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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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Taghipour A, Ghodsian S, Jabbari M, Olfatifar M, Abdoli A, Ghaffarifar F. Global prevalence of intestinal parasitic infections and associated risk factors in pregnant women: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 2021; 115:457-470. [PMID: 33007067 DOI: 10.1093/trstmh/traa101] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/04/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Intestinal parasitic infections (IPIs) during pregnancy, if left untreated, can cause adverse effects for the mothers, foetuses and newborns. However, limited information is available about the global status of IPIs in pregnant women. Here we undertook a meta-analysis to estimate the global prevalence of IPIs and associated risk factors in pregnant women. METHODS We searched the PubMed, Science Direct, Scopus, Web of Science and Google Scholar databases for relevant studies that were published between 1 January 1987 and 30 December 2019. A random effects meta-analysis model was used to estimate the pooled prevalence, odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS A total of 114 studies comprising 98 342 pregnant women across 35 countries were included in the systematic review and meta-analysis. Among IPIs identified from pregnant women, three helminth infections (hookworm 19% [95% CI 15 to 23], Ascaris lumbricoides 17% [95% CI 13 to 21] and Trichuris trichiura 11% [95% CI 7 to 16]) and three protozoan infections (Blastocystis sp. 21% [95% CI 4 to 46], Entamoeba histolytica/dispar 9% [95% CI 3 to 19] and Giardia sp. 8% [95% CI 4 to 13]) were identified as the most prevalent intestinal parasites. Moreover, we found that there was a significant association between IPIs with increased risk of anaemia in pregnant women (OR 2.65 [95% CI 2.08 to 3.37]). The prevalence of IPIs was slightly higher in geophagic pregnant women compared with controls, but this was not significant (OR 1.22 [95% CI 0.87 to 1.71]). According to species, the pooled OR of A. lumbricoides infection had a significantly higher risk in geophagic pregnant women compared with controls (OR 2.66 [95% CI 1.37 to 5.16]). There was a positive relationship between the high prevalence of IPIs in pregnant women living in rural areas compared with urban residents (OR 3.36 [95% CI 1.57 to 7.19]). CONCLUSIONS The current review revealed a relatively high prevalence of IPIs in pregnant women, especially in some low- and middle-income countries. These results suggest a need for improved prevention and control efforts to reduce the health risks to pregnant women.
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Affiliation(s)
- Ali Taghipour
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, P.O. Box 14115-111, Tehran, Iran
| | - Sahar Ghodsian
- Department of Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Jabbari
- Department of Microbiology, Faculty of Basic Science, Tabriz Branch, Islamic Azad University, Tabriz, Iran
| | - Meysam Olfatifar
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Abdoli
- Department of Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.,Zoonoses Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Fatemeh Ghaffarifar
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, P.O. Box 14115-111, Tehran, Iran
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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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Konlan KD, Abdulai JA, Konlan KD, Amoah RM, Doat A. Practices of pica among pregnant women in a tertiary healthcare facility in Ghana. Nurs Open 2020; 7:783-792. [PMID: 32257266 PMCID: PMC7113508 DOI: 10.1002/nop2.451] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/03/2020] [Indexed: 01/31/2023] Open
Abstract
Aim This study assessed the practice of pica among pregnant women in the Ho Teaching Hospital. Design Descriptive cross-sectional. Methods Systematic sampling technique was used to recruit 286 pregnant women. Questionnaire was used to collect data. Data entered into Statistical Package for Social Sciences for analysis. Result Of the 286 pregnant women, 21.2% and 17.8% considered white clay and ice respectively as nutritious. Prevalence of pica was 47.5%, while 44.9% of pregnant women who practised pica reported they feel uncomfortable when they do not eat pica as 63.3% considered intake of pica as harmful. Among women who received education against pica practice, 49.4% have ever taken pica as 50.9% of them with education on effects of pica were currently engaged in the activity (χ2 = 1.93 p = .17). Conclusion Health professionals, especially midwives must intensify education on effects of pica among pregnant women.
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Affiliation(s)
- Kennedy Diema Konlan
- Department of Public Health NursingSchool of Nursing and MidwiferyUniversity of Health and Allied SciencesHoGhana
| | | | | | - Roberta Mensima Amoah
- Department of Public HealthSchool of Allied SciencesUniversity for Development StudiesTamaleGhana
| | - Abdul‐Razak Doat
- Nursing and Midwifery Training CollegeTamaleGhana
- Tehran University of Medical SciencesTehranIran
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Madziva C, Chinouya MJ. Clay Ingestion During Pregnancy Among Black African Women in a North London Borough: Understanding Cultural Meanings, Integrating Indigenous and Biomedical Knowledge Systems. FRONTIERS IN SOCIOLOGY 2020; 5:20. [PMID: 33869429 PMCID: PMC8022624 DOI: 10.3389/fsoc.2020.00020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/11/2020] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- Cathrine Madziva
- Department of Health, London Metropolitan University, London, United Kingdom
| | - Martha Judith Chinouya
- School of Tropical Medicine, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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6
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Traugott MT, Singh M, Raj DK, Kutalek R. Geophagy in India: a qualitative exploratory study on motivation and perception of female consumers. Trans R Soc Trop Med Hyg 2020; 113:123-130. [PMID: 30476287 DOI: 10.1093/trstmh/try123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/28/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Geophagy, the consumption of soil, is well documented in Africa and other continents, but is rarely investigated in Asia and even less so in India. The main aim of this exploratory qualitative study was therefore to understand the motivation for clay consumption, the social perception of the habit, the mode and quantity of consumption, as well as subjectively perceived effects of clay consumption in Himachal Pradesh, North India. METHODS We conducted semi-structured interviews with 27 female geophagists aged 18-80 years. RESULTS We could show that geophagy exists across all ages and social groups. The main type of consumed soil is yellow clay used for house wall plastering. Geophagy is usually practised because of a craving for soil despite various fears of negative health effects. It is normally done secretly and under-reported to local doctors. The most common self-reported positive effect of geophagy was the feeling of relief. Geophagy was generally considered as harmful to health and various complaints were associated with it. It is not practised because of food shortages or as a remedy. On the contrary, it is generally seen as an addiction detrimental to health. CONCLUSIONS Awareness of geophagy has to be ameliorated in the Indian population and specifically among health workers to improve support for affected individuals. Geophagy should be routinely included in national antenatal care guidelines.
