(P24-062-24) Aflatoxin Contamination in Northern Uganda: A cRCT to Reduce Total Maize Aflatoxin and Aflatoxin B1-Lysine to Prevent Malnutrition

Objectives: Households in Agago district, Uganda experience recurrent or persistent crises, such as drought, conflict or instability; poor nutrition is likely holding back efforts to build resilience in these environments. We conducted a 1:1:1 cluster randomized clinical trial with three arms (control, NIPP, NIPP+) to test if a multi-sectoral nutrition-sensitive intervention is effective in reducing total maize aflatoxin and aflatoxin B1-lysine (AFB1-lys).

Methods: NIPP households received a comprehensive nutrition, food security, and WASH social behavior change communication (SBCC) intervention package. NIPP+ households received this package and additional training on how to use water testing kits, hermetic bags, improved maize seeds, and hygrometers; we nudged NIPP households to purchase them.

We conducted an agriculture production survey, collected maize samples from storage containers, and collected venous blood from female caregivers before and after the intervention. We analyzed maize samples using a VICAM Afla-V Aqua kit in triplicates. We collected venous blood samples from female caregivers and stored them at -80°C within 4 hours of collection. Then we transported blood samples from Uganda to United States. Technicians at Center for Disease Control Atlanta and Cornell University quantified AFB1-lys using a liquid chromatography-mass spectrometry and serum albumin using a chemistry analyzer.

We used a generalized linear mixed model with a Poisson distribution and log link with cluster adjusted robust standard errors to assess if there is an intervention effect on total maize aflatoxin and AFB1-lysine (crude and albumin normalized).

Results: In unadjusted and adjusted models, compared to control, NIPP and NIPP+ did not have statistically significant different risk of total maize aflatoxin concentration greater than 10 ppb or 20 ppb. These results were the same after sensitivity analysis using multiple imputation. Compared to control, we did not find any significant effects of NIPP or NIPP+ interventions on AFB1-lys.

Conclusions: We found no significant intervention effects on total maize aflatoxin or AFB1-lys. Future interventions should consider building stronger farmer to market and farmer to agricultural input dealer linkages and increasing the exposure intensity of agricultural interventions.

Funding Sources: USAID