1921
Volume 83, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

The etiology of pica, the purposive consumption of non-food substances, is not understood, despite its ubiquity among gravidae. We examined correlates of pica in a representative obstetric population (n = 2,368) on Pemba Island, Zanzibar, Tanzania to examine proposed etiologies. Cross-sectional data were collected on socioeconomic characteristics, food intake, geophagy (earth consumption), amylophagy (raw starch consumption), anthropometry, iron status, parasitic burden, and gastrointestinal morbidities. Amylophagy was reported by 36.3%, geophagy by 5.2%, and any pica by 40.1%. There was a strong additive relationship of geophagy and amylophagy with lower hemoglobin (Hb) concentration and iron deficiency anemia. By multivariate logistic regression, any pica was associated with Hb level (odds ratio [OR] = 0.76, 95% confidence interval [CI] = 0.72–0.81), nausea (OR = 1.45, 95% CI = 1.20–1.73), and abdominal pain (OR = 1.22, 95% CI = 1.01–1.48). These striking results indicate that the nature of the relationship between pica, pregnancy, gastrointestinal distress, and iron deficiency anemia merits further investigation.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.2010.09-0442
2010-07-01
2019-02-20
Loading full text...

Full text loading...

/deliver/fulltext/14761645/83/1/144.html?itemId=/content/journals/10.4269/ajtmh.2010.09-0442&mimeType=html&fmt=ahah