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Affiliation(s)
- Marianna T Traugott
- Unit Medical Anthropology and Global Health, Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15, Vienna, Austria
| | - Mitasha Singh
- Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Tatui Tanda (District Kangra), Himachal Pradesh, India
| | - Des K Raj
- Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Tatui Tanda (District Kangra), Himachal Pradesh, India
| | - Ruth Kutalek
- Unit Medical Anthropology and Global Health, Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15, Vienna, Austria
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7
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Miller JD, Fitzgerald KG, Smith AL, Young SL. Geophagy among a Cohort of Kenyan Women with Mixed HIV Status: A Longitudinal Analysis. Am J Trop Med Hyg 2020; 101:654-660. [PMID: 31333167 DOI: 10.4269/ajtmh.19-0149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Geophagy, the craving and purposive consumption of earth, is commonly reported during pregnancy. To date, most studies of geophagy have been cross-sectional and have not assessed its relationship with HIV infection. Therefore, to concurrently examine proposed etiologies of geophagy, a cohort of 371 women with mixed HIV status from Nyanza region, Kenya were recruited in late pregnancy and interviewed about pica at nine time points, through 21 months postpartum. Nutritional status (hemoglobin concentration and food insecurity), physical health (HIV infection and gastrointestinal distress), and psychosocial health (depression and perceived stress) were also repeatedly assessed. Prevalence of geophagy was greatest during pregnancy and decreased significantly postpartum. In a two-level hierarchical linear model, a one-unit increase in average hemoglobin (g/dL) was associated with a 35% decrease in the odds of geophagy. The adjusted odds ratios (CI) of geophagy were 3.98 (2.99, 5.29), 2.54 (1.13, 5.69), and 1.68 (1.15, 2.44) times higher if a woman was pregnant, reported diarrhea in the prior 24 hours, or was HIV positive, respectively. The adjusted odds ratio of geophagy was 1.61 (1.06, 2.45) times higher if a woman reported geophagy during childhood. Our results lend greatest plausibility to the protection hypothesis (i.e., that geophagy occurs in response to compromised immunity and/or infection). Given the high prevalence of geophagy, clinicians should regularly screen for the behavior and measure inflammatory biomarkers before treating geophagy with iron supplements, which can exacerbate some infections.
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Affiliation(s)
- Joshua D Miller
- Department of Anthropology, Northwestern University, Evanston, Illinois
| | | | - Abigail L Smith
- Department of Statistics, Northwestern University, Evanston, Illinois
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, Illinois
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8
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Kambunga SN, Candeias C, Hasheela I, Mouri H. Review of the nature of some geophagic materials and their potential health effects on pregnant women: some examples from Africa. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2019; 41:2949-2975. [PMID: 30977022 DOI: 10.1007/s10653-019-00288-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/27/2019] [Indexed: 05/25/2023]
Abstract
The voluntary human consumption of soil known as geophagy is a global practice and deep-rooted in many African cultures. The nature of geophagic material varies widely from the types to the composition. Generally, clay and termite mound soils are the main materials consumed by geophagists. Several studies revealed that gestating women across the world consume more soil than other groups for numerous motives. These motivations are related to medicinal, cultural and nutrients supplementation. Although geophagy in pregnancy (GiP) is a universal dynamic habit, the highest prevalence has been reported in African countries such as Kenya, Ghana, Rwanda, Nigeria, Tanzania, and South Africa. Geophagy can be both beneficial and detrimental. Its health effects depend on the amount and composition of the ingested soils, which is subjective to the geology and soil formation processes. In most cases, the negative health effects concomitant with the practice of geophagy eclipse the positive effects. Therefore, knowledge about the nature of geophagic material and the health effects that might arise from their consumption is important.
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Affiliation(s)
- Selma N Kambunga
- Department of Geology, University of Johannesburg, Johannesburg, South Africa
| | - Carla Candeias
- GeoBioTec, Geosciences Department, University of Aveiro, Aveiro, Portugal
- EpiUnit, Public Health Institute, University of Porto, Porto, Portugal
| | - Israel Hasheela
- Environmental and Engineering Geology Division, Geological Survey of Namibia, Windhoek, Namibia
| | - Hassina Mouri
- Department of Geology, University of Johannesburg, Johannesburg, South Africa.
