at the time of sampling to determine a poten- tial association between level of awareness and aflatoxin concentrations in their homegrown maize. For all 3 years combined, 59% of our study participants with homegrown maize reported receiving information about drying and storing maize. There was a statistically significant increase in the percentage of people who reported receiving information in 2007 [190/256 (74%)] compared with 2005 [31/82 (38%)] and 2006 [35/96 (36%)] (p-value < 0.0001) (Table 4). However, we found no significant difference in GM aflatoxin levels between households that reported receiving information and those that did not (overall or by year). Although the difference was not sta- tistically significant, in 2006 the GM aflatoxin levels were considerably lower in households that reported receiving information (Table 4). We asked respondents if they thought eat- ing moldy maize could cause muuku (jaun- dice); 252 (75%) respondents in all 3 years combined responded “yes” to this question. We found a statistically significant difference in percentage of those who reported thinking that jaundice may be caused by eating moldy maize when comparing 2005 and 2006 (62% and 63%, respectively) with 2007 (82%) (Table 4) (p-value < 0.0001). However, responses were not associated with statistically significant dif- ferences in GM aflatoxin levels (Table 4). Finally, we asked respondents if they had heard about people getting muuku from eat- ing moldy maize. In all 3 years combined, 216 (51%) of respondents answered yes to this question (Table 4). We found no statistically significant difference by year in proportions of those who responded yes to this question and no statistically significant differences in GM maize aflatoxin levels for those who responded yes compared with those who responded no. Discussion Fungal contamination of home-stored sub- sistence crops such as maize is a global public health problem. However, there is little infor- mation about the concentrations of fungal tox- ins on foods actually eaten by families engaging in subsistence farming. A study conducted in Tanzania showed concentrations of afla- toxin on homegrown maize as high as 158 ppb (Kimanya et al. 2008). These levels were a sig- nificant concern; however, in the current study even higher concentrations were found in food stores in Kenya. This study suggests that con- suming homegrown maize is a major source of aflatoxin exposure in the aflatoxicosis-prone southern region of Eastern Province of Kenya. To minimize the potential human expo- sure to aflatoxins, the content of aflatoxin in food is regulated in most parts of the world (Shephard 2008; Van Egmond et al. 2007), including Kenya. Regulatory limits vary among countries, and none of the regulatory Environmental Health Perspectives • volume 119 | number 12 | December 2011 limits (including those in Kenya) are based on human health data. At the time of analy- sis, the Kenya regulatory limit for aflatoxin in food for human consumption was 20 ppb (Kenya Bureau of Standards 1988), which is also the FDA regulatory limit used in the United States (FDA 2000). However, Kenya has since reduced their regulatory limit to 10 ppb. Given that the consumption of maize in Kenya is high, making up 36% of the daily caloric intake of Kenyans (Gitu 2004), a lower limit for aflatoxin contamination in grains should be beneficial. However, the results of this study suggest that achieving the new 10-ppb limit will be a significant challenge for public health officials in Kenya. Homegrown food consumed by subsis- tence farmers is not monitored for aflatoxin or other contaminants through traditional regu- latory authorities. Researchers (Kimanya et al. 2008; Shephard 2003; Wild and Gong 2010; Williams et al. 2004 ) agree that people living in rural settings where locally grown crops are consumed should have enforced regula- tory standards and other protective measures. Such measures could include providing agri- cultural extension officers to monitor food Table 3. Maize aflatoxin levels by source, 2005–2007. Maize aflatoxin levels in eastern Kenya at the subsistence farm level, which may reduce the risk of exposure among these farm- ers (Redwooda Y, Lewisa L, Njapaub H, Breimanc R, Mwihiad J, Daniela J, et al., unpublished data), and could be coupled with interventions to help farmers properly store and dry their maize to reduce the risk of afla- toxin contamination. Although homegrown maize had the highest levels of contamination and most samples in 2005 and 2006 exceeded the regu- latory limit for aflatoxin, many purchased maize samples also had aflatoxin levels above the regulatory limit, some as high as 13,800 ppb in 2005. A previous study by Lewis et al. (2005) describing sources of maize found in local markets showed that homegrown maize may not remain within the household of a farmer after harvest. Farmers tend to sell maize to market vendors and purchase it back as needed. Therefore, the local trade and dis- tribution of contaminated homegrown maize may facilitate and sustain the cycle of aflatoxin exposure for both farmers and the local com- munity. The amount of exported maize or of aflatoxin-contaminated grain from this region and its effect on wider markets is unknown. Samples with < 20 ppb [n (%)] Samples with > 20 ppb [n (%)] Maize source 2005 Homegrown Purchased Relief 2006 Homegrown Purchased Relief 2007 Homegrown Purchased Relief All years combined Homegrown Purchased Relief Year 2005 Yes No 2006 Yes No 2007 Yes No All years combined Yes No n (%) 31 (38) 51 (62) 35 (36) 61 (64) 190 (74) 66 (26) 256 (59) 178 (41) 30 (36) 95 (59) 50 (94) 39 (40) 39 (60) 2 (67) 213 (84) – – 282 (65) 134 (59) 52 (93) GM (ppb) 51.42 71.72 93.73 33.56 1.96 2.12 15.60 16.79 aAll estimates are adjusted for division and village. bEstimates are adjusted for year. Table 4. Geometric mean aflatoxin levels in homegrown maize samples according to responses to aflatoxin awareness questions, 2005–2007. Have you received information about how to dry and store your maize? Do you think that eating moldy maize can cause muuku? Did you hear about people getting muuku in this area from eating moldy maize? 53 (64) 67 (41) 3 (6) 58 (60) 26 (40) 1 (33) 40 (16) – – 151 (35) 93 (41) 4 (7) GM (range) of aflatoxin levels (ppb)a 62.61 (0.43–48,000) 10.05 (0.11–13,800) 1.99 (0.37–720) 46.47 (0.49–24,400) 14.57 (0.30–2,800) 6.21 (2.1–22) 1.95 (< LOD–2,500) – – 17.96 (< LOD–48,000)b 3.64 (0.11 – 13,800)b 0.73 (0.37 – 720)b n (%) 37 (62) 23 (38) 44 (63) 26 (37) 171 (82) 37 (18) 252 (75) 86 (25) GM (ppb) 60.88 58.26 89.68 64.13 2.02 2.71 15.37 22.79 n (%) 43 (54) 37 (46) 50 (54) 43 (46) 123 (49) 129 (51) 216 (51) 209 (49) GM (ppb) 53.54 90.20 88.74 31.37 1.56 2.48 14.76 18.89 1797