The impacts of aflatoxin standards on health and nutrition in sub-Saharan Africa: The case of Kenya

Prevalence of aflatoxin along processing points of locally made complementary food formulae in northern Uganda: Safety and children's exposure across seasons

Aflatoxin contamination along the processing points of locally made complementary food composite needs to be ascertained and minimized to reduce exposure to weaning children. The study established the concentrations of total aflatoxin (TAF) and aflatoxin B1 (AFB1) along the processing points of locally made malted millet sesame soybean composite (MMSSC) across season one (wet) and season two (dry) and determined children's exposure to them. A total of 363 samples were collected in 2019. TAF and AFB1 concentrations were determined quantitatively using an enzyme-linked immunosorbent assay (ELISA). Consequently, exposure of individual children was assessed as Estimated Daily Intake (EDI), (ng kg-1 bw day-1). All the samples along the processing points had detectable concentrations of TAF and AFB1 ranging from 0.578 μg kg-1 to 1.187 μg kg-1 and 0.221 μg kg-1 to 0.649 μg kg-1 respectively. Contamination was highest in raw materials; soybean (Glycine max) > sesame (Sesamum indicum), followed by stored composite, freshly prepared composite, and least in millet (Eleusine coracana). Contamination varied significantly across seasons with the wet season having higher contamination than the dry season at P = 0.05. All samples (100%) were within the European Commission (EC) acceptable maximum tolerable level for TAF and AFB1 (4 μg kg-1 and 2 μg kg-1) respectively for processed foods for general consumption. But were below the EU acceptable maximum tolerable level for TAF and AFB1 (0.4 μg kg-1 and 0.1 μg kg-1) respectively for processed baby foods cereals. However, all were within the United States- Food and Drug Authority (US-FDA) and East African Community (EAC) set maximum acceptable limit of 20 μg kg-1 for TAFs, 10 μg kg-1 and 5 μg kg-1 for TAF and AFB1 respectively. Conversely, exposure to these toxins was much higher than the Provisional Maximum Tolerable Dietary Intake (PMTDI) of 0.4 ng kg-1 bw day-1 to 1.0 ng kg-1 bw day-1. A significant difference in exposure to both toxins was observed with the weight. The age of 5 months was the most exposed. A concerted effort is needed to reduce children's exposure to MMSSC to TAF and AFB1, taking sesame and soybean as priority ingredients and proper storage based on season to control contamination.

Spatial investigation of the links between aflatoxins legislation, climate, and liver cancer at the global scale

Aflatoxins are carcinogenic toxins produced by fungi, and many countries legislate limits in food. Previous research suggests elevated liver cancer (LC) mortality in some areas may be due to aflatoxin exposure, but this has not been investigated spatially. We investigate links between aflatoxin legislation, climate, and LC mortality and other covariates globally. Comparison tests of LC mortality showed expected patterns with legislation and climate. They also showed associations between high LC mortality and high Hepatitis, low alcohol consumption, low health expenditure and high family agriculture rates. Spatial analysis showed latitudinal trend with significant clusters of low LC mortality in Europe and high rates in West Africa, Central America, East and South-East Asia. Only health expenditure and Hepatitis were significant in spatial regression, but climate and family agriculture were also significant in multiple linear regression (MLR). Results suggest that aflatoxin education and legislation should be expanded, particularly in hot/wet climates.

Mycotoxins in milk: Occurrence and evaluation of certain detoxification attempts

Milk contaminated with mycotoxins is a significant issue affecting human health, especially in infants. The current study aimed to investigate the presence of mycotoxins in milk collected from women farmers' vendors (WFV), and to evaluate certain herbal plant fibers as green mycotoxin binders. Moreover, explore the binding efficiency ratios of mycotoxins using shaking or soaking process incorporated with herbal extracts. Furthermore, compare the taste evaluations of tested milk are enriched with herbal extracts. Results indicated that the fumonisins were not detected in the collected cow milk samples but realized a 25% occurrence ratio in buffalo's milk samples. A high occurrence ratio of aflatoxin M1 (aflaM1) was observed in buffalo and cow milk samples. The soaking process of plant fibers in contaminated milk overnight significantly degrades and adsorbs mycotoxins particles. The shacking process incorporated with plant fibers exhibited more effectiveness in mycotoxins degradation than soaking or shacking processes alone. The speed of shacking process played an important role in the mycotoxin's binding process. All the tested plant fibers effectively reduced all mycotoxin presence in contaminated milk, especially green tea, during the soaking or shacking process. Moreover, the shacking process incorporated with plant fibers promoted and supported the mycotoxins degradation process.

Aflatoxins: Source, Detection, Clinical Features and Prevention

The most potent mycotoxin, aflatoxins are the secondary metabolite produced by fungi, especially Aspergillus, and have been found to be ubiquitous, contaminating cereals, crops, and even milk and causing major health and economic issues in some countries due to poor storage, substandard management, and lack of awareness. Different aspects of the toxin are reviewed here, including its structural biochemistry, occurrence, factors conducive to its contamination and intoxication and related clinical features, as well as suggested preventive and control strategies and detection methods.

Impact of frequency of application on the long-term efficacy of the biocontrol product Aflasafe in reducing aflatoxin contamination in maize

Aflatoxins, produced by several Aspergillus section Flavi species in various crops, are a significant public health risk and a barrier to trade and development. In sub-Saharan Africa, maize and groundnut are particularly vulnerable to aflatoxin contamination. Aflasafe, a registered aflatoxin biocontrol product, utilizes atoxigenic A. flavus genotypes native to Nigeria to displace aflatoxin producers and mitigate aflatoxin contamination. Aflasafe was evaluated in farmers' fields for 3 years, under various regimens, to quantify carry-over of the biocontrol active ingredient genotypes. Nine maize fields were each treated either continuously for 3 years, the first two successive years, in year 1 and year 3, or once during the first year. For each treated field, a nearby untreated field was monitored. Aflatoxins were quantified in grain at harvest and after simulated poor storage. Biocontrol efficacy and frequencies of the active ingredient genotypes decreased in the absence of annual treatment. Maize treated consecutively for 2 or 3 years had significantly (p < 0.05) less aflatoxin (92% less) in grain at harvest than untreated maize. Maize grain from treated fields subjected to simulated poor storage had significantly less (p < 0.05) aflatoxin than grain from untreated fields, regardless of application regimen. Active ingredients occurred at higher frequencies in soil and grain from treated fields than from untreated fields. The incidence of active ingredients recovered in soil was significantly correlated (r = 0.898; p < 0.001) with the incidence of active ingredients in grain, which in turn was also significantly correlated (r = -0.621, p = 0.02) with aflatoxin concentration. Although there were carry-over effects, caution should be taken when drawing recommendations about discontinuing biocontrol use. Cost-benefit analyses of single season and carry-over influences are needed to optimize use by communities of smallholder farmers in sub-Saharan Africa.

