Assessing aflatoxin knowledge, perceptions, and related practices, in a rural coastal community: a population-based cross-sectional survey

Aflatoxin contamination is a significant yet under-addressed food safety challenge in low-resource settings, driven by a complex interplay of environmental, agricultural, and socio-economic factors. Limited access to agricultural inputs, inadequate post-harvest handling and storage, and weak regulatory enforcement alongside food scarcity and climate change heighten the risk of contamination and exposure. Human exposure is associated with serious health consequences, including hepatocellular carcinoma, immune suppression, and childhood stunting. Although aflatoxin is increasingly recognized as a global food safety concern, little is known about community-level knowledge, risk perceptions, and preventive practices. This study examined household heads’ awareness, perceptions, and behaviours related to aflatoxin exposure and mitigation in a rural coastal community in Kenya. We conducted a cross-sectional survey using a census approach within the Kaloleni-Rabai Health and Demographic Surveillance System (KRHDSS). Between July and December 2022, data were collected from 17,813 household heads through face-to-face, interviewer-administered, digitized questionnaires. Farming was the predominant occupation (n = 5,757; 32.3%). Maize was sourced primarily from household harvests and local markets, with over three-quarters (n = 13,818; 77.6%) of respondents consuming maize flour three or more times weekly. Despite maize being a dietary staple, awareness of aflatoxin was limited: only 49.5% (n = 8,816) had heard of aflatoxin. Even fewer (< 20%) respondents were able to identify foods at risk, signs of contamination, causes of fungal growth, or health consequences of exposure. Socio-economic status, rurality, education, and sex influenced aflatoxin-related knowledge, perceptions, and practices. Low awareness of aflatoxin constrains rural households’ ability to prevent contamination and limit exposure. As aflatoxin risk arises at multiple points along the agricultural value chain, and vulnerability to exposure is heightened during periods of food scarcity, comprehensive control approaches are required. Effective prevention will depend on integrated strategies that combine educational initiatives, infrastructural support, and policy interventions targeting agricultural practices, food security, and consumer behaviour. What is already known about this topic? Aflatoxin contamination is a major yet under-addressed food safety challenge in low-resource settings. In the absence of analytical methods for community-level detection of aflatoxin exposure, low-cost household surveillance approaches capable of estimating exposure risks at the community level can be highly informative. What does this study add? The limited awareness of aflatoxin in our study population (particularly among rural residents, poorer households, and individuals without formal education) suggests the presence of poorly implemented control measures to mitigate contamination and reduce exposure. Maize is consumed frequently establishing a pathway for chronic aflatoxin exposure. How might these findings affect research, practice, or policy? These findings signal an urgent need to prioritize aflatoxin prevention by investing in surveillance and embedding community education into agricultural and health programs.