From Analysis to Action: Aflatoxins
Aflatoxin. It’s a small and somewhat unobtrusive word that belies its destructive and harmful impacts. Research has conclusively demonstrated the causal link between long-term exposure to aflatoxin contamination and liver cancer, and preliminary data suggests its impact on child stunting. Acute exposure can lead to aflatoxicosis and death; in 2003 120 people died in Kenya. But what is an Aflatoxin? As plants grow in the soil, some naturally occurring fungi produce toxic and fungal metabolites that spread throughout a variety of crops, including maize. Among the various strains of fungi, Aflatoxin B1 is the most toxic and exists in latitudes between 40 degrees N and 40 degrees S (or rather, the entire continent of Africa).
On January 16th a host of agriculture, nutrition, and food security professionals gathered at the World Bank to learn about Tulika Narayan’s current research on measuring the impact of Aflatoxins in Tanzania and Nigeria.
Aflatoxins represent the “negative nexus between agriculture, nutrition, and health”. Tulika Narayan, who is an Agricultural Economist at Abt Associates, justified this statement by highlighting its impact on agriculture, trade, and health sectors. Her research focused on Nigeria and Tanzania and utilized a mixed-methods approach to understand the key risks and economic impacts of Aflatoxin contamination. This research thus allowed her to identify promising opportunities for control. Ultimately, this study delivered a conceptual framework for conducting economic assessments on Aflatoxins using a replicable, low-cost model that monetized its effects on GDP, and conducted participatory workshops to initiate country-led action.
The presentation focused on the conceptual framework’s three key objectives (i) identifying prevalence of Aflatoxins and characterizing the risks of contamination (ii) estimating the economic impacts on health, trade, and agriculture sectors, and (iii) identifying opportunities for control and initiating a multi-stakeholder approach.
(i) The risk of Aflatoxin contamination on agriculture and food security, trade, and/or health is determined by level of aflatoxin contamination, the uses of contaminated crops, level of awareness among key actors, and actions taken by those key actors. The study utilized a mixed-methods approach to better understand these elements. Information on aflatoxin contamination came from previous studies in Nigeria and through primary data collection and testing in Tanzania. Quantitative data on consumption were gathered using a Living Standard Measurement Survey-Integrated Surveys on Agriculture. Finally, qualitative primary data were gathered on level of awareness, regulations and their enforcement and best practices among farmers.
(ii) Nigeria and Tanzania showed weak links between contamination and losses of agricultural returns and contamination and a loss in exports. The clear link, however, was between Aflatoxin contamination and impacts on health. Tulika Narayan explained the significant quantitative link between contamination and liver cancer, and the more nascent link between stunting and contamination. Secondary data sources on population, age structure, HBV prevalence, and WHO life-tables were used to estimate the health impacts and to monetize the liver cancer impacts
Using her economic model in Tanzania, she found that 1092 out of 1209 liver cancer cases can be attributed to Aflatoxins. In Nigeria, 7,761 out of an estimated 10,130 liver cancer cases can be attributed to Aflatoxins. Using the Value of Statistical Life measure, the monetized impact ranges from .2% to 1.6% of GDP in Nigeria alone.
(iii) The presentation then transitioned into potential solutions and approach to initiate country-led action that engages all three sectors: health, agriculture and trade. The host of the event, SecureNutrition, is a World Bank supported project that bridges the divide between agriculture, nutrition, and food security fields. This multi-sectoral approach makes it an ideal mechanism to highlight aflatoxin contamination and bring it to the international arena. Leslie Elder from the World Bank noted the concern of Aflatoxins to health and agriculture, and how Ministers of Health and Ministers of Agriculture should jointly own this issue.
The Q and A brought a lively end to the presentation. Many dedicated nutrition, agriculture, and food security professionals raised various points on potential pathways forward.
Lynn Brown of the World Bank introduced a conceptual turning point: why not frame this as a massive public health problem? This way poor farmers don’t have to struggle to find solutions, rather donors provide the material means of relief. As an example, Aflasafe can be framed as a public good and given to farmers.
However, any intervention must incorporate the fact that Aflatoxins disproportionately affect poor and subsistent farmers, most of which are women. Again, Lynn Brown pointed towards research that examines how the poorest children in the poorest areas are most likely to consume contaminated food. Agricultural interventions geared towards Aflatoxins must properly bring women into the conversation.
A lively hour and a half covered a host of issues surrounding Aflatoxins. Tulika Narayan delivered a conceptual framework for an economic analysis on Aflatoxins, focusing on health in Tanzania and Nigeria. Whether a public health risk or a detriment to economic development, Aflatoxins must enter into mainstream development agendas.