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Yamamoto SS, Premji SS, Nyanza EC, Jahanpour O. Investigating the association between stress. Anxiety and geophagy among pregnant women in mwanza, Tanzania. Appetite 2019; 142:104328. [PMID: 31238080 DOI: 10.1016/j.appet.2019.104328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 11/05/2018] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
Geophagy, the craving and intentional consumption of soil, is common especially among pregnant women in some low- and middle-income settings. Soils may contain a variety of non-nutritive components such as heavy metals and microbes or substances that interfere with gastrointestinal absorptive processes, posing health risks to pregnant women. Several hypotheses regarding the practice have been proposed but very few have examined the role of maternal stress. The practice of geophagy may help to alleviate stress or anxiety during gestation from perceived dietary or other pregnancy-related concerns. In this study, we evaluated several measures of maternal stress (general anxiety, Pregnancy-Related Anxiety Scores (10-item revised), and Perceived Stress Scores) and other covariates in relation to geophagic behaviour in early pregnancy in 227 women (12-19 weeks gestation) recruited from two hospitals in the Nyamagana district of Mwanza City, Tanzania. Geophagy was reported by 24.7% of the pregnant women. Using LASSO regression, self-reported treatment of nausea or vomiting during pregnancy (adjusted OR = 3.12, 95%CI: 1.43 to 6.83), paternal education level (adjusted OR = 2.79, 95%CI: 1.32 to 5.87 for primary or lower education level), antenatal hospital site (adjusted OR = 3.71, 95%CI: 1.78 to 7.75), prescription drug use prior to pregnancy (adjusted OR = 1.76, 95%CI: 0.87 to 3.56) and general anxiety (feeling worried, tense or anxious in the past four weeks) (adjusted OR = 1.81, 95%CI: 0.88 to 3.72) were associated with geophagic behaviour. Given that relatively little has been done to examine geophagy in relation to the public health risk it may pose to pregnant women, these findings suggest the need for further investigations regarding maternal stress.
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Affiliation(s)
- Shelby S Yamamoto
- School of Public Health, University of Alberta, Edmonton Clinic Health Academy, 11405-87Ave, Edmonton, Alberta, T6G 1C9, Canada.
| | - Shahirose S Premji
- School of Nursing, Faculty of Health, York University, 313 HNES Building, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada.
| | - Elias C Nyanza
- Department of Environmental and Occupational Health, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Bugando Area, Mwanza, Tanzania.
| | - Ola Jahanpour
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, P.O. Box 2240, Tanzania.
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10
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Pebsworth P. Feeding ecology of chacma baboons (
Papio ursinus)
living in a human‐modified environment. Afr J Ecol 2019. [DOI: 10.1111/aje.12684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Paula Pebsworth
- National Institute of Advanced Studies Bangalore India
- Department of Anthropology The University of Texas TX USA
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11
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Chung EO, Mattah B, Hickey MD, Salmen CR, Milner EM, Bukusi EA, Brashares JS, Young SL, Fernald LCH, Fiorella KJ. Characteristics of Pica Behavior among Mothers around Lake Victoria, Kenya: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2510. [PMID: 31337101 PMCID: PMC6679355 DOI: 10.3390/ijerph16142510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/08/2019] [Accepted: 07/10/2019] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Esther O Chung
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599-7435, USA.
| | - Brian Mattah
- Ekialo Kiona Research Dept, Organic Health Response, Mbita, P.O. Box 224-40305, Kenya
| | - Matthew D Hickey
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, UCSF, 1001 Potrero Ave, San Francisco, CA 94110, USA
| | - Charles R Salmen
- Ekialo Kiona Research Dept, Organic Health Response, Mbita, P.O. Box 224-40305, Kenya
- Department of Family Medicine and Community Health, University of Minnesota, 5516 Delaware St SE, Minneapolis, MN 55455, USA
| | - Erin M Milner
- Bureau for Global Health, USAID, Washington, DC 20001, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Hospital Road, Nairobi 00100, Kenya
| | - Justin S Brashares
- Department of Environmental Science, Policy, and Management, University of California, Berkeley, 130 Mulford Hall #3114, Berkeley, CA 94720, USA
| | - Sera L Young
- Department of Anthropology, Northwestern University, 1810 Hinman Avenue, Evanston, IL 60208, USA
| | - Lia C H Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Room 5302, Berkeley, CA 94720-7360, USA
| | - Kathryn J Fiorella
- Master of Public Health Program, Department of Population Medicine and Diagnostic Sciences, Cornell University, S2-004 Shurman Hall, Ithaca, NY 14853, USA
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Mireku MO, Davidson LL, Zoumenou R, Massougbodji A, Cot M, Bodeau-Livinec F. Consequences of prenatal geophagy for maternal prenatal health, risk of childhood geophagy and child psychomotor development. Trop Med Int Health 2018; 23:841-849. [PMID: 29876999 PMCID: PMC6103800 DOI: 10.1111/tmi.13088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
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.
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Affiliation(s)
- Michael O Mireku
- School of Psychology, University of Lincoln, Lincoln, UK
- Institut de Recherche pour le Développement, Mère et Enfant Face aux Infections Tropicales, Paris, France
| | - Leslie L Davidson
- Mailman School of Public Health and the College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Romeo Zoumenou
- Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Bénin
| | | | - Michel Cot
- Institut de Recherche pour le Développement, Mère et Enfant Face aux Infections Tropicales, Paris, France
- PRES Sorbonne Paris Cité, Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Paris, France
| | - Florence Bodeau-Livinec
- Département Méthodes Quantitatives en Santé Publique, Ecole des Hautes Etudes en Santé Publique, Rennes, France
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
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Miller JD, Collins SM, Omotayo M, Martin SL, Dickin KL, Young SL. Geophagic earths consumed by women in western Kenya contain dangerous levels of lead, arsenic, and iron. Am J Hum Biol 2018; 30:e23130. [PMID: 29722093 DOI: 10.1002/ajhb.23130] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/25/2018] [Accepted: 04/07/2018] [Indexed: 01/13/2023] Open
Abstract
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.
