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Aflatoxin content and health risks associated with consumption of some herbal products sold in Kampala, Uganda

Persuasive adverts and exaggeration of health benefits from consumption of herbal products as well as the mental picture of ‘natural’ is ‘safe’ has boosted traditional medicine use in Uganda. However, herbal products may be unsafe due to the possibility of their contamination with mycotoxins. In this study, we quantified the levels of aflatoxins (B1, B2, G1 and G2) in Real Koff product, Eddagala ly’e kifuba n’e senyiga, Omusujja, Cough mixture and Fever herbal products sold in Kampala, Uganda using high performance liquid chromatography-tandem mass spectrometry. The associated consumption health risks were assessed using the hazard index method. Only aflatoxin B1 was detected in 60% of the samples, with 40% of these surpassing WHO guidelines of ≤ 5 µg/kg. The hazard indices were all less than 1, implying that Ugandans who heavily rely on the herbal products are exposed to aflatoxins at sublethal doses which may lead to chronic effects in the long run. Studies using a larger sample size should assess whether the current observation is a routine occurrence or a sporadic event.


Introduction
Plants have been known for their medicinal potential since antiquity [1]. They continue to be a veritable source of not less than 40% of the current therapeutically utilized products. Some studies have indicated that the use of herbal products to address health challenges could be unsafe due to the possibility of their contamination with heavy metals [2,3], pesticide residues, and toxigenic fungi such as Aspergillus, Fusarium and Penicillium species during processing and packaging [4,5]. These fungi are known to produce potential mycotoxins ( Figure 1). Kampala was chosen because of the big market and high sale turnover of herbal medicines [12]. Selection of these herbal formulations was also based on their availability and affordability by the public following a pilot survey. Samples were analyzed at Directorate of Government Analytical Laboratory, Wandegeya, Kampala, Uganda.
The concentration of each aflatoxin in the samples were separately calculated by using the individual calibration curves obtained from the peak heights of each aflatoxin standard.
Standards and samples were analyzed with a method detection limit of 0.03 µg/kg.
Where daily intake of herbal medicine is in L/day, mean level of aflatoxins in ng/kg and average body weight in kg.

Results and Discussion
Aflatoxin content of the herbal medicines  [23,25,26]. This may account for the high incidence and concentrations of AFB1 compared with AFG1 and AFG2 in the herbal products investigated in this study. In addition, the total absence of other AFs in herbal products have been reported before [23,27,28]. infusions and medicinal plants analyzed [28].  [32][33][34][35].

Human exposure assessment
The estimated daily intakes of the herbal medicines ranged from 5.61 × 10 -2 μg/kg/bw/day to 1.51 × 10 -1 μg/kg/bw/day for both Ugandan children and adults (Table 3). The recorded hazard indices were in the range of 7.93 × 10 -7 to 2.32 × 10 -6 . Hazard indices less than or equal to 1 indicates no significant health risk but the possibility of longterm adverse health effects increases with increasing hazard index. Hazard index between 1.1 and 10 reflects a moderate risk while hazard index greater than 10 indicates high risk [17].
The computed hazard indices were all less than 1, implying that daily consumption of the individual herbal products may not pose health risks. However, the risk is higher in children.
This is due to their higher dietary exposure per kg body weight and the differences in their body physiology when compared to adults [36]. The risks may also be amplified if two or more of the herbal products are consumed in tandem.

Conclusions
In the current study, we found that three out of the five commonly used herbal medicines in Kampala, Uganda were contaminated with aflatoxin B1, a potent carcinogen. Thus, Ugandans who heavily rely on herbal products could be exposed to aflatoxins at sublethal doses, which could have long term carcinogenic effects.
We recommend further studies using a large sample size and in other parts of Uganda. The mycoflora associated with the contamination as well as co-ocurrence of aflatoxins with other mycotoxins in Ugandan herbal products should be investigated.