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Child Health: Dealing with Aflatoxins in Children’s Food

Aflatoxins, produced primarily by Aspergillus flavus and A. parasiticus, are highly toxic and carcinogenic mycotoxins that contaminate key food crops in tropical and subtropical regions. In low- and middle-income countries (LMICs), especially across sub-Saharan Africa, chronic exposure to aflatoxins in staple foods poses grave health risks for children, including growth impairment, immunosuppression, developmental deficits, and increased vulnerability to infectious diseases. This paper explores the sources of aflatoxin contamination in children's food, its public health impacts, and proposes multisectoral policies and interventions to protect child health and nutrition, with a focus on evidence from Africa.

1. Introduction

Aflatoxin contamination is one of the most pressing yet under-addressed food safety challenges affecting children in LMICs. Staple foods such as maize, sorghum, groundnuts, and dairy products are prone to aflatoxin contamination during cultivation, harvesting, storage, and processing. Children, particularly those under five years of age, are most at risk due to their lower body weight, higher metabolic rates, and immature immune systems.

Aflatoxin exposure is not just a health issue but a food security and developmental challenge, undermining efforts to achieve Sustainable Development Goals (SDGs) 2 (Zero Hunger), 3 (Good Health and Well-being), and 4 (Quality Education).

2. Aflatoxins and Their Impact on Child Health

2.1 Acute and Chronic Toxicity

Aflatoxin B₁ (AFB₁), the most potent and prevalent form, is a Group 1 human carcinogen (IARC, 2012). Acute exposure can lead to aflatoxicosis, characterized by vomiting, liver damage, and even death. Chronic exposure, more common in children, results in:

  • Growth faltering (stunting and underweight)
    Studies in The Gambia and Benin-Togo have shown a strong association between serum aflatoxin-albumin levels and growth retardation in children (Gong et al., 2002; Turner et al., 2007).

  • Immune suppression
    Aflatoxins interfere with immunoglobulin production, increasing susceptibility to diseases like pneumonia and diarrhoea (Turner et al., 2003).

  • Cognitive and neurodevelopmental impairments
    Aflatoxins may impair the development of the central nervous system, affecting learning outcomes and school performance (Khlangwiset et al., 2011).

  • Micronutrient malabsorption
    Chronic aflatoxin exposure interferes with zinc, vitamin A, and iron absorption, compounding risks of anemia and micronutrient deficiencies.

3. Sources and Pathways of Aflatoxin Contamination

Aflatoxin contamination typically occurs along multiple points of the food chain:

  • Pre-harvest: Drought stress, insect damage, and poor soil nutrition create conducive environments for fungal growth.

  • Post-harvest: Inadequate drying, poor storage infrastructure, and delayed processing facilitate fungal proliferation.

  • Food Processing and Retail: Contamination is exacerbated by the mixing of moldy and healthy grains, lack of traceability systems, and minimal testing in informal markets.

Children are most frequently exposed through:

  • Complementary foods such as maize-based porridge.

  • Peanut butter and groundnut-based weaning foods.

  • Milk from livestock fed contaminated feeds (AFM₁ metabolite).

4. Current Policy Gaps and Challenges

Despite the severity of the problem, aflatoxin regulation remains weak in many countries:

  • Inadequate enforcement: Even where aflatoxin limits exist (e.g., Kenya, Nigeria, Tanzania), enforcement is sporadic due to lack of equipment, funding, or personnel (USAID, 2012).

  • Lack of child-specific food standards: National food standards often do not include lower permissible aflatoxin levels for foods consumed by children.

  • Low public awareness: Many caregivers are unaware of aflatoxins and their health impacts.

  • Weak coordination: Fragmented efforts among agriculture, health, education, and trade sectors limit integrated responses.

5. Policy and Programmatic Recommendations

5.1 Strengthen Regulation and Monitoring

  • Establish child-specific aflatoxin thresholds in food, aligned with Codex Alimentarius guidelines.