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Affiliation(s)
- Joshua D Miller
- Department of Anthropology, Northwestern University, Evanston, Illinois 60208
| | - Shalean M Collins
- Department of Anthropology, Northwestern University, Evanston, Illinois 60208
| | - Moshood Omotayo
- Program in International Nutrition, Cornell University, Ithaca, New York 14850.,Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York 14214
| | - Stephanie L Martin
- Department of Nutrition, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Katherine L Dickin
- Department of Nutritional Sciences, Cornell University, Ithaca, New York 14850
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, Illinois 60208
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Placek CD. Ethnomedical and Sociocultural Factors of Pica Substances in Rural South India. Ecol Food Nutr 2017; 56:238-255. [DOI: 10.1080/03670244.2017.1311255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Caitlyn D. Placek
- Department of Epidemiology, Florida International University, Miami, Florida, USA
- Department of Anthropology, Washington State University, Pullman, Washington, USA
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Ivoke N, Ikpor N, Ivoke O, Ekeh F, Ezenwaji N, Odo G, Iyaji F, Onoja U, Eyo J. Geophagy as risk behaviour for gastrointestinal nematode infections among pregnant women attending antenatal clinics in a humid tropical zone of Nigeria. Afr Health Sci 2017; 17:24-31. [PMID: 29026374 DOI: 10.4314/ahs.v17i1.5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Geophagy is wide spread among pregnant women in Ebonyi State, Nigeria. OBJECTIVE The aim of this study was to assess intestinal nematode infections among geophagous pregnant women in Southern Ebonyi State, Nigeria. METHODS Pregnant women were aged 17-45 years at gestational ages of ≥ 14 to 24 weeks on hospital enrolment were sampled. Data on geophagy was collected using structured questionnaire. Gastrointestinal nematode status of the participants was determined by stool analyses. Soil types ingested were examined for intestinal nematode ova / larvae. RESULTS The prevalence of geophagy (46.4%) was associated with socio-demographic characteristics. Ascaris lumbricoides and hookworm were associated with geophagy while Trichuris trichiura and Strongyloides stercoralis had no association. Prevalence of A. lumbricoides, T. trichiura and S. stercoralis differed significantly (p<0.05) between geophagous and non-geophagous women. The soil types consumed had eggs / larvae of A. lumbricoides and T. trichiura. Geophagy is a risk behaviour directly associated with A. lumbricoides, hookworm, T. trichiura, and to a lesser extent S. stercoralis infection among pregnant women. CONCLUSION Sensitization and mass education of pregnant women on the dangers of geophagy is needed. Furthermore, deworming of pregnant women should be integrated into the healthcare delivery system of the State.
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Affiliation(s)
- Njoku Ivoke
- University of Nigeria, Department of Zoology and Environmental Biology
| | - Nnenna Ikpor
- University of Nigeria, Department of Zoology and Environmental Biology
| | - Obinna Ivoke
- Jackson State University, Department of Epidemiology and Biostatistics, School of Public Health
| | - Felicia Ekeh
- University of Nigeria, Department of Zoology and Environmental Biology
| | - Ngozi Ezenwaji
- University of Nigeria, Department of Zoology and Environmental Biology
| | - Gregory Odo
- University of Nigeria, Department of Zoology and Environmental Biology
| | - Florence Iyaji
- Kogi State University, Department of Biological Sciences
| | - Uwakwe Onoja
- University of Nigeria, Department of Home Science, Nutrition and Dietetics, Faculty of Agriculture
| | - Joseph Eyo
- University of Nigeria, Department of Zoology and Environmental Biology
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Placek CD, Hagen EH. Fetal Protection : The Roles of Social Learning and Innate Food Aversions in South India. HUMAN NATURE-AN INTERDISCIPLINARY BIOSOCIAL PERSPECTIVE 2016; 26:255-76. [PMID: 26286435 DOI: 10.1007/s12110-015-9239-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pregnancy involves puzzling aversions to nutritious foods. Although studies generally support the hypotheses that such aversions are evolved mechanisms to protect the fetus from toxins and/or pathogens, other factors, such as resource scarcity and psychological distress, have not been investigated as often. In addition, many studies have focused on populations with high-quality diets and low infectious disease burden, conditions that diverge from the putative evolutionary environment favoring fetal protection mechanisms. This study tests the fetal protection, resource scarcity, and psychological distress hypotheses of food aversions in a resource-constrained population with high infectious disease burden. The role of culture is also explored. In the first of two studies in Tamil Nadu, India, we investigated cultural explanations of pregnancy diet among non-pregnant women (N = 54). In the second study, we conducted structured interviews with pregnant women (N = 94) to determine their cravings and aversions, resource scarcity, indices of pathogen exposure, immune activation, psychological distress, and emic causes of aversions. Study 1 found that fruits were the most commonly reported food that pregnant women should avoid because of their harmful effects on infants. Study 2 found modest support for the fetal protection hypothesis for food aversions. It also found that pregnant women most commonly avoided fruits as well as "black" and "hot" foods. Aversions were primarily acquired through learning and focused on protecting the infant from harm. Our findings provide modest support for the fetal protection hypothesis and surprisingly strong support for the influence of cultural norms and learning on dietary aversions in pregnancy.
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Affiliation(s)
- Caitlyn D Placek
- Department of Anthropology, Washington State University, PO Box 644910, Pullman, WA, 99163, USA,
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Trends and consequences of consumption of food and non-food items (pica) by pregnant women in Western Kenya. NFS JOURNAL 2016. [DOI: 10.1016/j.nfs.2016.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Huebl L, Leick S, Guettl L, Akello G, Kutalek R. Geophagy in Northern Uganda: Perspectives from Consumers and Clinicians. Am J Trop Med Hyg 2016; 95:1440-1449. [PMID: 27698274 DOI: 10.4269/ajtmh.15-0579] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 08/08/2016] [Indexed: 12/23/2022] Open
Abstract
The etiology and health consequences of geophagy are still poorly understood. The consumed soil, individual motives, consumption habits, and the clinical perspective of geophagy in northern Uganda were examined. A total of 50 semistructured interviews (17 pregnant, eight nonpregnant women, 10 men, and 15 health-care professionals) were conducted. Our results suggest that geophagy is not limited to pregnancy and can also be found among nonpregnant women and men. During gestation, excessive amounts of various soil types are consumed and can replace food at times. Nonpregnant women and men consume less soil and stick to one type. When pregnant, craving and alleviating gastrointestinal upset are the main motives. In men, the main reasons for geophagy were craving, hypersalivation, and natural stimulants. If soil is craved, it can show similarities to a dependency syndrome. When picked up in childhood, geophagy is more likely to be continued throughout life. The consumption habits differ and thereby vary in their possible implications on health. Our findings suggest that men should be included in further studies. Especially nurses from the antenatal care are exposed to geophagists; however, no national guidelines exist for geophagy. Further research is necessary to create guidelines to be included in medical training and practice.
