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Geophagy (Soil-eating) in Relation to Anemia and Helminth Infection among HIV–Infected Pregnant Women in Tanzania

Geophagy, the regular and deliberate consumption of soil, is prevalent among pregnant women in sub-Saharan Africa. We examined the associations of geophagy with anemia and helminth infection among 971 human immunodeficiency virus (HIV)-positive pregnant women in Tanzania. About 29% of pregnant women regularly consumed soil. Occupation, marital status, and gestational age were associated with geophagy. Ascaris lumbricoides infection was associated with the prevalence of geophagy (adjusted-prevalence ratio 1.81; 95% confidence interval [CI] = 1.37–2.40); however, hookworm, Trichuris trichiura, and Strongyloides stercoralis showed no association. Anemia and red blood cell characteristics suggestive of iron deficiency were strongly correlated with geophagy at baseline. In longitudinal analyses, we found evidence suggesting that soil consumption may be associated with an increased risk of anemia (adjusted-relative risk 1.16; 95% CI = 0.98–1.36) and a lower hemoglobin concentration (adjusted-mean difference –3.8 g/L; 95% CI [–7.3, –0.4]). Pregnant women should be informed about the potential risks associated with soil consumption.

Received April 26, 2008. Accepted for publication October 1, 2008.

Acknowledgements: We thank the mothers and children who participated in this study and the field teams, including nurses, midwives, supervisors, laboratory staff, and administrative staff who made the study possible.

Financial support: This study was supported by the National Institute of Child Health and Human Development (NICHD R01 32257) and the Fogarty International Center (NIH D43 TW00004).

^* Address correspondence to Kosuke Kawai, Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115. E-mail: kkawai{at}hsph.harvard.edu

Authors’ addresses: Kosuke Kawai, Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, E-mail: kkawai{at}hsph.harvard.edu. Elmar Saathoff, Department of Infectious Diseases and Tropical Medicine, University of Munich, Germany, E-mail: saathoff{at}lrz.uni-muenchen.de. Gretchen Antelman and Wafaie W. Fawzi, Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave., Boston, MA 02115, E-mail: mina{at}hsph.harvard.edu. Gernard Msamanga, Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, E-mail: gmsamanga{at}muchs.ac.tz.

Reprint requests: Kosuke Kawai, Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, E-mail: kkawai{at}hsph.harvard.edu.