Farmer's knowledge and suggested approaches for controlling aflatoxin contamination of raw milk in Pakistan

Monitoring of aflatoxin levels in milk is often complicated in developing countries due to the dominance of informal markets channeling milk in raw form. Farmer's awareness and voluntary participation in aflatoxin mitigation can be critical in such scenarios. Therefore, the present study was conducted to understand the perceptions of dairy farmers about aflatoxins and link it with aflatoxin mitigation programs on milk in Pakistan. Information was collected from 450 peri-urban dairy farmers in seven cities using questionnaires. Majority (77.9%) of the farmers were aware of the negative impact of moldy feed on animal health. However, only 40.6% of the farmers were aware of the transferability of the toxins from moldy feed to milk. The farmers had almost no awareness of aflatoxins as 95% never heard of the term. After receiving an onsite briefing on effects of the toxin on animal and human health, and its transferability to milk, 98.3% farmers showed willingness to buy aflatoxin-safe feedstuffs, while 88.5% showed willingness to control aflatoxin in milk. Around half of the farmers considered aflatoxin control programs as affordable. On average, farmers agreed to pay 10.1% higher price for aflatoxin certified oilseed cakes. Availability of feedstuffs certified of low aflatoxin content was suggested by 22% of the participants as the critical step in reducing aflatoxins in milk. Other important suggestions included; subsidy on quality feeds (18%), raising awareness (18%), and legislation and monitoring (16%). The present results suggest that the current practice of milk monitoring in the country can yield desirable results only if it is coupled with feed certification programs ensuing availability of aflatoxin-safe feeds. Further, awareness can positively impact participation of producers in aflatoxin control programs. In this regard, awareness about effects of aflatoxins on animal health was found to be a more powerful trigger of voluntary control compared with the awareness of the toxin's transferability to milk.

Histone deacetylase SirE regulates development, DNA damage response and aflatoxin production in Aspergillus flavus

Aspergillus flavus is a ubiquitous saprotrophic soil-borne pathogenic fungus that causes crops contamination with the carcinogen aflatoxins. Although Sirtuin E (SirE) is known to be a NAD-dependent histone deacetylase involved in global transcriptional regulation. Its biological functions in A. flavus are not fully understood. To explore the effects of SirE, we found that SirE was located in the nucleus and increased the level of H3K56 acetylation. The ΔsirE mutant had the most severe growth defect in the sirtuin family. The RNA-Seq revealed that sirE was crucial for secondary metabolism production as well as genetic information process and oxidation-reduction in A. flavus. Further analysis revealed that the ΔsirE mutant increased aflatoxin production. Both the sirE deletion and H3K56 mutants were highly sensitive to DNA damage and oxidative stresses, indicating that SirE was required for DNA damage and redox reaction by the H3K56 locus. Furthermore, the ΔsirE mutant displayed high sensitivity to osmotic stress and cell wall stress, but they may not be associated with the H3K56. Finally, the catalytic activity site N192 of SirE was required for regulating growth, deacetylase function and aflatoxin production. Together, SirE is essential for histone deacetylation and biological function in A. flavus.

Aflatoxins in Maize: Can Their Occurrence Be Effectively Managed in Africa in the Face of Climate Change and Food Insecurity?

The dangers of population-level mycotoxin exposure have been well documented. Climate-sensitive aflatoxins (AFs) are important food hazards. The continual effects of climate change are projected to impact primary agricultural systems, and consequently food security. This will be due to a reduction in yield with a negative influence on food safety. The African climate and subsistence farming techniques favour the growth of AF-producing fungal genera particularly in maize, which is a food staple commonly associated with mycotoxin contamination. Predictive models are useful tools in the management of mycotoxin risk. Mycotoxin climate risk predictive models have been successfully developed in Australia, the USA, and Europe, but are still in their infancy in Africa. This review aims to investigate whether AFs’ occurrence in African maize can be effectively mitigated in the face of increasing climate change and food insecurity using climate risk predictive studies. A systematic search is conducted using Google Scholar. The complexities associated with the development of these prediction models vary from statistical tools such as simple regression equations to complex systems such as artificial intelligence models. Africa’s inability to simulate a climate mycotoxin risk model in the past has been attributed to insufficient climate or AF contamination data. Recently, however, advancement in technologies including artificial intelligence modelling has bridged this gap, as climate risk scenarios can now be correctly predicted from missing and unbalanced data.

A review of toxigenic fungi and mycotoxins in feeds and food commodities in West Africa

Fungal contamination is a threat to food safety in West Africa with implications for food and feed due to their climate, which is characterised by high temperatures and high relative humidity, which are environmental favourable for fast fungal growth and mycotoxin production. This report gives perspective on studies on toxigenic fungi (Aspergillus, Fusarium and Penicillium) and their toxins, mainly aflatoxins, fumonisins and ochratoxins commonly found in some West African countries, including Benin, Burkina Faso, Gambia, Ghana, Ivory Coast, Mali, Nigeria, Senegal, Sierra Leone, and Togo. Only four of these countries have mycotoxins regulations in place for feeds and food products (Ghana, Ivory Coast, Nigeria, and Senegal). Food commodities that are widely consumed and were thoroughly investigated in this region include cereals, peanuts, cassava chips (flakes), cassava flour, chilies, peanuts, locust beans, melon, and yam products. In conclusion, authorities and scientists needed to consider research and approaches to monitor mycotoxins in foods and feeds produced and consumed in West Africa.

Aflatoxin M1 in milk does not contribute substantially to global liver cancer incidence

BACKGROUND

For 60 y, it has been known that aflatoxin B1 (AFB1), a mycotoxin produced by Aspergillus fungi in certain food and feed crops, causes hepatocellular carcinoma (liver cancer; HCC) in humans. The annual global burden of AFB1-related HCC has been estimated. However, much less is known about the potential carcinogenic impact of a metabolite of AFB1 called aflatoxin M1 (AFM1), which is secreted in milk when dairy animals consume AFB1-contaminated feed. The cancer risk of AFM1 to humans from milk consumption has not yet been evaluated.

OBJECTIVES

We sought to estimate the global risk of AFM1-related liver cancer through liquid milk consumption, accounting for possible synergies between AFM1 and chronic infection with hepatitis B virus (HBV) in increasing cancer risk.

METHODS

We conducted a quantitative cancer risk assessment by analyzing extensive datasets of national population sizes, dairy consumption patterns, AFM1 concentrations in milk in 40 nations, and chronic HBV prevalence. Two separate cancer risk assessments were conducted: assuming a possible synergy between AFM1 and HBV in increasing cancer risk in a manner similar to that of AFB1 and HBV, and assuming no such synergy.

RESULTS

If there is no synergy between AFM1 and HBV, AFM1 may contribute ∼0.001% of total annual HCC cases globally. If there is synergy between AFM1 and HBV infection, AFM1 may contribute ∼0.003% of all HCC cases worldwide. In each case, the total expected AFM1-attributable cancer cases are ∼13-32 worldwide.

