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Numerous population-based studies have documented high prevalence of aflatoxin associated childhood stunting in low income countries. We provide an estimate of the disease burden of aflatoxin related stunting using data from the four African countries. For this empirical analysis, we obtained blood aflatoxin albumin adduct biomarker based exposure data as measured using ELISA technique and anthropometric measurement data from surveys done over a 12-year period from 2001 to 2012 in four low income countries in Africa. We used these data to calculate population attributable risk (PAR), life time disease burden for children under five by comparing two groups of stunted children using both prevalence and incidence-based approaches. We combined prevalence estimates with a disability weight, measuring childhood stunting and co-occurrence of stunting-underweight to produce years lived with disability. Using a previously reported mortality, years of life lost were estimated. We used probabilistic analysis to model these associations to estimate the disability-adjusted life-years (DALYs), and compared these with those given by the Institute for Health Metrics and Evaluation's Global Burden of Disease (GBD) 2016 study. The PAR increased from 3 to 36% for aflatoxin-related stunting and 14-50% for co-occurrence of stunting and underweight. Using prevalence-based approach, children with aflatoxin related stunting resulted in 48,965.20 (95% uncertainty interval (UI): 45,868.75-52,207.53) DALYs per 100,000 individuals. Children with co-occurrence of stunting and underweight due to exposure to aflatoxin resulted in 40,703.41 (95% UI: 38,041.57-43,517.89) DALYs per 100,000 individuals. Uncertainty analysis revealed that reducing aflatoxin exposure in high exposure areas upto non-detectable levels could save the stunting DALYs up to 50%. The burden of childhood all causes stunting is greater in countries with higher aflatoxin exposure such as Benin. In high exposure areas, these results might help guide research protocols and prioritisation efforts and focus aflatoxin exposure reduction. HEFCE Global Challenge Research Fund Aflatoxin project.

Large volume of multidimensional data can be summarised, both in terms of tabulated statistics, and as graphic geospatial visualisations. The latter approach allows rapid interpretation and communication of complex information to stake-holders such as regulators, risk assessors and policy makers. In the main study on polychlorinated naphthalene (PCN), individual samples representing different edible fish species were analysed from around the UK. PCNs were observed in all samples with nearly all of the twelve measured congeners being detected. Summed congener concentrations ranged from 0.7 ng/kg ww (turbot) to 265 ng/kg ww (sprats). The highest contamination levels were recorded for sprats and mackerel with mean summed concentrations of 67 ng/kg ww and 68 ng/kg ww respectively. Two ancillary studies, on potentially toxic elements (PTEs) in crabs from China and aflatoxin in children's blood from Tanzania, demonstrate the wide applicability of this approach. The PTE contents in crab showed strong dependence on the tested tissues and elements, and crabs from Tai and Yangcheng Lakes showed obviously higher PTE levels than the other lakes. Geospatial distribution of the aflatoxin biomarker AF-alb in children's serum from 3 locations showed how individual anthropometric or socio-economic data reveals the relationship between family size, socio-economic score and magnitude of serum aflatoxin levels. In addition to facilitating the flow of interpreted data to stakeholders, these techniques can direct the formulation of risk mitigation activities and help with the identification of data gaps. When combined with hierarchical cluster analyses, correlations within the data can also be predicted., (Copyright © 2019. Published by Elsevier Ltd.)