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This study explored African migrant women's clay ingestion experiences during pregnancy against a backdrop of health risks warnings in order, to inform public health interventions by the UK Food Standards Agency and Public Health England, now known as the UK Health Security Agency. An interpretative phenomenological approach (IPA) was utilized, and data were collected with a total of 30 participants through individual in-depth interviews and one focus group discussion. Findings showed clay ingestion is a fluid and widely accepted cultural practice among African communities with most participants having been socialized into ingestion during childhood, through family influences and current social networks in their adulthood. Vomiting, nausea, spitting, appetite challenges, and cravings were cited as the main reasons for clay ingestion during pregnancy. With strong claims regarding its effectiveness, clay was ingested every day by most participants, and at times in large quantities despite the potential health risks. This calls for innovative and culturally sensitive public health interventions starting with the inclusion of clay ingestion health risk messages in maternal health nutrition information within antenatal settings. This can be done as part of multilevel interventions informed by life course approaches, which also consider community health messages and an enabling regulatory policy framework focusing on clay sold for human ingestion.

Background: Pica, the craving and purposeful consumption of nonfoods, is poorly understood. We described the prevalence of pica among women on Mfangano Island, Kenya, and examined sociodemographic and health correlates. Methods: Our cross-sectional study included 299 pregnant or postpartum women in 2012. We used a 24-h recall to assess pica, defined as consumption of earth (geophagy), charcoal/ash, or raw starches (amylophagy) and built multivariable logistic regression models to examine sociodemographic and health correlates of pica. Results: Eighty-one women (27.1%) engaged in pica in the previous 24 h, with 59.3% reporting amylophagy and 56.8% reporting geophagy, charcoal, and/or ash consumption. The most common substances consumed were raw cassava (n = 30, 36.6%), odowa, a chalky, soft rock-like earth (n = 21, 25.6%), and soil (n = 17, 20.7%). Geophagy, charcoal, and/or ash consumption was negatively associated with breastfeeding (OR = 0.38, 95% CI: 0.18-0.81), and amylophagy was associated with pregnancy (OR = 4.31, 95% CI: 1.24-14.96). Pica was more common within one of six study regions (OR = 3.64, 95% CI: 1.39-9.51). We found no evidence of an association between food insecurity and pica. Conclusion: Pica was a common behavior among women, and the prevalence underscores the need to uncover its dietary, environmental, and cultural etiologies.

Background: Geophagy is an ancestral practice particularly found among African women who describe beneficial effects on the sympathetic signs of pregnancy. Studies have reported a significant prevalence of consumption of kaolin, known as geophagy, within migrant population. However, this behavior, like other environmental factors, could lead to obstetrical and neonatal risks. Objective: The objective of our study was to evaluate the obstetrical and neonatal impact of kaolin consumption, especially on Z-SCORE for weight-for-gestational age in the newborn. Methods: This mono-centric historical cohort study was carried out on the basis of questionnaires and patients’ obstetrical records. It was conducted between January 1 and July 1, 2017. Patients were divided into two groups: 1) women who consumed kaolin (at least once during their pregnancy), and 2) women who did not consume kaolin. Morphometric characteristics of the newborn were retrieved in obstetrical records. Results: Results: 105 pregnant women were included: 26 exposed and 79 non exposed. Women who consumed kaolin were more frequently without social protection at their first consultation (p < .01). Multivariate analysis did not show a significant association between Z-SCORE for weight-for gestational age in the newborn and kaolin consumption (β = 0.13, p = .54) after adjusting on age, precariousness, BMI, intake of toxic substances, anemia and beginning eclampsia. Among these covariates, precariousness was significantly associated with both a decrease in Z-SCORE for weight (β = -0.87, p < .002) and size (β = -0.68, p < .01). Conclusion: Geophagy is not to be neglected in socially advantaged countries due to increased immigration. This study found no association between kaolin consumption and birth weight. However, there was a correlation between precariousness and low birth weight which reinforces the importance of tightening the follow-up during pregnancies in the most precarious women. [ABSTRACT FROM AUTHOR]

