Heavy metals and parasitic geohelminths toxicity among geophagous pregnant women: a case study of Nakuru Municipality, Kenya

Trace elements in Foodstuffs from the Mediterranean Basin-Occurrence, Risk Assessment, Regulations, and Prevention strategies: A review

Trace elements (TEs) are chemical compounds that naturally occur in the earth's crust and in living organisms at low concentrations. Anthropogenic activities can significantly increase the level of TEs in the environment and finally enter the food chain. Toxic TEs like cadmium, lead, arsenic, and mercury have no positive role in a biological system and can cause harmful effects on human health. Ingestion of contaminated food is a typical route of TEs intake by humans. Recent data about the occurrence of TEs in food available in the Mediterranean countries are considered in this review. Analytical methods are also discussed. Furthermore, a discussion of existing international agency regulations will be given. The risk associated with the dietary intake of TEs was estimated by considering consumer exposure and threshold values such as Benchmark dose lower confidence limit and provisional tolerable weekly intake established by the European Food Safety Authority and the Joint FAO/WHO Expert Committee on Food Additives, respectively. Finally, several remediation approaches to minimize TE contamination in foodstuffs were discussed including chemical, biological, biotechnological, and nanotechnological methods. The results of this study proved the occurrence of TEs contamination at high levels in vegetables and fish from some Mediterranean countries. Lead and cadmium are more abundant in foodstuffs than other toxic trace elements. Geographical variations in TE contamination of food crops clearly appear, with a greater risk in developing countries. There is still a need for the regular monitoring of these toxic element levels in food items to ensure consumer protection.

The Neurology and Psychopathology of Pica

PURPOSE OF REVIEW

Pica is defined by the American Psychiatric Association's Diagnostic and Statistical Manual, 5th edition (DSM 5) as the ongoing ingestion of materials with no nutritive or food value. More specifically such ingestions must be unremitting for at least 1 month and occur at a developmentally inconsistent age for such behavior. This article reviews the association of pica with pregnancy, micronutrient deficiencies, psychiatric disorders, dementia, and developmental disorders with emphasis on autism spectrum disorders (ASD).

RECENT FINDINGS

Some variants of non-nutritive consumption are prevalent behavioral norms in non-western cultures, so not all picas should be considered pathological. However, the strong association of pica with iron deficiency anemia (IDA) lends credence to the hypothesis that dopamine transmission may be disrupted in this disorder. Picas associated with ASD are resistant to medications but can be treated with applied behavioral analysis therapy (ABA). Etiological hypotheses for pica are explored with a focus on neurobiological, neuroimaging, and psychiatric correlations. Pharmacological management and behavior modification strategies are also discussed. The possibility that pica is a form of addiction analogous to food cravings is introduced and suggested as an area for further research pursuits.

Geophagic Materials Characterization and Potential Impact on Human Health: The Case Study of Maputo City (Mozambique)

This study aims to characterize and estimate risk assessment associated with geophagic materials consumption in Maputo city (Mozambique). Samples were collected in extraction mines, unprepared and prepared ones, and in Maputo markets. Fractions < 2 mm (total consumed material) and <63 μm were analyzed to determine pH, EC, OM, chemical composition (XRF), and mineral phases present (XRD). The results revealed pH from slightly acidic to slightly alkaline, and electrical conductivity ranging from 13 to 47 μS/cm in mine unprepared and prepared samples, while 264–465 μS/cm in sampled sold in markets. Organic matter content was <2.76%, except in one sample (8.14%), suggesting a potential risk of containing bacteria. Textural analysis revealed that sand-size particles were more representative in all samples (57.2–93.02%). Mineralogical phases identified in the consumed sample were ranked quartz (>60%) > Fe oxides/hidroxides > phyllosilicates (micas and kaolinite) > feldspars, suggesting a risk of dental enamel damage and perforation of the sigmoid colon. The chemical concentration of some elements was higher than recommended daily dose, suggesting a potential risk. However, geophagic materials’ chemical composition does not pose a carcinogenic risk.

