Health risks from lost awareness of cultural behaviours rooted in traditional medicine: An insight in geophagy and mineral intake

Geophagia: Benefits and potential toxicity to human—A review

Geophagy is the habit of consuming clay soil such as chalk or kaolin. Though it is globally practiced, the safety of those involved is yet to be fully established. It is thought to be highly prevalent in pregnant women because of its antinausea or therapeutic effects. This practice is also thought to be provoked by some nutritional needs, but in modern society its etiology is obscure. The mineralogical and chemical compositions of clay may vary from one region to another and even in all form of rocks clay constitutes. Published articles in geophagy indicate lack of adequate investigations into the toxicity of geophagy, though it is globally practiced and more prevalent in Africa (as a continent) or in Africans migrants. Some studies have helped to identify some minerals that are toxic to human if ingested. In most cases, the potential toxicity emphasized by these studies is based on the detection of the presence of these nuisance elements in the geophagic materials. Scientifically, a lot has been done in the light of detection of toxic matter, but more investigations on metabolic studies are still necessary. The variability of clay content with respect to source motivated this review on geophagy and its potential toxicity to human. This review is aimed at bringing out findings that would enable a better understanding of the toxicity potential of geophagy across context and taxa.

Remote Fieldwork With African Migrant Women During COVID-19 Pandemic in London: A Reflection

As coronavirus disease 2019 (COVID-19) pandemic unraveled, state-led preventative restrictions created a "new" normal through remote home-working. A long-planned follow-up qualitative research study on risk perceptions and experiences regarding Clay Ingestion among black African women during pregnancy, in London, was disrupted as England went into lockdown. Against this backdrop, we shifted to remote data collection which raised pertinent concerns around access to technology and participant digital skills. We share our experiences of navigating through remote fieldwork during the pandemic with black African mothers with caring responsibilities as well as the extra burden of homeschooling, the challenges we encountered and how we mitigate these and the lessons learnt. Thus, drawing from our remote qualitative research experiences, we refer to notable examples of challenges, mitigating strategies applied and potential lessons to inform future practice.

Kaolin consumption in pregnant women: what impact on the weight of newborns?

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.

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.

Toxicological Risk Analysis in Data-Poor Countries: A Narrative Approach to Feed an "Awareness Raising-Community Empowerment" Vortex

Background and objectives: With globalization of culture and products, choices and behaviors associated with the unawareness of toxicological risk factors result in human and environmental toxic exposures along with health disparities. Toxic exposures are risk factors for malnutrition and diseases, impairing the chances of being healthy and having a healthy adulthood for current and next generation(s). Increasing research funds, infrastructures, analytical data and risk assessment is a reality well worth attention in sub-Saharan Africa. These countries are still unprotected nowadays and are particularly exposed and data-poor in respect to risk factors (e.g., neurotoxicants, immunotoxicants and endocrine disruptors). This paper presents how-based on scientific literature-low-resource countries may achieve more with less. As one of the world's most important emerging markets, Africa can, and should, assess the benefits and risks of modernity versus tradition and ask for safe and quality products at affordable prices while producing safe and nutritious foods. Materials and Methods: Exempla and experiences of risk analysis based on participant observation in field anthropological research, consumer safaris and reportages in the field of food safety, environmental health and consumer products are discussed in terms of "narrative prevention" and its power to highlight previously unrecognized/overlooked real-life risk scenarios. Knowledge return initiatives are discussed in light of their power to feed awareness raising, informed choice and empowerment of communities. Results: In some cases, data exist but remain too sparse, unknown or underused; in other cases, the information is totally neglected. When there is international scientific evidence, a diagnostic risk assessment is feasible. Despite significant resource constraints, properly science-driven targeted reportages in data-poor countries can bridge the gaps between international scientific knowledge and the implementation of relevant findings in an "awareness-empowerment vortex". When a clear message promoting healthy choices and behaviors is given, African communities are ready to respond. Conclusions: Poor skills are an avoidable consequence of low national income. Narrative prevention does not replace scientific research but stimulates scientific research and toxicological risk analysis during the ongoing risk transition in Africa. While African populations increasingly aspire to improve life expectancy in health, increasing exposure to such new health risk factors in sub-Saharan Africa needs top-down choices for diseases prevention, One Health, as well as public awareness and empowerment towards everyday habits and health protective choices.