Objectives: The objective of study was to find out the frequency of pica in pregnant females attended for antenatal clinics in low-income population. This study also found association between pica and hemoglobin level among the low-income population. Method: This is a cross sectional study that was carried out at the department of gynecology and obstetrics of Liaquat college of Social Security hospital (LCSSH) for period of three months i.e., January 2020 to March 2020. Criteria for inclusion include belonging to low-income population with income per capita of less than 15000/Rs. Females of all parity between 18 and 45 years of age carrying single fetus with any gestational age and no co morbidities were included and those with food allergies, eating disorders, substance abuse or underlying mal absorption syndromes are excluded from the study. The total number of pregnant females (n=385) were selected using convenience non probability sampling technique. They inquire about pica practices, previous and family history of pica, reason of pica practice and type of pica substance consumed. Results: SPSS version 21 is used for data analysis purpose which indicates that of the 385 pregnant females, 174 (45%) were found to engaged with Pica activities with the p value of p<0.05. Commonest pica item consumed is Fullers clay (multani mitti) in 14.5 % followed by uncooked rice 5.5 %. Reason is likening of taste and smell of Fullers clay and crispy texture of rice for chewing. Significant association was found between pica behavior and low hemoglobin status p<0.05. Further analysis revealed statistically strong correlation between pica habit and previous history of pica p<0.00 and having family history of pica p<0.05 but association between pica and use of iron medications was not found statistically significant p>0.05. Conclusion: Pica is found to be a quite common practice with the frequency of around 45% in our population and significantly associated with anemia. Further work is required on large scale for proper screening of pregnant females for pica and its relationship with other nutritional deficiencies. [ABSTRACT FROM AUTHOR]

Although pica, the craving and purposive consumption of non-food substances, is common among many populations, especially during pregnancy, the health consequences are not well understood. Further, very little is known about pica among Mexican populations in the United States and Mexico. Therefore, we conducted formative research to understand pica in this understudied population. Our objectives were to identify the frequency and types of pica behaviours, to understand perceived aetiologies and consequences of pica and to ascertain if the behaviour was common enough to warrant a larger study. We held nine focus group discussions (three in the Salinas Valley, California; six in Xoxocotla, Morelos, Mexico) with 76 Mexican-born women who were currently pregnant or had delivered within the past 2 years. Earth, adobe, bean stones and ice were the most commonly reported pica substances. Twenty-eight of the 76 participants (37%) reported ever engaging in pica; 22 participants (29%) reported doing so during pregnancy. The proportion of women reporting pica in the United States and Mexico was 43% and 34%, respectively. Women attributed pica to the overwhelming organoleptic appeal of pica substances (especially smell and texture) and to micronutrient deficiencies. Perceived consequences of unfulfilled pica cravings were birthmarks or fetal loss; fulfilled pica cravings were also thought to be generally harmful to the mother or child, with several women specifying toxic lead, pesticides or 'worms'. In sum, pica among Mexican women is common enough to warrant a larger epidemiologic study of its sociodemographic correlates and physiological consequences.

The function of human geophagy has long been questioned. We sought to test hypotheses concerning its potential physiological effects through analysis of soils and patterns in geophagy behavior. Eleven samples of geophagic soils consumed by pregnant women on Pemba Island, Zanzibar, Tanzania, were characterized according to their color, texture, major element chemistry, trace element chemistry, bulk mineralogy, and clay mineralogy. An epidemiological study (N = 2367) and ethnographic interviews (N = 57) on Pemba yielded information about geophagic behaviors and socio-demographic and biological characteristics of those who consumed earth. The soils varied widely in color, ranging from light red to white through various shades of brown and yellow, and texture ranged from clay to sand. Major element chemistry of the soils also varied greatly; most were low in Fe and Ca. Trace elements, whether of biological or non-biological significance, were uniformly low when compared with normal ranges of mineral soils. The sole commonality among the samples is that all clay fractions were dominated by a kaolin mineral: kaolinite, halloysite, or a mixture of both. Geophagy behavior also varied greatly, with one major exception: a greater proportion of pregnant women (7.1%) and young children (4.5%) consumed earth than non-pregnant women (0.2%) or men (0%). The presence of kaolin mineral in all samples, its palliative and detoxifying properties, and the highest prevalence of geophagy among those most biologically vulnerable suggest that geophagy may be a protective behavior.

