South Africa (SA) is a leading exporter of maize in Africa. The commercial maize farming sector contributes to about 85% of the overall maize produced. More than 33% of South Africa’s population live in rural settlements, and their livelihoods depend entirely on subsistence farming. The subsistence farming system promotes fungal growth and mycotoxin production. This review aims to investigate the exposure levels of the rural population of South Africa to dietary mycotoxins contrary to several reports issued concerning the safety of South African maize. A systematic search was conducted using Google Scholar. Maize is a staple food in South Africa and consumption rates in rural and urban communities are different, for instance, intake may be 1–2 kg/person/day and 400 g/person/day, respectively. Commercial and subsistence maize farming techniques are different. There exist differences influencing the composition of mycotoxins in food commodities from both sectors. Depending on the levels of contamination, dietary exposure of South Africans to mycotoxins is evident in the high levels of fumonisins (FBs) that have been detected in SA home-grown maize. Other potential sources of exposure to mycotoxins, such as carryover effects from animal products and processed foods, were reviewed. The combined effects between FBs and aflatoxins (AFs) have been reported in humans/animals and should not be ignored, as sporadic breakouts of aflatoxicosis have been reported in South Africa. These reports are not a true representation of the entire country as reports from the subsistence-farming rural communities show high incidence of maize contaminated with both AFs and FBs. While commercial farmers and exporters have all the resources needed to perform laboratory analyses of maize products, the greater challenge in combatting mycotoxin exposure is encountered in rural communities with predominantly subsistence farming systems, where conventional food surveillance is lacking.
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