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Affiliation(s)
- Lena Huebl
- Unit Ethnomedicine and International Health, Department of General Practice and Family Medicine, Center of Public Health, Medical University of Vienna, Vienna, Austria
| | - Stephan Leick
- Unit Ethnomedicine and International Health, Department of General Practice and Family Medicine, Center of Public Health, Medical University of Vienna, Vienna, Austria
| | - Lukas Guettl
- Unit Ethnomedicine and International Health, Department of General Practice and Family Medicine, Center of Public Health, Medical University of Vienna, Vienna, Austria
| | - Grace Akello
- Department of Mental Health, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Ruth Kutalek
- Unit Ethnomedicine and International Health, Department of General Practice and Family Medicine, Center of Public Health, Medical University of Vienna, Vienna, Austria.
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Raman S, Nicholls R, Ritchie J, Razee H, Shafiee S. How natural is the supernatural? Synthesis of the qualitative literature from low and middle income countries on cultural practices and traditional beliefs influencing the perinatal period. Midwifery 2016; 39:87-97. [DOI: 10.1016/j.midw.2016.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 05/03/2016] [Accepted: 05/07/2016] [Indexed: 11/26/2022]
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Raman S, Nicholls R, Ritchie J, Razee H, Shafiee S. Eating soup with nails of pig: thematic synthesis of the qualitative literature on cultural practices and beliefs influencing perinatal nutrition in low and middle income countries. BMC Pregnancy Childbirth 2016; 16:192. [PMID: 27464710 PMCID: PMC4964025 DOI: 10.1186/s12884-016-0991-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The perinatal period, i.e. pregnancy, childbirth and early infancy, is a significant transition period where the biological and the social strongly intersect. In low and middle-income countries the disease burden arising from the perinatal period, is still substantial. The perinatal period is also a crucial window of opportunity for reducing undernutrition and its long term adverse effects. METHODS We explored qualitative research conducted in low resource settings around the perinatal continuum over the past two decades, with a particular focus on the 'cultural' realm, to identify common themes influencing maternal and infant nutrition. We systematically searched electronic databases from 1990 to 2014, including MEDLINE, EMBASE, PsycINFO, Scopus and Cumulative Index to Nursing and Allied Health Literature, using relevant search terms including traditional beliefs, practices, pregnancy, childbirth, developing countries etc. Adapted Consolidated Criteria for Reporting Qualitative Health Research and Critical Appraisal Skills Programme criteria were used to determine quality of studies. We synthesised the literature thematically, enabled by NVivo 10 software. RESULTS Most studies showed cultural support for breastfeeding, although most traditional societies delayed breastfeeding due to colostrum being considered 'dirty'. A range of restrictive practices through pregnancy and the post- partum period were revealed in Asia, Latin America and Africa. There was a strong cultural understanding of the healing power of everyday foods. A wide range of good foods and bad foods continued to have currency through the perinatal continuum, with little consensus between groups of what was beneficial versus harmful. Cross-cutting themes that emerged were 1) the role of the woman/mother/wife as strong and good; 2) poverty restricting women's nutrition choices; 3) change being constant, but the direction of change unpredictable. CONCLUSIONS A rich and diverse repertoire of cultural practices and beliefs influenced perinatal nutrition. Results from this synthesis should influence public health policymakers and practitioners, to tailor contextually specific, culturally responsive perinatal nutrition interventions to optimise health and wellbeing of mother-infant dyads. Ideally these interventions should build on culturally sanctioned life affirming behaviours such as breastfeeding, promoting post-partum rest and recovery, while modifying the potentially harmful aspects of other cultural practices in the perinatal period.
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Affiliation(s)
- Shanti Raman
- School of Public Health & Community Medicine, University of New South Wales, & South Western Sydney Local Health District, Health Services Building Level 3, Cnr Campbell & Goulburn St, Liverpool, NSW, 2170, Australia.