CONCLUSION

AFM1 exposure through liquid milk consumption does not substantially increase liver cancer risk in humans. Policymakers should consider this low risk against the nutritional benefits of milk consumption, particularly to children, in a current global situation of milk being discarded because of AFM1 concentrations exceeding regulatory standards.

Six Main Contributing Factors to High Levels of Mycotoxin Contamination in African Foods

Africa is one of the regions with high mycotoxin contamination of foods and continues to record high incidences of liver cancers globally. The agricultural sector of most African countries depends largely on climate variables for crop production. Production of mycotoxins is climate-sensitive. Most stakeholders in the food production chain in Africa are not aware of the health and economic effects of consuming contaminated foods. The aim of this review is to evaluate the main factors and their degree of contribution to the high levels of mycotoxins in African foods. Thus, knowledge of the contributions of different factors responsible for high levels of these toxins will be a good starting point for the effective mitigation of mycotoxins in Africa. Google Scholar was used to conduct a systemic search. Six factors were found to be linked to high levels of mycotoxins in African foods, in varying degrees. Climate change remains the main driving factor in the production of mycotoxins. The other factors are partly man-made and can be manipulated to become a more profitable or less climate-sensitive response. Awareness of the existence of these mycotoxins and their economic as well as health consequences remains paramount. The degree of management of these factors regarding mycotoxins varies from one region of the world to another.

A concise review towards defining the exposome of oesophageal cancer in sub-Saharan Africa

CONTEXT

Oesophageal cancer (EC) is among the common causes of illness and death among all cancers worldwide. Advanced EC has a poor prognosis, with worse outcomes observed in low-income settings. Oesophageal squamous cell carcinoma (ESCC) is the most common EC histology reported globally, with the highest ESCC incidence rates in the 'Asian Belt' and the African EC corridor. While the aetiology of ESCC is well-documented in the 'Asian belt', data for the African EC corridor and the entirety of sub-Saharan Africa (SSA) are fewer.

OBJECTIVE

To help address gaps in ESCC aetiology in SSA, we critically evaluated evidence of lifestyle, environmental, and epigenetic factors associated with ESCC risk and discussed prospects of defining ESCC exposome.

DATA INCLUSION

Unlimited English and non-English articles search were made on PubMed Central and Web of Science databases from January 1970 to August 2021. In total, we retrieved 999 articles and considered meta-analyses, case-control, and cohort studies. The quality of individual studies was assessed using the Newcastle-Ottawa scale.

DATA EXTRACTION

Details extracted include the year of publication, country of origin, sample size, comparators, outcomes, study subjects, and designs.

DATA ANALYSIS

Together, we assessed 13 case-control studies and two meta-analyses for the effect of lifestyle or environmental exposures on ESCC risk. Again, we evaluated seven case-control studies and one meta-analysis regarding the role of epigenetics in ESCC tumorigenesis.

RESULTS

In general, evidence of ESCC aetiology points to essential contributions of alcohol, tobacco, hot beverages, biomass fuel, and poor oral health/hygiene, although more precise risk characterisation remains necessary.

CONCLUSION

We conclude that ESCC in SSA is a multifactorial disease initiated by several external exposures that may induce aberrant epigenetic changes. The expanding aetiological research in this domain will be enhanced by evidence synthesis from classical and molecular epidemiological studies spanning the external and internal exposome.

Physico-chemical characteristics and aflatoxins production of Atractylodis Rhizoma to different storage temperatures and humidities

This study aimed to investigate the characteristics, moisture contents, chemical fingerprints changes and aflatoxins accumulation of Atractylodis rhizoma during storage, further to determine the optimum temperature and relative humidity conditions. Based on the suitable temperature (20–40 °C) and relative humidity (80–95%), 13 different temperature and humidity conditions were set up by the central composite design-response surface methodology (CCD-RSM) for Aspergillus flavus. After inoculation with Aspergillus flavus by artificial infection, A. rhizoma samples were stored under normal conditions and 13 different temperature and relative humidity levels. By taking the changes of characteristics, the contents of moisture, chemical fingerprints and aflatoxins as the evaluation indexes for A. rhizoma with or without Aspergillus flavus fungi to optimize the optimal storage conditions. After storage for 10 days, the color of A. rhizoma was deepened, the water content and chemical composition increased, and some unknown components were detected. The susceptible condition for aflatoxins production in A. rhizoma was identified at temperature 22–37 °C and relative humidity over 87.5%. Thus, the suitable storage conditions for A. rhizoma should be controlled at temperature below 20 °C and relative humidity less than 85%. This paper screened out the optimum temperature and humidity for the storage of A. rhizoma. Then, the storage specification for A. rhizoma was proposed, lying technical and data support for the scientific preservation of other food or herbs.

Aflatoxin contamination in maize: occurrence and health implications in Latin America

According to the United Nations Food and Agriculture Organisation, mycotoxicoses constitute the second most pressing food safety problem worldwide, with most cases occurring in developing countries. Maize (Zea mays L.), the main staple for many Latin Americans, is one of the best suitable substrates for mycotoxigenic Aspergillus fungi. Aflatoxins (AFs) produced primarily by Aspergillus flavus, are of significant concern, especially in developing countries. While AFs production occurs mainly in warmer, tropical, and subtropical environments, recent evidence suggests that global climate change favours their presence in regions with little or no awareness of this issue. AFs interfere with metabolic processes, causing cancer and other health disorders resulting in health hazards and even death. The setting of national acceptable regulatory levels of AFs is necessary for Latin American countries. Unfortunately, no estimates of the economic impact of AFs in this region are currently available nor the cost of regulatory programs designed to reduce health risks to animals and humans. This review explores relevant data about incidence of AFs in maize produced in the region and the adverse effects of the consumption of contaminated foods and the associated health consequences for Latin American consumers. Regulations aimed to mitigate AFs exposure to consumers are also reviewed and identified gaps for researchers and actors of the maize value chain are also proposed.