Prevalence, risk factors and adverse pregnancy outcomes of second trimester bacterial vaginosis among pregnant women in Bukavu, Democratic Republic of the Congo

BACKGROUND

Bacterial vaginosis (BV) is the most common gynecological condition in women of reproductive age and associated with adverse pregnancy outcomes. In the Democratic Republic of the Congo (DRC), neonatal mortality rate is as high as 2.8 percent with preterm birth (PTB) and low birth weight (LBW) as leading causes. Because no studies have addressed BV in DRC, we aimed to investigate the prevalence of BV, the risk factors and the association between BV and adverse pregnancy outcomes in a population of pregnant women from Bukavu, DRC.

METHODS

A total of 533 pregnant women in the second trimester of pregnancy were recruited in the Provincial Reference Hospital of Bukavu, DRC, between January and October 2017, and followed until delivery. Clinical and sociodemographic data of mother and newborn, and data on (vaginal) hygiene practices, sexual behavior and reproductive history were collected. BV was diagnosed by Nugent scoring of Gram-stained vaginal smears. Two multivariate regression models were built to identify risk factors for BV and to investigate BV as a risk factor for adverse pregnancy outcomes.

RESULTS

The prevalence of BV was 26.3% and approximately half of the women with BV were asymptomatic. Independent risk factors for BV were the use of alternatives to water for intravaginal washing, concurrent partners, unemployed status, the presence of vaginal Candida and clay consumption. BV was independently associated with both LBW and PTB of an infant with LBW.

CONCLUSION

The prevalence of BV in Bukavu is high but in line with the global average. BV was associated with adverse pregnancy outcomes in our study population. Hence, research on modifiable risk factor-based interventions to reduce the prevalence of BV, and on screening/treatment of BV during antenatal care should be explored to reduce neonatal mortality and morbidity.

Geophagic Clays from Cameroon: Provenance, Metal Contamination and Health Risk Assessment

This study assessed the mineralogical and geochemical characteristics of geophagic clays sold in some markets in Cameroon to ascertain their provenance, contamination status and human health risk. To achieve this, 40 samples from 13 markets in Cameroon were purchased and analysed using X-ray diffractometry, X-ray fluorescence and laser ablation inductively coupled plasma mass spectrometry for their mineralogy and geochemistry, respectively. The geophagic clays were dominantly made up of kaolinite and quartz. Their chemistry was dominated by SiO₂, Al₂O₃ and LOI with means of 48.76 wt%, 32.12 wt% and 13.93 wt%, respectively. The major, trace and rare earth elements data showed that these geophagic clays were predominantly derived from felsic rocks. The contamination assessment indicated no enrichment of metals from anthropogenic sources, except for Zn in samples from Acacia, Madagascar and Mfoudi markets. The index of geo-accumulation indicated no contamination to moderate contamination of the clays. The non-carcinogenic index values for Fe, Co, Cr, Cu, Ni, Pb and Zn were generally less than 1, suggesting no non-carcinogenic risk exposure to children and adults consuming the geophagic clays from these metals. The carcinogenic risk index (TCR) for Ni and Cr were above 10⁻⁶, which implies that children and adults are vulnerable to minimal carcinogenic health risk. The TCR values from Ni posed the highest risk, especially to children consuming clays from some markets.

Seven potential sources of arsenic pollution in Latin America and their environmental and health impacts

