Neurotoxicants on the Menu: Mapping the Link between Food Contaminants and Autism in African Children - A Scoping Review

Background: Autism Spectrum Disorder (ASD) is a growing neurodevelopmental concern in Africa, with environmental risk factors such as neurotoxic food contaminants believed to play a role in its prevalence among children.

Objective: This review aims to synthesize evidence linking dietary exposure to neurotoxic food contaminants, such as heavy metals, pesticides and mycotoxins, with ASD risk in African children and to highlight regional exposure patterns, regulatory contexts, and research gaps.

Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and African regional databases for studies published between 2000 and 2025. Grey literature from WHO and FAO was also included. Eligibility criteria covered African populations, experimental models, and food safety policies addressing neurotoxic exposure and ASD outcomes. Data extraction focused on contaminant types, sources, outcomes, and country-level regulation. Results were synthesized qualitatively to map evidence and identify gaps.

Results: Heavy metals, pesticides, and mycotoxins were frequently identified in staple African foods, with animal and epidemiological studies suggesting higher burdens in children with ASD. The critical exposure periods are prenatal and early childhood. Regulatory and surveillance deficiencies were evident, especially in rural and informal market settings.

Discussion: Widespread exposure to neurotoxicants, combined with weak food safety oversight, increases ASD risk among African children. Evidence is fragmented and underrepresents rural contexts. Multidisciplinary research and robust governance are needed to clarify the exposure-disease link.

Conclusion: Foodborne neurotoxins pose significant risks to ASD in Africa. Enhancing surveillance, regulation, and research, particularly for vulnerable populations, is vital to prevent ASD and protect children's health.

Autism Spectrum Disorder (ASD), also known as autism, is a neurodevelopmental disorder generally characterized by early alterations of social communication and interactions, repetitive and restricted patterns of behaviors, activities, or interests; in some cases, sensory and cognitive delays are observed [1,2]. It is called “spectrum” because the symptoms and their severity vary widely among individuals. Due to its rising prevalence, ASD has been considered a growing global public health concern associated with burden on the family and the community, which affects approximately 1 in 100 children worldwide [3]. According to a recent systematic review and meta-analysis, the global prevalence of ASD is estimated to be 0.6% [4]. However, other studies have reported an overall estimated prevalence between 1.5% and 2% [5]. This variation of ASD prevalence suggests an implication of some socio-demographic factors, such as sex, with males more affected by ASD than females; racial/ethnic groups; geographical area (rural/urban, agricultural and industrial area) [6-8]. The prevalence of ASD in Africa is very scarce and varies according to different African countries. Due to many challenges and obstacles, the estimation of ASD prevalence in Africa is very difficult. One of the top challenges is the inappropriate diagnosis, especially in low-income countries (rural areas), with the lack of healthcare professionals and the availability of resources and assessment tools. Another challenge and obstacle is the limited or lack of awareness of ASD and stigmatization around ASD, as many African communities consider it as witchcraft, taboo, and caused by supernatural forces; leading the families and caregivers to delay the proper diagnosis and seeking medical attention; and consequently, many cases of ASD remain undiagnosed or misdiagnosed [9,10]. The estimated prevalence of ASD in Africa is 1% [4]. In sub-Saharan Africa, Nigeria and South Africa emerge as the main countries with many studies on ASD [10]. The prevalence of ASD in Nigeria, Somalia, Uganda, and Libya is estimated to be 2.3%, 2.07%, 0.68% and 0.33% respectively [11].