Mycotoxins in Poultry Feed and Feed Ingredients from Sub-Saharan Africa and Their Impact on the Production of Broiler and Layer Chickens: A Review

The poultry industry in sub-Saharan Africa (SSA) is faced with feed insecurity, associated with high cost of feeds, and feed safety, associated with locally produced feeds often contaminated with mycotoxins. Mycotoxins, including aflatoxins (AFs), fumonisins (FBs), trichothecenes, and zearalenone (ZEN), are common contaminants of poultry feeds and feed ingredients from SSA. These mycotoxins cause deleterious effects on the health and productivity of chickens and can also be present in poultry food products, thereby posing a health hazard to human consumers of these products. This review summarizes studies of major mycotoxins in poultry feeds, feed ingredients, and poultry food products from SSA as well as aflatoxicosis outbreaks. Additionally reviewed are the worldwide regulation of mycotoxins in poultry feeds, the impact of major mycotoxins in the production of chickens, and the postharvest use of mycotoxin detoxifiers. In most studies, AFs are most commonly quantified, and levels above the European Union regulatory limits of 20 μg/kg are reported. Trichothecenes, FBs, ZEN, and OTA are also reported but are less frequently analyzed. Co-occurrences of mycotoxins, especially AFs and FBs, are reported in some studies. The effects of AFs on chickens' health and productivity, carryover to their products, as well as use of mycotoxin binders are reported in few studies conducted in SSA. More research should therefore be conducted in SSA to evaluate occurrences, toxicological effects, and mitigation strategies to prevent the toxic effects of mycotoxins.

The potential for aflatoxin predictive risk modelling in sub-Saharan Africa: a review

This review presents the current state of aflatoxin risk prediction models and their potential for value actors throughout the food chain in sub-Saharan Africa, with a specific focus on improving smallholder farmer management practices. Several empirical and mechanistic models have been developed either in academic research or by private sector aggregators and processors in high-income countries including Australia, the USA, and Southern Europe, but these models have been only minimally applied in sub-Saharan Africa, where there is significant potential and increasing need due to climate variability. Predictions can be made based on historic occurrence data using either a mechanistic microbiological framework for aflatoxin accumulation or an empirical model based on statistical correlations with climate conditions and local agronomic factors. Model results can then be distributed to smallholders through private, public, or mobile extension services, used by policymakers for strategy or policy, or utilised by private sector institutions for management decisions. Specific agricultural advice can be given during the three most critical points in the phenological cycle: preseason insight including sowing timing and crop varieties, preharvest advice about management and harvest timing, and postharvest optimal practices including storage, drying, and market information. Model development for sub-Saharan Africa is limited by a dearth of georeferenced aflatoxin occurrence data and real-time high resolution climate data; the wide diversity of farm typologies each with significant information and technology gaps; a prevalence of informal market structures and lack of economic incentives systems; and general lack of awareness around aflatoxins and best management practices to mitigate risk. Given advancements towards solving these challenges, predictive aflatoxin models can be integrated into decision support platforms to focus on optimisation of value for smallholders by minimising yield and nutritional losses, which can propagate value throughout the production and postharvest phases.

Management strategies for aflatoxin risk mitigation in maize, dairy feeds and milk value chains—case study Kenya

Widespread aflatoxin contamination of a great number of food and feed crops has important implications on global trade and health. Frequent occurrence of aflatoxin in maize and milk poses serious health risks to consumers because these commodities are staple foods in many African countries. This situation calls for development and implementation of rigorous aflatoxin control measures that encompass all value chains, focusing on farms where food and feed-based commodities prone to aflatoxin contamination are cultivated. Good agricultural practices (GAP) have proven to be an effective technology in mitigation and management of the aflatoxin risk under farm conditions. The prevailing global climate change is shown to increase aflatoxin risk in tropical and subtropical regions. Thus, there is an urgent need to devise and apply novel methods to complement GAP and mitigate aflatoxin contamination in the feed, maize and milk value chains. Also, creation of awareness on aflatoxin management through training of farmers and other stakeholders and enforcement of regular surveillance of aflatoxin in food and feed chains are recommended strategies. This literature review addresses the current situation of aflatoxin occurrence in maize, dairy feeds and milk produced and traded in Kenya and current technologies applied to aflatoxin management at the farm level. Finally, a case study in Kenya on successful application of GAP for mitigation of aflatoxin risk at small-scale farms will be reviewed.

The Scourge of Aflatoxins in Kenya: A 60-Year Review (1960 to 2020)

Aflatoxins are endemic in Kenya. The 2004 outbreak of acute aflatoxicosis in the country was one of the unprecedented epidemics of human aflatoxin poisoning recorded in mycotoxin history. In this study, an elaborate review was performed to synthesize Kenya’s major findings in relation to aflatoxins, their prevalence, detection, quantification, exposure assessment, prevention, and management in various matrices. Data retrieved indicate that the toxins are primarily biosynthesized by Aspergillus flavus and A. parasiticus, with the eastern part of the country reportedly more aflatoxin-prone. Aflatoxins have been reported in maize and maize products (Busaa, chan’gaa, githeri, irio, muthokoi, uji, and ugali), peanuts and its products, rice, cassava, sorghum, millet, yams, beers, dried fish, animal feeds, dairy and herbal products, and sometimes in tandem with other mycotoxins. The highest total aflatoxin concentration of 58,000 μg/kg has been reported in maize. At least 500 acute human illnesses and 200 deaths due to aflatoxins have been reported. The causes and prevalence of aflatoxins have been grossly ascribed to poor agronomic practices, low education levels, and inadequate statutory regulation and sensitization. Low diet diversity has aggravated exposure to aflatoxins in Kenya because maize as a dietetic staple is aflatoxin-prone. Detection and surveillance are only barely adequate, though some exposure assessments have been conducted. There is a need to widen diet diversity as a measure of reducing exposure due to consumption of aflatoxin-contaminated foods.

MILK Symposium review: Foodborne diseases from milk and milk products in developing countries-Review of causes and health and economic implications

Dairy production is rapidly increasing in developing countries and making significant contributions to health, nutrition, environments, and livelihoods, with the potential for still greater contributions. However, dairy products can also contribute to human disease in many ways, with dairyborne disease likely being the most important. Health risks may be from biological, chemical, physical, or allergenic hazards present in milk and other dairy products. Lacking rigorous evidence on the full burden of foodborne and dairyborne disease in developing countries, we compiled information from different sources to improve our estimates. The most credible evidence on dairyborne disease comes from the World Health Organization initiative on the Global Burden of Foodborne Disease. This suggests that dairy products may has been responsible for 20 disability-adjusted life years per 100,000 people in 2010. This corresponds to around 4% of the global foodborne disease burden and 12% of the animal source food disease burden. Most of this burden falls on low- and middle-income countries (LMIC). However, the estimate is conservative. Weaker evidence from historical burden in high-income countries, outbreak reports from LMIC and high-income countries, and quantitative microbial risk assessment suggest that the real burden may be higher. The economic burden in terms of lost human capital is at least US$4 billion/yr in LMIC. Among the most important hazards are Mycobacterium bovis, Campylobacter spp., and non-typhoidal Salmonella enterica. The known burden of chemical hazards is lower but also more uncertain. Important chemical hazards are mycotoxins, dioxins, and heavy metals. Some interventions have been shown to have unintended and unwanted consequences, so formative research and rigorous evaluation should accompany interventions. For example, there are many documented cases in which women's control over livestock is diminished with increasing commercialization. Dairy co-operatives have had mixed success, often incurring governance and institutional challenges. More recently, there has been interest in working with the informal sector. New technologies offer new opportunities for sustainable dairy development.