Pica is simply defined as the consumption of none food products such as laundry starch, clay dirt, ice, soap, and chalk. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies Pica as the habitual consumption of nonfood and non-nutritive substances for at least one year. Pica disorder is usually unnoticed, under-reported, causes serious harm to clients especially African American women, and seldom discussed in social work scholarship. It is, therefore, important to begin to sensitize social workers to the harmful effects of Pica, especially because it is often unrecognized and misdiagnoses can cause harm. This article provides a panoramic overview of Pica, the signs and symptoms of the disorder specifically among African American women and also address some of the adverse effects, and highlights some of the evidence-based effective treatment strategies. Finally, an urgent clarion call to social workers to conduct more research on Pica disorders among African American women is articulated. [ABSTRACT FROM AUTHOR]

Nausea is usually associated with early to late stages of pregnancy. Geophagy-deliberate consumption of soil is a common method of managing gravidae-induced discomfort. To control nausea, pregnant women in Nigeria commonly eat baked clay called “Eko” and another type of clay that induces buccal constriction called “Omumu”. The metal contents in Eko and Omumu, digested under different pH conditions (acidic, alkaline and neutral), were investigated using Inductively Coupled Plasma Optical Emission Spectroscopy (ICPS-OES). We identified and quantitate the elements present and speculate on their potential impact on maternal and fetal health upon gestational exposure beyond the acceptable exposure levels and the Millennium Contaminant Level Goals (MCLG) set by the United States Environmental Protection Agency (USEPA). Specifically, our result indicates unacceptably high levels of aluminum in Eko and Omumu (>10-fold greater than the highest desirable levels set by the USEPA). The aluminum concentrations were influenced by the pH condition in which the samples were digested. Dietary exposure to aluminum at such high levels may be deleterious to maternal health and fetal development. Therefore consumption of Eko and Omumu as an antidote to reduce nausea during pregnancy should be discouraged. Future studies are planned to investigate specific impacts on fetal and maternal health and likely teratogenicity in rodent models.

Objective: To investigate the relationship between prenatal geophagy, maternal prenatal haematological indices, malaria, helminth infections and cognitive and motor development among offspring.Methods: At least a year after delivery, 552 of 863 HIV-negative mothers with singleton births who completed a clinical trial comparing the efficacy of sulfadoxine-pyrimethamine and mefloquine during pregnancy in Allada, Benin, responded to a nutrition questionnaire including their geophagous habits during pregnancy. During the clinical trial, helminth infection, malaria, haemoglobin and ferritin concentrations were assessed at 1st and 2nd antenatal care visits (ANV) and at delivery. After the first ANV, women were administered daily iron and folic acid supplements until three what? post-delivery. Singleton children were assessed for cognitive function at age 1 year using the Mullen Scales of Early Learning.Results: The prevalence of geophagy during pregnancy was 31.9%. Pregnant women reporting geophagy were more likely to be anaemic (AOR = 1.9, 95% CI [1.1, 3.4]) at their first ANV if they reported geophagy at the first trimester. Overall, prenatal geophagy was not associated with maternal haematological indices, malaria or helminth infections, but geophagy during the third trimester and throughout pregnancy was associated with poor motor function (AOR = -3.8, 95% CI [-6.9, -0.6]) and increased odds of geophagous behaviour in early childhood, respectively.Conclusions: Prenatal geophagy is not associated with haematological indices in the presence of micronutrient supplementation. However, it may be associated with poor child motor function and infant geophagy. Geophagy should be screened early in pregnancy. [ABSTRACT FROM AUTHOR]