The diagnosis of ASD is generally based on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria of 2013 and is usually made under the age of 3 years. The diagnostic criteria include persistent deficits in social communication and interaction; restricted and repetitive patterns of behavior, interest, or activities; the symptoms must be present in the early developmental period [12]. In Africa, various diagnostic and assessment tools are used for ASD, resulting in the different prevalence observed across African countries. The Autism Spectrum Quotient (AQ), Autism Spectrum Screening Questionnaire (ASSQ), Social Communication Questionnaire (SCQ), Childhood Autism Rating Scale (CARS), Modified Checklist for Autism in Toddlers (M-CHAT), and Autism Diagnostic Interview-Revised (ADI-R) are among the screening tools used for ASD in Africa [9,13,14]. Most treatment of ASD is based on the management of ASD-related symptoms with pharmacological treatment, management of medical comorbidities, and complementary behavioral therapies. For the pharmacological treatment, the antipsychotic medications, Selective Serotonin Reuptake Inhibitors (SSRIs), and stimulants are used to relieve ASD symptoms such as irritability, hyperactivity, and anxiety [11]. While for the management of medical comorbidities such as seizures, insomnia, and gastrointestinal issues, anticonvulsants, melatonin, and probiotics can be used, respectively. Complementary behavioral therapies enhance the outcomes for individuals with ASD; Applied Behavioral Analysis (ABA) for communication, social skills, and adaptive behavior, speech therapy, and occupational therapy for communication and daily living skills are commonly used [11]. ASD has become a burden for families and caregivers.

The etiology of ASD has been attributed to genetic factors for many years. However, the implications of environmental toxicants, alongside genetic factors in ASD, have been more explored. It is estimated that direct exposure to environmental neurotoxicants during the prenatal and postnatal period contributes to 3% of neurodevelopmental disorders [15]. Neurotoxicants refer to any chemicals or substances capable of crossing the blood-brain barrier and interfering with the normal function of the central or peripheral nervous systems. Heavy metals, pesticides, and mycotoxins are among the neurotoxins that alter brain development during the early developmental period (prenatal and postnatal periods) [16]. Diet-influenced factors are part of the landscape of potential environmental risk factors for autism, as children or pregnant women are exposed through consumption of contaminated foods, fruits, and water with neurotoxicants. Another source of exposure is inhalation of polluted air, especially for children or pregnant women living in industrial or agricultural areas [17].

This scoping review followed Arksey and O’Malley’s framework, refined for public health research. Relevant peer-reviewed literature, reports, and policy documents were identified through systematic searches of PubMed, Scopus, Web of Science, and regional African databases covering the years 2000-2025. Keywords included “autism,” “ASD,” “food contaminants,” “neurotoxicants,” “Africa,” “pesticides,” “mycotoxins,” and “heavy metals.” The search was complemented with grey literature from the World Health Organization (WHO), Food and Agriculture Organization (FAO), and regional food safety agencies. Inclusion criteria encompassed studies on African populations, experimental animal models with neurodevelopmental outcomes, and policy analyses related to food safety. Exclusion criteria eliminated studies with no direct relevance to neurodevelopmental or dietary exposure pathways. Data were charted by type of contaminant, exposure source, study design, outcomes, and geographic focus. Policy framework documents were analyzed for regulatory gaps, enforcement capacity, and integration with health surveillance. Findings were synthesized qualitatively to map evidence patterns, identify exposure pathways, and highlight gaps in knowledge and governance.

Various types of neurologic food contaminants have been reported in African foods from diverse sources. Table 1 summarises the three most prominent neurotoxicants reported in various food types in Africa. These include different heavy metals, pesticides, and mycotoxins.

Heavy metals (Mercury (Hg), Lead (Pb), Cadmium (Cd), and Arsenic (As)) are very frequent neurotoxicant metals found in the environment, which pose serious threats to human health due to their non-biodegradability and to their capacity to accumulate in the food chain [18]. Heavy Metals (HMs) originate from natural or anthropogenic sources, which end up in soil, water, and air. Natural sources of heavy metals are volcanic eruptions, forest fires, and weathering of metal-bearing rocks, while anthropogenic sources, the main human exposure to heavy metals, are industries, agriculture, irrigation, sewage disposal, mining, and metallurgical processes. After the release of HMs by natural and anthropogenic sources, soil and water are contaminated, which results in the contamination of foods (Cops and vegetables), aquatic organisms (Fish and shellfish) [18-20]. Heavy metals are commonly found in food products such as vegetables, fruits, seafood, fish, rice, and wheat. Human exposure can be through the consumption of these food products, contaminated water, or inhalation of polluted air.