Aflatoxin M1 in Africa: Exposure Assessment, Regulations, and Prevention Strategies - A Review

Aflatoxins are the most harmful mycotoxins causing health problems to human and animal. Many acute aflatoxin outbreaks have been reported in Africa, especially in Kenya and Tanzania. When ingested, aflatoxin B1 is converted by hydroxylation in the liver into aflatoxin M1, which is excreted in milk of dairy females and in urine of exposed populations. This review aims to highlight the AFM1 studies carried out in African regions (North Africa, East Africa, West Africa, Central Africa, and Southern Africa), particularly AFM1 occurrence in milk and dairy products, and in human biological fluids (breast milk, serum, and urine) of the populations exposed. Strategies for AFM1 detoxification will be considered, as well as AFM1 regulations as compared to the legislation adopted worldwide and the assessment of AFM1 exposure of some African populations. Egypt, Kenya, and Nigeria have the highest number of investigations on AFM1 in the continent. Indeed, some reports showed that 100% of the samples analyzed exceeded the EU regulations (50 ng/kg), especially in Zimbabwe, Nigeria, Sudan, and Egypt. Furthermore, AFM1 levels up to 8,000, 6,999, 6,900, and 2040 ng/kg have been reported in milk from Egypt, Kenya, Sudan, and Nigeria, respectively. Data on AFM1 occurrence in human biological fluids have also shown that exposure of African populations is mainly due to milk intake and breastfeeding, with 85-100% of children being exposed to high levels. Food fermentation in Africa has been tried for AFM1 detoxification strategies. Few African countries have set regulations for AFM1 in milk and derivatives, generally similar to those of the Codex alimentarius, the US or the EU standards.

Multi-Mycotoxin Occurrence in Dairy Cattle and Poultry Feeds and Feed Ingredients from Machakos Town, Kenya

Mycotoxins are common in grains in sub-Saharan Africa and negatively impact human and animal health and production. This study assessed occurrences of mycotoxins, some plant, and bacterial metabolites in 16 dairy and 27 poultry feeds, and 24 feed ingredients from Machakos town, Kenya, in February and August 2019. We analyzed the samples using a validated multi-toxin liquid chromatography-tandem mass spectrometry method. A total of 153 mycotoxins, plant, and bacterial toxins, were detected in the samples. All the samples were co-contaminated with 21 to 116 different mycotoxins and/or metabolites. The commonly occurring and EU regulated mycotoxins reported were; aflatoxins (AFs) (70%; range 0.2–318.5 μg/kg), deoxynivalenol (82%; range 22.2–1037 μg/kg), ergot alkaloids (70%; range 0.4–285.7 μg/kg), fumonisins (90%; range 32.4–14,346 μg/kg), HT-2 toxin (3%; range 11.9–13.8 μg/kg), ochratoxin A (24%; range 1.1–24.3 μg/kg), T-2 toxin (4%; range 2.7–5.2 μg/kg) and zearalenone (94%; range 0.3–910.4 μg/kg). Other unregulated emerging mycotoxins and metabolites including Alternaria toxins, Aspergillus toxins, bacterial metabolites, cytochalasins, depsipeptides, Fusarium metabolites, metabolites from other fungi, Penicillium toxins, phytoestrogens, plant metabolites, and unspecific metabolites were also detected at varying levels. Except for total AFs, where the average contamination level was above the EU regulatory limit, all the other mycotoxins detected had average contamination levels below the limits. Ninety-six percent of all the samples were contaminated with more than one of the EU regulated mycotoxins. These co-occurrences may cause synergistic and additive health effects thereby hindering the growth of the Kenyan livestock sector.

Effects of the Use of Good Agricultural Practices on Aflatoxin Levels in Maize Grown in Nandi County, Kenya

Aflatoxin contaminated maize is of public health concern in Kenya. Training farmers on good agricultural practice (GAP) has been touted as a mitigative measure. Little is known of the effect of such training on aflatoxin levels in maize grown in Kenya. This study evaluated what effect training farmers on GAP has on aflatoxin levels in maize grown in Kaptumo, Kilibwoni, and Kipkaren divisions in Nandi County. Ninety farmers were recruited for the study and interviewed on GAP. Maize samples were additionally collected from the participating farmers and analyzed for aflatoxins using competitive enzyme-linked immunosorbent assay (c-ELISA). All farmers prepared the land before planting, applied correct spacing between the planted crops, carried out weeding, cleaned their stores before use, checked the condition of the maize after harvesting, sorted maize after shelling, and knew about aflatoxins. The majority of the farmers (90%) used fertilizers, dried maize after harvesting, knew that aflatoxins were harmful to humans, and used clean transport in transporting the harvested maize. About 98% of farmers did stooking after harvesting and 97% used wooden pallets in the maize stores. The percentage of farmers who practiced early planting, top dressing, crop rotation, raising stores above the ground, applying insecticide after shelling and feeding damaged/rotten seeds to their animals was 84–96%, 62–80%, 67–85%, 86–98%, 63–81%, and 7–21% respectively. About 18/90 (20%) of all farmers reported that they had a relative who had died from liver cancer, and the mean aflatoxin levels in season 1 were significantly different from those in season 2 (1.92 ± 1.07 ppb; 1.30 ± 1.50 ppb). Our findings suggest that although training farmers to adopt good agricultural practices was observed to be efficient in mitigating the problem of aflatoxins, the receptiveness of farmers to different aspects of the training may have differed. Therefore, in designing an optimized regional aflatoxin contamination strategy, local applicability should be considered.

Using the rapid alert system for food and feed: potential benefits and problems on data interpretation

The Rapid Alert System for Food and Feed (RASFF), where competent authorities in each Member State (MS) submit notifications on the withdrawal of unsafe or illegal products from the market, makes a significant contribution to food safety control in the European Union. The aim of this paper is to frame the potential challenges of interpreting and then acting upon the dataset contained within the RASFF system. As it is largest cause of RASFF notifications, the lens of enquiry used is mycotoxin contamination. The methodological approach is to firstly iteratively review existing literature to frame the problem, and then to interrogate the RASFF system and analyze the data available. Findings are that caution should be exercised in using the RASFF database both as a predictive tool and for trend analysis, because iterative changes in food law impact on the frequency of regulatory sampling associated with border and inland regulatory checks. The study highlights the variability of engagement by MSs with the RASFF database, influencing generalisability of the trends noted. As importing countries raise market standards, there are wider food safety implications for the exporting countries themselves. As this is one of the first studies articulating the complexities and opportunities of using the RASFF database, this research makes a strong contribution to literature.

