Aflatoxins are secondary metabolites of the fungi Aspergillus flavus and A. parasiticus, occur widely on many staple foods and cause a broad range of detrimental health effects in animals and humans. As a consequence, maximum tolerated levels (MTLs) have been legislated in many countries. However, in developing countries where food safety compliance can be low and significant levels of the food supply are locally consumed by the producers or purchased at local markets, more comprehensive strategies are required. In this regard, risk analysis with its components of risk assessment, risk management and risk communication, is an important tool in dealing with food safety issues. Risk assessment for aflatoxin B(1) in Africa has been performed using the carcinogenic potency, established by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) and applying it to typical food products and consumption across the continent, to illustrate the significant health implications caused by the intake of high levels of contaminated foods. Highlighted in this assessment is the fact that even low levels of contamination, which might of themselves fall within legislated limits, can have serious health implications due to high levels of consumption, i.e. meeting a MTL does not of itself guarantee food safety. Recent developments have highlighted the growth retardation and immune suppression caused by aflatoxin exposure in human populations in west Africa. Using the limited data available on both these health effects, a first step has been taken to incorporate them into a risk assessment paradigm quantifying the risk of immunosuppression, malnutrition and stunting in children exposed to aflatoxins and highlighting again how excessive consumption of foods meeting MTLs can carry significant health risks.