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Geophagy, the craving and purposive consumption of earth, is commonly reported during pregnancy. To date, most studies of geophagy have been cross-sectional and have not assessed its relationship with HIV infection. Therefore, to concurrently examine proposed etiologies of geophagy, a cohort of 371 women with mixed HIV status from Nyanza region, Kenya were recruited in late pregnancy and interviewed about pica at nine time points, through 21 months postpartum. Nutritional status (hemoglobin concentration and food insecurity), physical health (HIV infection and gastrointestinal distress), and psychosocial health (depression and perceived stress) were also repeatedly assessed. Prevalence of geophagy was greatest during pregnancy and decreased significantly postpartum. In a two-level hierarchical linear model, a one-unit increase in average hemoglobin (g/dL) was associated with a 35% decrease in the odds of geophagy. The adjusted odds ratios (CI) of geophagy were 3.98 (2.99, 5.29), 2.54 (1.13, 5.69), and 1.68 (1.15, 2.44) times higher if a woman was pregnant, reported diarrhea in the prior 24 hours, or was HIV positive, respectively. The adjusted odds ratio of geophagy was 1.61 (1.06, 2.45) times higher if a woman reported geophagy during childhood. Our results lend greatest plausibility to the protection hypothesis (i.e., that geophagy occurs in response to compromised immunity and/or infection). Given the high prevalence of geophagy, clinicians should regularly screen for the behavior and measure inflammatory biomarkers before treating geophagy with iron supplements, which can exacerbate some infections.
Financial support: Research activities and S. L. Y. were supported by the National Institute of Mental Health (K01 MH098902 and R21 MH108444). K. G. F. was supported by the U.S. Department of Education, Institute of Education Sciences, Multidisciplinary Program in Education Sciences (R305B140042). Authors had full access to all study data and had final responsibility for the decision to submit for publication.
Authors’ addresses: Joshua D. Miller and Sera L. Young, Department of Anthropology, Northwestern University, Evanston, IL, E-mails: firstname.lastname@example.org and email@example.com. Kaitlyn G. Fitzgerald and Abigail L. Smith, Department of Statistics, Northwestern University, Evanston, IL, E-mails: firstname.lastname@example.org and email@example.com.