Effects of the Use of Good Agricultural Practices on Aflatoxin Levels in Maize Grown in Nandi County, Kenya

Aflatoxin contaminated maize is of public health concern in Kenya. Training farmers on good agricultural practice (GAP) has been touted as a mitigative measure. Little is known of the effect of such training on aflatoxin levels in maize grown in Kenya. This study evaluated what effect training farmers on GAP has on aflatoxin levels in maize grown in in maize grown in Kaptumo, Kilibwoni, and Kipkaren divisions in Nandi County. Ninety farmers were recruited for the study and interviewed on GAP. Maize samples were additionally collected from the participating farmers and analyzed for aflatoxins using competitive enzyme-linked immunosorbent assay (c-ELISA). All farmers prepared the land before planting, did correct spacing between the planted crops, carried out weeding, cleaned their stores before use, checked the condition of the maize after harvesting, sorted maize after shelling, and knew aflatoxins. A majority of the farmers (90%) used fertilizers, dried maize after harvesting, knew that aflatoxins were harmful to humans, and used clean transport in transporting the harvested maize. About 98% of farmers did stooking after harvesting and 97% used wooden pallets in the maize stores. The percentage of farmers who practiced early planting, top dressing, crop rotation, raising stores above the ground, applying insecticide after shelling and feeding damaged/rotten seeds to their animals was 84–96%, 62–80%, 67–85%, 86–98%, 63–81%, and 7–21% respectively. About 18/90 (20%) of all farmers reported that they had a relative who had died from liver cancer and the mean aflatoxin levels in season 1 were significantly different from season 2 (1.92 ± 1.07 ppb; 1.30 ± 1.50 ppb). Our findings suggest that although training farmers to adopt good agricultural practices was observed to be efficient in mitigating the problem of aflatoxins, the receptiveness of farmers to different aspects of the training may have differed. Therefore, in designing an optimized regional aflatoxin contamination strategy, local applicability should be considered.

A Review of the Impact of Mycotoxins on Dairy Cattle Health: Challenges for Food Safety and Dairy Production in Sub-Saharan Africa

Mycotoxins are secondary metabolites of fungi that contaminate food and feed and have a significant negative impact on human and animal health and productivity. The tropical condition in Sub-Saharan Africa (SSA) together with poor storage of feed promotes fungal growth and subsequent mycotoxin production. Aflatoxins (AF) produced by Aspergillus species, fumonisins (FUM), zearalenone (ZEN), T-2 toxin (T-2), and deoxynivalenol (DON) produced by Fusarium species, and ochratoxin A (OTA) produced by Penicillium and Aspergillus species are well-known mycotoxins of agricultural importance. Consumption of feed contaminated with these toxins may cause mycotoxicoses in animals, characterized by a range of clinical signs depending on the toxin, and losses in the animal industry. In SSA, contamination of dairy feed with mycotoxins has been frequently reported, which poses a serious constraint to animal health and productivity, and is also a hazard to human health since some mycotoxins and their metabolites are excreted in milk, especially aflatoxin M1. This review describes the major mycotoxins, their occurrence, and impact in dairy cattle diets in SSA highlighting the problems related to animal health, productivity, and food safety and the up-to-date post-harvest mitigation strategies for the prevention and reduction of contamination of dairy feed.

Aflatoxins: Producing-Molds, Structure, Health Issues and Incidence in Southeast Asian and Sub-Saharan African Countries

This review aims to update the main aspects of aflatoxin production, occurrence and incidence in selected countries, and associated aflatoxicosis outbreaks. Means to reduce aflatoxin incidence in crops were also presented, with an emphasis on the environmentally-friendly technology using atoxigenic strains of Aspergillus flavus. Aflatoxins are unavoidable widespread natural contaminants of foods and feeds with serious impacts on health, agricultural and livestock productivity, and food safety. They are secondary metabolites produced by Aspergillus species distributed on three main sections of the genus (section Flavi, section Ochraceorosei, and section Nidulantes). Poor economic status of a country exacerbates the risk and the extent of crop contamination due to faulty storage conditions that are usually suitable for mold growth and mycotoxin production: temperature of 22 to 29 °C and water activity of 0.90 to 0.99. This situation paralleled the prevalence of high liver cancer and the occasional acute aflatoxicosis episodes that have been associated with these regions. Risk assessment studies revealed that Southeast Asian (SEA) and Sub-Saharan African (SSA) countries remain at high risk and that, apart from the regulatory standards revision to be more restrictive, other actions to prevent or decontaminate crops are to be taken for adequate public health protection. Indeed, a review of publications on the incidence of aflatoxins in selected foods and feeds from countries whose crops are classically known for their highest contamination with aflatoxins, reveals that despite the intensive efforts made to reduce such an incidence, there has been no clear tendency, with the possible exception of South Africa, towards sustained improvements. Nonetheless, a global risk assessment of the new situation regarding crop contamination with aflatoxins by international organizations with the required expertise is suggested to appraise where we stand presently.

"Ground-Truthing" Efficacy of Biological Control for Aflatoxin Mitigation in Farmers' Fields in Nigeria: From Field Trials to Commercial Usage, a 10-Year Study

In sub-Saharan Africa (SSA), diverse fungi belonging to Aspergillus section Flavi frequently contaminate staple crops with aflatoxins. Aflatoxins negatively impact health, income, trade, food security, and development sectors. Aspergillus flavus is the most common causal agent of contamination. However, certain A. flavus genotypes do not produce aflatoxins (i.e., are atoxigenic). An aflatoxin biocontrol technology employing atoxigenic genotypes to limit crop contamination was developed in the United States. The technology was adapted and improved for use in maize and groundnut in SSA under the trademark Aflasafe. Nigeria was the first African nation for which an aflatoxin biocontrol product was developed. The current study includes tests to assess biocontrol performance across Nigeria over the past decade. The presented data on efficacy spans years in which a relatively small number of maize and groundnut fields (8-51 per year) were treated through use on circa 36,000 ha in commercially-produced maize in 2018. During the testing phase (2009-2012), fields treated during one year were not treated in the other years while during commercial usage (2013-2019), many fields were treated in multiple years. This is the first report of a large-scale, long-term efficacy study of any biocontrol product developed to date for a field crop. Most (>95%) of 213,406 tons of maize grains harvested from treated fields contained <20 ppb total aflatoxins, and a significant proportion (>90%) contained <4 ppb total aflatoxins. Grains from treated plots had preponderantly >80% less aflatoxin content than untreated crops. The frequency of the biocontrol active ingredient atoxigenic genotypes in grains from treated fields was significantly higher than in grains from control fields. A higher proportion of grains from treated fields met various aflatoxin standards compared to grains from untreated fields. Results indicate that efficacy of the biocontrol product in limiting aflatoxin contamination is stable regardless of environment and cropping system. In summary, the biocontrol technology allows farmers across Nigeria to produce safer crops for consumption and increases potential for access to premium markets that require aflatoxin-compliant crops.