Objetivo: Evaluar mediante indicadores bioquímicos el estado nutricional del hierro y el zinc en mujeres con y sin diagnóstico de pica durante el embarazo. Metodología: Se seleccionaron 109 puérperas del Hospital Fiorito, Argentina. El diagnostico de pica se realizó en 42 de ellas, en tanto que 67 mujeres no refirieron el hábito. Mediante un contador hematológico se determinaron los valores de hemoglobina, volumen corpuscular medio, hemoglobina corpuscular media, concentración de hemoglobina corpuscular media y hematocrito. Los niveles de zinc en plasma y en eritrocito se determinaron mediante espectrofotometría de absorción atómica. Resultados: Las sustancias consumidas durante la práctica de pica fueron: hielo, tierra, papel, ladrillo, desinfectante y alimento para perros. Las mujeres con diagnóstico de pica tuvieron prevalencias más elevadas de antecedentes familiares de pica y antecedentes personales de pica en la infancia (OR: 15,9). Las características sociodemográficas, antropométricas y el peso del neonato fueron similares en ambos grupos, no obstante las mujeres con diagnóstico de pica tuvieron valores más bajos en el volumen corpuscular medio (p = 0,008) la hemoglobina corpuscular media (p = 0,009) y el zinc en eritrocito (p = 0,008). Aplicando un modelo de regresión logística, el zinc eritrocitario continuó asociado al diagnóstico de pica (p = 0,028). Conclusiones: Durante el puerperio, las mujeres que presentaron pica durante el embarazo pueden tener indicadores bioquímicos más bajos del estado nutricional del hierro y el zinc, por lo se sugiere que el diagnóstico temprano de pica puede ayudar a identificar deficiencias de micronutrientes.Objective: To evaluate by biochemical parameters iron and zinc nutritional status in women with and without pica diagnosis during pregnancy. Metodology: During puerperium 109 women were evaluated at Fiorito Hospital, Argentina. Pica diagnosis was made in 42 women while 67 did not refer the practice. Fasting blood samples were obtained and analyzed in a hematology analyzer for values of red blood cells, hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and hematocrit. Serum zinc and erythrocyte zinc was analyzed by atomic absorption spectrophotometry. Results: Substances consumed during pica practice were: earth, ice, brick, paper, desinfectant and dog food. Women with pica diagnosis had higher a rate of family history of pica and personal antecedents of pica in childhood (OR: 15.9). Sociodemographic and anthropometric characteristics and neonatal birth weight were similar between both groups, although women with pica diagnosis had lower values in mean corpuscular volume (p = 0,008), mean corpuscular hemoglobin (p = 0,009) and erythrocyte zinc (0,008). Applying a logistic regression model, erythrocyte zinc was the only biochemical indicator associated with pica practice (p = 0,028). Conclusiones: At puerperium, women with pica during pregnancy could have lower levels in biochemical parameters for iron and zinc status so we suggest that early diagnosis of pica could help to identify micronutrient deficient.

Geophagia is defined as deliberate consumption of earths' materials, e.g. soil, clay and soft stones. The practice is widespread among pregnant women, and there are conflicting views as to whether it is beneficial to health or not. Geophagic materials may be a source of micronutrients though the materials may bind the micronutrients thus reducing or hindering their bioavailability in the body. Geophagia is closely associated with geohelminthic infections among pregnant women and heavy metal poisoning, which constitute significant public health problem in many developing countries such as Kenya. In our research, the geophagic materials consumed by the pregnant women were studied. A total of 38 geophagic materials in the possession by different pregnant women were analysed. The collected samples were subjected to standard digestion procedures and analysed for zinc, lead and iron by atomic absorption spectroscopy. Results indicated that the geophagic materials contained elevated levels of Fe at mean concentration value of 80.10 ppm, Pb at 3.28 ppm and Zn 1.81 ppm for a 1.00 g sample. An average of 20 g of the geophagic materials was being consumed per day. Based on the average consumption, the pregnant women were exposed to 65.52 ppm Pb per day, 36.2 ppm Zn per day and 1602 ppm Fe per day. Lead exceeded the WHO-lead exposure limits of 25 ppm/day for pregnant women. The materials were also subjected to microscopic examination for Ascaris lumbricoides, Trichuris trichiura, Taenia Spp. , Necator americanus and Ancylostoma duodenale. In conclusion, the women were exposed to heavy metals-iron, zinc and lead, but there was no observable eggs, larvae or adult species of the geohelminths. The key recommendation was that there is need to integrate public health education on geophagia, lead screening and testing with antenatal support care systems. This will enhance maternal and child health, thus reducing infant and maternal morbidity and mortality rates. [ABSTRACT FROM AUTHOR]

Although pica, the craving and purposive consumption of non‐food substances, is common among many populations, especially during pregnancy, the health consequences are not well understood. Further, very little is known about pica among Mexican populations in the United States and Mexico. Therefore, we conducted formative research to understand pica in this understudied population. Our objectives were to identify the frequency and types of pica behaviours, to understand perceived aetiologies and consequences of pica and to ascertain if the behaviour was common enough to warrant a larger study. We held nine focus group discussions (three in the Salinas Valley, California; six in Xoxocotla, Morelos, Mexico) with 76 Mexican‐born women who were currently pregnant or had delivered within the past 2 years. Earth, adobe, bean stones and ice were the most commonly reported pica substances. Twenty‐eight of the 76 participants (37%) reported ever engaging in pica; 22 participants (29%) reported doing so during pregnancy. The proportion of women reporting pica in the United States and Mexico was 43% and 34%, respectively. Women attributed pica to the overwhelming organoleptic appeal of pica substances (especially smell and texture) and to micronutrient deficiencies. Perceived consequences of unfulfilled pica cravings were birthmarks or fetal loss; fulfilled pica cravings were also thought to be generally harmful to the mother or child, with several women specifying toxic lead, pesticides or ‘worms’. In sum, pica among Mexican women is common enough to warrant a larger epidemiologic study of its sociodemographic correlates and physiological consequences. [ABSTRACT FROM AUTHOR]