This review presents a holistic overview of the occurrence, mobilization, and pathways of arsenic (As) from predominantly geogenic sources into different near-surface environmental compartments, together with the respective reported or potential impacts on human health in Latin America. The main sources and pathways of As pollution in this region include: (i) volcanism and geothermalism: (a) volcanic rocks, fluids (e.g., gases) and ash, including large-scale transport of the latter through different mechanisms, (b) geothermal fluids and their exploitation; (ii) natural lixiviation and accelerated mobilization from (mostly sulfidic) metal ore deposits by mining and related activities; (iii) coal deposits and their exploitation; (iv) hydrocarbon reservoirs and co-produced water during exploitation; (v) solute and sediment transport through rivers to the sea; (vi) atmospheric As (dust and aerosol); and (vii) As exposure through geophagy and involuntary ingestion. The two most important and well-recognized sources and mechanisms for As release into the Latin American population's environments are: (i) volcanism and geothermalism, and (ii) strongly accelerated As release from geogenic sources by mining and related activities. Several new analyses from As-endemic areas of Latin America emphasize that As-related mortality and morbidity continue to rise even after decadal efforts towards lowering As exposure. Several public health regulatory institutions have classified As and its compounds as carcinogenic chemicals, as As uptake can affect several organ systems, viz. dermal, gastrointestinal, peptic, neurological, respiratory, reproductive, following exposure. Accordingly, ingesting large amounts of As can damage the stomach, kidneys, liver, heart, and nervous system; and, in severe cases, may cause death. Moreover, breathing air with high As levels can cause lung damage, shortness of breath, chest pain, and cough. Further, As compounds, being corrosive, can also cause skin lesions or damage eyes, and long-term exposure to As can lead to cancer development in several organs.

Effect of industrial wastewater on wheat germination, growth, yield, nutrients and bioaccumulation of lead

Due to fresh water scarcity, farmers are using polluted water for irrigation. This research was conducted to study the bioaccumulation of Pb in wheat (Cv. Shafaq-2006). The experiment was comprised of seven treatments of lead i.e. 0–1,000 mg Pb/kg. The results revealed that lead severely reduces germination (− 30%), seedling fresh weight (− 74%), seedling dry weight (− 77%), vigor index (− 89%), tolerance index (− 84%), plant height (− 33%), number of leaves (− 41%), root fresh weight (− 50%), shoot fresh weight (− 62%), root dry weight (− 63%), shoot dry weight (− 71%), and root length (− 45%). The physiological parameters also respond negatively like stomatal conductance (− 82%), transpiration rate (− 72%) and photosynthetic rate (− 74%). Similarly, biochemical parameters also showed negative impacts, like carotenoids (− 41), total chlorophyll (− 43), chlorophyll a (− 42) and chlorophyll b (− 53). Yield parameters like the number of seed/plant, seed weight/plant, 1,000 seed weight and harvest index were reduced by 90%, 88%, 44% and 61%, respectively in T₆. In addition, protein contents (− 81%), phosphorous (− 60%) and potassium (− 55%) were highly effected in the highest lead concentration (T₆). Lead accumulation was extremely higher in seeds (119%) as compared to control plants. Lead bio-accumulation above threshold concentrations in crop parts is a serious human health concern.

Agnathia otocephaly: A case from the Katanga Copperbelt

BACKGROUND

Agnathia otocephaly is a rare craniofacial malformation complex characterised by absent/hypoplastic mandible, abnormally positioned ears meeting at level of neck. Besides mutations in two genes, PRRX1 and OTX2, a teratogenic cause has been suggested. A higher risk of congenital malformations has been associated with paternal work in mining in the Democratic Republic of the Congo's part of the Copperbelt.

CASE

We studied a female neonate with a clinical diagnosis of agnathia otocephaly, stillborn in Lubumbashi in 2019. The child's father had been working as an artisanal mineworker at the time of conception.

RESULTS

Genetic analysis did not reveal a causal mutation. The concentrations of cobalt, arsenic cadmium, and uranium in cord blood of the infant were much higher than those of normal neonates from a previous study.

CONCLUSION

In the absence of identified genetic causes, we hypothesize this case of agnathia otocephaly was related to an exogenous cause, possibly the father's mining-related job.