Pesticides are various natural or synthetic chemical substances used to control, eliminate insects, pests, and weeds that affect plant growth. Many pesticides have been identified and classified according to their chemical structure, mode of action, hazards, and application [21]. The common pesticides are organochlorine, pyrethroids, carbamates, and organophosphates. Organochlorine compounds are synthetic pesticides that play an important role in both industry and agriculture. These include DichloroDiphenylTrichloroethane (DDT), p,p-DichloroDiphenyldichloroEthylene (DDE), lindane, dieldrin, aldrin, and endosulfan. Moreover, pyrethroid pesticides are commonly used as insecticides such as allethrin, dimethrin, tetramethin, permethrin, and alphamethrin. Carbamate pesticides are also insecticides with carbofuran, carbaryl, aldicarb, pyrolan, and carbanolate, the most notable carbamates. Additionally, organophosphate pesticides are carbamates in their mechanism of action but with a different chemical structure. These are a wide group of pesticides commonly applied in industry, agriculture, and used for residential purposes, with chlorpyrifos, malathion, parathion, and diazinon being the most organophosphate compounds [21-23]. To increase agriculture and food production, pesticides are used, and some of these are regarded as Persistent Organic Pollutants (POPs) due to their ability to persist in the environment for a long period of time after their usage. Pesticides can enter the food chain through different sources, like food crops, polluted air, and contaminated water. Fruits, vegetables, and cereals are the most contaminated foods by pesticide residues. Cereals like wheat, rice, maize, millet, barley, and rye are generally sprayed with pesticides after harvesting to protect them against insects and pests.

Mycotoxins are secondary metabolites produced by filamentous fungi such as Aspergillus, Fusarium, Penicillium, and Claviceps. Many mycotoxins have been identified, with Aflatoxins (AFs), Ochratoxin A (OTA), Zearalenone (ZEN), Fumonisins (FBs), and trichothecenes (Deoxynivalenol (DON) and T-2 toxin (T-2) considered to pose serious health problems. The occurrence of mycotoxins in the food and feed supply chain is through contamination of agricultural products in the field or during growth, harvest, and storage [24]. Aflatoxins (AFs), including aflatoxin B1, B2, G1, G2, M1, and M2, with AFB1 the most harmful to humans and animals, are produced by Aspergillus flavus and Aspergillus parasiticus. They contaminated food crops such as maize (Corn), cereals, oilseeds, milk, milk products, and some spices [25]. Ochratoxins (OTs), particularly Ochratoxin A (OTA), which contaminate various food products such as oilseeds, cereals such as wheat, barley, and oats, as well as coffee, dried fruits, wine, beer, and grape juice, are mainly produced by Aspergillus ochraceus and Penicillium verrucosum [26]. Fumonisins (FBs), commonly produced by Fusarium verticillioides (formerly Fusarium moniliforme) and Fusarium proliferatum, are mainly found in maize, maize-based products, rice, sorghum, and peanuts [27]. Meanwhile, ZEN is primarily produced by Fusarium graminearum, Fusarium culmorum, Fusarium cerealis, Fusarium equiseti, and Fusarium crookwellense and frequently contaminates crops such as maize, wheat, rice, sorghum, and cereals [28]. DON, also known as vomitoxin, is the most common form of trichothecene, which is produced mainly by Fusarium graminearum and Fusarium culmorum, and occurs in grains such as wheat, oats, corn, barley, and, less often, in rice and sorghum [29]. The occurrence of mycotoxins in food crops contributes to great economic and health issues for humans and animals, with more than 25 percent of the world’s food contaminated with a variety of mycotoxins [30].

Summary of animal and epidemiological studies

According to numerous reports, ASDs are caused by the interactions between genetic and exposure to environmental factors [2,31]. Heavy metals, pesticides, and mycotoxins, considered as neurotoxicants, may be associated with ASD due to their ability to interfere with normal function and compromise adaptation in the central nervous system. These neurotoxicants primarily enter the body through inhalation or ingestion of contaminated foods. Evidence suggests the possible link between environmental toxicants (Heavy metals, pesticides, and mycotoxins) and maternal exposure in pregnancy (Utero) or in the early years of the infant’s life (From birth to 3 years up), and a higher risk of the child being diagnosed with autism spectrum disorder. This association has been supported by many experimental and epidemiological studies.