Retrospective and Prospective Look at Aflatoxin Research and Development from a Practical Standpoint

Among the array of structurally and toxicologically diverse mycotoxins, aflatoxins have attracted the most interest of scientific research due to their high toxicity and incidence in foods and feeds. Despite the undeniable progress made in various aspects related to aflatoxins, the ultimate goal consisting of reducing the associated public health risks worldwide is far from being reached due to multiplicity of social, political, economic, geographic, climatic, and development factors. However, a reasonable degree of health protection is attained in industrialized countries owing to their scientific, administrative, and financial capacities allowing them to use high-tech agricultural management systems. Less fortunate situations exist in equatorial and sub-equatorial developing countries mainly practicing traditional agriculture managed by smallholders for subsistence, and where the climate is suitable for mould growth and aflatoxin production. This situation worsens due to climatic change producing conditions increasingly suitable for aflatoxigenic mould growth and toxin production. Accordingly, it is difficult to harmonize the regulatory standards of aflatoxins worldwide, which prevents agri-foods of developing countries from accessing the markets of industrialized countries. To tackle the multi-faceted aflatoxin problem, actions should be taken collectively by the international community involving scientific research, technological and social development, environment protection, awareness promotion, etc. International cooperation should foster technology transfer and exchange of pertinent technical information. This review presents the main historical discoveries leading to our present knowledge on aflatoxins and the challenges that should be addressed presently and in the future at various levels to ensure higher health protection for everybody. In short, it aims to elucidate where we come from and where we should go in terms of aflatoxin research/development.

Aflatoxin Exposure from Milk in Rural Kenya and the Contribution to the Risk of Liver Cancer

Milk is an important commodity in Kenya; the country has the largest dairy herd and highest per capita milk consumption in East Africa. As such, hazards in milk are of concern. Aflatoxin M₁ (AFM₁) is a toxic metabolite of aflatoxin B₁ (AFB₁) excreted in milk by lactating animals after ingesting AFB₁-contaminated feeds. This metabolite is injurious to human health, but there is little information on the risk to human health posed by AFM₁ in milk in rural Kenya. To fill this gap, a quantitative risk assessment (QRA) applying probabilistic statistical tools to quantify risks was conducted. This assessed the risk of liver cancer posed by AFM₁ in milk, assuming 10-fold lower carcinogenicity than AFB₁. Data from four agro–ecological zones in Kenya (semi-arid, temperate, sub-humid and humid) were used. We estimated that people were exposed to between 0.3 and 1 ng AFM₁ per kg body weight per day through the consumption of milk. The annual incidence rates of cancer attributed to the consumption of AFM₁ in milk were 3.5 × 10⁻³ (95% CI: 3 × 10⁻³–3.9 × 10⁻³), 2.9 × 10⁻³ (95% CI: 2.5 × 10⁻³–3.3 × 10⁻³), 1.4 × 10⁻³ (95% CI: 1.2 × 10⁻³–1.5 × 10⁻³) and 2.7 × 10⁻³ (95% CI: 2.3 × 10⁻³–3 × 10⁻³) cancers per 100,000 in adult females, adult males, children 6–18 years old, and in children less than five years old, respectively. Our results show that aflatoxin exposure from milk contributes relatively little to the incidence of liver cancer. Nonetheless, risk managers should take action based on cumulative exposure from all sources of aflatoxins.

Aflatoxin Binders in Foods for Human Consumption-Can This be Promoted Safely and Ethically?

Aflatoxins continue to be a food safety problem globally, especially in developing regions. A significant amount of effort and resources have been invested in an attempt to control aflatoxins. However, these efforts have not substantially decreased the prevalence nor the dietary exposure to aflatoxins in developing countries. One approach to aflatoxin control is the use of binding agents in foods, and lactic acid bacteria (LAB) have been studied extensively for this purpose. However, when assessing the results comprehensively and reviewing the practicality and ethics of use, risks are evident, and concerns arise. In conclusion, our review suggests that there are too many issues with using LAB for aflatoxin binding for it to be safely promoted. Arguably, using binders in human food might even worsen food safety in the longer term.

Occurrence of aflatoxin M1 in raw milk traded in peri-urban Nairobi, and the effect of boiling and fermentation

Background: Dairy production in Kenya is important and dominated by small-holder farmers who market their produce through small-scale traders in the informal sector. Method: This study aimed to determine the prevalence of aflatoxin (AFM1) in informally marketed milk in peri-urban Nairobi, Kenya, and to assess knowledge of milk traders on aflatoxins using questionnaires. A total of 96 samples were analyzed for AFM1 using enzyme-linked immunosorbent assay. In addition, boiling and fermentation experiments were carried out in the laboratory. Results: All samples had AFM1 above the limit of detection (5 ng/kg) (mean of 290.3 ± 663.4 ng/kg). Two-thirds of the samples had AFM1 levels above 50 ng/kg and 7.5% of the samples exceeded 500 ng/kg. Most of the traders had low (69.8%) or medium (30.2%) knowledge. Educated (p = 0.01) and female traders (p= 0.04) were more knowledgeable. Experimentally, fermenting milk to lala (a traditional fermented drink) and yogurt significantly reduced AFM1 levels (p< 0.01) (71.8% reduction in lala after incubation at room temperature for 15 h, and 73.6% reduction in yogurt after incubation at 45ºC for 4h). Boiling had no effect. Conclusion: The study concluded that the prevalence of raw milk with AFM1 was high, while knowledge was low. Fermentation reduced the AFM1 levels.

Assessment of Aflatoxin and Fumonisin Contamination and Associated Risk Factors in Feed and Feed Ingredients in Rwanda

Mycotoxins are fungal metabolites that contaminate crops, food, and animal feeds. Aflatoxins and fumonisins are among the mycotoxins that have been increasingly reported to affect health and productivity of livestock globally. Given that the health and productivity of livestock can directly influence human food safety and security, a study was conducted to assess the levels and factors for aflatoxin and fumonisin contamination in feed and feed ingredients in Rwanda. Aflatoxins and fumonisins were analyzed in 3328 feed and feed ingredient samples collected at six time points between March and October 2017 in all 30 districts of Rwanda. Of the 612 participants providing samples, there were 10 feed processors, 68 feed vendors, 225 dairy farmers, and 309 poultry farmers. Enzyme-Linked Immunosorbent Assay (ELISA) was used for aflatoxin and fumonisin analyses. Mean aflatoxin levels of 108.83 µg/kg (Median (MD): 43.65 µg/kg), 103.81µg/kg (MD: 48.4 µg/kg), 88.64 µg/kg (MD: 30.90 µg/kg), and 94.95 µg/kg (MD: 70.45 µg/kg) were determined for dairy farmers, poultry farmers, feed vendors, and feed processors, respectively. Mean fumonisin levels were 1.52 mg/kg (MD: 0.71 mg/kg), 1.21 mg/kg (MD: 0.56 mg/kg), 1.48 mg/kg (MD: 0.76 mg/kg), and 1.03 mg/kg (MD: 0.47 mg/kg) for dairy farmers, poultry farmers, feed vendors, and feed processors, respectively. Aflatoxin contamination was significantly affected by time of sampling and district from which feed samples originated (p < 0.05). Fumonisins did not show any correlation trends. Ninety-two percent of survey participants were unaware of aflatoxins and fumonisins and their adverse effects. This study has provided the basic understanding of the extent of feed contamination across the country and has established a baseline for future interventions in Rwanda. Further studies are needed to explore strategies for mitigating mycotoxins in the feed value chain in Rwanda.

