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.

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

Milk is an important source of energy and nutrients, especially for children, and in Kenya, milk consumption is higher than other countries in the region. One major concern with milk is the risks of chemical contaminants, and reports of high levels of aflatoxin M1 (AFM1) in milk in Kenya has been causing public health concerns. This study collected marketed milk products every month during 1 year, just as a consumer would purchase them from retailers and traders in a low-income area, and a major supermarket in a middle/high-income area. In total, 291 sampled milk products (raw, pasteurised, UHT milk, yoghurt and lala) were collected and analysed for AFM1 using a commercial ELISA kit. More than 50% of the samples exceeded 50 ng/kg (the level allowed in the EU), but only three samples exceeded 500 ng/kg (the level allowed in the USA). Geometric mean AFM1 level was 61.9 ng/kg in the 135 samples from the low-income area while it was 36.1 ng/kg in the 156 from the higher income area (p < 0.001). The levels varied significantly depending on the time of year, with lowest levels of milk in January. There were also differences between manufacturers and products, with UHT milk having lower levels. There was no difference depending on the price for all dairy products, but when only including milk, higher price was associated with lower levels of AFM1. In conclusion, this study shows that milk purchased by a consumer is likely to contain AFM1 above 50 ng/kg, and that further research is needed to find ways to mitigate AFM1 contamination through working with farmers and milk processors both in the formal and informal sectors.

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Aflatoxin M1 levels in different marketed milk products in Nairobi, 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 ...

https://tandfonline.com/doi/pdf/10.1080/20008686.2018.1547095

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.

Contamination of African staple foods is a major issue for human and animal health, nutrition, and trade. This review aimed to collect and synthesize the available evidence on geographical spread, scale of contamination, disease burden, economic impact, and mitigation measures for aflatoxins in Africa by way of a systematic literature review. This knowledge can enhance management strategies for the major challenges to combat aflatoxins. The search was conducted by applying a predefined search strategy, using bibliographic databases and websites, covering the period 2010 to 2018. Results showed that maize, peanuts, and animal feeds were the most studied commodities. For maize, all studies indicated mean AFB1 to exceed the European Union legal limit. From studies on contamination levels and biomarkers, it is clear that overall exposure is high, leading to a substantial increase in long-term disease burden. In addition, concentrations in food occasionally can reach very high levels, causing acute aflatoxicoses. The trade-related impact of aflatoxin contamination was mainly evaluated from the standpoint of aflatoxin regulation affecting products imported from Africa. There was a limited number of studies on health-related economic impacts, pointing out a gap in peer-reviewed literature. A number of mitigation measures have been developed, but proof of cost-effectiveness or even costs alone of the practices is often lacking. We recommend more emphasis to be put in peer-reviewed studies on evidence-based cost-effective mitigation strategies for aflatoxins, on the scale and spread of the problem and its impacts on public health and economics for use in evidence-based policies.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/1541-4337.12731

The aflatoxin situation in Africa : Systematic literature review

Abstract Informal milk trading in peri-urban Nairobi plays a key role in supporting both livelihoods and nutrition, particularly among poor households. Gender dynamics affect who is involved in and benefits from milk trading. To better understand gendered constraints and opportunities in informal, peri-urban dairy marketing, a qualitative study was conducted in 2017 with 45 men and 50 women milk traders in Dagoretti, a peri-urban area of Nairobi, Kenya. The findings show that milk trading is more lucrative for older men than for women and younger men among the respondents. This article illustrates the differences between these women’s and men’s experiences as milk traders and explores the reasons behind these differences. It discusses the implications of the findings for agricultural research and development interventions that aim to enhance the sustainability and equity of the dairy sector.

https://www.tandfonline.com/doi/pdf/10.1080/09718524.2022.2084491?needAccess=true

Gendered barriers and opportunities in Kenya's informal dairy sector: enhancing gender-equity in urban markets

Aflatoxin is a human health threat in many developing countries. This study examines Kenyan milk consumers’ behaviour toward aflatoxin by way of choice experiments. Further, the willingness to pay for different types of milk and aflatoxin status awareness was assessed. Five attributes were selected to describe milk products: milk processing technique, fat content, packaging, price and aflatoxin-free certification. Results indicate that awareness of aflatoxin is high, and that consumers are willing to pay a significant premium for milk that is certified as aflatoxin-free. Results also show, however, that the substantial majority does not know how to avoid aflatoxin-contaminated milk. The results indicate a great need for further education and awareness-raising programs throughout the Kenyan dairy value chain, and a potential for market-based solutions to aflatoxin control in milk.

Kenyan Awareness of Aflatoxin: An Analysis of Processed Milk Consumers

Aflatoxin is a human health threat concern in many developing countries. This study examines Kenyan milk consumers’ behaviour toward aflatoxin by way of choice experiments. Further, willingness to pay for different types of milk and aflatoxin status awareness were assessed. Four attributes were selected to describe milk products: smell, colour, price and aflatoxin-free certification. Results indicate that awareness of aflatoxin is relatively high, and that consumers are willing to pay a significant premium for milk that is certified as aflatoxin-free. Results also show, however, that the substantial majority does not know how to avoid aflatoxin-contaminated milk. The results indicate a great need for further education and awareness-raising programs throughout the Kenyan dairy value chain, and a potential for market-based solutions to aflatoxin control in milk.

Maria Walke

Papers

Kenyan Awareness of Aflatoxin: An Analysis of Processed Milk Consumers

Kenyan perceptions of aflatoxin: an analysis of raw milk consumption

Kenyan milk consumers’ behaviour and perceptions of aflatoxin