Experimental evidence: Various experimental studies in animals have elaborated the possible link between ASD and neurotoxicants as risk factors. Arsenic exposure during pregnancy and lactation period has been proven to induce autism-like behaviour in male offspring mice with the decrease of synaptic density in the cortex, hippocampus, and cerebellum; also with abnormal social behaviour and repetitive behaviour [32]. Exposure to low doses of heavy metals (Lead, cadmium, and mercury) equivalent to those detected in the blood of the general population has been reported to impair spatial memory by perturbing the dynamic of dendritic spine pruning from weaning to adolescence in rats [33]. Dendritic spines are the main structures of pyramidal neurons, very important for post-synaptic plasticity, and memory and learning function. Exposure to lead during the gestational period in the rat model alters spine plasticity with impairments of cognitive function [34].

Regarding pesticides, some experimental studies have been done to establish the possible association between ASD and pesticides; and conclude that exposure during pregnancy, lactation, or early life may increase the risk of ASD [35,36]. Exposure to pesticides such as pyrethroid, chlorpyrifos, deltamethrin, endosulfan, lindane, glyphosate during prenatal or postnatal in rats or mice had been reported to induce spatial learning, memory deficits in the offspring and young adult male rats through mechanisms involving oxidative stress, neurotransmission disruption, impairment of hippocampus neurogenesis and synaptic damage [37-39].

Additionally, mycotoxins such as aflatoxins, ochratoxin A, and fumonisin B1 have been studied in experimental models to provide evidence that prenatal or postnatal exposure to these mycotoxins can increase the risk of ASD. Exposure to FB1 during the gestational period in rats may cause impaired synaptic plasticity that may underlie modification of learning and memory processes in their offspring [40]. Taken together, experimental studies provide some evidence regarding environmental toxicants as risk factors for ASD. Although some experiences are not directly related to ASD, the findings presented here support the possible implication of environmental neurotoxicants during the critical period on brain development, which may result in ASD.

Epidemiological evidence: In African context, some epidemiological studies have been done to establish the link between environmental contaminants and ASD. ASD patients have a reduced ability to excrete the neurotoxicants such as heavy metals, pesticides, and mycotoxins, which sometimes lead to their accumulation in different organs. Bio-monitoring their levels in the autistic children (hair, whole blood, serum or plasma, and urine), or evaluating the cognitive performance of children exposured to neurotoxicants (regions with high risk exposure due to agricultural practices) during pregnancy and early childhood may indicate their potential as risk factors in the pathogenesis of ASD. Table 2 provides a summary of some epidemiology studies done in African settings.

Possible link between autism spectrum disorder and heavy metals: A case-control study with autistic children and healthy children in Egypt revealed the positive correlation between ASD and heavy metals. This study found higher levels of mercury and lead in the hair of autistic patients compared to healthy children; also, the levels of mercury and lead were positively correlated with maternal fish consumption, suggesting the heavy metals as environmental risk factors of autism [41]. Another observational case-control comparative study assessed blood and urine Hg and Pb levels in autistic and healthy children, found the higher levels of Pb and Hg in autistic patients compared to healthy children [42]. One study has reported higher levels of lead in hair of children with autism when compared with non-autistic children [43]. A case-control study conducted on patients diagnosed with autism based on DSM-IV-TR criteria in Egypt revealed a higher hair mercury level in autistic patients than in the control group [44]. A longitudinal follow-up study carried out in an artisanal small-scale gold mining area in Northwestern Tanzania to examined the effects of multi-chemical prenatal exposure to heavy metals on developmental milestones for children aged 3-4 years ayalerevealed that exposure to heavy metals (Pb, Hg, Cd and As) during prenatal have an impact on children cognitive, social, motor and language skills [45]. Additionally, a study conducted by Blaurock-Busch and Nwokolo Chijioke (2018) in Nigerian children diagnosed with ASD revealed that these children carry a greater burden of toxic metals compared to healthy children living in the same region, with the ASD group showing a higher metal concentration in blood and hair, combined with low blood zinc levels [46]. Another study reported the higher level of Pb in whole blood leading to an increase in oxidative stress observed in autistic children [47]. These results from an epidemiological study highlight heavy metal exposures as risk factors for ASD in Africa.

