Blighia sapida in Africa 1­ origin, distribution and local names 2­ Traditional uses 3­ Aril composition 4­ Blighia sapida, the Ackee tree, still a sword of Damocles over children in Africa? 1­ origin, distribution and local names Blighia sapida Koenig (Sapindales, Sapindaceae), the Ackee tree, is a species native to the semi‐deciduous forests of western Africa (Ivory Coast, Ghana). It was introduced by man in many tropical regions of the world, especially America and the Caribbean to the west and India to the east. In West Africa, it was introduced in the villages and fields of savannah regions north of its original area, where it has become very common. He is well known for example from the Malinke, who call it Finzan, which gave the name that is sometimes used in French, "Fisanier". Its name in English speaking countries, ackee (or akee, akee apple tree or savor akee), comes from the Ashanti and is now used worldwide, including in French speaking countries. Ackee was also planted along avenues in cities where its dense foliage is a source of shade and where fruit with bright red and yellow colors are very decorative. It is a tree that reaches only a few meters when planted in full light, but that is much more developed in forest, where it reaches 10‐15 meters. Flowering in or near the region of origin, takes place from January to May, and fruiting from March to June. In the northern regions, the tree is earlier (flowering from November to December and fruiting from January to March, and a second flowering may take place in May‐June, followed by a fruiting in July‐August). The fruit, pear‐shaped, is a capsule 5 to 7 cm long, which opens in three valves and contains three black seeds, shiny and oblong, surrounded at their base by a cup‐ shaped yellowish‐white aril. Local names in West Africa Ethnic group Local name Tagwana Kou, kohou, koum Djimini Kokougo Baoulé Kaa Malinké Finzan Ebrié Atuanbi Shien Pagwé Gouro Tia Attie Baza Agni Founzan, Foufoué, Baza Gagou Sen Koulango Songo Bété Newgouei Wobé Goihien Bobo Finsan Dioula Finzan Bambara Finzan Mooré Finzan Haoussa Fisa, Gwanja Kousa Ashanti Achin, akyen, akye Twi Ankye, akye, fufuo Fanti twi Takwada Ga Hatschi, Ayigbeatia Krobo Kngatscho Ewe Adza, atsia Awuna Adza, atsia Chumbulu Kake Tschandjo Peso Kabure Peso Losso Peso Kuatchi Keka Basari Bugpom Konkomba Bugpob Fulani Feso Nupe Ila, ella Yorouba Ishin, ishin jife, ishin oka Benin Ukpe, ukpe nofoua, ukpe‐aghaba Sobo Ukpe rehren Ibo Okpu Owerri Okpu ocha Onitscha Okwocha Boki Otusi‐shet Kukuruku Awai Jekri Abikotor Ijaw Ilipa Adja Atjan Ditamari somba Nufugodom, Moufodom Kabyé Kposso Koto kolé Kpezo Moba Gbeng Batombu Diremou Natemba Foulama Fon Lissètin, Sissitin 2­ Traditional uses ‐ food Only the aril of ripe fruit is consumed. It is eaten raw, or incorporated into a sauce, or fried or dried. The risk of poisoning related to consumption is often recognized but is attributed by some ethnic groups, in Nigeria and in Benin and in Côte d’Ivoire, to the bitter membrane, which is in contact with the aril. The toxicity of the aril of unripe fruit seems little known and this lack of knowledge is one of the reasons that explain the case of massive fatal poisoning that was identified for the first time in Africa in Côte d'Ivoire in 1984 (see below). ‐ Manufacture of soap It is an ancient practice of women in West Africa. Fruit valves are burned and the ash is put in a pan full of holes; the holes are protected by rods of dried cereals and hot water is poured on the ashes while kneading; the liquid that comes out is then boiled for an hour until it forms a dark precipitate to which is then added melted shea butter; the mixture is heated during 75‐90 minutes, while stirring regularly. This results in a gray paste, which is the traditional soap that is sold in many markets in West Africa. The seeds are sometimes used together with the valves. ‐ fishing Some tribes take advantage of the toxicity of seeds and green fruit to catch fish. Crushed seeds and valves are poured into streams where fish are poisoned and die. ‐ fetish In Otamari of Benin, a sauce containing arils is offered to fetishes during the ceremony following the death of a child. In Betammaribé, dried bark is used as incense to ward off evil spirits. ‐ Medicine All parts of the tree ‐ leaves, roots, bark, seeds, capsules‐ are used in traditional medicine . In Benin, the main symptoms treated with decoction of the leaves are fever and pain, for example to calm teething troubles of children. The ground bark is used to help wound healing and calm sprains. The plant is often considered as a stimulant and tonic. In Côte d'Ivoire it is recommended as a diuretic and purgative in cases of generalized edema. In Ghana, the juice of the leaves is used to treat eye or migraines. 