Written documentation concerning human consumption of non-food items and resulting health issues has a long history in medical records dating from shortly after the invention of the printing press. In modern times the legacy of possible ill or salubrious effects continues to exist concerning the consumption of such items as clay, raw starches, dirt, burned matches, and even lead paint samples. Such practices become more poignant when considering ingesting these substances during pregnancy, possibly endangering the health of women and their unborn fetuses. Although women and their partners discuss the subject of unusual cravings as commonplace during pregnancy, the substances on the list of odd cravings can be harmless to life threatening. Global scientific inquiry into the true nature of cravings and resulting consumption of the various materials listed as pica is not yet complete. [ABSTRACT FROM AUTHOR]

Background: Geophagy, a form of pica, is the deliberate consumption of soil and is relatively common across Sub-Saharan Africa. In Tanzania, pregnant women commonly eat soil sticks sold in the market (pemba), soil from walls of houses, termite mounds, and ground soil (kichuguu). The present study examined geophagy practices of pregnant women in a gold mining area of Geita District in northwestern Tanzania, and also examined the potential for exposure to chemical elements by testing soil samples. Method: We conducted a cross sectional study using a convenience sample of 340 pregnant women, ranging in age from 15-49 years, who attended six government antenatal clinics in the Geita District, Tanzania. Structured interviews were conducted in June-August, 2012, to understand geophagy practices. In addition, soil samples taken from sources identified by pregnant women practicing geophagy were analysed for mineral element content. Results: Geophagy was reported by 155 (45.6%) pregnant women with 85 (54.8%) initiating the practice in the first trimester. A total of 101 (65%) pregnant women reported eating soil 2 to 3 times per day while 20 (13%) ate soil more than 3 times per day. Of 155 pregnant women 107 (69%) bought pemba from local shops, while 48 (31%) consumed ground soil kichuguu. The estimated mean quantity of soil consumed from pemba was 62.5 grams/day. Arsenic, chromium, copper, iron, manganese, nickel and zinc levels were found in both pemba and kichuguu samples. Cadmium and mercury were found only in the kichuguu samples. Based on daily intake estimates, arsenic, copper and manganese for kichuguu and copper and manganese for pemba samples exceed the oral Minimum Risk Levels designated by the U.S. Agency for Toxic Substance and Disease Registry. Conclusion: Almost 50% of participants practiced geophagy in Geita District consistent with other reports from Africa. Both pemba and kichuguu contained chemical elements at varying concentration, mostly above MRLs. As such, pregnant women who eat soil in Geita District are exposed to potentially high levels of chemical elements, depending upon frequency of consumption, daily amount consumed and the source location of soil eaten. [ABSTRACT FROM AUTHOR]

Abstract: Geophagy, the practice of consuming clay or soil, is encountered among pregnant women in Africa, Eastern Asia and Latin America, but also in Western societies. However, certain types of clay are known to contain high concentrations of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs). The aim of this study was to determine the PCDD/F contents of orally consumed clays purchased from Dutch and African markets. Congener patterns were compared with those of pooled human milk samples collected in eight African countries, to investigate a possible relationship with clay consumption. From the Dutch market thirteen clay products were examined, seven of African and six of Suriname origin. From seven African countries, twenty clay products were collected. All 33 clay products were screened with a cell-based bioassay and those showing a high response were analyzed by GC/HRMS. High PCDD/F concentrations were measured in three clay products from the Dutch market, ranging from 66 to 103 pg TEQ g-1, whereas clay products from African countries were from 24 to 75 pg TEQ g-1. Patterns and relatively high concentrations of PCDD/Fs in human milk samples from the Democratic Republic of the Congo and Côte d’Ivoire suggest a relationship with the consumption of contaminated clay. Frequent use of PCDD/F contaminated clay products during pregnancy may result in increased exposure of the mother and subsequently the developing fetus and new-born child. The use of these contaminated clays during pregnancy should be carefully considered or even discouraged. [Copyright &y& Elsevier]

