Mycotoxin contamination in Malawi: A systematic review of progress and trends in contamination, knowledge, attitude, and practices.

Mycotoxin contamination remains a persistent barrier to Malawi's food safety, public health, and agricultural development. This systematic review assessed 36 peer-reviewed and grey literature sources published between 2009 and 2025 to evaluate contamination prevalence, knowledge, attitudes, and practices (KAP) among food value chain stakeholders, and the effectiveness of existing interventions. The review followed PRISMA guidelines and applied thematic analysis to identify trends and gaps. Findings show critically low awareness levels, with a national average of 24.5 %, and no measurable improvements in KAP indicators between 2012 and 2025, despite numerous interventions. Aflatoxins were the most studied, primarily in maize and groundnuts, which accounted for 75.5 % of analyzed samples, while other toxins and susceptible foods such as dried fish, mushrooms, and vegetables remain largely overlooked. Misconceptions about mold-related health risks persist, and socio-economic constraints often lead communities to consume or sell contaminated food. Recommended mitigation strategies, such as drying and hand sorting, are underused due to labor intensity and limited technical support. Conflicting findings on post-harvest practices, particularly drying methods, have further complicated efforts to standardize effective interventions. This review consolidates fragmented data and reorganizes it to expose persistent knowledge gaps, neglected commodities, and intervention blind spots. It highlights the importance of conducting research that is rooted in agroecology and tailored to specific contexts. Furthermore, it advocates for a coordinated, multi-sectoral approach that strengthens surveillance, ensures regulatory compliance, and promotes education among stakeholders.