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Kenyans have been highly affected by aflatoxicosis for a long time because of excessive exposure to high aflatoxin containing maize-based products. Maize has been the staple food in Kenya which is more highly consumed than any other cereal product. Many countries with strict aflatoxin threshold application, have consumers who still consume maize-based products, which has not gone through testing. The more remote and lower income areas are more affected by untested maize, ending up exposing themselves to Hepatocellular carcinoma which is a health hazard. The study was designed to determine the exposure of aflatoxin in Kiandutu slum which is a marginalized area in Thika, Kiambu County, Kenya. Ninety seven households were used in the study where number of maize-based products obtained from each household was sampled. Quantitative analysis was used to determine the aflatoxin levels by use of ELISA method. Questionnaires were used to collect the consumption data and sampling of maize- based products was done purposively. Aflatoxins were found in 30.93% of maize flour at between 0 to 34.19 [micro]g /kg, 29.33% of composite flour at between 0 to 30.06 [micro]g /kg, 18.67% of maize grain at between 0 and 20.92 [micro]g /kg and 6.97% of Muthokoi at between 0 to 7.14 [micro]g /kg. Across all sampled households, daily consumption of maize-based products in kilograms per body weight was found to be highest in maize flour, followed by whole maize grains, composite flour and muthokoi in that order. Monte Carlo risk simulation was used to generate the quantitative exposure data. Daily maize flour consumption was higher than other maize-based products with a mean of 0.0038 kg/kg bw/day. It also had the highest daily aflatoxin exposure at a mean of 0.0301 [micro]g/kg/bw/day. The percentage level of the health risk was found to be highest through maize flour consumption at 68.65. Results showed that the frequency of consumption of maize-based products is an important contributor to dietary exposure risk. Key words: Aflatoxin, Exposure, Slum, Food safety, Maize-based products, Households, population, INTRODUCTION In Kenya, maize grains are an important staple food in every household [1]. Their daily consumption is at an average of 400g per person while 98kg has been estimated [...]

Objective To estimate the incidence of, and trends in, catastrophic health expenditure in sub-Saharan Africa. Methods We systematically reviewed the scientific and grey literature to identify population-based studies on catastrophic health expenditure in sub-Saharan Africa published between 2000 and 2021. We performed a meta-analysis using two definitions of catastrophic health expenditure: 10% of total household expenditure and 40% of household non-food expenditure. The results of individual studies were pooled by pairwise meta-analysis using the random-effects model. Findings We identified 111 publications covering a total of 1 040 620 households across 31 sub-Saharan African countries. Overall, the pooled annual incidence of catastrophic health expenditure was 16.5% (95% confidence interval, CI: 12.9-20.4; 50 datapoints; 462 151 households; [I.sup.2] = 99.9%) for a threshold of 10% of total household expenditure and 8.7% (95% CI: 7.2-10.3; 84 datapoints; 795 355 households; [I.sup.2] = 99.8%) for a threshold of 40% of household non-food expenditure. Countries in central and southern sub-Saharan Africa had the highest and lowest incidence, respectively. A trend analysis found that, after initially declining in the 2000s, the incidence of catastrophic health expenditure in sub-Saharan Africa increased between 2010 and 2020. The incidence among people affected by specific diseases, such as noncommunicable diseases, HIV/AIDS and tuberculosis, was generally higher. Conclusion Although data on catastrophic health expenditure for some countries were sparse, the data available suggest that a non-negligible share of households in sub-Saharan Africa experienced catastrophic expenditure when accessing health-care services. Stronger financial protection measures are needed. Objectif Evaluer le taux d'incidence et les tendances liees aux depenses de sante catastrophiques en Afrique subsaharienne. Methodes Nous avons procede a une revue