Possible link between autism spectrum disorder and pesticides: In Africa, several studies have been reported on the environmental risk of pesticides in human health, especially in regions with a potential high risk of pesticide exposure due to contamination from agricultural activities. In Tanzania, horticultural farmers exposed to organophosphates and carbamates were reported to have memory loss with a decrease in Acetylcholinesterase (AChE) levels [48]. A cross-sectional study involving mother-child pairs in Tanzania revealed the association between maternal pesticide exposure during pregnancy among smallholder farmers and adverse neurodevelopment outcomes in their children. Children's neurodevelopment was evaluated using the International Development and Early Learning Assessment (IDELA), which measures domains such as motor skills, literacy, numeracy, social-emotional development, and executive function; and the Malawi Child Development Tool (M-DAT) assessing the child's level of development [49,50]. Another cross-sectional study conducted in Uganda reports that overall pesticide exposure was associated with several neurobehavioral outcomes, while glyphosate exposure was associated with impaired visual memory in smallholder farmers [51]. Children living in agricultural zones are more vulnerable to pesticide exposure with subsequent cognitive and learning impairment. In rural agricultural areas in the Western Cape of South Africa, school-age children’s neurocognitive performances (Attention, memory, and processing speed) were significantly affected after cognitive assessment [52].

Possible link between autism spectrum disorder and mycotoxins: Africa is the continent with the largest variety of emerging mycotoxins in foods dedicated for infant and children consumption [53], but epidemiological studies concerning the implication of mycotoxins in neurocognitive and learning impairment with possible outcomes of ASD are scarce compared to other continents such as Europe, where some epidemiological studies report that mycotoxins play a role in the pathobiology of ASD [54-56]. Epidemiological studies conducted in Africa have observed a significant association between long-term dietary mycotoxin exposure and child growth impairment, including childhood stunting [57,58].

Exposure pathways (prenatal, early childhood)

Prenatal and postnatal life (Early childhood) are crucial periods for brain development. During these periods, the brain undergoes different processes to shape the structural, functional, and interconnections between neurons [59]. Any environmental neurotoxicant exposure during these periods of life could have an impact on the brain with subsequent development of ASD. Exposure to neurotoxicants during pregnancy can affect the development and growth of the fetus’s brain. A child can be exposed to dietary neurotoxicants in utero (Through maternal diet, which can cross the placenta), through breastfeeding, and from complementary feeding after weaning.

Environmental factors can affect the placenta, another key organ involved in the various processes that regulate fetal development. In fact, the placenta can be considered as an intermediate organ that, in the case of prenatal exposure to various pollutants, has the potential to express abnormal biological signatures that may prove to be useful as early indicators of the development of the disease later in life [36].

Breast milk is the best source of nutrients for neonates and infants during the first few months of their lives. Besides nutrients, breastmilk also contains antibodies and other protective factors that are beneficial to the baby’s immune system. However, lactating mothers exposed to contaminated food can secrete heavy metals, mycotoxins, or their adduct form in their milk. As the child develops and grows, baby foods become more complementary with the addition of some food items, including cereals and processed cereal products, mashed fruits, vegetables, and meat products until 2 years of age. In many developing countries, baby foods are introduced earlier, which increases the likelihood of children's exposure to neurotoxicants [60].

Regional exposure patterns and country-level risk

The exposure of African children to neurotoxic food contaminants varies widely across the continent, shaped by intersecting factors such as climate, agricultural practices, industrial activities, and socio-economic conditions. Heavy metal contamination, particularly from lead and mercury, is a major concern in regions affected by informal gold mining or unregulated industrial waste. In parts of West and East Africa, artisanal mining frequently leads to mercury pollution of soil and water, which then enters the food chain via fish and crops [61]. Similarly, lead exposure from old paints, contaminated water systems, and industrial emissions disproportionately affects children in urban informal settlements [62].