| | - Rachel Nicholls
- Faculty of Health, University of Technology, Sydney Level 7, 235 Jones St, Ultimo, NSW, 2007, Australia
| | - Jan Ritchie
- School of Public Health & Community Medicine, University of New South Wales, Samuels Building, Gate 11, Botany Street, Randwick, UNSW, Sydney, NSW, 2052, Australia
| | - Husna Razee
- School of Public Health & Community Medicine, University of New South Wales, Samuels Building, Gate 11, Botany Street, Randwick, UNSW, Sydney, NSW, 2052, Australia
| | - Samaneh Shafiee
- School of Public Health & Community Medicine, University of New South Wales, Samuels Building, Gate 11, Botany Street, Randwick, UNSW, Sydney, NSW, 2052, Australia
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A meta-analysis of the worldwide prevalence of pica during pregnancy and the postpartum period. Int J Gynaecol Obstet 2016; 133:277-83. [DOI: 10.1016/j.ijgo.2015.10.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/16/2015] [Accepted: 01/19/2016] [Indexed: 11/18/2022]
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Compaore A, Gies S, Brabin B, Tinto H, Brabin L. "There is iron and iron…" Burkinabè women's perceptions of iron supplementation: a qualitative study. Matern Child Health J 2015; 18:1976-84. [PMID: 25138626 DOI: 10.1007/s10995-014-1443-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Most pregnant women in Burkina Faso are iron deficient and many are anemic. This study assessed women's understanding of anemia and the role of iron in preventing and treating this condition. A qualitative study was conducted within a randomized controlled trial of weekly iron supplementation in a rural malaria endemic area. Focus groups with women of similar age, parity, and marital status took place in 12 of 24 study villages. Two additional focus groups were conducted with female field workers. Tape-recorded transcripts were translated into French and analyzed using Framework analysis. Anemia, for which no Mooré term or traditional treatment for anemia was evident, was described in terms of blood volume. Moderate blood loss (diminished blood) could be easily replaced by eating well and was not considered serious. Massive blood loss (finished blood) was a rare, life-threatening illness. Iron tablets could increase blood volume and help women withstand massive blood loss at delivery, but for the latter, transfusion was indicated. Women had no knowledge of iron's role and did not readily concede that iron supplements contained elemental iron. Neither adolescents nor field workers were convinced of the benefits of supplementing non-pregnant adolescents, who were incorrectly considered to be at low risk of anemia. Young women's knowledge of anemia did not provide an adequate explanatory framework to motivate anemia prevention. Improving information on the role of iron is especially important for adolescent girls who may be incorrectly considered at low risk of anemia as they have not yet experienced pregnancy.
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Affiliation(s)
- A Compaore
- Clinical Research Unit Nanoro, Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, Bobo-Dioulasso, Burkina Faso
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Orloff NC, Hormes JM. Pickles and ice cream! Food cravings in pregnancy: hypotheses, preliminary evidence, and directions for future research. Front Psychol 2014; 5:1076. [PMID: 25295023 PMCID: PMC4172095 DOI: 10.3389/fpsyg.2014.01076] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 09/08/2014] [Indexed: 12/20/2022] Open
Abstract
Women in the United States experience an increase in food cravings at two specific times during their life, (1) perimenstrually and (2) prenatally. The prevalence of excess gestational weight gain (GWG) is a growing concern due to its association with adverse health outcomes in both mothers and children. To the extent that prenatal food cravings may be a determinant of energy intake in pregnancy, a better understanding of craving etiology could be crucial in addressing the issue of excessive GWG. This paper reviews the available literature to corroborate and/or dispute some of the most commonly accepted hypotheses regarding the causes of food cravings during pregnancy, including a role of (1) hormonal changes, (2) nutritional deficits, (3) pharmacologically active ingredients in the desired foods, and (4) cultural and psychosocial factors. An existing model of perimenstrual chocolate craving etiology serves to structure the discussion of these hypotheses. The main hypotheses discussed receive little support, with the notable exception of a postulated role of cultural and psychosocial factors. The presence of cravings during pregnancy is a common phenomenon across different cultures, but the types of foods desired and the adverse impact of cravings on health may be culture-specific. Various psychosocial factors appear to correlate with excess GWG, including the presence of restrained eating. Findings strongly suggest that more research be conducted in this area. We propose that future investigations fall into one of the four following categories: (1) validation of food craving and eating-related measures specifically in pregnant populations, (2) use of ecological momentary assessment to obtain real time data on cravings during pregnancy, (3) implementation of longitudinal studies to address causality between eating disorder symptoms, food cravings, and GWG, and (4) development of interventions to ensure proper prenatal nutrition and prevent excess GWG.
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Affiliation(s)
- Natalia C. Orloff
- Health Behaviors Laboratory, Department of Psychology, University at Albany – State University of New YorkAlbany, NY, USA
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Dako-Gyeke P, Aikins M, Aryeetey R, McCough L, Adongo PB. The influence of socio-cultural interpretations of pregnancy threats on health-seeking behavior among pregnant women in urban Accra, Ghana. BMC Pregnancy Childbirth 2013; 13:211. [PMID: 24246028 PMCID: PMC3840661 DOI: 10.1186/1471-2393-13-211] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 11/15/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although antenatal care coverage in Ghana is high, there exist gaps in the continued use of maternity care, especially utilization of skilled assistance during delivery. Many pregnant women seek care from different sources aside the formal health sector. This is due to negative perceptions resulting from poor service quality experiences in health facilities. Moreover, the socio-cultural environment plays a major role for this care-seeking behavior. This paper seeks to examine beliefs, knowledge and perceptions about pregnancy and delivery and care-seeking behavior among pregnant women in urban Accra, Ghana. METHODS A qualitative study with 6 focus group discussions and 13 in-depth interviews were conducted at Taifa-Kwabenya and Madina sub-districts, Accra. Participants included mothers who had delivered within the past 12 months, pregnant women, community members, religious and community leaders, orthodox and non-orthodox healthcare providers. Interviews and discussions were audio-taped, transcribed and coded into larger themes and categories. RESULTS Evidence showed perceived threats, which are often given socio-cultural interpretations, increased women's anxieties, driving them to seek multiple sources of care. Crucially, care-seeking behavior among pregnant women indicated sequential or concurrent use of biomedical care and other forms of care including herbalists, traditional birth attendants, and spiritual care. Use of multiple sources of care in some cases disrupted continued use of skilled provider care. Furthermore, use of multiple forms of care is encouraged by a perception that facility-based care is useful only for antenatal services and emergencies. It also highlights the belief among some participants that care from multiple sources are complementary to each other. CONCLUSIONS Socio-cultural interpretations of threats to pregnancy mediate pregnant women's use of available healthcare services. Efforts to encourage continued use of maternity care, especially skilled birth assistance at delivery, should focus on addressing generally perceived dangers to pregnancy. Also, the attractiveness of facility-based care offers important opportunities for building collaborations between orthodox and alternative care providers with the aim of increasing use of skilled obstetric care. Conventional antenatal care should be packaged to provide psychosocial support that helps women deal with pregnancy-related fear.
