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Thomas DSK, Asori M, Nyanza EC. The role of geophagy and artisanal gold mining as risk factors for elevated blood lead levels in pregnant women in northwestern Tanzania. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002958. [PMID: 38394051 PMCID: PMC10889643 DOI: 10.1371/journal.pgph.0002958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Neither artisanal and small-scale gold mining (ASGM) or geophagy practices have received substantial attention related to blood lead levels despite the well documented deleterious effects of lead. This cross-sectional analytical study aimed to document the risk of lead exposure from geophagy and mining-related occupational activities for pregnant women. The study recruited 1056 pregnant women (883 in an ASGM area and 173 in a non-ASGM area) between April 2015 -April 2017. Generalized Linear Model with an identity link function was used to model the association between blood lead levels (BLLs) and geophagy practices and involvement in gold mining. The prevalence of geophagy was 36.2% (95% CI: 33.6, 39.4%) and 6.3% engaged in mining as a primary occupation. Practicing geophagy increased BLLs by 22% (β = 1.22, 95% CI: 1.116, 1.309, p<0.0001). Living in a gold mining area increased BLLs by 33.4% (β = 1.334, 95% CI: 1.2, 1.483, p<0.0001). Having mining as a primary occupation increased BLLs by 1.3% β = 1.013, 95% CI: 0.872, 1.176, p = 0.869) even though the association was not statistically significant. Socioeconomic wealth quantile (β = 1.037, 95% CI: 1.021, 1.054, p<0.001) increased blood lead levels by 3.7%. Developing a comprehensive inventory capturing sources of community-level lead exposure is essential. Further, increasing public health campaigns and education are crucial to limit geophagy practices and to minimize work in gold mining activities during pregnancy.
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Affiliation(s)
- Deborah S K Thomas
- Department of Geography and Earth Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Moses Asori
- Department of Geography and Earth Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Elias C Nyanza
- Department of Environmental, Occupational and Research GIS, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Jovine J, Nyanza EC, Asori M, Thomas DS. Prenatal arsenic and mercury levels among women practicing geophagy in areas with artisanal and small-scale gold mining activities, Northwestern Tanzania. BMC Pregnancy Childbirth 2023; 23:854. [PMID: 38087268 PMCID: PMC10714484 DOI: 10.1186/s12884-023-06174-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Artisanal and small-scale gold mining (ASGM) areas potentially pose increased exposure to arsenic and mercury through community contamination, occupations at gold mines, and/or geophagy when soil is locally sourced. This study examined the effects of geophagy, a deliberate soil eating practice, along with community and occupational exposures in ASGM areas on urinary arsenic and blood mercury levels among pregnant women in the Mining and Health Longitudinal Cohort in northwestern Tanzania. METHODS Data on maternal arsenic and mercury levels were captured for 1056 pregnant women using an unprovoked morning urine samples and dried blood spots respectively. We used a step-wise generalized linear regression model to retain the most relevant covariates for the model. A generalized linear regression model with identity link function was used to predict the effect of geophagy practices on arsenic and mercury levels separately. The model was adjusted using sociodemographic correlates, including maternal age, education level, whether respondents lived in mining or non-mining area, years of residence, marital status, maternal occupation, individual partner's education, and occupational, and socioeconomic status. RESULTS In the adjusted regression model, eating soil during pregnancy increased arsenic concentration by almost 23% (β = 1.229, 95% CI: 1.094, 1.38, p < 0.001) and living in mining areas had a 21.2% (β = 1.212; 95% CI: 1.039,1.414, p = 0.014) increased risk. Geophagy significantly increased mercury levels by 13.3% (β = 1.133, 95% CI: 1.022, 1.257, p = 0.018). Living in areas with ASGM activities was associated with a 142% (β = 2.422, 95% CI: 2.111, 2.776, p < 0.0001) increase in blood mercury. CONCLUSION Geophagy practices increased urinary arsenic and blood mercury levels in pregnant women, which was especially true for arsenic when living in areas with ASGM activities. Working in mining = increased risk for blood mercury levels. Community-based environmental health policies should address reductions in occupational and community exposures, along with strategic geophagy reduction interventions.
