Geophagia in Man: Its Nature and Nutritional Effects

Halsted, James A.

doi:10.1093/ajcn/21.12.1384

Cited by 159 publications

(80 citation statements)

References 21 publications

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“…7,[17][18][19] The medical consequences, if any, of pica for mother and fetus vary with the nature of the substance ingested. 20,21 Effects on the mother could include dental injury, constipation, intestinal obstruction, dysfunctional labor due to fecal impaction, parasitic infections, toxemia, interference with the absorption of minerals, lead poisoning, and hyperkalemia. 3,9,13 Possible effects on the fetus include prematurity, perinatal mortality, low birth weight, irritability, decreased fetal head circumference, and exposure to chemicals such as lead, pesticides, and herbicides.…”

Section: Summary Pointsmentioning

confidence: 99%

Pica during pregnancy in low-income women born in Mexico

Simpson

Mull²,

Longley³

et al. 2000

Western Journal of Medicine

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ⅷ Objective To describe pica behavior (ingestion of nonfood items) in pregnant low-income Mexican-born women in Mexico and the United States. ⅷ Design A convenience sample of informants was interviewed with a questionnaire containing open-ended and closed-ended questions. ⅷ Setting A low-income community on the outskirts of Ensenada, Mexico, and clinics serving low-income people in southern California (Santa Ana, Bakersfield, and Los Angeles). ⅷ Participants Of a total of 225 Mexican-born women, 75 (33%) were interviewed in Ensenada, and 150 (67%) were interviewed in southern California. ⅷ Results The prevalence of pica during pregnancy was 44% (n = 33) in the Ensenada group and 31% (n = 46) in the southern California group. Those who reported pica behavior more commonly had a relative who also practiced pica. ⅷ Conclusion The high reported rate of pica in this sample indicates that pregnant Mexicanborn women should be screened for pica and educated about the potentially serious effects on the fetus and mother.BACKGROUND Pica-the ingestion of nonfood items-has aroused the curiosity of medical personnel since at least the 16th century. 1 Pica in children has been studied extensively, but pica during pregnancy remains understudied and underreported. Recent articles exploring the practice 1-4 have been contradictory and present little conclusive evidence about its cause and prevalence. Pica during pregnancy is a worldwide phenomenon, 5-8 but in the United States it has been studied largely in the South, with an occasional report from the Midwest. Although this behavior is known to occur in pregnant Latina immigrants in the Los Angeles area, 9 there are no detailed descriptions of the practice in Mexican-born women either in the United States or in Mexico.The prevalence of pica in pregnant women has been reported from as low as 0% to as high as 68% in the various groups studied. 10 In general, pica behavior is probably underreported because the ingestion of nonfood items may be seen as either shameful or merely unimportant and "normal." 4 Suggested risk factors also vary between studies. A meta-analysis of dirt-, clay-, and starch-eating women found that race was the major risk factor for pica during pregnancy: it was 4 times higher in black women than in white women. 3 A study by Edwards et al, 11 however, found no significant racial difference in the prevalence of pica in a rural obstetric population; instead, a childhood, family, and nonpregnant history of pica behavior played a role. The meta-analysis also indicated that rural women were twice as likely as urban residents to exhibit pica and that lower socioeconomic status, greater maternal age, impaired nutritional status, and a childhood or family history of pica were additional risk factors. 3

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Section: Summary Pointsmentioning

confidence: 99%

Pica during pregnancy in low-income women born in Mexico

Simpson

Mull²,

Longley³

et al. 2000

Western Journal of Medicine

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“…Proponents of pica suggest potential benefits such as mineral supplementation (especially iron and calcium), relief of gastrointestinal distress and detoxification, particularly of plant secondary compounds (Johns, 1999;Profet, 1992;Wiley and Katz, 1998). Others posit a range of harmful effects, including geohelminth infection, caloric displacement, constipation, dental damage, eclampsia, fatigue, hypertension, intestinal blockage, iron deficiency, lead poisoning, peritonitis and, most frequently, anaemia (Halsted, 1968;Key et al, 1982;Rothenberg et al, 1999;Sayetta, 1986).…”

Section: Introductionmentioning

confidence: 99%

“…It has been postulated that pica, namely geophagia, increases the likelihood of transmission of orally transmitted parasitic nematodes (Anell and Lagercrantz, 1958;Glickman et al, 1999;Halsted, 1968;Hooper and Mann, 1906). Whilst there is strong epidemiological and biological evidence that geophagia is not a significant mechanism for hookworm infection (Geissler et al, 1998a;Gelfand, 1945;Saathoff et al, 2002;Vermeer and Frate, 1979), there is insufficient evidence to determine whether there is a relationship between geophagia or the consumption of other non-food substances and non-hookworm nematode infections, namely Trichuris and Ascaris.…”

Section: Introductionmentioning

confidence: 99%

Geophagia is not associated with Trichuris or hookworm transmission in Zanzibar, Tanzania