References

  1. Laufer B, , 1930. Geophagy 18(2). Chicago: Field Museum of Natural History. [Google Scholar]
  2. Danford D, , 1982. Pica and nutrition. Annu Rev Nutr 2: 303322.[Crossref] [Google Scholar]
  3. Young SL, Wilson MJ, Miller D, Hillier S, , 2008. Toward a comprehensive approach to the collection and analysis of pica substances, with emphasis on geophagic materials. PLoS One 3: e3147.[Crossref] [Google Scholar]
  4. Jenkins CL, , 1980. Geophagy in Fayette county, Tennessee: a symbolic interpretation. Tennessee Anthropologist 5: 7391. [Google Scholar]
  5. Krishnamani R, Mahaney W, , 2000. Geophagy among primates: adaptive significance and ecological consequences. Anim Behav 59: 899915.[Crossref] [Google Scholar]
  6. Kreulen DA, , 1985. Lick use by large herbivores: a review of benefits and banes of soil consumption. Mammal Rev 15: 107123.[Crossref] [Google Scholar]
  7. Rothenberg S, Manalo M, Jiang J, Khan F, Cuellar R, Reyes S, Sanchez M, Reynoso B, Aguilar A, Diaz M, Acosta S, Jauregui M, Johnson C, , 1999. Maternal blood lead level during pregnancy in south central Los Angeles. Arch Environ Health 54: 151157.[Crossref] [Google Scholar]
  8. Abrahams P, Follansbee M, Hunt A, Smith B, Wragg J, , 2006. Iron nutrition and possible lead toxicity: an appraisal of geophagy undertaken by pregnant women of UK Asian communities. Appl Geochem 21: 98108.[Crossref] [Google Scholar]
  9. Patterson EC, Staszak DJ, , 1977. Effects of geophagia (kaolin ingestion) on the maternal blood and embryonic development in the pregnant rat. J Nutr 107: 20202025. [Google Scholar]
  10. Thomas FB, Falko JM, Zuckerman K, , 1976. Inhibition of intestinal iron absorption by laundry starch. Gastroenterology 71: 10281032. [Google Scholar]
  11. Minnich V, Okcuoglu A, Tarcon Y, Arcasoy A, Cin S, Yorukoglu O, Renda F, Demirag B, , 1968. Pica in Turkey. II. Effect of clay upon iron absorption. Am J Clin Nutr 21: 7886. [Google Scholar]
  12. Hooda PS, Henry CJ, Seyoum TA, Armstrong LD, Fowler MB, , 2004. The potential impact of soil ingestion on human mineral nutrition. Sci Total Environ 333: 7587.[Crossref] [Google Scholar]
  13. Luoba A, Geissler P, Estambale B, Ouma J, Alusala D, Ayah R, Mwaniki D, Magnussen P, Friis H, , 2005. Earth-eating and reinfection with intestinal helminths among pregnant and lactating women in western Kenya. Trop Med Int Health 10: 220227.[Crossref] [Google Scholar]
  14. Saathoff E, Olsen A, Kvalsvig JD, Geissler PW, , 2002. Geophagy and its association with geohelminth infection in rural schoolchildren from northern KwaZulu-Natal, South Africa. Trans R Soc Trop Med Hyg 96: 485490.[Crossref] [Google Scholar]
  15. Young S, Goodman D, Farag T, Ali S, Khatib M, Khalfan S, Tielsch J, Stoltzfus R, , 2007. Geophagia is not associated with Trichuris or hookworm transmission in Zanzibar, Tanzania. Trans R Soc Trop Med Hyg 101: 766772.[Crossref] [Google Scholar]
  16. Abrahams P, Follansbee M, Hunt A, Smith B, Wragg J, , 2006. Iron nutrition and possible lead toxicity: an appraisal of geophagy undertaken by pregnant women of UK Asian communities. Appl Geochem 21: 98108.[Crossref] [Google Scholar]
  17. Yanai J, Noguchi J, Yamada H, Sugihara S, Kilasara M, Kosaki T, , 2009. Function of geophagy as supplementation of micronutrients in Tanzania. Soil Sci Plant Nutr 55: 215223.[Crossref] [Google Scholar]
  18. Dominy N, Davoust E, Minekus M, , 2004. Adaptive function of soil consumption: an in vitro study modeling the human stomach and small intestine. J Exp Biol 207: 319324.[Crossref] [Google Scholar]
  19. Gilardi JD, Duffey SS, Munn CA, Tell LA, , 1999. Biochemical functions of geophagy in parrots: detoxification of dietary toxins and cytoprotective effects. J Chem Ecol 25: 897922.[Crossref] [Google Scholar]
  20. Johns T, Duquette M, , 1991. Detoxification and mineral supplementation as functions of geophagy. Am J Clin Nutr 53: 448456. [Google Scholar]
  21. Horner R, Lackey C, Kolasa K, Warren K, , 1991. Pica practices of pregnant women. J Am Diet Assoc 91: 3438. [Google Scholar]
  22. Reid RM, , 1992. Cultural and medical perspectives on geophagia. Med Anthropol 13: 337351.[Crossref] [Google Scholar]