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Affiliation(s)
- Jovina Jovine
- Department of Environmental and Occupational Health, School of Public Health, Catholic University of Health and Allied Sciences, Wurzburg Road, P.O.BOX 1464, Mwanza, Tanzania
| | - Elias C Nyanza
- Department of Environmental and Occupational Health, School of Public Health, Catholic University of Health and Allied Sciences, Wurzburg Road, P.O.BOX 1464, Mwanza, Tanzania.
| | - Moses Asori
- Department of Geography & Earth Sciences, University of North Carolina at Charlotte, Charlotte, USA
| | - Deborah Sk Thomas
- Department of Geography & Earth Sciences, University of North Carolina at Charlotte, Charlotte, USA
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Champion WM, Buerck AM, Nenninger C, Yusuf K, Barrett LJP, Rakotoarisoa L, Rakotondrazaka R, Alfredo K, Cunningham J, Khaliq M, Mihelcic JR. Childhood blood lead levels and environmental risk factors in Madagascar. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:68652-68665. [PMID: 35545747 DOI: 10.1007/s11356-022-20586-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
One-third of children globally have blood lead levels (BLLs) exceeding the (former) US CDC reference value of 5 µg/dL; this value may be as high as one-half for children in low- and middle-income countries (LMICs). Lead exposure occurs through a variety of routes (e.g., water, dust, air), and in LMICs specifically, informal economies (e.g., battery recycling) can drive lead exposures due, in part, to absent regulation. Previous work by our team identified a ubiquitous source of lead (Pb), in the form of Pb-containing components used in manually operated pumps, in Toamasina, Madagascar. Characterization of BLLs of children exposed to this drinking water, and identification of additional exposure routes were needed. BLLs were measured for 362 children (aged 6 months to 6 years) in parallel with surveying to assess 14 risk factors related to demographics/socioeconomics, diet, use of pitcher pumps, and parental occupations. BLL data were also compared against a recent meta-review of BLLs for LMICs. Median childhood BLL (7.1 µg/dL) was consistent with those of other Sub-Saharan African LMICs (6.8 µg/dL) and generally higher than LMICs in other continents. Risk factors significantly associated (p < 0.05, univariate logistic regression) with elevated BLL (at ≥ 5 µg/dL) included male gender, living near a railway or major roadway (owing potentially to legacy lead pollution), having lower-cost flooring, daily consumption of foods (beans, vegetables, rice) commonly cooked in recycled aluminum pots (a previously identified lead source for this community), and a maternal occupation (laundry-person) associated with lower socioeconomic status (SES). Findings were similar at the ≥ 10 µg/dL BLL status. Our methods and findings may be appropriate in identifying and reducing lead exposures for children in other urbanizing cities, particularly in Sub-Saharan Africa, where lead exposure routes are complex and varied owing to informal economics and substantial legacy pollution.
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Affiliation(s)
- Wyatt M Champion
- College of Engineering, Department of Civil and Environmental Engineering, University of South Florida, 4202 E. Fowler Ave., ENG 030, Tampa, FL, 33620, USA.
| | - Adaline M Buerck
- College of Engineering, Department of Civil and Environmental Engineering, University of South Florida, 4202 E. Fowler Ave., ENG 030, Tampa, FL, 33620, USA
| | - Christopher Nenninger
- College of Engineering, Department of Civil and Environmental Engineering, University of South Florida, 4202 E. Fowler Ave., ENG 030, Tampa, FL, 33620, USA
| | - Korede Yusuf
- College of Nursing and Public Health, Adelphi University, One South Ave., Garden City, NY, 11530, USA
| | | | | | | | - Katherine Alfredo
- College of Engineering, Department of Civil and Environmental Engineering, University of South Florida, 4202 E. Fowler Ave., ENG 030, Tampa, FL, 33620, USA
| | - Jeffrey Cunningham
- College of Engineering, Department of Civil and Environmental Engineering, University of South Florida, 4202 E. Fowler Ave., ENG 030, Tampa, FL, 33620, USA
| | - Mahmooda Khaliq
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., MDC 56, Tampa, FL, 33612, USA
| | - James R Mihelcic
- College of Engineering, Department of Civil and Environmental Engineering, University of South Florida, 4202 E. Fowler Ave., ENG 030, Tampa, FL, 33620, USA
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Narh CT, Dzamalala CP, Mmbaga BT, Menya D, Mlombe Y, Finch P, Nyakunga G, Schüz J, McCormack V. Geophagia and risk of squamous cell esophageal cancer in the African esophageal cancer corridor: Findings from the ESCCAPE multicountry case-control studies. Int J Cancer 2021; 149:1274-1283. [PMID: 34004024 PMCID: PMC8411422 DOI: 10.1002/ijc.33688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 02/06/2023]
Abstract
Geophagia, the intentional practice of consuming soil, occurs across the African esophageal cancer corridor, particularly during pregnancy. We investigated whether this practice is linked to endemic esophageal squamous cell carcinoma (ESCC) in this region. We conducted ESCC case-control studies in Tanzania, Malawi and Kenya. Cases were patients with incident histologically/clinically confirmed ESCC and controls were hospital patients/visitors without digestive diseases. Participants were asked if they had ever eaten soil (never/regularly/pregnancy-only). Odds ratios (OR) are adjusted for sex, age, tobacco, alcohol, country, religion and marital status. Overall, 934 cases (Malawi 535, Tanzania 304 and Kenya females 95) and 995 controls provided geophagia information. Among controls, ever-geophagia was common in women (Malawi 49%, Kenya 43% and Tanzania 29%) but not in men (10% Malawi, <1% Tanzania). In women, ESCC ORs were 1.25 (95% CI: 0.70, 2.22) for regular versus never geophagia and 0.88 (95% CI: 0.64, 1.22) for pregnancy-only versus never. Findings were stronger based on comparisons of cases with hospital visitor controls and were null using hospital patients as controls. In conclusion, geophagia is too rare to contribute to the male ESCC burden in Africa. In women, the practice is common but we did not find consistent evidence of a link to ESCC. The study cannot rule out selection bias masking modest effects. Physical effects of geophagia do not appear to have a large impact on overall ESCC risk. Research with improved constituent-based geophagia exposure assessment is needed.