Young

Goodman

Farag

et al. 2007

Transactions of the Royal Society of Tropical Medicine and Hygi

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SummaryGeophagia may be harmful as a method for the transmission of geohelminths. In this study, we pose two questions in a representative sample of 970 pregnant women from Pemba Island, Zanzibar, Tanzania. Can consumed earth be a vector for geohelminth infection? And do geophagists have differential parasitic infection? The parasitological content of 59 non-food substance samples was analysed. Cross-sectional data regarding pica behaviour were collected through interviews conducted by local researchers. Ascaris, Trichuris and hookworm status was ascertained through Kato-Katz smears. The prevalence of geophagia at baseline was 5.6% and the overall prevalence of Ascaris, Trichuris and hookworm infection was 5.6%, 33.2% and 32.9%, respectively. No consumed soil samples contained infectious parasitic stages, and only one of the consumed pica substances (charcoal) contained parasites of potential risk to human health. Neither the prevalence nor the intensity of infection with Ascaris, Trichuris or hookworm differed significantly by geophagia status. Furthermore, in multivariate models, geophagia was not a significant predictor of helminth infection status. We conclude that geophagia is not a source of Trichuris or hookworm infection among pregnant women in Pemba (insufficient power to evaluate the effect of Ascaris), which is in contrast to existing findings of helminth infection and geophagia. KeywordsPica; Geophagia; Helminthiasis; Pregnancy; Parasites; Zanzibar * Corresponding author. Tel.: +1 607 351 0172; fax: +1 607 255 1033. E-mail address: sly3@cornell.edu (S.L. Young). Authors' contributions: SLY conceived the substudy design, oversaw sample collection, collected ethnographic data and drafted the paper; DG determined sample preservation methods, examined pica samples, interpreted parasitology results and wrote the parasitology methods; THF designed and supervised the parasitological sample collection and analysis, and assisted with data analysis and drafting the paper; SMA assisted with substudy design, researcher training and pica sample collection;

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“…Geophagy is the habit of deliberately eating earth and is common among many societies (Abrahams & Parsons 1996;Anell & Lagercrantz 1958;Halstead 1968). It is widespread in sub-Saharan Africa, particularly among women, who eat a variety of earth types, especially earth collected by termites and smooth, dried clay mined from particular places and traded (Vermeer 1971;Geissler et al 1997;Saathoff et al 2002).…”

Section: Introductionmentioning

confidence: 99%

“…It is widespread in sub-Saharan Africa, particularly among women, who eat a variety of earth types, especially earth collected by termites and smooth, dried clay mined from particular places and traded (Vermeer 1971;Geissler et al 1997;Saathoff et al 2002). Geophagy has long been suspected to be a source of geohelminth infection (Anell & Lagercrantz 1958;Halstead 1968;Hunter 1973), but only recently has the practice been associated with infection with Ascaris lumbricoides and, although less conclusively, Trichuris trichiura, among institutionalized orphans in Jamaica (Wong et al 1991) and schoolchildren in western Kenya (Geissler et al 1998a), KwaZulu-Natal in South Africa (Saathoff et al 2002) and Lusaka, Zambia (Nchito et al 2004). The impact of geophagy on pregnant women in terms of helminth infections has not been previously studied, although anecdotal evidence suggests that it is particularly common in this group (Anell & Lagercrantz 1958).…”

Section: Introductionmentioning

confidence: 99%

Earth-eating and reinfection with intestinal helminths among pregnant and lactating women in western Kenya

Luoba

Geissler

Estambale

et al. 2005

Trop Med Int Health

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SummaryWe conducted a longitudinal study among 827 pregnant women in Nyanza Province, western Kenya, to determine the effect of earth-eating on geohelminth reinfection after treatment. The women were recruited at a gestational age of 14-24 weeks (median: 17) and followed up to 6 months postpartum. The median age was 23 (range: 14-47) years, the median parity 2 (range: 0-11). After deworming with mebendazole (500 mg, single dose) of those found infected at 32 weeks gestation, 700 women were uninfected with Ascaris lumbricoides, 670 with Trichuris trichiura and 479 with hookworm. At delivery, 11.2%, 4.6% and 3.8% of these women were reinfected with hookworm, T. trichiura and A. lumbricoides respectively. The reinfection rate for hookworm was 14.8%, for T. trichiura 6.65, and for A. lumbricoides 5.2% at 3 months postpartum, and 16.0, 5.9 and 9.4% at 6 months postpartum. There was a significant difference in hookworm intensity at delivery between geophagous and non-geophagous women (P ¼ 0.03). Women who ate termite mound earth were more often and more intensely infected with hookworm at delivery than those eating other types of earth (P ¼ 0.07 and P ¼ 0.02 respectively). There were significant differences in the prevalence of A. lumbricoides between geophagous and non-geophagous women at 3 (P ¼ 0.001) and at 6 months postpartum (P ¼ 0.001). Women who ate termite mound earth had a higher prevalence of A. lumbricoides, compared with those eating other kinds of earth, at delivery (P ¼ 0.02), 3 months postpartum (P ¼ 0.001) and at 6 months postpartum (P ¼ 0.001).The intensity of infections with T. trichiura at 6 months postpartum was significantly different between geophagous and non-geophagous women (P ¼ 0.005). Our study shows that geophagy is associated with A. lumbricoides reinfection among pregnant and lactating women and that intensities built up more rapidly among geophagous women. Geophagy might be associated with reinfection with hookworm and T. trichiura, although these results were less unequivocal. These findings call for increased emphasis, in antenatal care, on the potential risks of earth-eating, and for deworming of women after delivery.

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Geophagia in Man: Its Nature and Nutritional Effects

Cited by 159 publications

References 21 publications

Pica during pregnancy in low-income women born in Mexico

Pica during pregnancy in low-income women born in Mexico

Geophagia is not associated with Trichuris or hookworm transmission in Zanzibar, Tanzania

Earth-eating and reinfection with intestinal helminths among pregnant and lactating women in western Kenya

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