Association of Pica with Anemia and Gastrointestinal Distress among Pregnant Women in Zanzibar, Tanzania

Abstract

* Indicates significance of difference by t -tests between no pica and any pica groups. † Values are mean (SD). 147PICA, ANEMIA, AND GI DISTRESS IN ZANZIBAR, TANZANIA The prevalence of IDA followed a similar pattern, with the prevalence of IDA significantly higher among amylophagists than among those who reported no pica at any point in pregnancy (52.6% versus 36.1%; P < 0.001) and highest among women who ate both pica substances (57.0% versus 36.1%; P < 0.001) ( Figure 2 ). The effect of uncooked rice and earth on iron status was independent; there was no evidence of interaction between the two types of pica behavior on Hb or ZPP.A significantly higher proportion of women who had eaten earth in the current pregnancy had experienced abdominal pain and constipation than non-geophagic women ( Table 4 ). A significantly higher proportion of pregnant women who had consumed uncooked rice at some point in the current pregnancy had experienced nausea and abdominal pain than those who had not. More women who had engaged in any form of pica had experienced nausea, abdominal pain, and constipation in this pregnancy than those who had not. There were no significant differences in loss of appetite, diarrhea, or vomiting between the pica versus non-pica group.Statistical models of pica. We built a multivariate logistic regression model of any pica to examine the relative strength of the association of the correlates of pica when considered jointly ( Table 5 ). Hookworm was not included for three reasons: it greatly limited the sample size, the effects of hookworm on iron status are largely captured by the inclusion of Hb, and we have already established that geophagy is not a vector for hookworm transmission in this population. 15Women with lower Hb concentrations, women who were later in gestation, and women who had experienced abdominal pain or nausea were more likely to engage in pica. Older women and women whose husbands had received formal education were less likely to engage in pica. The variable with the strongest association with any pica was nausea (OR = 1.45, 95% CI = 1.20-1.73), followed by Hb. For every g/dL decrease in Hb concentration, the likelihood of engaging in pica increased by 31.5% (OR = 0.76, 95% CI = 0.73-0.81).We then examined how the predictors of any pica determined geophagy and amylophagy separately ( Table 5 ). The ORs in logistic models of geophagy and amylophagy separately were consistently in the same direction and of similar magnitude as they were for any pica. DISCUSSIONOf the 2,367 pregnant women, 897 (37.9%) had engaged in geophagy by the time of their enrollment into the larger study of the prevention of severe anemia in pregnancy. Of these, 36.3% were amylophagists, 5.2% were geophagists, and 3.6% had eaten raw rice and earth.The prevalence of geophagy among pregnant women in Africa has been reported to range from 28% to 100% [31][32][33][34][35][36][37][38][39][40] ; the prevalence on Pemba Island was markedly lower (5.2%). However, the amounts of earth consumed in Pemba (26.5 grams/day)...

Kaolin consumption and outcome of surgery in women: a comparative study of 263 operations at the Yaound and eacute; Gyneco-Obstetric and Pediatric Hospital

“…2 We propose an explanation for this rate in the fact that we included non-pregnant women undergoing gynecologic surgery and excluded occasional kaolin consumers in the study. As a matter of fact, the strong desire for kaolin ingestion by pregnant women is known, and explained mostly by cultural reasons and gastric discomfort relief (7)(8). However, rates reported in South-America are similar to ours.…”

Geophagy is Associated with Environmental Enteropathy and Stunting in Children in Rural Bangladesh

“…45,46 A recent meta-analysis found that pica was significantly associated with an increased risk for anemia and low hemoglobin, hematocrit, and plasma zinc. 27 However, there are no published studies that we are aware of that have been able to establish a causal relationship between geophagy and micronutrient status.…”

Soil Ingestion is Associated with Child Diarrhea in an Urban Slum of Nairobi, Kenya

“…3 This behavior is practiced by both children and adults and has been found to be associated with micronutrient deficiency, anemia, enteric distress, soil-transmitted helminth infections, and hunger. [3][4][5][6][7][8] Nonetheless, the direction of the causal relationship for many of these associations and whether geophagy serves as a risky or protective behavior is still debated. 6,7 Beyond the learned behaviors of geophagy, soil ingestion is also an involuntary behavior as part of mouthing and exploration in young children.…”