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Affiliation(s)
- Clement T. Narh
- Branch of Environment and Lifestyle EpidemiologyInternational Agency for Research on Cancer (IARC)LyonFrance
- School of Public HealthUniversity of Health and Allied SciencesHohoeGhana
| | | | - Blandina T. Mmbaga
- Kilimanjaro Clinical Research InstituteMoshiTanzania
- Kilimanjaro Christian Medical CentreMoshiTanzania
| | - Diana Menya
- School of Public HeathMoi UniversityEldoretKenya
| | | | - Peter Finch
- College of MedicineUniversity of MalawiBlantyreMalawi
| | | | - Joachim Schüz
- Branch of Environment and Lifestyle EpidemiologyInternational Agency for Research on Cancer (IARC)LyonFrance
| | - Valerie McCormack
- Branch of Environment and Lifestyle EpidemiologyInternational Agency for Research on Cancer (IARC)LyonFrance
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Nyanza EC, Bernier FP, Martin JW, Manyama M, Hatfield J, Dewey D. Effects of prenatal exposure and co-exposure to metallic or metalloid elements on early infant neurodevelopmental outcomes in areas with small-scale gold mining activities in Northern Tanzania. ENVIRONMENT INTERNATIONAL 2021; 149:106104. [PMID: 32948351 DOI: 10.1016/j.envint.2020.106104] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/07/2020] [Accepted: 08/27/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Artisanal and small-scale gold mining (ASGM) is associated with release of neurotoxic metallic or metalloid chemical elements including lead (Pb), mercury (Hg), cadmium (Cd) and arsenic (As). OBJECTIVE To examine associations between prenatal exposure and co-exposure to total lead (T-Pb), total mercury (T-Hg), total cadmium (T-Cd) and total arsenic (T-As) and infant neurodevelopment at 6 to 12 months of age in areas with ASGM activities in Tanzania. METHODS Women in their second trimester of pregnancy who resided in ASGM areas were enrolled from 2015 to 2017 (n = 883). At 6 to 12 months of age, children were assessed with the Malawi Developmental Assessment Tool (MDAT) (n = 439). We measured T-Pb, T-Hg, and T-Cd in maternal dried blood spots and T-As in maternal urines. Poisson regression was used to examine associations between prenatal concentrations of these elements and neurodevelopmental outcomes. RESULTS Prenatal T-Hg concentration was associated with global neurodevelopment status (aPR 1.03, CI:1.01-1.04; p < 0.001) and language impairment (aPR 1.05, CI:1.03-1.07; p < 0.001) on the MDAT. When prenatal T-Hg and T-As values were at or above the human biomonitoring reference values (≥95%) of the German Environmental Survey for Human Biomonitoring, that is 0.80 µg/L and 15 µg/L, respectively, the prevalence ratio of global neurodevelopmental impairment was two times higher (aPR 2.1, CI:1.0-4.3; p = 0.034). There was a 40% increase in the prevalence ratio of global neurodevelopmental impairment (aPR 1.4, CI:0.90-2.10, p = 0.027), when prenatal T-Hg was at or above the reference value of 0.80 µg/L and T-Pb was at or above the reference value of 35 µg/L. When prenatal T-Hg was at or above the reference value of 0.80 µg/L and T-As was at or above the reference value of 15 µg/L, the prevalence ratio of global neurodevelopmental impairment was two times higher (aPR 2.1, CI:1.0-4.3; p < 0.034). DISCUSSION Infants born to women in areas with ASGM activities are at significant risk for neurodevelopmental impairment and this is associated with exposure to higher concentrations of Hg prenatally. Co-exposure to high concentrations of Hg and Pb, or Hg and As appeared to have negative potentiated effects on infants' neurodevelopment.