  • Invest in rapid testing technologies (e.g., ELISA kits, mobile chromatography) at markets, schools, and processing plants.

  • Implement traceability systems to monitor contamination sources and recall unsafe products.

5.2 Promote Safer Agricultural and Storage Practices

  • Scale up the use of biocontrol agents like Aflasafe, which outcompetes toxigenic fungi (Bandyopadhyay et al., 2016).

  • Disseminate hermetic storage technologies (e.g., Purdue Improved Crop Storage—PICS bags) to reduce post-harvest moisture and pest damage.

  • Support climate-smart agriculture and Good Agricultural Practices (GAPs) among smallholder farmers.

5.3 Improve Child Feeding and Institutional Food Safety

  • Integrate aflatoxin control into school feeding programs and daycare nutrition policies.

  • Conduct routine testing of food supplied to early childhood development centers.

  • Promote nutrition diversification to reduce over-reliance on maize and groundnuts.

5.4 Empower Communities and Households

  • Launch nationwide media campaigns on aflatoxin awareness.

  • Train caregivers in home-based food safety practices, including proper drying, sorting, and storage.

  • Encourage community-level drying platforms and grain banks.

5.5 Foster Multisectoral and International Collaboration

  • Create interministerial coordination bodies on mycotoxin control.

  • Collaborate with international partners such as FAO, WHO, and IITA on capacity building and surveillance.

  • Embed aflatoxin control in national nutrition action plans, food safety policies, and climate adaptation frameworks.

6. Case Studies: Progress and Lessons from Africa

Kenya

After several fatal outbreaks, Kenya implemented maximum limits of 10 ppb for aflatoxins in maize and 0.05 ppb for AFM₁ in milk. Adoption of Aflasafe KE01 in counties such as Makueni and Machakos has reduced contamination levels in maize by over 70% (IITA, 2018).

Nigeria

Through the Aflasafe Nigeria initiative, aflatoxin reduction programs have been integrated into national agriculture policy. Over 300,000 hectares have been covered with biocontrol, protecting food for millions of children (Bandyopadhyay et al., 2016).

7. Conclusion

Aflatoxins pose a silent but devastating threat to child health, education, and future productivity, particularly in African countries. Addressing aflatoxin contamination in children’s food requires urgent multisectoral action, underpinned by robust policies, research, education, and investment. National governments, donors, civil society, and international bodies must prioritize aflatoxin control as a child health and development agenda. Only then can children access safe, nutritious food that supports their full potential.

References

  • Bandyopadhyay, R., et al. (2016). Biological control of aflatoxins in Africa: current status and potential challenges in the future. World Mycotoxin Journal, 9(5), 771–789.

  • Gong, Y. Y., et al. (2002). Dietary aflatoxin exposure and impaired growth in young children from Benin and Togo: cross sectional study. BMJ, 325(7354), 20–21.

  • International Agency for Research on Cancer (IARC). (2012). Aflatoxins. Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 100F.

  • Khlangwiset, P., Shephard, G. S., & Wu, F. (2011). Aflatoxins and growth impairment: A review. Critical Reviews in Toxicology, 41(9), 740–755.

  • Turner, P. C., et al. (2003). Reduced growth associated with aflatoxin exposure in children from West Africa. International Journal of Epidemiology, 32(4), 556–562.

  • Turner, P. C., et al. (2007). Aflatoxin exposure in utero causes growth faltering in Gambian infants. International Journal of Epidemiology, 36(5), 1119–1125.

  • USAID (2012). Aflatoxin: A Synthesis of the Research in Health, Agriculture and Trade. USAID Bureau for Food Security.

  • IITA (International Institute of Tropical Agriculture). (2018). Aflasafe KE01®: Fighting aflatoxin in Kenya’s maize.

  • WHO/FAO Codex Alimentarius Commission. (2020). General Standard for Contaminants and Toxins in Food and Feed.

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