network cohort
Background Chronic exposure to aflatoxins is associated with liver cancer, impaired child growth, and compromised immune function. The Childhood Acute Illness and Nutrition (CHAIN) Network cohort was established to identify risk factors for mortality in acutely ill children admitted to nine hospital...
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BMJ Publishing Group
2025-07-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/10/7/e017375.full |
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| author | Tahmeed Ahmed Molline Timbwa Moses Ngari Mohammod Jobayer Chisti Kirkby D Tickell Hama Diallo Robert Bandsma Judd L Walson Syed Asad Ali James Berkley Ezekiel Mupere Ali Faisal Saleem Lei Xia Wieger Voskuijl Hang Wu Benson Singa Shalton Mwaringa Christina Lancioni Isabel Potani Abu Sadat Mohammad Sayeem bin Shahid Caroline Tigoi James Njunge Yunyun Gong Michael N Routledge |
| author_facet | Tahmeed Ahmed Molline Timbwa Moses Ngari Mohammod Jobayer Chisti Kirkby D Tickell Hama Diallo Robert Bandsma Judd L Walson Syed Asad Ali James Berkley Ezekiel Mupere Ali Faisal Saleem Lei Xia Wieger Voskuijl Hang Wu Benson Singa Shalton Mwaringa Christina Lancioni Isabel Potani Abu Sadat Mohammad Sayeem bin Shahid Caroline Tigoi James Njunge Yunyun Gong Michael N Routledge |
| author_sort | Tahmeed Ahmed |
| collection | DOAJ |
| description | Background Chronic exposure to aflatoxins is associated with liver cancer, impaired child growth, and compromised immune function. The Childhood Acute Illness and Nutrition (CHAIN) Network cohort was established to identify risk factors for mortality in acutely ill children admitted to nine hospitals in four African and two South Asian countries. We examined the role of aflatoxin exposure in inpatient and post-discharge mortality.Methods In a nested case-cohort from the CHAIN cohort, we compared aflatoxin exposure at admission and discharge with death or survival in hospital (n=755) or up to 180-days post-discharge (n=585) and with community participants (CP, n=222). Children were stratified into non-wasting, medium-wasting and severe-wasting groups based on mid-upper arm circumference. Serum samples were analysed for an aflatoxin exposure biomarker, the aflatoxin-albumin adduct (AF-alb) using ELISA.Findings Overall, 56% of hospitalised participants tested positive for AF-alb at admission. The AF-alb level was higher in deceased (geometric mean and 95% CI (GM and 95% CI) 5.9 (4.9 to 7.1)) than in survivors (4.2 (3.8 to 4.7)) and CP (3.7 (3.1 to 4.3)) pg/mg alb. AF-alb concentration was higher at admission (4.7, (4.2 to 5.1)) than at discharge (3.7, (3.3 to 4.1)) and in the CP group (3.7, (3.1 to 4.3)) pg/mg alb (p<0.01) and in African vs Asian children (7.4 (6.5 to 8.5) vs 1.9 (1.8 to 2.1)) (p<0.001). Adjusted logistical regression showed no significant association between AF-alb levels and mortality, but after separating the nutrition strata, AF-alb was significantly associated with mortality (highest vs lowest quartile group OR=4.84, p=0.014) in non-wasted children.Interpretation Moderate to severe malnutrition is a more important risk factor for mortality than aflatoxin in acutely ill children, but aflatoxin exposure may contribute to mortality in non-wasted children. Controlling aflatoxin exposure should be integrated into clinical and public health interventions to reduce mortality in areas with high levels of exposure.Funding Bill and Melinda Gates Foundation (OPP1131320 & INV-003225). |
| format | Article |
| id | doaj-art-3ca5fe15b5ec4338b8b942dcef17741f |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-3ca5fe15b5ec4338b8b942dcef17741f2025-08-20T03:51:03ZengBMJ Publishing GroupBMJ Global Health2059-79082025-07-0110710.1136/bmjgh-2024-017375Aflatoxin exposure and mortality in acutely ill children: results from the CHAIN network cohortTahmeed Ahmed0Molline Timbwa1Moses Ngari2Mohammod Jobayer Chisti3Kirkby D Tickell4Hama Diallo5Robert Bandsma6Judd L Walson7Syed Asad Ali8James Berkley9Ezekiel Mupere10Ali Faisal Saleem11Lei Xia12Wieger Voskuijl13Hang Wu14Benson Singa15Shalton Mwaringa16Christina Lancioni17Isabel Potani18Abu Sadat Mohammad Sayeem bin Shahid19Caroline Tigoi20James Njunge21Yunyun Gong22Michael N Routledge23Cardiology, ICDDRB, Dhaka, Dhaka District, BangladeshClinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, KenyaClinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, KenyaNutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, BangladeshKEMRI, Nairobi, Nairobi County, KenyaPublic Health, Universite Joseph Ki-Zerbo, Ouagadougou, Centre, Burkina FasoPaediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Southern Region, MalawiGlobal Health, Medicine & Pediatrics, University