  23. Vermeer D, Frate D, , 1979. Geophagia in rural Mississippi: environmental and cultural contexts and nutritional implications. Am J Clin Nutr 32: 21292135. [Google Scholar]
  24. Young SL, , 2010. Pica in pregnancy: new ideas about an old condition. Annu Rev Nutr (in press). doi: 10.1146/annurev.nutr.012809.104713 [Google Scholar]
  25. Government of Zanzibar, UNICEF, 2001. Situation Analysis for Women and Children in Zanzibar. Zanzibar: Ministry of Finances and Economic Affairs and UNICEF. [Google Scholar]
  26. Ash LR, Orihel TC, Savioli L, , 1994. Bench Aids for the Diagnosis of Intestinal Parasites. Geneva: World Health Organization. [Google Scholar]
  27. Farag T, Stoltzfus R, Khalfan S, Tielsch J, , 2007. Helicobacter pylori infection is associated with severe anemia of pregnancy on Pemba Island, Zanzibar. Am J Trop Med Hyg 76: 541548. [Google Scholar]
  28. WHO Expert Committee, 2002. Prevention and Control of Schistosomiasis and Soil-Transmitted Helminthiasis. Geneva: World Health Organization. [Google Scholar]
  29. Young SL, Wilson MJ, Hillier S, Delbos E, Ali SM, Stoltzfus R, , 2010. Differences and commonalities in physical, chemical, and mineralogical properties of Zanzibari geophagic soils. J Chem Ecol 36: 129140.[Crossref] [Google Scholar]
  30. Morris S, Carletto C, Hoddinott J, Christiaensen L, , 2000. Validity of rapid estimates of household wealth and income for health surveys in rural Africa. J Epidemiol Community Health 54: 381387.[Crossref] [Google Scholar]
  31. Izugbara CO, , 2003. The Cultural context of geophagy among pregnant and lactating Ngwa women of south eastern Nigeria. Am Anthropol 10: 180199. [Google Scholar]
  32. Luoba AI, Geissler PW, Estambale B, Ouma JH, Magnussen P, Alusala D, Ayah R, Mwaniki D, Friis H, , 2004. Geophagy among pregnant and lactating women in Bondo District, western Kenya. Trans R Soc Trop Med Hyg 98: 734741.[Crossref] [Google Scholar]
  33. Vermeer DE, , 1971. Geophagy among the ewe of Ghana. Ethnology 10: 5672.[Crossref] [Google Scholar]
  34. Thomson J, , 1997. Anaemia in pregnant women in eastern Caprivi, Namibia. S Afr Med J 87: 15441547. [Google Scholar]
  35. Antelman G, Msamanga G, Spiegelman D, Urassa E, Narh R, Hunter D, Fawzi W, , 2000. Nutritional factors and infectious disease contribute to anemia among pregnant women with human immunodeficiency virus in Tanzania. J Nutr 130: 19501957. [Google Scholar]
  36. Hunter JM, , 1993. Macroterme geophagy and pregnancy clays in southern Africa. J Cultural Geography 14: 6992.[Crossref] [Google Scholar]
  37. Adam I, Khamis AH, Elbashir MI, , 2005. Prevalence and risk factors for anaemia in pregnant women of eastern Sudan. Trans R Soc Trop Med Hyg 99: 739743.[Crossref] [Google Scholar]
  38. Knudsen J, , 2002. Akula udongo (Earth eating habit): a social and cultural practice among Chagga women on the slopes of Mount Kilimanjaro. Indilinga 1: 1926. [Google Scholar]
  39. Kawai K, Saathoff E, Antelman G, Msamanga G, Fawzi WW, , 2009. Geophagy (soil-eating) in relation to anemia and helminth infection among HIV-infected pregnant women in Tanzania. Am J Trop Med Hyg 80: 3643. [Google Scholar]
  40. Geissler P, Shulman C, Prince R, Mutemi W, Mnazi C, Friis H, Lowe B, , 1998. Geophagy, iron status and anaemia among pregnant women on the coast of Kenya. Trans R Soc Trop Med Hyg 92: 549553.[Crossref] [Google Scholar]
  41. Corbett R, Ryan C, Weinrich S, , 2003. Pica in pregnancy: does it affect pregnancy outcomes? MCN Am J Matern Child Nurs 28: 183189; quiz 190–191.[Crossref] [Google Scholar]
  42. Rainville AJ, , 1998. Pica practices of pregnant women are associated with lower maternal hemoglobin level at delivery. J Am Diet Assoc 98: 293296.[Crossref] [Google Scholar]
  43. Keith D, Keith L, Berger GS, Foot J, Webster A, , 1975. Amylophagia during pregnancy: some maternal and perinatal correlations. Mt Sinai J Med 42: 410414. [Google Scholar]
  44. Rowles-Sewing S, , 1981. “We're Made from Clay, It Won't Hurt Nobody”: A Cross-Cultural Study of Geophagia in Houston. Houston: Department of Anthroplology, University of Houston. [Google Scholar]