Pica, the craving and purposive consumption of non-food substances, is of public health concern for its potential deleterious and salubrious health consequences. However, neither its prevalence nor demographic correlates have been well characterized. Therefore, we conducted the first population-based study of pica and amylophagy in Madagascar. From February to December 2009, we surveyed pica and amylophagy behaviors in a random sample of 760 individuals >5 years in 167 households among two ethnic groups in 16 villages in the Makira Protected Area of Madagascar. Of the 760 individuals interviewed, 62.5% were children (5-11 years), 5.4% were adolescents (12-16 years), and 35.1% were adults (≥17 years). Thirteen non-food items were reported being consumed. Across the entire population in the prior year, the prevalence of geophagy was 53.4%, of amylophagy, 85.2%, and of other pica substances (e.g. charcoal, chalk) was 19.0%. The prevalence of these behaviors was not higher during pregnancy. These findings differ from previous studies in terms of the higher overall prevalence of these behaviors, the high prevalence among men, and the absence of any peak in behaviors during pregnancy. However, there are two categories of substances that elevate our estimates but fall outside the strict definition of pica as a craving: 1) substances consumed for self-medication and 2) substances viewed as food, such as all amylophagic substances in this case. Our results suggest that population-based studies of pica should include males of all ages. Further, the prevalence of the behavior underscores the importance of understanding the etiology and health consequences of these ingestive behaviors (Abstract S1). [ABSTRACT FROM AUTHOR]

Objective: To evaluate by biochemical parameters iron and zinc nutritional status in women with and without pica diagnosis during pregnancy. Methodology: During puerperium 109 women were evaluated at Fiorito Hospital, Argentina. Pica diagnosis was made in 42 women while 67 did not refer the practice. Fasting blood samples were obtained and analyzed in a hematology analyzer for values of red blood cells, hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and hematocrit. Serum zinc and erythrocyte zinc was analyzed by atomic absorption spectrophotometry. Results: Substances consumed during pica practice were: earth, ice, brick, paper, disinfectant and dog food. Women with pica diagnosis had higher a rate of family history of pica and personal antecedents of pica in childhood (OR: 15.9). Sociodemographic and anthropometric characteristics and neonatal birth weight were similar between both groups, although women with pica diagnosis had lower values in mean corpuscular volume (p = 0,008), mean corpuscular hemoglobin (p = 0,009) and erythrocyte zinc (0,008). Applying a logistic regression model, erythrocyte zinc was the only biochemical indicator associated with pica practice (p = 0,028). Conclusions: At puerperium, women with pica during pregnancy could have lower levels in biochemical parameters for iron and zinc status so we suggest that early diagnosis of pica could help to identify micronutrient deficient. [ABSTRACT FROM AUTHOR]

Geophagy has been hypothesized to be an adaptive behavior, either as a means to allay nutrient deficiency or to protect against ingested pathogens and toxins. Others have proposed that geophagy is non-adaptive, occurring either to allay hunger or as an epiphenomenon of nutrient deficiencies. This paper evaluates these hypotheses using 482 published cultural-level accounts of human geophagy and 330 accounts of geophagy among 297 species of mammals, birds, and reptiles. Information was extracted from reports of human geophagy to permit statistical analysis; reports of non-human geophagy were tabulated. Human geophagy did not parallel changes in nutrient requirements, occurred most frequently among children and pregnant women and in tropical areas (where pathogen densities are highest), and was associated with ingestion of toxic substances and gastrointestinal distress. Earth ingested by humans was craved and carefully selected and prepared; it had high clay content, but few bioavailable mineral nutrients. In primates, geophagy was associated with both protection from toxins and obtaining nutrients, whereas in other vertebrates it was associated mainly with obtaining nutrients. Our results indicate that human geophagy is best explained as providing protection from dietary chemicals, parasites, and pathogens, whereas animal geophagy may involve both micronutrient acquisition and protection. [ABSTRACT FROM AUTHOR]

