Prevalence of Aflatoxin M1 in Raw Milk and Milk Products in Sub-Saharan Africa: A Systematic Review.
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Aflatoxin M1 (AFM1), a hepatotoxic and carcinogenic metabolite of aflatoxin B1, commonly contaminates milk and dairy products following the ingestion of aflatoxin-contaminated feed by dairy animals. This systematic review assessed the prevalence and concentration of AFM1 in raw milk and milk products across Sub-Saharan Africa. Literature searches of Scopus, Web of Science, ScienceDirect, Google Scholar, and ResearchGate identified 504 records in the original search and a further 514 in a broader re-run on 9 October 2026, giving 1,018 records in total; after removal of 120 duplicates, 898 records were screened, 26 full-text reports were assessed, and 17 studies from seven countries (Ethiopia, Ghana, Kenya, Nigeria, Rwanda, Tanzania, and Uganda) met the inclusion criteria. Included studies covered raw and pasteurized cow, goat, and camel milk, as well as fermented and processed dairy products such as cottage cheese, yogurt, butter, wagashi, brukina, bokina, and Bongo. AFM1 was widely detected, with positivity rates ranging from 37% to 100% of samples across studies. All 17 studies reported at least some samples above the stringent European Union limit of 0.05 µg/L, and in nine studies most samples exceeded it. Concentrations varied substantially by product type and country, with raw milk generally showing higher contamination than fermented or processed products. Only five studies included a formal health risk assessment (two from Ghana, one from Kenya, and two from Ethiopia); the Ghanaian and Ethiopian studies identified infants, toddlers and heavy dairy consumers as being at greatest risk, whereas the Kenyan study estimated a negligible lifetime liver cancer risk. These findings highlight persistent and geographically widespread AFM1 contamination of milk and dairy products in Sub-Saharan Africa and underscore the need for strengthened regulatory monitoring, improved dairy feed management, and targeted public health interventions, particularly to protect children.