Occurrence, behaviour, and human exposure pathways and health risks of toxic geogenic contaminants in serpentinitic ultramafic geological environments (SUGEs): A medical geology perspective

Serpentinitic ultramafic geological environments (SUGEs) contain toxic geogenic contaminants (TGCs). Yet comprehensive reviews on the medical geology of SUGEs are still lacking. The current paper posits that TGCs occur widely in SUGEs, and pose human health risks. The objectives of the review are to: (1) highlight the nature, occurrence and behaviour of TGCs associated with SUGEs; (2) discuss the human intake pathways and health risks of TGCs; (4) identify the key risk factors predisposing human health to TGCs particularly in Africa; and (5) highlight key knowledge gaps and future research directions. TGCs of human health concern in SUGEs include chrysotile asbestos, toxic metals (Fe, Cr, Ni, Mn, Zn, Co), and rare earth elements. Human intake of TGCs occur via inhalation, and ingestion of contaminated drinking water, wild foods, medicinal plants, animal foods, and geophagic earths. Occupational exposure may occur in the mining, milling, sculpturing, engraving, and carving industries. African populations are particularly at high risk due to: (1) widespread consumption of wild foods, medicinal plants, untreated drinking water, and geophagic earths; (2) weak and poorly enforced environmental, occupational, and public health regulations; and (3) lack of human health surveillance systems. Human health risks of chrysotile include asbestosis, cancers, and mesothelioma. Toxic metals are redox active, thus generate reactive oxygen species causing oxidative stress. Dietary intake of iron and geophagy may increase the iron overload among native Africans who are genetically predisposed to such health risks. Synergistic interactions among TGCs particularly chrysotile and toxic metals may have adverse human health effects. The occurrence of SUGEs, coupled with the several risk factors in Africa, provides a unique and ideal setting for investigating the relationships between TGCs and human health risks. A conceptual framework for human health risk assessment and mitigation, and future research direction are highlighted.

Removal of heavy metals from water sources in the developing world using low-cost materials: A review

Heavy metal contamination is a growing concern in the developing world. Inadequate water and wastewater treatment, coupled with increased industrial activity, have led to increased heavy metal contamination in rivers, lakes, and other water sources in developing countries. However, common methods for removing heavy metals from water sources, including membrane filtration, activated carbon adsorption, and electrocoagulation, are not feasible for developing countries. As a result, a significant amount of research has been conducted on low-cost adsorbents to evaluate their ability to remove heavy metals. In this review article, we summarize the current state of research on the removal of heavy metals with an emphasis on low-cost adsorbents that are feasible in the context of the developing world. This review evaluates the use of adsorbents from four major categories: agricultural waste; naturally-occurring soil and mineral deposits; aquatic and terrestrial biomass; and other locally-available waste materials. Along with a summary of the use of these adsorbents in the removal of heavy metals, this article provides a summary of the influence of various water-quality parameters on heavy metals and these adsorbents. The proposed adsorption mechanisms for heavy metal removal are also discussed.

High prevalence of kaolin consumption in migrant women living in a major urban area of France: A cross-sectional investigation

Geophagia is a feeding behavior involving the regular intake of soil, including clay-like kaolin. Frequent in Africa, kaolin consumption is associated with heavy metal intoxication, iron and other micronutrient deficiencies, geohelminth infection and inactivation of concomitantly taken drugs. It is expected that this practice would be imported into an asylum country during the immigration process. To confirm this hypothesis, a single center, cross-sectional study was conducted at the University Hospital of Nantes, France, whose main objective was to assess whether the prevalence of kaolin consumers was high in a migrant population living in a large French metropolitan area (the city of Nantes). Each woman consulting for the first time at the Medical and Psychosocial Gynecology Obstetric Unit during the inclusion period ranging from January 1, 2017, to July 1, 2017, was asked for consent to be included in the study. The main outcome was the proportion of positive answers regarding consumption of kaolin within the last twelve months, with its 95% confidence interval (CI). A logistic regression was performed to identify drivers of consumption, and a clustering approach was conducted to identify profiles of consumers. A total of 284 women were included in the study, of whom 110 (38.7%) were pregnant. Our main finding was a 14.1% (95% CI: 10.5-18.6) prevalence of clay consumers. Second, the characteristic most strongly associated with consumption was Central or West Africa origin (adjusted Odds Ratio (aOR) = 52.7; 95% CI: 13.7-202.2). Finally, 60% of consumers showed signs of addictive-like phenomena, and three profiles were identified, depicting a continuum of patients in regard to their control over their kaolin consumption. Our results suggest that kaolin consumption is frequent in particular subpopulations of migrants. This warrants further study of the clinical consequences of kaolin consumption and its associated addictive-like symptoms.