  45. Hunter JM, de Kleine R, , 1984. Geophagy in Central America. Geogr Rev 74: 157169.[Crossref] [Google Scholar]
  46. Ward P, Kutner NG, , 1999. Reported pica behavior in a sample of incident dialysis patients. J Ren Nutr 9: 1420.[Crossref] [Google Scholar]
  47. Kettaneh A, Eclache V, Fain O, Sontag C, Uzan M, Carbillon L, Stirnemann J, Thomas M, , 2005. Pica and food craving in patients with iron-deficiency anemia: a case-control study in France. Am J Med 118: 185188.[Crossref] [Google Scholar]
  48. Thomson J, , 1997. Anaemia in pregnant women in eastern Caprivi, Namibia. S Afr Med J 87: 15441547. [Google Scholar]
  49. Geissler P, Shulman C, Prince R, Mutemi W, Mnazi C, Friis H, Lowe B, , 1998. Geophagy, iron status and anaemia among pregnant women on the coast of Kenya. Trans R Soc Trop Med Hyg 92: 549553.[Crossref] [Google Scholar]
  50. Kawai K, Saathoff E, Antelman G, Msamanga G, Fawzi WW, , 2009. Geophagy (soil-eating) in relation to anemia and helminth infection among HIV-infected pregnant women in Tanzania. Am J Trop Med Hyg 80: 3643. [Google Scholar]
  51. Smulian J, Motiwala S, Sigman R, , 1995. Pica in a rural obstetric population. South Med J 88: 12361240.[Crossref] [Google Scholar]
  52. Wiley AS, Katz SH, , 1998. Geophagy in pregnancy: a test of a hypothesis. Curr Anthropol 39: 532545.[Crossref] [Google Scholar]
  53. Hunter JM, , 1973. Geophagy in Africa and in the United States: a culture-nutrition hypothesis. Geogr Rev 63: 170195.[Crossref] [Google Scholar]
  54. Hooda PS, Henry CJ, Seyoum TA, Armstrong LD, Fowler MB, , 2004. The potential impact of soil ingestion on human mineral nutrition. Sci Total Environ 333: 7587.[Crossref] [Google Scholar]
  55. Talkington KM, Gant NF, Scott DE, Pritchard JA, , 1970. Effect of ingestion of starch and some clays on iron absorption. Am J Obstet Gynecol 108: 262267.[Crossref] [Google Scholar]
  56. Wilson MJ, , 2003. Clay mineralogical and related characteristics of geophagic materials. J Chem Ecol 29: 15251547.[Crossref] [Google Scholar]
  57. Smith B, Rawlins B, Cordeiro M, Hutchins M, Tiberindwa J, Sserunjog IL, Tomkins A, , 2000. The bioaccessibility of essential and potentially toxic trace elements in tropical soils from Mukono District, Uganda. J Geol Soc London 157: 885891.[Crossref] [Google Scholar]
  58. Lukmanji Z, Hertzmark E, Mlingi N, Assey V, Ndossi G, Fawzi W, , 2008. Tanzania Food Composition Tables. Available at: http://www.hsph.harvard.edu/nutritionsource/files/tanzania-food-composition-tables.pdf. [Google Scholar]
  59. Hui YH, Smith RA, Spoerke DG, , 2001. Foodborne Disease Handbook. Volume 1. Diseases Caused by Bacteria. New York: Marcel Dekker, Inc. [Google Scholar]
  60. Hui YH, Smith RA, Spoerke DG, , 2001. Foodborne Disease Handbook. Volume 3. Plant Toxicants. New York: Marcel Dekker, Inc. [Google Scholar]
  61. Brouillard MY, Rateau JG, , 1989. Adsorption potency of 2 clays, smectite and kaolin on bacterial enterotoxins. In vitro study in cell culture and in the intestine of newborn mice [in French]. Gastroenterol Clin Biol 13: 1824. [Google Scholar]
  62. Dornai D, Mingelgrin U, Frenkel H, Bar-Joseph M, , 1993. Direct quantification of unadsorbed viruses in suspensions of adsorbing colloids with the enzyme-linked immunosorbent assay. Appl Environ Microbiol 59: 31233125. [Google Scholar]
  63. Barr M, , 1957. Adsorption studies on clays. II. The adsorption of bacteria by activated attapulgite, halloysite, and kaolin. J Am Pharm Assoc 46: 490492.[Crossref] [Google Scholar]
  64. Gonzalez R, De Medina FS, Martinez-Augustin O, Nieto A, Galvez J, Risco S, Zarzuelo A, , 2004. Anti-inflammatory effect of diosmectite in hapten-induced colitis in the rat. Br J Pharmacol 141: 951960.[Crossref] [Google Scholar]
  65. Gardiner KR, Anderson NH, McCaigue MD, Erwin PJ, Halliday MI, Rowlands BJ, , 1993. Adsorbents as antiendotoxin agents in experimental colitis. Gut 34: 5155.[Crossref] [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2010.09-0442
Loading
/content/journals/10.4269/ajtmh.2010.09-0442
Loading

Data & Media loading...

  • Received : 02 Aug 2009
  • Accepted : 08 Mar 2010

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error