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Affiliation(s)
- Phyllis Dako-Gyeke
- School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana.
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Jumbam ND. Geophagic materials: the possible effects of their chemical composition on human health. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/0035919x.2013.843606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Placek CD, Hagen EH. A test of three hypotheses of pica and amylophagy among pregnant women in Tamil Nadu, India. Am J Hum Biol 2013; 25:803-13. [PMID: 24130118 DOI: 10.1002/ajhb.22456] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 08/20/2013] [Accepted: 08/21/2013] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Pica has been studied in India and elsewhere for more than 100 years, yet no compelling and empirically well-supported explanation for it has emerged. Amylophagy, sometimes considered a type of pica and sometimes studied separately, is less frequently investigated and also lacks a convincing explanation. This study used a biocultural approach to test three hypotheses of pica and amylophagy: protection, hunger/nutrition, and psychological distress. METHODS The research took place in Tamil Nadu, India. In study 1, a cultural investigation was carried out among nonpregnant, adult women (n = 54) to determine nonfood substances that are consumed in this region and perceptions of health consequences. Next, using the substances identified in Study 1, three hypotheses of pica and amylophagy were tested in a cross-sectional study of pregnant women (Study 2, n = 95). Logistic regression analysis was used to analyze the presence or absence of engaging in pica and amylophagy. A series of bivariate analyses were used to examine the variation in amount and frequency of consumption. RESULTS Study 1 revealed that cultural attitudes strongly shape the selection of nonfood substances. In Study 2, the presence or absence of pica was not predicted by any of the variables included in the study, whereas the frequency and amount of consumption of pica substances were primarily explained by the psychological distress and hunger/nutrition hypotheses. Both the presence or absence of amylophagy as well as the frequency and amount of consumption were best explained by the protection hypothesis. CONCLUSIONS This research provided partial support for the protection and hunger/nutrition hypotheses for amylophagy, and also provided some evidence for the role of psychological distress and hunger or nutrition in pica.
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Affiliation(s)
- Caitlyn D Placek
- Department of Anthropology, Washington State University, Pullman, Washington
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Reeuwijk N, Klerx W, Kooijman M, Hoogenboom L, Rietjens I, Martena M. Levels of lead, arsenic, mercury and cadmium in clays for oral use on the Dutch market and estimation of associated risks. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2013; 30:1535-45. [DOI: 10.1080/19440049.2013.811297] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Getachew M, Tafess K, Zeynudin A, Yewhalaw D. Prevalence soil transmitted helminthiasis and malaria co-infection among pregnant women and risk factors in Gilgel Gibe Dam area, southwest Ethiopia. BMC Res Notes 2013; 6:263. [PMID: 23837685 PMCID: PMC3710253 DOI: 10.1186/1756-0500-6-263] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 07/03/2013] [Indexed: 11/24/2022] Open
Abstract
Background Malaria and Soil Transmitted Helminthiasis (STH) are co-endemic and major public health problems in Ethiopia. The aim of the study was to assess the prevalence of malaria and STHs co-infection and to determine the association risk factors. Methods A cross-sectional community based study was conducted on 388 pregnant women living in three districts around Gilgel Gibe Dam area, southwestern Ethiopia. Socio-demographic and socio-economic data, single stool sample and blood sample were collected from each participant. Results The prevalence of STH and malaria was 159 (41%) and 45 (11.6%), respectively and the prevalence of STHs/malaria co-infection was 30 (7.7%). Hookworm was the most prevalent 114 (29.4%) soil transmitted helminthiasis infection followed by Ascaris lumbricoides (A. lumbricoides) 58 (15%) and Trichuris trichiura (T. trichiura) 13 (3.4%). Habit of eating soil (Adjusted Odds Ratio (AOR) = 4.64, 95% CI: 1.50-14.36, P=0.008), presence of stagnant water near study participants’ house (AOR=2.99, 95% CI: 1.28-6.99, P=0.012) and habit of using human feces as a fertilizer (AOR= 5.34, 95% CI: 1.99-14.28, P<0.001) were found to be significantly associated with malaria and STH co-infection among the pregnant women. Hookworm parasitic load was positively correlated with malaria parasitic load (r = 0.299, P<0.001) while A. lumbricoides parasitic load was negatively correlated with malaria parasitic load (r = −0.095, P<0.001). Conclusion Intestinal parasite and/or malaria co-infection is a health problem among pregnant women living around Gilgel Gibe dam area. Therefore, intervention including improving sanitation, removing stagnant water, and health education to the pregnant women should be given.
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Affiliation(s)
- Million Getachew
- Department of Biomedical Science, School of Health and Hospital, Adama Science and Technology University, Asella, Ethiopia
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Abstract
INTRODUCTION 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. RECOMMENDATIONS 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. TARGET AUDIENCE Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES 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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Abdelgadir MA, Khalid AR, Ashmaig AL, Ibrahim ARM, Ahmed AAM, Adam I. Epidemiology of anaemia among pregnant women in Geizera, central Sudan. J OBSTET GYNAECOL 2011; 32:42-4. [DOI: 10.3109/01443615.2011.617849] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Young SL, Sherman PW, Lucks JB, Pelto GH. Why on earth?: Evaluating hypotheses about the physiological functions of human geophagy. THE QUARTERLY REVIEW OF BIOLOGY 2011; 86:97-120. [PMID: 21800636 DOI: 10.1086/659884] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
- Sera L Young
- Department of Obstetrics and Gynecology, University of California, San Francisco, California 94105, USA.