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Affiliation(s)
- Elias C Nyanza
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Department of Environmental, Occupational Health and GIS, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Bugando, Mwanza, Tanzania
| | - Francois P Bernier
- Department of Paediatrics, University of Calgary, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada; Department of Medical Genetics, Cumming School of Medicine, 3330 Hospital Drive NW University of Calgary, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Room 294, Heritage Medical Research Building, 3330 Hospital Drive, NW Calgary, AB T2N 4N1, Canada
| | - Jonathan W Martin
- Science for Life Laboratory, Department of Environmental Science, Stockholm University, 106 91 Stockholm, Sweden; Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Mange Manyama
- Division of Medical Education, Weill-Cornell Medicine-Qatar, Doha, Qatar
| | - Jennifer Hatfield
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Deborah Dewey
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Department of Paediatrics, University of Calgary, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada; Department of Medical Genetics, Cumming School of Medicine, 3330 Hospital Drive NW University of Calgary, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Room 294, Heritage Medical Research Building, 3330 Hospital Drive, NW Calgary, AB T2N 4N1, Canada; Owerko Centre, #397 Child Development Centre, University of Calgary, 2500 University Dr. NW Calgary, AB T2N 1N4, Canada.
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Mashao U, Ekosse GI, Odiyo J, Bukalo N. Geophagic practice in Mashau Village, Limpopo Province, South Africa. Heliyon 2021; 7:e06497. [PMID: 33817373 PMCID: PMC8010397 DOI: 10.1016/j.heliyon.2021.e06497] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 08/28/2020] [Accepted: 03/09/2021] [Indexed: 11/19/2022] Open
Abstract
Large quantities of earth materials are consumed daily in Mashau Village; nonetheless, this practice had not been studied. Furthermore, the motivations for this geophagic behaviour in the study area were unclear. Thus, questionnaires were distributed to 200 participants in the study area with the aim of generating data on the motivations of and potential medical conditions associated to this practice. About 91% of the participants were geophagists, of which 98.5% were female. Craving was found to be the main reason (73.9%) why people of the Mashau communities consume soil. The majority of the geophagists in Mashau craved for the soil upon seeing it (31.2%), during pregnancy (22.5%) and when experiencing sleeplessness (21%). About 60% of the geophagists had chronic illnesses, and they were diagnosed with headaches (31.6%), low haemoglobin level (29.9%), constipation (18.8%), iron deficiency (12.0%) and high blood pressure (7.7%). There is a concern that the soil from the study area may be adversely affecting individuals ingesting these soils. Since females mostly reported practicing geophagia, counselling and education of women and girls would be a useful public health measure. Soil characterisation and beneficiation for healthy geophagic practices should also be carried out at Mashau Village.
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Affiliation(s)
- Unarine Mashao
- School of Environmental Sciences, University of Venda, Private Bag X5050, Thohoyandou 0950, Limpopo Province, South Africa
| | - Georges-Ivo Ekosse
- Directorate of Research and Innovation, University of Venda, Private Bag X5050, Thohoyandou 0950, Limpopo Province, South Africa
| | - John Odiyo
- School of Environmental Sciences, University of Venda, Private Bag X5050, Thohoyandou 0950, Limpopo Province, South Africa
| | - Nenita Bukalo
- School of Environmental Sciences, University of Venda, Private Bag X5050, Thohoyandou 0950, Limpopo Province, South Africa
- Corresponding author.
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Prevalence of geophagy and knowledge about its health effects among native Sub-Saharan Africa, Caribbean and South America healthy adults living in France. Eat Weight Disord 2020; 25:465-469. [PMID: 30547293 DOI: 10.1007/s40519-018-0624-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022] Open
Abstract
Geophagy is widespread among women from Sub-Saharan Africa, South America and the Caribbean and may persist in western countries. This practice may be associated with adverse effects such as anaemia, constipation or intestinal occlusion. We aimed to determine the prevalence of geophagy and the level of knowledge about its health effects among healthy adults originating from these countries and attending a travel medicine and international vaccination consultation in France. Among 101 travellers enrolled in the study, 83 (82.1%) were born in Sub-Saharan Africa and 13 (12.8%) in South America or the Caribbean. The mean duration of residence in France was 15.6 ± 10.4 years. Previous or current geophagy was present in 42 travellers [previous geophagy in 31 (30.7%) and current consumption in 11 (10.9%)]; 38 (90.5%) were women. The rate of awareness of harmful effects of geophagy as the risk of iron-deficient anaemia (18.8%) and soil-transmitted intestinal parasitic infections (11.9%) was low overall. Women with previous or current geophagy more often had history of iron therapy compared to those who never consumed, both during pregnancy (50.0 versus 14.3%; p = 0.0009) and outside pregnancy (47.4 versus 2.8%; p < 0.0001). Despite a long period of residence in France, geophagy was still a current practice among 10.9% of Sub-Saharan, South American and Caribbean travellers, who are poorly informed of its harmful effects. Therefore, specific information tailored to Sub-Saharan, South American and Caribbean about the risks of geophagy should be implemented in western countries.Level of evidence Level V, descriptive cross-sectional survey.
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