**2.2. Factors that facilitate the prevalence of mycotoxins in Africa**

The prevalence of mycotoxins in African food and feed commodities have been well documented in literature, and major factors that contribute to this have been identified as climate change, poverty, limited/lack of awareness, pro-regulation and legislation, poor agricultural practices, amongst others. Climate change has in fact been proposed as probably the most serious environmental issue facing our planet [21], and Africa has been the most affected. In fact, 2016 was identified as the hottest year in about a century, and accordingly, a manifestation of this was the 2016 *El-nino* drought episode of Southern Africa, which resulted in agricultural losses amounting to millions of US dollars (US\$). Such imbalances, drastic changes in rainfall, temperature and CO2 patterns could increase the risk of pathogen migration and influence colonization of crops by mycotoxigenic fungal genera [22]. Since mycotoxin production is climate dependent, changes in climatic conditions have been suggested and proven to lead to possible drastic modifications in fungal population and attendant mycotoxin production [23, 24]. These would not only favour the emergence of new mycotoxigenic fungal strains, but also attendant mycotoxin production in agricultural commodities.

modulated by exposure to mycotoxins accounted for up to 40% of lost disability-adjusted life years (DALYs) [27], and it is no doubt that Africa is the most affected. In 2004, an outbreak caused by food poisoning with AFs occurred in Kenya, where 317 cases of illness were reported and 68 of the persons were children below the age of 5 and 90 were from 5 to 15 years. In this incidence, at least 123 deaths were recorded [28–30]. In sub-Saharan Africa, about 250,000 deaths are caused by hepatocellular carcinoma annually and this can be linked to risk factors such as AFs and high prevalence of hepatitis B [31]. AF contamination in groundnuts and maize in Nigeria contributed to 7761 liver cancer cases, which results in a total burden of 100,965 DALYs [32]. In 2014, due to AF contamination, about 3334 cases of hepatocellular carcinoma was calculated in Tanzania, 95% of which ended as deaths resulting to a loss of 96,686 DALYs [33].

Based on several studies in Southern Africa, AFs contamination have been strongly linked with child undernutrition, increased mortality and morbidity due to their negative effect on micronutrient absorption and immune function [34]. In addition to these, immune disruption by AFs may aggravate health impacts of principal diseases plaguing Africa such as malaria, kwashiorkor and HIV/AIDS [35]. In Nigeria, posthumous autopsy of infants who suffered from kwashiorkor showed a significant level of AFs in their brains, because of consumption of contaminated maize

were found within Ghanaian population that also had abnormal liver function and high level of HBV infections. Turner *et al*. [38] reported decreased levels of secretory immunoglobulin A (IgA) in Gambian children exposed to AFs. In Kenya, the mean birthweight of the children of women exposed to AFs prenatally was lesser than that of those who had not been similarly exposed [39].

In the Gambia, maternal dietary intake was indicated to be an important factor in carcinogenic-induced damage in the unborn baby, due to a highly significant correlation between AF-albumin adduct levels in the mothers venous and respective cord sera [40]. In the same country, children with reduced level of salivary Secretory Immunoglobulin A (sIgA) have been linked with exposure to AFs [38]. The consumption of FBs contaminated maize have been correlated to the high incidence of oesophageal cancer in parts of South Africa [41] and Malawi [42]. According to Ferlay *et al*. [42], Malawi has the highest prevalence rate (24.2 per 100,000 persons) of oesophageal cancer in the world. ZEA as a naturally occurring endocrinedisrupting chemical has been implicated in the manifestations of gynecomastia with testicular atrophy in rural males in Southern Africa [43]. In 1977 to 1978 an outbreak of ergotism occurred in Wollo, Ethiopia where 140 persons were affected, four children lost both or at least one leg and the mortality as high as 34% [44]. In North Africa, particularly Tunisia and Egypt, cases of human nephropathies have been strongly associated with elevated exposure to OTA and outbreaks of ochratoxicosis, *i.e*., illness due to ochratoxin exposure [45–47]. Alpha-ZEA has been implicated as a potential risk factor for breast cancer in Tunisia [48]. Likewise, high levels of OTA in Moroccan foods and other agricultural commodities have been linked to some chronic illnesses [49, 50]. **Table 1** shows some other mycotoxins and the toxic effects they provoke on human health. Further studies are required to establish the association between other poorly investigated diseases and dietary exposure to other mycotoxins

Though tremendously difficult to estimate in Africa, the net monetarized impact of mycotoxins on human health in Africa [including physical pain, death (in severe cases), temporary or permanent impairment, loss of productivity, costs of diagnosis, treatment, hospitalization

and acute aflatoxicosis symptoms

The Socio-Economic Impact of Mycotoxin Contamination in Africa

http://dx.doi.org/10.5772/intechopen.79328

7

based gruel [36]. According to Jolly *et al.* [37], high levels of AFB<sup>1</sup>

(emerging, modified and multiple mycotoxins).

Africa is the poorest continent in the world [25]. Nearly one in five people living in Africa is undernourished and/or go hungry, the highest prevalence of such in the world [26]. This can have a huge significance on the quality of food commodities consumed in Africa. There are limited resources to adopt relevant technologies/systems to control mycotoxins proliferation, and in dire need for food and "quenching" hunger, the quality and safety of food ingested is totally irrelevant (even though visibly contaminated). Under such circumstances, having food is much more vital and subsequently prioritized. Further to this, limited public awareness on the mycotoxins issue has been identified as a critical factor on the prevalence of mycotoxins in Africa. Knowledge is power. The available information on the incidence, public health importance, prevention and control of mycotoxins in many African countries is still grossly lacking, with no indication that such will be addressed anytime soon. Equally important is the lack of appropriate mechanisms to promote and educate consumers on the harmful effects of mycotoxins, good agricultural practices and post-harvest handling of commodities. Due to all these factors, the issue of mycotoxins on the continent has remained infamously persistent, with attendant grave implications. The next section of this chapter discusses in detail the socio-economic impact of these fungal pollutants on the African continent.
