Peanut (Arachis hypogaea L.) is an important crop in Malawi and Zambia. The crop is valued for soil improvement in cereal-based cropping systems, for improving the livelihoods of farming households who consume it and also sell it for cash, and for earning foreign exchange when exported. Research and development efforts have resulted in an increase in both peanut production area and productivity. However, a key challenge that still needs to be solved in these countries is how to produce peanuts with acceptable levels of aflatoxin contamination. Data continues to show that aflatoxin continues to be a problem in both formal and informal trade. As a result, unlike 30 years ago, most of the peanut trade has now shifted to domestic and regional markets that do not restrict the sale of aflatoxin-contaminated peanuts. Impacts of aflatoxin contamination on health and also on the full cost burden of control are not well documented. Technologies are available for mitigating against aflatoxin contamination. The advantages, disadvantages, and gaps associated with these technologies are discussed. Considerable money and effort continues to be invested in Malawi and Zambia into mitigating aflatoxin contamination, but evidence of long-term success is limited. Based on past and current initiatives, the prospects of eliminating aflatoxin in the near future at the household level and in trade are not promising.