Geography and local food systems play a central role in determining exposure risk. Regions with intensive agriculture, mining, or industrial activity, such as West and Central Africa, report higher contamination levels due to the use of pesticides and environmental pollutants. Informal food markets, which supply the majority of the population, often lack proper inspection and regulatory oversight.

Mycotoxin exposure, especially from aflatoxins, poses a widespread public health challenge in sub-Saharan Africa. Warm, humid climates support the growth of moulds on staple crops such as maize, groundnuts, and cassava, particularly in the Sahel, Central, and Southern Africa [63]. Inadequate post-harvest handling and poor storage practices exacerbate contamination risks, increasing chronic exposure in children. For example, aflatoxins have well-documented neurodevelopmental effects [64-66].

In East Africa (e.g., Kenya, Uganda, Tanzania), recurring outbreaks of aflatoxins in maize and dairy chains highlight systemic vulnerabilities. While countries like South Africa and Ghana have more advanced regulatory systems and surveillance, rural and peri-urban communities remain highly exposed due to limited enforcement [67]. In the Sahel and northern Africa, food insecurity and recurrent droughts exacerbate the risk, increasing reliance on poorly regulated imports and locally grown crops susceptible to fungal contamination.

Current food safety and environmental health regulations

Despite the clear risks, food safety regulations in many African countries remain underdeveloped, fragmented, and poorly enforced. A major obstacle is the absence of a centralized regulatory authority with the mandate and capacity to oversee the entire food chain-from production to consumption [68,69]. Instead, responsibilities are distributed among various ministries (e.g., agriculture, health, environment), often resulting in poor coordination, overlapping mandates, and regulatory gaps. Notwithstanding, the African Food Safety Agency (AfFSA) was established recently [70] and the perspective of the agency has been clearly elucidated [71].

Many legal frameworks are outdated and insufficient to address emerging threats such as mycotoxin contamination or trace element exposure from modern industrial activities [72]. Enforcement is further constrained by limited financial resources, a lack of trained personnel, and the dominance of informal food markets that fall outside official oversight. Although countries like South Africa have made progress in developing more comprehensive environmental health and chemical safety regulations, many others continue to struggle with systemic inefficiencies [73].

Moreover, there is a widespread absence of targeted policies and surveillance systems for neurodevelopmental disorders such as Autism Spectrum Disorder (ASD). Data collection remains inconsistent or non-existent, making it difficult to draw epidemiological connections between environmental exposures and health outcomes. Table 3 summarizes national food safety policies and the status of surveillance systems for neurodevelopmental conditions, underscoring the urgent need for integrated, evidence-based approaches. Meanwhile, a situational analysis of national food safety systems in Africa has been listed in the FAO/WHO Regional Conference on Food Safety for Africa (https://www.afro.who.int/sites/default/files/201706/fao_who_conf_national_food_safety_africa.pdf).

Food safety policies and systemic gaps: A continental overview

Food safety governance across Africa is diverse and evolving. Some key observations include continental and national initiatives. For example, the African Union’s Food Safety Strategy for Africa (FSSA), which intends to promote a harmonized, risk-based framework centered on stakeholder inclusivity and capacity development [74,75]. At the levels of different nations, policies are often fragmented, with overlapping jurisdiction among ministries of health, agriculture, and trade, leading to regulatory inefficiencies and enforcement challenges [67,74]. South Africa stands out as the only country among those reviewed that uses risk-based, quantitative methods to guide inspection and regulation. In contrast, other nations rely on piecemeal or ad hoc systems [67]. Infrastructure deficits, including inadequate laboratory capacity and a shortage of trained food safety personnel, undermine the ability to conduct effective monitoring and risk assessment [74]. Most countries lack formal surveillance programs for ASD, thus preventing the timely identification of environmental risk factors and limiting public health response capacity [67,74]. Recent regional initiatives have encouraged participatory risk analysis and targeted support for informal markets, but adoption and implementation remain slow and uneven [67,75].

Significant research gaps persist in the investigation of neurotoxic food exposures and ASD risk in African children. These deficiencies are particularly acute when considering rural versus urban environments, informal markets, and the broader collaborative frameworks required for robust public health action [76,77].

