The epidemiology of ackee poisoning has not really been understood well and the true incidence and mortality rate are believed to be under-reported. This problem is endemic in Jamaica. In Jamaica, the annual rate of ackee poisoning is 2 cases per 100,000 persons younger than 15 years of age and 0.4 cases per 100,000 persons older than 15 years. It is also frequent in certain other countries in the Caribbean and Western Africa. In contrast, it is rare in France and other Western countries. As ackee is consumed mostly in West Africa and Jamaica; therefore, most cases have occurred in those areas only.
Before treatments were developed, the mortality rate was as high as 80%. In recent years, there have been reported incidences of this illness in Burkina Faso, The Ivory Coast, Togo and Benin. Lethality was 100% in the Burkina Faso epidemic and victims of the illness were all children [2]. Deaths were linked to ackee intoxication due to enhanced concentrations of dicarboxylic acids in the urine of the victims. Suggestions have been made that the ingestion of unripe ackee fruits may be responsible for a substantial number of unexplained deaths in preschool children in West Africa.