as soil and clay. Common among pregnant women in rural, tropical areas, it is culturally accepted within some societies and stigmatized within others. There is no scientific consensus on the effects of geophagy on human health. This study was developed as a comprehensive diagnostic to assess the causes, social aspects and potential health impacts of geophagy among pregnant women in rural Panama. Methods: Private, structured interviews (n=41) were carried out with women in ten subsistence community farms in the province of Veraguas and the Ngöbe-Bugle Comarca. Additional interviews with healthcare workers were conducted at nearby healthcare facilities. Five soil samples were collected in locations indicated by confirmed geophagists, subjected to simulated human digestion and analyzed for mineral composition and parasite eggs. Results: There is no cultural or religious element to the practice; rather it seems to be driven by physiological desires tied to the smell of the material. Prevalence is higher among women with lower education levels and poorer nutritional status suggesting that the practice is associated with low socioeconomic status. Soil analysis did not indicate presence of parasites, but there are potential nutritional benefits of the practice by providing essential minerals missing in the diet. Discussion: We find that geophagy in Panama may offer nutritional benefits. However, without a clearer understanding of specific effects of soil in the gastrointestinal tract, it is difficult to determine direct biophysical impacts of geophagy [ABSTRACT FROM AUTHOR]

Pica, the purposive consumption of nonfood substances, is a millennia-old nutritional enigma. Its worldwide ubiquity, prevalence among pregnant women and children, and association with both positive and negative health outcomes, especially micronutrient deficiencies, underscore the importance of understanding this behavior. Multiple proposed etiologies of pica are reviewed, including cultural expectations, psychological stress, hunger, dyspepsia, micronutrient deficiencies (Fe, Zn, and Ca), and protection against toxins and pathogens. Currently available data, although limited, best support the protection hypothesis as a cause of most types of pica, although some evidence suggests that pagophagy (ice consumption) may occur during iron deficiency. It is possible that the binding capacity of pica substances explains the association with micronutrient deficiencies; earth, starch, etc. may render micronutrients in ingesta unavailable for absorption. Increased research efforts are warranted and must be hypothesis driven, interdisciplinary, and permit the testing of multiple causal inferences. [ABSTRACT FROM AUTHOR]

We 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 withAscaris lumbricoides, 670 withTrichuris trichiuraand 479 with hookworm. At delivery, 11.2%, 4.6% and 3.8% of these women were reinfected with hookworm,T. trichiuraandA. lumbricoidesrespectively. The reinfection rate for hookworm was 14.8%, forT. trichiura6.65, and forA. lumbricoides5.2% 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 = 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 = 0.07 andP = 0.02 respectively). There were significant differences in the prevalence ofA. lumbricoidesbetween geophagous and non-geophagous women at 3 (P = 0.001) and at 6 months postpartum (P = 0.001). Women who ate termite mound earth had a higher prevalence ofA. lumbricoides, compared with those eating other kinds of earth, at delivery (P = 0.02), 3 months postpartum (P = 0.001) and at 6 months postpartum (P = 0.001). The intensity of infections withT. trichiuraat 6 months postpartum was significantly different between geophagous and non-geophagous women (P = 0.005). Our study shows that geophagy is associated withA. lumbricoidesreinfection among pregnant and lactating women and that intensities built up more rapidly among geophagous women. Geophagy might be associated with reinfection with hookworm andT. 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. [ABSTRACT FROM AUTHOR]

Geophagy was studied among 827 pregnant women in western Kenya, during and after pregnancy. The women were recruited at a gestational age of 14–24 weeks and followed-up to 6 months post-partum. The median age (range) of the women was 23 years and median parity 2. At recruitment, 378 were eating earth, of which most (65%) reported earth-eating before pregnancy. The preferred type of earth eaten was soft stone, known locally as odowa (54.2%) and earth from termite mounds (42.8%). The prevalence remained high during pregnancy, and then declined to 34.5% and 29.6% at 3 and 6 months post-partum respectively (P < 0.001). The mean daily earth intake was 44.5 g during pregnancy, which declined to 25.5 g during lactation (P < 0.001). A random sample of 204 stools was collected from the women and analysed for silica content as a tracer for earth-eating. The mean silica content was 2.1% of the dry weight of stool. Geophagous women had a higher mean silica content than the non-geophagous ones (3.1% vs. 1.4%, P < 0.001). Faecal silica and reported geophagy were strongly correlated (P < 0.001). [Copyright &y& Elsevier]