Effects of the Use of Good Agricultural Practices on Aflatoxin Levels in Maize Grown in Nandi County, Kenya

Aflatoxin contaminated maize is of public health concern in Kenya. Training farmers on good agricultural practice (GAP) has been touted as a mitigative measure. Little is known of the effect of such training on aflatoxin levels in maize grown in Kenya. This study evaluated what effect training farmers on GAP has on aflatoxin levels in maize grown in Kaptumo, Kilibwoni, and Kipkaren divisions in Nandi County, Kenya. Ninety farmers were recruited into farmer field schools and a questionnaire on GAP administered to each farmer. Maize samples were collected from the farmers and analyzed for aflatoxins using competitive enzyme-linked immunosorbent assay (c-ELISA). All farmers weeded their farms before planting, prepared the land, correctly spaced the seedlings, sorted the maize after shelling, cleaned stores before use and knew that aflatoxins were harmful to humans and animals. Eighty-one farmers did early planting, 88/90 did stooking after harvesting, 89/90 applied fertilizer, 89/90 cleared bushes around the stores, 87/90 used wooden pallets to store maize, 89/90 dried maize after harvesting, 83/90 did crop rotation, and 89/90 used clean transport. Moreover, 62/90 had a relative who had died from liver cancer, 13/90 had fed damaged/rotten seeds to animals, and 45/90 had stored harvested seeds on the ground. The mean aflatoxin levels in season 1 were significantly different from season 2 (1.918 ± 1.065; 1.301 ± 1.501). Our findings suggest that some aspects of the training on GAP were better received than others. Training farmers on GAP results in a decrease in aflatoxin levels in maize grown in Nandi County. Farmers in other maize growing areas of Kenya may benefit from similar training on GAP.

Status of aflatoxin contamination in cow milk produced in smallholder dairy farms in urban and peri-urban areas of Nairobi County: a case study of Kasarani sub county, Kenya

Introduction: Milk consumption in Kenya supersedes other countries in East Africa. However, milk contamination with aflatoxin M1 (AFM1) is common, but the magnitude of this exposure and the health risks are poorly understood and need to be monitored routinely. This study aimed at assessing the awareness, knowledge and practices of urban and peri-urban farmers about aflatoxins and determining the levels of aflatoxin contamination in on-farm milk in a selected area within Nairobi County. Materials and methods: A cross-sectional study was undertaken to assess aflatoxin contamination levels of milk in Kasarani sub-county. A total of 84 milk samples were collected from small-holder dairy farms and analyzed for AFM1 using Enzyme-Linked Immunosorbent Assay (ELISA). Results and Discussion: Ninety nine percent of the samples (83/84) analysed were contaminated with AFM1. The mean aflatoxin level was 84 ng/kg with 64% of the samples exceeding the EU legal limit of 50 ng/kg. Whereas 80% of the farmers were aware of aflatoxin, there was no correlation between farmers' knowledge and gender with AFM1 prevalence. Conclusion: This study concludes that AFM1 is a frequent contaminant in milk and there is need to enhance farmers awareness on mitigation.

Prevalence and mitigation of aflatoxins in Kenya (1960-to date)

Aflatoxins are highly toxic metabolites of several Aspergillus species widely distributed throughout the environment. These toxins have adverse effects on humans and livestock at a few micrograms per kilogram (μg/kg) concentrations. Strict regulations on the concentrations of aflatoxins allowed in food and feed exist in many nations in the developing world. Loopholes in implementing regulations result in the consumption of dangerous concentrations of aflatoxins. In Kenya, where 'farm-to-mouth' crops become severely contaminated, solutions to the aflatoxins problem are needed. Across the decades, aflatoxins have repeatedly caused loss of human and animal life. A prerequisite to developing viable solutions for managing aflatoxins is understanding the geographical distribution and severity of food and feed contamination, and the impact on lives. This review discusses the scope of the aflatoxins problem and management efforts by various players in Kenya. Economic drivers likely to influence the choice of aflatoxins management options include historical adverse health effects on humans and animals, cost of intervention for mitigation of aflatoxins, knowledge about aflatoxins and their impact, incentives for aflatoxins safe food and intended scope of use of interventions. It also highlights knowledge gaps that can direct future management efforts. These include: sparse documented information on human exposure; few robust tools to accurately measure economic impact in widely unstructured value chains; lack of long-term impact studies on benefits of aflatoxins mitigation; inadequate sampling mechanisms in smallholder farms and grain holding stores/containers; overlooking social learning networks in technology uptake and lack of in-depth studies on an array of aflatoxins control measures followed in households. The review proposes improved linkages between agriculture, nutrition and health sectors to address aflatoxins contamination better. Sustained public awareness at all levels, capacity building and aflatoxins related policies are necessary to support management initiatives.

A Risk Assessment of Aflatoxin M1 Exposure in Low and Mid-Income Dairy Consumers in Kenya

Aflatoxin M₁ (AFM₁), a human carcinogen, is found in milk products and may have potentially severe health impacts on milk consumers. We assessed the risk of cancer and stunting as a result of AFM₁ consumption in Nairobi, Kenya, using worst case assumptions of toxicity and data from previous studies. Almost all (99.5%) milk was contaminated with AFM₁. Cancer risk caused by AFM₁ was lower among consumers purchasing from formal markets (0.003 cases per 100,000) than for low-income consumers (0.006 cases per 100,000) purchasing from informal markets. Overall cancer risk (0.004 cases per 100,000) from AFM₁ alone was low. Stunting is multifactorial, but assuming only AFM₁ consumption was the determinant, consumption of milk contaminated with AFM₁ levels found in this study could contribute to 2.1% of children below three years in middle-income families, and 2.4% in low-income families, being stunted. Overall, 2.7% of children could hypothetically be stunted due to AFM₁ exposure from milk. Based on our results AFM₁ levels found in milk could contribute to an average of -0.340 height for age z-score reduction in growth. The exposure to AFM₁ from milk is 46 ng/day on average, but children bear higher exposure of 3.5 ng/kg bodyweight (bw)/day compared to adults, at 0.8 ng/kg bw/day. Our paper shows that concern over aflatoxins in milk in Nairobi is disproportionate if only risk of cancer is considered, but that the effect on stunting children might be much more significant from a public health perspective; however, there is still insufficient data on the health effects of AFM₁.