of Washington School of Public Health, Seattle, Washington, USAPediatrics & Child health, The Aga Khan University, Karachi, Sindh, PakistanKEMRI-Wellcome Trust Research Programme, Kilifi, KenyaMakerere University, Kampala, Kampala, UgandaPediatrics & Child health, The Aga Khan University, Karachi, Sindh, PakistanSchool of Food Science & Nutrition, University of Leeds Faculty of Engineering and Physical Sciences, Leeds, West Yorkshire, UKPediatrics, Amsterdam University Medical Centres, Amsterdam, NetherlandsSchool of Medicine, University of Leeds Faculty of Medicine and Health, Leeds, West Yorkshire, UKKEMRI, Nairobi, Nairobi County, KenyaClinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, KenyaUganda Case Western Reserve University Research Collaboration, Kampala, UgandaPaediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Southern Region, MalawiNutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, BangladeshClinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, KenyaKEMRI-Wellcome Trust Research Programme, Kilifi, KenyaSchool of Food Science & Nutrition, University of Leeds Faculty of Engineering and Physical Sciences, Leeds, West Yorkshire, UKSchool of Food and Biological Engineering, Jiangsu University, Zhenjiang, Jiangsu, ChinaBackground Chronic exposure to aflatoxins is associated with liver cancer, impaired child growth, and compromised immune function. The Childhood Acute Illness and Nutrition (CHAIN) Network cohort was established to identify risk factors for mortality in acutely ill children admitted to nine hospitals in four African and two South Asian countries. We examined the role of aflatoxin exposure in inpatient and post-discharge mortality.Methods In a nested case-cohort from the CHAIN cohort, we compared aflatoxin exposure at admission and discharge with death or survival in hospital (n=755) or up to 180-days post-discharge (n=585) and with community participants (CP, n=222). Children were stratified into non-wasting, medium-wasting and severe-wasting groups based on mid-upper arm circumference. Serum samples were analysed for an aflatoxin exposure biomarker, the aflatoxin-albumin adduct (AF-alb) using ELISA.Findings Overall, 56% of hospitalised participants tested positive for AF-alb at admission. The AF-alb level was higher in deceased (geometric mean and 95% CI (GM and 95% CI) 5.9 (4.9 to 7.1)) than in survivors (4.2 (3.8 to 4.7)) and CP (3.7 (3.1 to 4.3)) pg/mg alb. AF-alb concentration was higher at admission (4.7, (4.2 to 5.1)) than at discharge (3.7, (3.3 to 4.1)) and in the CP group (3.7, (3.1 to 4.3)) pg/mg alb (p<0.01) and in African vs Asian children (7.4 (6.5 to 8.5) vs 1.9 (1.8 to 2.1)) (p<0.001). Adjusted logistical regression showed no significant association between AF-alb levels and mortality, but after separating the nutrition strata, AF-alb was significantly associated with mortality (highest vs lowest quartile group OR=4.84, p=0.014) in non-wasted children.Interpretation Moderate to severe malnutrition is a more important risk factor for mortality than aflatoxin in acutely ill children, but aflatoxin exposure may contribute to mortality in non-wasted children. Controlling aflatoxin exposure should be integrated into clinical and public health interventions to reduce mortality in areas with high levels of exposure.Funding Bill and Melinda Gates Foundation (OPP1131320 & INV-003225).https://gh.bmj.com/content/10/7/e017375.full |
| spellingShingle | Tahmeed Ahmed Molline Timbwa Moses Ngari Mohammod Jobayer Chisti Kirkby D Tickell Hama Diallo Robert Bandsma Judd L Walson Syed Asad Ali James Berkley Ezekiel Mupere Ali Faisal Saleem Lei Xia Wieger Voskuijl Hang Wu Benson Singa Shalton Mwaringa Christina Lancioni Isabel Potani Abu Sadat Mohammad Sayeem bin Shahid Caroline Tigoi James Njunge Yunyun Gong Michael N Routledge Aflatoxin exposure and mortality in acutely ill children: results from the CHAIN network cohort BMJ Global Health |
| title | Aflatoxin exposure and mortality in acutely ill children: results from the CHAIN network cohort |
| title_full | Aflatoxin exposure and mortality in acutely ill children: results from the CHAIN network cohort |
| title_fullStr | Aflatoxin exposure and mortality in acutely ill children: results from the CHAIN network cohort |
| title_full_unstemmed | Aflatoxin exposure and mortality in acutely ill children: results from the CHAIN network cohort |
| title_short | Aflatoxin exposure and mortality in acutely ill children: results from the CHAIN network cohort |
| title_sort | aflatoxin exposure and mortality in acutely ill children results from the chain network cohort |
| url | https://gh.bmj.com/content/10/7/e017375.full |
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