Areas lacking data: Rural vs. Urban settings and informal food markets

Despite a growing body of evidence linking neurotoxic exposures to adverse health outcomes, particularly neurodevelopmental disorders, significant data gaps persist across the African continent. A critical limitation is the lack of disaggregated and geographically representative data, which hinders a nuanced understanding of exposure pathways and population-specific risks. Most existing studies are concentrated in urban centers, leaving rural and peri-urban areas underrepresented - despite their unique agricultural practices, water sources, and dietary patterns that may contribute to distinct exposure profiles [78].

For example, pesticide residues are likely more prevalent in rural farming communities, while urban populations may face higher risks from industrial pollutants, traffic emissions, and adulterated foods sourced from informal markets [79]. Informal food markets, which serve as the primary source of food for a majority of Africans, operate largely outside regulatory surveillance, creating critical "blind spots" for food safety monitoring and public health protection.

Furthermore, data on the prevalence and geographic distribution of Autism Spectrum Disorders (ASD) remain virtually non-existent in most African countries, making it difficult to establish clear epidemiological links between environmental neurotoxicants and developmental outcomes [80]. This absence of baseline data represents a fundamental barrier to understanding the scale, burden, and distribution of risk.

Most available studies are partial, cross-sectional, or focused on specific commodities and cities. Longitudinal data, regional comparisons, and studies on cumulative exposures remain scarce. Rural communities are particularly vulnerable to chronic exposure to mycotoxins, pesticides, and naturally occurring heavy metals due to weak regulatory enforcement. Meanwhile, urban populations often contend with risks associated with processed foods, chemical preservatives, and environmental pollution.

Informal markets are among the most understudied sectors, despite being hotspots for food adulteration, poor hygiene, and socio-economic barriers that compromise food safety. Without comprehensive and stratified research, including longitudinal studies across both rural and urban settings, it remains challenging to develop effective interventions or accurately assess the cumulative burden of neurotoxic exposure and risk of ASDs [76,77].

Need for multidisciplinary collaborations and public health action

Addressing the intricate link between foodborne neurotoxins and Autism Spectrum Disorder (ASD) requires a paradigm shift from siloed, single-discipline research to integrated, multidisciplinary collaboration. Coordinated efforts involving public health experts, toxicologists, epidemiologists, geneticists, environmental scientists, and social scientists are essential to fully understand the exposure-outcome pathway [81].

For instance, toxicologists can identify and characterize neurotoxic compounds in food; epidemiologists can map exposure trends and correlate them with health outcomes; geneticists can explore how genetic susceptibility may amplify toxic effects [82]. Such synergy is necessary to unravel the complex interactions between environmental exposures, biological vulnerability, and neurodevelopment.

Beyond research, there is an urgent call for decisive public health action. Governments, regional bodies, and international organizations must prioritize the establishment and enforcement of robust food safety regulations. Public awareness campaigns, particularly targeting mothers and caregivers, are needed to promote safe food handling and reduce preventable exposures [83]. The focus should move from reactive management of disorders to a proactive prevention strategy that addresses the root causes of contamination. Closing these gaps will require sustained collaboration across disciplines and sectors (Table 4). National surveillance programs, participatory risk assessments in informal food markets, and operational research across rural–urban settings are essential. In parallel, investments in laboratory infrastructure, harmonized data reporting, and local capacity building will strengthen evidence-based policy formulation and targeted interventions [76,77].

The findings suggest a plausible link between foodborne neurotoxicants and ASD risk in African children, particularly through prenatal and early childhood exposure to contaminated crops, fish, and water. Heavy metals, pesticides, and mycotoxins alter neurodevelopmental processes, supported by both experimental and early epidemiological evidence. However, research remains fragmented and limited in scope, with rural and informal food system exposures underrepresented. Weak regulatory systems and minimal ASD surveillance exacerbate the risks. To address these challenges, coordinated multidisciplinary research, stronger food safety governance, and comprehensive neurodevelopmental monitoring are essential. Targeted interventions, such as improved agricultural storage, regulation of pesticide use, and community awareness campaigns, are critical steps toward reducing preventable exposures and safeguarding child neurodevelopment in Africa.

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