Abstract:
Oesophageal carcinoma (OC) is highly prevalent in Western Kenya especially among the members of the Kalenjin
community who reside in the Northern and Southern areas of the Rift Valley. Previous authors have suggested
potential association of environmental and genetic risk factors with this high prevalence. The environmental factors
that have been suggested include contamination of food by mycotoxins and/or pesticides, consumption of
traditional alcohol (locally referred to “Busaa” and “Chan’gaa”), use of fermented milk (“Mursik”), poor diet, tobacco
use and genetic predisposition. The aim of this paper is to critically examine the potential contribution of each of
the factors that have been postulated to be associated with the high prevalence of the disease in order to establish
the most likely cause. We have done this by analyzing the trends, characteristics and behaviours that are specifically
unique in the region, and corroborated this with the available literature.
From our findings, the most plausible cause of the high incidence of OC among the Kalenjin community is
mycotoxins, particularly fumonisins from the food chain resulting from poor handling of cereals; particularly maize
combined with traditional alcohol laced with the toxins interacting synergistically with other high-risk factors such
as dietary deficiencies associated alcoholism and viral infections, especially HPV. Urgent mitigating strategies should
be developed in order to minimize the levels of mycotoxins in the food chain.