systematique de la litterature scientifique et de la litterature grise afin d'identifier les etudes relatives aux depenses de sante catastrophiques, menees aupres des populations d'Afrique subsaharienne entre 2000 et 2021. Nous avons ensuite effectue une meta-analyse en definissant ces depenses de deux manieres: 10% des depenses totales d'un menage et 40% de ses depenses non alimentaires. Les resultats de chaque etude ont ete regroupes par paires de meta-analyses a l'aide d'un modele a effets aleatoires. Resultats Nous avons selectionne 111 publications representant un total de 1 040 620 menages repartis dans 31 pays d'Afrique subsaharienne. Globalement, le taux d'incidence annuel combine des depenses de sante catastrophiques s'elevait a 16,5% (intervalle de confiance de 95%, IC: 12,9-20,4; 50 points de donnees; 462 151 menages; [I.sup.2] = 99,9%) pour un seuil de 10% des depenses totales d'un menage, et a 8,7% (IC de 95%: 7,2-10,3; 84 points de donnees; 795 355 menages; [I.sup.2] = 99,8%) pour un seuil de 40% de ses depenses non alimentaires. Les pays situes au centre de l'Afrique subsaharienne presentaient le taux d'incidence le plus eleve, tandis que ceux situes dans la region meridionale affichaient le taux d'incidence le moins eleve. Une analyse des tendances a permis de decouvrir qu'apres une baisse initiale survenue durant les annees 2000, le taux d'incidence des depenses de sante catastrophiques a augmente entre 2010 et 2020 en Afrique subsaharienne. En outre, chez les personnes souffrant de pathologies specifiques comme les maladies non transmissibles, le VIH/SIDA ou la tuberculose, ce taux d'incidence etait generalement plus eleve. Conclusion Malgre le manque de donnees disponibles a ce propos dans certains pays, les informations en notre possession semblent indiquer qu'une part non negligeable des menages d'Afrique subsaharienne est confrontee a des depenses catastrophiques en matiere d'acces aux soins de sante. Des mesures de protection financiere renforcees sont donc necessaires. Objetivo Estimar la tasa de incidencia y las tendencias de los gastos sanitarios catastroficos en el Africa subsahariana. Metodos Se reviso sistematicamente la literatura cientifica y gris para identificar los estudios poblacionales sobre el gasto sanitario catastrofico en el Africa subsahariana que fueron publicados entre 2000 y 2021. Se realizo un metanalisis empleando dos definiciones de gasto sanitario catastrofico: 10 % del gasto total del hogar y 40 % del gasto no alimentario del hogar. Los resultados de los estudios individuales se agruparon mediante un metanalisis por pares utilizando el modelo de efectos aleatorios. Resultados Se identificaron 111 publicaciones que incluian un total de 1 040 620 hogares en 31 paises del Africa subsahariana. En general, la tasa de incidencia anual conjunta de los gastos sanitarios catastroficos fue del 16,5 % (intervalo de confianza del 95 %, IC: 12,920,4; 50 observaciones estadisticas; 462 151 hogares; [I.sup.2] = 99,9 %) para un umbral del 10 % del gasto total del hogar y del 8,7 % (IC del 95 %: 7,2-10,3; 84 observaciones estadisticas; 795 355 hogares; [I.sup.2] = 99,8 %) para un umbral del 40 % del gasto no alimentario del hogar. Los paises del centro y del sur del Africa subsahariana presentaron la mayor y la menor tasa de incidencia, respectivamente. Un analisis de la tendencia revelo que, tras disminuir inicialmente en la decada de 2000, la tasa de incidencia de los gastos sanitarios catastroficos en el Africa subsahariana aumento entre 2010 y 2020. La tasa de incidencia entre las personas afectadas por enfermedades especificas, como las enfermedades no transmisibles, el VIH/SIDA y la tuberculosis, fue en general mayor. Conclusion Aunque los datos sobre los gastos sanitarios catastroficos de algunos paises fueron escasos, los datos disponibles sugieren que una parte significativa de los hogares del Africa subsahariana sufrieron gastos catastroficos al acceder a los servicios sanitarios. Por lo tanto, se requieren medidas de proteccion financiera mas solidas. [phrase omitted], Introduction In 2019, over 930 million people worldwide experienced financial hardship while obtaining health care and, annually, about 100 million people were impoverished. (1) Out-of-pocket payments, the predominant form of [...]