3­ Aril composition The main components of the arils are lipids, which constitute more than 40%, comparable to the peanut oil content. Proteins are also well represented with 20% while carbohydrates represent less than 10%. The aril is also rich in vitamin C (ascorbic acid) and contains various vitamins and various minerals, particularly magnesium, sodium, calcium and phosphorus. However, when the fruit is unripe, the aril contains a toxic compound, hypoglycin A; This is an amino acid which does not participate in the composition of proteins, and which consists of an alanine group linked to a cyclopropanyl methylene. Its scientific name is 2‐methylenecyclopropaneylalanine. Hypoglycin A is present in very large amount (1000 ppm) in the fruit not yet open, and its concentration decreases with maturation, down to less than 100 ppm in the ripe fruit. Consumption of unripe fruit arils leads to severe poisoning, often fatal in children. Hypoglycin A is indeed the cause of severe hypoglycemia, which develop in fatal coma. Once ingested, hypoglycin is metabolized in the liver to Méthylènecyclopropyl‐ Acetyl Coenzyme A. This compound interferes with the catabolism of fatty acids in mitochondria, preventing their oxidation and the energy production that results from it; the body can therefore produce the energy it needs only from carbohydrates, which leads to their excessive catabolism, which results in hypoglycemia. The consumption of arils of unripe fruit may cause massive deaths of children, who are particularly susceptible to hypoglycemia, but the first identified case of such massive poisoning in Africa occurred only in 1984. 4­ Blighia sapida, the Ackee tree, still a sword of Damocles over children in Africa? Reducing child mortality is a major public health issue in developing countries and one of WHO’s Millennium Development Goals. Infections are the most common causes of child deaths, but they are sometimes locally supplanted by other lesser‐known diseases. Poisoning by the arils of the Ackee tree, Blighia sapida, is one example. This tree, native to West Africa, was introduced to Jamaica in the late 18th century, where it caused the vomiting sickness that killed thousands of children during the 19th century. In 1916, Scott (1) eventually found out that the deaths were due to the consumption of arils of unripe fruit of Blighia, which contain hypoglycaemic toxins. In its native region however, the first mention of such poisoning dates back to only 1984, after many child deaths occurred in the region of Katiola, Côte d’Ivoire. This paper describes the difficult emergence and dissemination of this knowledge in Africa in order to remind people of the ever‐present poisoning risk on this continent. The occurrence of massive child deaths was revealed by the only Ivoirian daily newspaper at the time, Fraternité‐Matin. On May 30‐31 1984, the newspaper ran the headline: “Katiola. A mysterious sickness is killing the children” (fig. 1A). Within thirty days, more than fifty children from two villages had died. All were Tagouanas, the majority ethnic group in the region. The villagers suspected the corn they consumed. None of the treatments applied by the physicians had been effective. On Tuesday, June 12th, 1984, the newspaper headline said: "Epidemic of Katiola: the danger is identified" (fig. 1B). On Friday afternoon, the Minister for Health announced that, as soon as he had been informed of the situation by the newspaper article, he sent two experts to Katiola. Their investigation concluded that the deaths had not been caused by food but, rather, by contact with the organophosphate pesticides supplied by CIDT for protecting crops. [CIDT, acronym for “Compagnie Ivoirienne pour le Développement des fibres Textiles”, is the state enterprise that supervises farmers in the north half of Côte d’Ivoire, the cotton‐growing region. It was supplying cotton growers with the insecticides recommended by the local research institute, and it was taking all possible steps to limit poisoning hazards (2)]. On Monday, June 18th, 1984, the front page of Fraternité‐Matin was mainly devoted to the visit of the Minister for Health, accompanied by a large delegation of experts, to Katiola, from Friday to Sunday (fig. 1C). The conclusion of the mission was that “The causes of the sickness remained unknown. Indeed, after the corn and organophosphate insecticides, they suspected now a local fruit called koum.” The last article on this disease, published Thursday, June 28, 1984, was entitled "Katiola. The mysterious epidemic: the sickness is vanquished" (fig. 1D). On Monday, June 25, the journalists had met the chief doctor of the hospital of Katiola who had told them, "Only the Minister is empowered to tell you the cause of the disease. Today, what is certain is that the problem is identified.