The sources and chemical content of edible soil sticks sold in markets in Tanzania: a cross-sectional analytical study

Geophagy, or eating soil, is common in various countries including Tanzania. Studies have reported on the levels of different chemicals in consumed soil, some of which can be harmful to the health of individuals practicing geophagy. Dried soil sticks for eating, referred to as pemba, are commercially available in many markets in sub-Saharan Africa, but few studies have established the sources of the soils. The purpose of the current study was to: (1) systematically document the sources of the soils used in pemba commonly sold in regional markets throughout Tanzania using a global positioning system (GPS) to establish the supply chain flow of pemba to markets, and (2) assess the chemical element content of the soil sources for both water-extractable chemical element (WEC) and total chemical element (TC) contents. Surveys were conducted at regional markets across mainland Tanzania to identify the sources of soils commonly used in commercially available soil sticks. Then, soil samples were collected from identified sources in 12 regions across Tanzania and analyzed for WEC and TC content using an inductively coupled plasma mass spectrometry laboratory technique. Mining of the pemba soil was localized in 12 regions. Analysis of the supply chain flow revealed a well-established distribution network that ensured transportation and marketing of the soil sticks to regions throughout the country. WEC and TC of essential and trace elements (Ca, Fe, K, Mg, Na, Mn, Co, Cr, V, Mo, Cu, and Zn) and toxic elements (Al, As, Ba, Cd, Ni, and Pb) were detected at varying concentrations. Most of the trace and toxic elements were above the normal range, based on the oral maximum tolerable limits designated by the World Health Organization and US Agency for Toxic Substance and Disease Registry. This is the first study in Tanzania to document and examine the source soil locations for commercially available soil sticks at the macroscale across the entire country. The findings suggest that geophagy could be a significant exposure pathway for toxic elements.

Trace elements in soil-vegetables interface: Translocation, bioaccumulation, toxicity and amelioration - A review

The contamination of soil and vegetables with trace elements is one of the most severe ecological problems in developing industrialized countries. Trace elements are released into the environment from natural and anthropogenic activities and accumulated in soil and vegetables through various pathways which ultimately affects the human health. The present review aimed at 1) discussing the anthropogenic sources in detail, 2) describing the bioaccumulation, absorption, and transportation of trace elements, 3) exploring the options to reduce the health risk due to consumption of contaminated vegetables, 4) identifying the research and policy gaps related to soil and vegetables contamination with trace elements. Besides these objectives, the present review also detailed the several factors which affect the rate of accumulation, toxicity mechanism, and effects of trace elements on vegetables and humans. Various toxicity indices for health risk assessment have also been described. It is suggested to evaluate the trace metals concentration in irrigation water and soil prior to plant the vegetable to minimize the possible contamination.

Epidemiology of Taenia saginata taeniosis/cysticercosis: a systematic review of the distribution in southern and eastern Africa

Background

The beef tapeworm, Taenia saginata, causing cysticercosis in bovines and taeniosis in humans, is thought to have a global distribution. In eastern and southern Africa, cattle production plays a crucial role in the economy, but a clear overview of the prevalence of T. saginata in the region is still lacking. This review aims to summarize existing knowledge on T. saginata taeniosis and bovine cysticercosis distribution in eastern and southern Africa.

Methods

A systematic review was conducted, that gathered published and grey literature, including OIE reports, concerning T. saginata taeniosis and bovine cysticercosis in eastern and southern Africa published between January 1st, 1990 and December 31st, 2017.

