Article

Geophagy During Pregnancy in Africa: A Literature Review

International Masters in Public Health Program, Hebrew University Braun School of Public Health, Jerusalem, Israel.
Obstetrical & gynecological survey (Impact Factor: 1.86). 07/2011; 66(7):452-9. DOI: 10.1097/OGX.0b013e318232a034
Source: PubMed

ABSTRACT

Geophagy is a form of pica characterized by craving and eating of soil. The main materials ingested include anthill soils and soft stone. In this review, our objectives were to study the prevalence of geophagy in pregnancy (GiP), establish the risk factors for GiP, assess the effects of GiP on pregnancy outcomes, and recommend possible interventions for reducing GiP. PREVALENCE: Geophagy among pregnant women is common in many cultures. In some African countries, GiP prevalence of up to 84% has been observed. In Nigeria, the most populous country in Africa, the prevalence of GiP is estimated at 50%. The practice has been associated with religious practice, culture, and famine. RISKS: It is postulated that GiP is due to micronutrient deficiencies, cultural influences, and gastrointestinal upsets. Despite their potential to supply micronutrients, soils interfere with bioavailability of micronutrients leading to micronutrient deficiency and can also act as a pathway for ingestion of geohelminths and heavy metals, putting woman and fetus at risk. GAPS: Despite its association with anemia, pregnancy, and micronutrients, many antenatal care guidelines or National guidelines on micronutrient deficiency control are silent on GiP. The guidelines generally recommend iron supplementation and deworming of pregnant women as anemia control measures. However, not all women seek antenatal services; hence, there is need for more innovative ways of addressing micronutrient deficiencies in pregnancy.
It is imperative to enquire whether pregnant women are geophagous and discourage geophagy, strengthen and expand the existing supplementation programs, and mandate flour fortification to enhance population-wide iron supply and safer pregnancies.
Obstetricians & Gynecologists and Family Physicians.
After completing this CME activity, physicians should be better able to analyze the prevalence of GiP, identify the risk factors for GiP, and assess the effects of GiP on pregnancy outcomes. In addition to propose remedial interventions for reducing GiP.

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    • "Géophagie et grossesse : état des connaissances et conduite à tenir 3 de jeunes enfants, et certains malades (insuffisants rénaux, malades mentaux) ; elle demeure cependant très pratiquée par des migrantes non caucasiennes (asiatiques au Royaume Uni, africaines en France) 2—5. Sa prévalence reste mal connue et n'a été étudiée que sur des échantillons restreints : elle est très variable selon la composition sociale et ethnique de la population allant de 71 % des femmes enceintes Zaïroises à moins de un pour cent de celles du Danemark [5] [6]. "
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    ABSTRACT: Objective To provide an overview of the current state of knowledge concerning the determinants and consequences of geophagy during pregnancy. Method Bibliographic searching of articles published in English or French and included in the Scopus database, and reporting of our experience with the management of geophagic pregnant women at the maternity unit of Saint-Laurent-du-Maroni (French Guiana). Results Geophagy is a little known practice initiated by various stimuli, including nausea and iron deficiency. Sustained geophagy during pregnancy has many consequences, due to complex ionic interactions with the digestive tract. Clay consumption may lead to iron deficiency, which may even be life-threatening in cases of post-partum haemorrhage in severely anaemic women. For the foetus, in addition to the known risk of preterm birth associated with maternal anaemia, maternal geophagy may lead to overexposure to heavy metals, including aluminium in particular. This practice should therefore be considered potentially damaging to the neurological development of the child. The ionic imbalances caused by the ingestion of clay over a long period should be systematically evaluated and corrected, given the secondary malabsorption they may cause, often necessitating parenteral feeding.
    Full-text · Article · Sep 2014
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    • "Geophagy, the deliberate consumption of soil, is prevalent among pregnant women across Sub-Saharan African countries, such as Kenya, Ghana, Rwanda, Nigeria, Tanzania, and South Africa [1-9]. The prevalence of geophagy varies between and within countries, but is estimated between 10-75% [3-5,7]. It is likely that underreporting of geophagy occurs, for a variety of reasons, including embarrassment regarding the behavior, lack of knowledge and sensitive questioning on the part of investigator inquiring about geophagy and differing perceptions, beliefs, and cultural norms [4,10]. "
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    ABSTRACT: 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. 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. 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. 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.
    Full-text · Article · Apr 2014 · BMC Pregnancy and Childbirth
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    • "Géophagie et grossesse : état des connaissances et conduite à tenir 3 de jeunes enfants, et certains malades (insuffisants rénaux, malades mentaux) ; elle demeure cependant très pratiquée par des migrantes non caucasiennes (asiatiques au Royaume Uni, africaines en France) 2—5. Sa prévalence reste mal connue et n'a été étudiée que sur des échantillons restreints : elle est très variable selon la composition sociale et ethnique de la population allant de 71 % des femmes enceintes Zaïroises à moins de un pour cent de celles du Danemark [5] [6]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To provide an overview of the current state of knowledge concerning the determinants and consequences of geophagy during pregnancy. Bibliographic searching of articles published in English or French and included in the Scopus database, and reporting of our experience with the management of geophagic pregnant women at the maternity unit of Saint-Laurent-du-Maroni (French Guiana). Geophagy is a little known practice initiated by various stimuli, including nausea and iron deficiency. Sustained geophagy during pregnancy has many consequences, due to complex ionic interactions with the digestive tract. Clay consumption may lead to iron deficiency, which may even be life-threatening in cases of post-partum haemorrhage in severely anaemic women. For the foetus, in addition to the known risk of preterm birth associated with maternal anaemia, maternal geophagy may lead to overexposure to heavy metals, including aluminium in particular. This practice should therefore be considered potentially damaging to the neurological development of the child. The ionic imbalances caused by the ingestion of clay over a long period should be systematically evaluated and corrected, given the secondary malabsorption they may cause, often necessitating parenteral feeding.
    Full-text · Article · Jul 2013 · Journal de Gynécologie Obstétrique et Biologie de la Reproduction
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