Interventions to address aflatoxin contamination, exposure, and associated health outcomes among children and adolescents aged 0-17 years in aflatoxin-endemic settings: a scoping and systematic review protocol.

Aflatoxins are secondary metabolites that frequently contaminate staple foods in tropical and subtropical regions, threatening food safety, public health, and agricultural economies. Children are especially vulnerable, with chronic dietary exposure linked to impaired growth, immune dysfunction, neurodevelopmental deficits, hepatotoxicity, morbidity, and mortality. Climate change is intensifying this risk by favouring fungal proliferation and toxin production. Good Agricultural Practices (GAPs) and atoxigenic biocontrol products are promising interventions for reducing aflatoxin contamination. However, evidence remains fragmented, and it is unclear whether reductions in crop contamination translate into measurable improvements in child exposure and health outcomes. This review aims to i) map and characterise GAP and biocontrol interventions, applied alone or in combination, in aflatoxin-endemic settings, including the behaviour change approaches used to promote their adoption and their levels of uptake; and ii) synthesisze evidence on their effectiveness in reducing crop contamination and human exposure to aflatoxins, and improving child health outcomes. We will conduct a scoping review following the enhanced Arksey and O'Malley framework, with an embedded systematic review following Cochrane and PRISMA-P guidance and structured around three intervention arms: i) biocontrol alone, ii) GAP alone, and iii) combined. Searches will span MEDLINE, PubMed, Embase, Scopus, Web of Science, AGRIS, Global Health, Global Index Medicus, International System for Agricultural Science and Technology (AGRIS) African Journals Online (AJOL), Cochrane Central Register of Controlled Trials (CENTRAL) , Global Index Medicus, trial registries, and relevant grey literature sources. Two reviewers will independently screen studies, extract data, and assess risk of bias using validated tools, with certainty assessed using GRADE. Random-effects meta-analysis will be undertaken where appropriate; otherwise, findings will be synthesised narratively using Synthesis Without Meta-Analysis (SWiM) guidelines. Ethical approval will not be sought, as the review will use published data. This review will clarify whether reductions in crop contamination translate into meaningful protection against child health outcomes. Findings will inform the development and scale-up of climate-resilient mitigation strategies, support evidence-based policy and resource allocation, and highlight priorities for future interdisciplinary research, particularly where evidence linking agricultural interventions to human exposure and child health remains limited.