Cadmium and lead in geophagic clay consumed in Southern Nigeria: health risk from such traditional nutraceutical

Geophagy is a cultural behavior, based on the recurrent intentional eating of clay soil, that is raising increasing concern as it implies multidimensional (space, time) potential risk of serious adverse health effects. This study investigated the level of toxic metals (Cd and Pb) in 20 Nigerian geophagic clays intended for both local consumption and distribution to the West Africa market. After sampling in 4 open markets in southern Nigeria (Akwa Ibom, Abia, Rivers, Imo), samples were subjected to digestion, ashing and analysis. The Pb levels in all samples exceeded the WHO/FAO maximum permissible limit of 0.1 mg kg^-1 whereas 16% exceeded the Cd limit of 0.3 mg kg^-1. The estimated daily intake of Pb for all samples ranged from 0.0032-0.0286 mg kg_bw^-1 day^-1 to 0.0024-0.0215 mg kg_bw^-1 day^-1 for children and adults, respectively. The estimated daily intakes for Cd ranged from bdl (below detection limit)-0.0010 mg kg_bw^-1 day^-1 to bdl-0.0028 mg kg_bw^-1 day^-1 for children and adults, respectively. In both cases, the WHO/FAO provisional Tolerable Weekly Intake is exceeded through the ingestion of these soils. Our results confirm health risks related to the geophagic practices, its role in exceeding health guidelines when considering aggregate exposure in the Nigerian scenario and body burden in developing organisms, young women, women at fertile age, and pregnant women. We discuss how geophagists consider clays as traditional nutraceuticals and how clarifying the nutraceutical role of geophagy could facilitate risk communication. Geophagic products are implicitly or explicitly marketed as dietary supplements, and as such they should be regulated (1) by labeling, and prohibition of scientifically unfounded health claims and (2) by safety standards before marketing. This is particularly critical when clays originate from countries living rapid, unplanned and uncontrolled development and dumped, like Nigeria.

Hazards and risk assessment of heavy metals from consumption of locally manufactured painkiller drugs in Nigeria

In the informal sector of Nigeria's economy, jobs are done manually as against automation resulting in body stress and pain, hence the need for painkiller drugs. Thirty different locally manufactured painkiller drugs, with analgesic, antipyretic and anti-inflammatory effects, were randomly sampled from pharmaceutical shops within Awka in October 2016. The drugs were pulverised, sieved and ashed before digestion using conc aqua regia HCl : HNO3 (3:1), carcinogenic heavy metals (arsenic, cadmium, chromium, mercury, nicked and lead) were assayed using Varian AA240 atomic absorption spectrophotometer (AAS). Risk assessment was carried out using US EPA model. The highest levels of arsenic (0.350 mg/kg) were found in samples with code 01, 03 and 020, cadmium (0.107 mg/kg and 0.144 mg/kg) were in samples code 013 and 028, and samples 03 and 011 had chromium levels as 6.637 mg/kg and 5.298 mg/kg. Highest value of mercury (0.470 mg/kg) was in sample code 01. All the painkiller drugs have nickel in the range of 0.046-0.448 mg/kg while highest values of lead were in sample code 05, 025 and 029 as 2.47 mg/kg, 1.11 mg/kg and 1.16 mg/kg. Non-cancer risk ranged as As (Nd -1.60 × 10-3), Cd (Nd-1.97 × 10-4), Cr (Nd-6.06 × 10-6), Hg (Nd-2.15 × 10-4), Ni (9.93 × 10-6-3.34 × 10-5) and Pb (Nd-4.36 × 10-4) while the cancer risk were As (Nd-1.63 × 10-7), Cd (Nd-4.45 × 10-9), Cr (Nd-1.56 × 10-7), Hg (Nd -1.53 × 10-9), Ni (1.50 × 10-10 -1.46 × 10-9) and Pb (Nd-8.82 × 10-9). The total cancer risk (TCR) and total non-cancer risk (TNCR) for all the heavy metals were in the range of 7.21 × 10-13-1.25 × 10-10 and 1.51 × 10-7-5.56 × 10-5 respectively. The TCR was below 1 × 10-6 -1 × 10-4 range while TNCR for heavy metals was below 1; the values established by US EPA. In conclusion, continuous consumption of locally Nigerian made painkiller drugs may expose the subjects to heavy metal toxicity.