Results

A total of 1232 records were initially retrieved, with 78 full text articles retained for inclusion in the database. Unspecified taeniosis cases were reported for Angola, Ethiopia, Kenya, Madagascar, Malawi, South Africa, Tanzania, Uganda and Zambia, whereas T. saginata taeniosis cases were found for Ethiopia, Kenya, South Africa, Tanzania, Zambia and Zimbabwe. The prevalence of taeniosis ranged between 0.2–8.1% based on microscopy, and between 0.12–19.7% based on coproAg-ELISA. In Ethiopia, the percentage of tapeworm self-reporting was high (45.0–64.2%), and a substantial number of anthelmintic treatments were reported to be sold in towns. The presence of bovine cysticercosis was reported in all 27 countries/territories included in the study, except for Rwanda and Somalia, Comoros, Madagascar, Mauritius, Mayotte, Seychelles and Socotra. The prevalence of cysticercosis ranged between 0.02–26.3% based on meat inspection, and between 6.1–34.9% based on Ag-ELISA.

Conclusions

Although T. saginata has been reported in the majority of countries/territories of the study area, T. saginata taeniosis/cysticercosis remains a largely ignored condition, probably due to the absence of symptoms in cattle, the lack of data on its economic impact, and the fact that human taeniosis is considered a minor health problem. However, the occurrence of bovine cysticercosis is a clear sign of inadequate sanitation, insufficient meat inspection, and culinary habits that may favour transmission. Measures to reduce transmission of T. saginata are therefore warranted and the infection should be properly monitored.

Electronic supplementary material

The online version of this article (10.1186/s13071-018-3163-3) contains supplementary material, which is available to authorized users.

Geophagic earths consumed by women in western Kenya contain dangerous levels of lead, arsenic, and iron

OBJECTIVES

Geophagy is commonly reported by pregnant women and children, yet its causes and consequences remain poorly understood. Therefore, we sought to determine if geophagy could contribute micronutrients and/or be a source of heavy metal exposure by examining the elemental composition of earths consumed in Kakamega, Kenya.

METHODS

Ten samples of earths commonly consumed during pregnancy were collected by study enumerators and analyzed using inductively coupled plasma-atomic emission spectroscopy. Samples were either collected at markets or from walls of participants' homes, based on where participants reported most commonly sourcing their consumed earths.

RESULTS

Based on estimated intakes (40 g/day), all samples had lead levels that exceeded the provisional maximum tolerable daily intake, and one sample exceeded the threshold for arsenic. Further, estimated intakes of iron for all samples were at least 8.9 times higher than the established threshold. Elemental concentrations were also compared by the site of sample collection (market vs. household wall); market samples had significantly higher iron concentrations and lower calcium concentrations than wall samples.

CONCLUSIONS

Geophagic earths in Kakamega may be harmful because of dangerously high levels of lead, arsenic, and iron. The prevalence of geophagy among vulnerable populations underscores the importance of understanding its causes and consequences for accurate public health messaging.

Impact of Community-Based Nutrition Education on Geophagic Behavior and Dietary Knowledge and Practices among Rural Women in Nakuru Town, Kenya: A Pilot Study

OBJECTIVE

Geophagia, the deliberate consumption of rocks, soil, or clay, is prevalent in developing countries, particularly sub-Saharan Africa. Health risks associated with this behavior include parasitosis, heavy metal poisoning, nutrient deficiencies, and poor birth outcomes. This pilot study was designed to reduce geophagic practices and improve nutrition among rural Kenyan women.

METHODS

The researchers used snowball sampling to recruit participants (n = 135; aged 15-49 years) from low socioeconomic areas who consumed geophagic materials. Interviews were carried out before and after a nutrition intervention implemented by trained community health volunteers.

RESULTS

Nutrition education focusing on geophagia significantly (P < .001) decreased the practice in 77% of participants. Postintervention interviews also demonstrated substantial improvement in understanding the concept of making half the plate vegetables using the healthy plate model.

CONCLUSIONS AND IMPLICATIONS

Nutrition education can be useful for reducing geophagia (a largely ignored, unsafe dietary behavior) and enhancing nutritional knowledge in African women.