Scientists have shone a light on the cause of multiple serious and fatal food poisoning incidents in Uganda in 2019. They found all three outbreaks were caused by a single batch of a type of food aid called Super Cereal.

It is thought contaminated product, withdrawn after the first two incidents in March and April, was stolen from a warehouse and caused a third outbreak in August.

Super Cereal is distributed as part of a program to combat malnutrition and given to vulnerable populations such as mothers and children. It is corn or wheat blended with soya beans, fortified with vitamins and minerals and processed into flour.

First two outbreaks
In March 2019, 278 food related illnesses were reported in the Amudat and Napak districts of the Karamoja Region of Uganda and five people died. The World Food Programme (WFP) stopped distribution of Super Cereal across the country and started an investigation.

Testing of samples using untargeted analysis at three labs found the presence of several tropane alkaloids, such as atropine and scopolamine at parts per million concentrations, levels at which acute toxicity are highly likely. These alkaloids were present due to incorporation of Datura seeds during production of the Super Cereal.

Nine cases were also reported on one day in April and all recovered. They appeared to be linked to the first episode as all had consumed the same suspect batch of Super Cereal, which had been stored since the March outbreak.

based on the lot numbers of contaminated Super Cereal the supplier was identified as a Turkish company. An inspection of the firm in mid-April found failures in quality management procedures.

Products with the same batch number were shipped from a port in Turkey to Algeria, Tanzania and Kenya. In Kenya it was dispatched to other African countries: Uganda, Tanzania, Central African Republic, Rwanda and Somalia. In Uganda, it was transported from a central warehouse in Karamoja to other sites in Kotido, Kaabong and Moroto with further distribution to about 90 health centers.

Identifying supplier in third poisoning incident
In a third incident, 33 cases of food poisoning were reported in the Lamwo District of Uganda, some 400 kilometers from Amudat in late August. Super Cereal was suspected but it was from a different supply chain involving a Belgian firm, which led to the WFP suspending all supplies of the food aid.

Researchers at Queen’s University Belfast’s Institute for Global Food Security (IGFS) supported the investigation. The World Health Organization, WFP, Ministry of Health in Uganda, Merieux Nutrisciences, U.S. Centers for Disease Control and Prevention, and Center for Food Safety and Applied Nutrition at the U.S. Food and Drug Administration also investigated the outbreaks.

Professor Chris Elliott, Simon Haughey and the team at IGFS suspected that fraud had occurred and were able to show that both outbreaks were caused by contaminated ingredients from the same batches produced in Turkey, according to a study published in the journal Food Control.

The WFP was then able to release millions of dollars’ worth of the unaffected, detained Super Cereal back into circulation.

Professor Elliott said: “We were delighted to be able to support this investigation as we hold the WFP and their work in the highest esteem. Our approach to investigate the incidents was based on using the combined strengths of many forms of analytical chemistry.”

Results from modelling showed differences between samples from the Turkish and Belgian suppliers, likely due to variations in the materials and processing.

Samples from households with reported intoxication were shown to be different from the retained Belgian samples and those from Super Cereal stores, which indicated they did not come from the same producer.

According to the WFP, it seems likely that some of the contaminated material withdrawn from distribution was stolen from a warehouse and sent to another region of the country.

The WFP has increased oversight for the production cycle of Super Cereal, including spot checks and sampling of cargo along the supply chain to test for potential contamination.

The FAO and WHO headed an expert meeting earlier this year to provide scientific advice on tropane alkaloids in processed and unprocessed WFP products to allow development of risk management measures in the supply chain and prevent future outbreaks.