Physicochemical characterization of the pelotherapeutic and balneotherapeutic clayey soils and natural spring water at Isinuka traditional healing spa in the Eastern Cape Province of South Africa

Isinuka Springs at Port St Johns in the Eastern Cape Province of South Africa is a traditional spa sacred to the AmaMpondo tribe of the Xhosa speaking people. The bathing pond is considered to have healing powers both spiritually and therapeutically. Hundreds of people flock into the spiritual pond every weekend for both recreational and its spiritual healing power. In this study, we present the metal concentrations of the bathing pond (sediments and water samples), the hole drinking water as well as sediments from a cave situated at the bottom of the hill harbouring the bathing pond. Our results show that the geophagic clays from the cave and bathing pond has elevated concentrations of earth metals (up to 134,506 mg kg^-1 for calcium), trace metals (up to 36,272 mg kg^-1 for iron) and toxic metals (up to 25 mg kg^-1 for lead). The levels of both essential and toxic metals in the drinking water were above the recommended daily limits except for zinc and copper. Aluminium, a metal with antibacterial activity was as high as 71,792 mg kg^-1 in pond sediments. Even though the results show elevated concentrations especially for toxic metals, the study observes that the spa remains limited in potential for metal toxipathy because the frequency of contact with the pond is minimal estimated at once a week by traditional healers and once a month for locals while visitors from other parts of the province rarely come back.

Clay Ingestion During Pregnancy Among Black African Women in a North London Borough: Understanding Cultural Meanings, Integrating Indigenous and Biomedical Knowledge Systems

Findings from this qualitative audit conducted in a North London Borough among Black African women show that clay ingestion during pregnancy is a cultural phenomenon embedded in indigenous knowledge (IK). Reasons for clay ingestion include curbing morning sickness, nausea, satisfying cravings, "mineral deficiency" and other life sustaining beliefs. However, Public Health practitioners' top down approach and response which considers the practice as "dangerous" and potentially harmful to the health of the woman and unborn child with midwives and General Practitioner doctors called upon to discourage it, risks alienating the target population. Furthermore, within such a top down framework, opportunities to integrate biomedical science and indigenous knowledge systems are potentially missed. The use of culturally sensitive Public health interventions which consider a community approach, while attempting to integrate these two knowledge systems through further research is likely to bear more fruits.

Elements of kitchen toxicology to exploit the value of traditional (African) recipes: The case of Egusi Okra meal in the diet of HIV+/AIDS subjects

The Egusi Okra soup is a traditional African meal that is considered of high nutritional value and protective against weight loss. We introduce the concept of "kitchen toxicology" to analyse the recipe of the Egusi Okra soup and highlight possible mitigation measures for toxic and/or antinutritional effects in the wide spectrum of health and nutritional needs of HIV+/AIDS subjects. In particular, we focus on toxicants (environmental contaminants, process contaminants, substances leaching from food contact materials) dysregulating the immune status, as well as on interactions between nutrients, contaminants, and/or antinutrients which may lead to secondary/conditioned nutritional deficiencies or imbalances; in their turn, these can modulate the ability to cope with toxicants, and increase nutritional requirements. Recommendations are given for practices preserving the Egusi Okra soup from such risk factors, identifying points of particular attention during meal preparation, from purchase of raw ingredients through to food handling, cooking, storage, and consumption. The Egusi Okra soup is discussed in the context of a diet that is asked to mitigate complications (weight loss, opportunistic infections) and support antiretroviral therapy in African countries with high HIV/AIDS prevalence. The paper discusses how nutritional interventions benefit of the integration of kitchen toxicology practices in everyday life. Toxicological risk assessment is crucial to understand the history and status of the person exposed to or affected by infectious diseases.