All ETDs from UAB

Advisory Committee Chair

Pauline E Jolly

Advisory Committee Members

John E Ehiri

Ellen Funkhouser

Craig Wilson

Sharina D Person

William Ellis

Document Type


Date of Award


Degree Name by School

Doctor of Public Health (DrPH) School of Public Health


Aflatoxins are fungal metabolites that contaminate staple food crops in many developing countries. Although studies have linked these toxins to adverse health outcomes, few studies have investigated the association between birth outcomes and aflatoxin B1-lysine adduct levels among pregnant women. The objective of this dissertation was to investigate the association between birth outcomes and aflatoxin B1- lysine adduct levels among pregnant women in Kumasi, Ghana. In a cross-sectional study of 755 pregnant women, Aflatoxin B1-lysine adduct (AF-ALB) levels were determined by High Performance Liquid Chromatography. AF-ALB associations were assessed as both continuous and categorical values. Analysis of variance (ANOVA) was used on log transformed AF-ALB values for bivariate and adjusted analyses. Participants were also divided into quartiles "low", "moderate", "high", and "very high". Logistic regression was used to examine the association between maternal anemia, birth outcomes and AF-ALB. From the predictors study, the mean AF-ALB in maternal serum was 10.9 ± 19.00 pg/mg albumin (range=0.44-268.73 pg/mg/ albumin). Participants with weekly income levels above 20 Ghana cedis (GHc) had reduced odds of having high aflatoxin levels (OR, 0.67; 95% CI, 0.50-0.90). Similarly, participants who were employed (OR, 0.58; 95% CI, 0.40-0.83), had a flush toilet system (OR, 0.56; 95% CI, 0.41-0.79) or had only one child (OR, 0.68; 95% CI, 0.48-0.94) had reduced odds of having high aflatoxin levels. The second study found that 30.3% of participants were anemic. The odds of being anemic increased 21% (OR, 1.21, p=0.01) with each quartile of AF-ALB reaching an 85% increased odds in the "very high" compared to the "low" category (OR, 1.85; CI, 1.16-2.95). This association was stronger among women with malaria and findings were robust when women with evidence of iron deficiency anemia were excluded. The study investigating the association between birth outcomes and AF-ALB found that participants in the highest AFB1-lysine quartile with `very high' AFB1-lysine level (>11.34 pg ⁄ mg) were more likely to have low birth weight babies (OR, 2.09; 95% CI, 1.19-3.68), and showed a trend of increasing risk for low birth weight (Ptrend = 0.007) compared to participants in the lowest quartile.

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