The prevalence of aflatoxin and fumonisin was investigated in maize intended for immediate human consumption in eastern Kenya at a time in 2010 when an aflatoxin outbreak was recognized. Samples were collected from people who brought their maize for processing at local commercial mills. Sites were selected using a geographical information system overlay of agroecological zones and Kenya's administrative districts. Interviews and collection of maize flour samples was conducted from 1,500 people who processed maize at 143 mills in 10 administrative districts. Mycotoxins were analyzed using enzyme-linked immunosorbent assays for aflatoxin and fumonisin, leading to detection at levels above the respective maximum tolerable limits in 39 and 37% of the samples, respectively. Samples with aflatoxin contamination above the legal limit ranged between 22 and 60% across the districts. A higher occurrence of aflatoxin was associated with smaller maize farms, lower grain yield, and monocropping systems, while a larger magnitude of the toxin was observed in the subhumid agroecological zone, in samples with more broken kernels, and, curiously, less maize ear damage at harvest. Analysis of paired grain samples (visually sorted and unsorted) showed that sorting reduced fumonisin by 65%, from above to below the legal limit of 1,000 ppb. Sorting did not, however, reduce aflatoxin levels. Although the aflatoxin problem is widely acknowledged, the high prevalence of fumonisin has not previously been reported. There is need for surveillance of the two mycotoxins and establishment of intervention strategies to reach vulnerable small-scale farmers.

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We conducted a survey of aflatoxin and fumonisin in maize in western Kenya. In a regional survey of aflatoxin conducted in 2009 across three agroecological zones within three administrative regions, milled maize samples were collected from 985 patrons of 26 hammer mills. Aflatoxin contamination was detected in 49% of samples and was above the regulatory (10 ppb) in 15% of the samples overall; 65% of samples from a drought-prone area were over the limit. In a detailed survey in Bungoma County, we investigated aflatoxin and fumonisin contamination in four popular maize varieties at harvest and after 2 and 4 months of storage. We collected whole-grain samples from farmers' storage sheds and milled samples from patrons of local mills. Mean aflatoxin contamination was identical for storage sheds and mills at 2.3 ppb. In all, 41% of the samples from mills had detectable aflatoxin, with 4% over the regulatory limit, whereas 87% had detectable fumonisin, with 50% over the regulatory limit (1 ppm). Mean contamination levels did not change during storage. Maize varieties differed in fumonisin contamination, with the most popular varieties vulnerable to both mycotoxins and weevils, which are potential factors in exacerbating mycotoxin contamination. Mycotoxin surveillance is important not just in areas known previously for aflatoxin contamination and acute poisoning but also is needed in all maize-producing regions.

MC acceptance in a population of novice users, many with limited experience with tampons, indicates that there is a pool of potential users in low-resource settings.

IntroductionObservational studies have documented an association between aflatoxin (AF) exposure and reduced linear growth in infants and young children. Our objective was to assess the effectiveness of reducing AF exposure on child linear growth and serum AF levels in rural areas in Eastern Kenya.MethodsA cluster randomised controlled design was used (28 intervention and 28 control clusters). The intervention arm received a swapping (contaminated maize was replaced with safe maize) and a stockist intervention (households were encouraged to purchase from a stockist supplied with clean maize). Women in the fifth to final month of pregnancy were invited to enrol in the study. Outcomes were child length-for-age Z-score (LAZ), the prevalence of stunting and child serum AFB1-lysine adduct level 24 (endline, primary outcomes) and 11 to 19 months (midline, secondary outcomes) after trial commencement, respectively. The trial was registered with socialscienceregistry.org.ResultsOf the 1230 unborn children enrolled in the study, 881 (72%) were included in the LAZ and 798 (65%) in the serum AFB1 analysis. The intervention significantly reduced endline ln serum AFB1-lysine adduct levels (intervention effect—0.273, 95% CI −0.547 to 0.001; one-sided p=0.025), but had no effect on endline LAZ or stunting (mean LAZ at endline was −1.64). At midline, the intervention increased LAZ by 0.16 (95% CI −0.009 to 0.33; one-sided p=0.032) and reduced stunting by seven percentage points (95% CI −0.125 to −0.007; one-sided p=0.015), but had no impact on serum AFB1 levels.ConclusionImproving access to AF-free maize substantially reduced endline serum AF, but had no effect on child linear growth. The midline analysis suggests that AF may affect linear growth at younger ages.Trial registration numberAEARCTR-0000105.

Free provision of preventive health products can dramatically increase access in low income countries. A cost concern about free provision is that some recipients may not use the product, wasting resources (over-inclusion). Yet charging a price to screen out non-users may screen out poor people who need and would use the product (over-exclusion). We report on a randomized controlled trial of a screening mechanism that combines the free provision of chlorine solution for water treatment with a small non-monetary cost (household vouchers that need to be redeemed monthly in order). Relative to a non-voucher free distribution program, this mechanism reduces the quantity of chlorine procured by 60 percentage points, but reduces the share of households whose stored water tests positive for chlorine residual by only one percentage point, dramatically improving the tradeoff between over-inclusion and over-exclusion.

Despite massive expansion of human and livestock populations, fuelled by agricultural innovations, nearly one billion people are hungry and 2 billion are sickened each year from the food they eat. Agricultural and food systems are intimately connected to health outcomes, but health policy and programs often stop at the clinic door. A consensus is growing that the disconnection between agriculture, health and nutrition is at least partly responsible for the disease burden associated with food and farming. Mycotoxins produced by fungi are one of the most serious food safety problems affecting staple crops (especially maize and groundnuts).Aflatoxins, the best studied of these mycotoxins, cause around 90,000 cases of liver cancer each year and are strongly associated with stunting and immune suppression in children. Mycotoxins also cause major economic disruptions through their impacts on trade and livestock production. In this paper we use the case of fungal toxins to explore how agricultural research can produce innovations, understand incentives and enable institutions to improve, simultaneously, food safety, food accessibility for poor consumers and access to markets for smallholder farmers, thus making the case for research investors to support research into agricultural approaches for enhancing food safety in value chains. We first discuss the evolution of food safety research within the CGIAR. Then we show how taking an epidemiological and economic perspective on aflatoxin research connects health and nutrition outcomes. Finally, we present three case studies illustrating the traditional strengths of CGIAR research: breeding better varieties and developing new technologies.

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