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Wulandari LPL, Klinken Whelan A. Beliefs, attitudes and behaviours of pregnant women in Bali. Midwifery 2010; 27:867-71. [PMID: 21131110 DOI: 10.1016/j.midw.2010.09.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 08/07/2010] [Accepted: 09/24/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore beliefs, attitudes and behaviours of pregnant women in Bali, Indonesia. DESIGN Descriptive qualitative study using in-depth interviews. SETTING Community health-care centre in South Kuta, Bali, Indonesia. PARTICIPANTS 18 Pregnant women aged 20-35 years. FINDINGS Insights into beliefs and attitudes regarding pregnancy emerged from the analysis. Participants believed that some foods should or should not be eaten by pregnant women. They believed that vegetables are better than meat during pregnancy. Strong beliefs about traditional herbal remedies also emerged. Complex beliefs on locus of control were also expressed by the majority of the respondents regarding who was responsible for the health and well-being of their infant. Women maintained that they themselves, health-care professionals, nature and God were all responsible for the health of their infant. In addition, some respondents acknowledged the crucial role of the family for support and advice during pregnancy. IMPLICATIONS FOR PRACTICE Interventions to improve the quality of antenatal care and pregnancy outcomes in Indonesia should consider these beliefs and attitudes. Counselling by health-care workers, for example, might explicitly seek women's complex beliefs on locus of control, and views on preferences for traditional remedies and food, especially low meat intake. Involvement of husbands and other family members during pregnancy and birth should also be encouraged and re-inforced by health promotion programmes. Community and religious leaders should be engaged to support key messages.
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Affiliation(s)
- Luh Putu Lila Wulandari
- Faculty of Medicine, School of Public Health, Udayana University, Denpasar, Bali 80232, Indonesia.
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Abstract
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.
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Affiliation(s)
- Sera L Young
- Department of Pediatrics, University of California, Davis, California 95817, USA.
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Dunker KLL, Alvarenga MDS, Alves VPDO. Transtornos alimentares e gestação: uma revisão. JORNAL BRASILEIRO DE PSIQUIATRIA 2009. [DOI: 10.1590/s0047-20852009000100010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Estudar o impacto dos transtornos alimentares nas funções reprodutivas, problemas na gestação e puerpério, e dificuldades com a alimentação dos filhos. MÉTODOS: Realizou-se revisão da literatura nos últimos 28 anos nos bancos de dados MedLine e Lilacs. Combinaram-se os descritores anorexia nervosa, bulimia nervosa, transtornos alimentares e gestação. RESULTADOS: Os estudos de revisão, estudos de caso e pesquisas realizadas com gestantes apontam uma associação entre TA e uma variedade de complicações na gestação, no parto, para o feto, com aumentado risco de morbidade perinatal, além de complicações na alimentação futura da criança. CONCLUSÕES: Observa-se uma maior necessidade de acompanhamento especializado, principalmente no pré-natal, em relação aos hábitos alimentares e preocupação com peso e forma corporais - especialmente nas mulheres que apresentam ganho ponderal inadequado, hiperêmese gravídica, picacismo, entre outros.
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Young SL, Wilson MJ, Miller D, Hillier S. Toward a comprehensive approach to the collection and analysis of pica substances, with emphasis on geophagic materials. PLoS One 2008; 3:e3147. [PMID: 18773081 PMCID: PMC2522275 DOI: 10.1371/journal.pone.0003147] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 07/22/2008] [Indexed: 11/22/2022] Open
Abstract
Background Pica, the craving and subsequent consumption of non-food substances such as earth, charcoal, and raw starch, has been an enigma for more than 2000 years. Currently, there are little available data for testing major hypotheses about pica because of methodological limitations and lack of attention to the problem. Methodology In this paper we critically review procedures and guidelines for interviews and sample collection that are appropriate for a wide variety of pica substances. In addition, we outline methodologies for the physical, mineralogical, and chemical characterization of these substances, with particular focus on geophagic soils and clays. Many of these methods are standard procedures in anthropological, soil, or nutritional sciences, but have rarely or never been applied to the study of pica. Principal Findings Physical properties of geophagic materials including color, particle size distribution, consistency and dispersion/flocculation (coagulation) should be assessed by appropriate methods. Quantitative mineralogical analyses by X-ray diffraction should be made on bulk material as well as on separated clay fractions, and the various clay minerals should be characterized by a variety of supplementary tests. Concentrations of minerals should be determined using X-ray fluorescence for non-food substances and inductively coupled plasma–atomic emission spectroscopy for food-like substances. pH, salt content, cation exchange capacity, organic carbon content and labile forms of iron oxide should also be determined. Finally, analyses relating to biological interactions are recommended, including determination of the bioavailability of nutrients and other bioactive components from pica substances, as well as their detoxification capacities and parasitological profiles. Significance This is the first review of appropriate methodologies for the study of human pica. The comprehensive and multi-disciplinary approach to the collection and analysis of pica substances detailed here is a necessary preliminary step to understanding the nutritional enigma of non-food consumption.
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Affiliation(s)
- Sera L Young
- School of Public Health, University of California, Berkeley, California, United States of America
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Klein N, Fröhlich F, Krief S. Geophagy: soil consumption enhances the bioactivities of plants eaten by chimpanzees. Naturwissenschaften 2008; 95:325-31. [DOI: 10.1007/s00114-007-0333-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 11/08/2007] [Accepted: 11/17/2007] [Indexed: 11/30/2022]
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Affiliation(s)
- Margaret E Mills
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Young SL, Ali SM. Linking traditional treatments of maternal anaemia to iron supplement use: an ethnographic case study from Pemba Island, Zanzibar. MATERNAL AND CHILD NUTRITION 2006; 1:51-8. [PMID: 16881879 PMCID: PMC6874392 DOI: 10.1111/j.1740-8709.2004.00002.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Iron deficiency anaemia is the most common form of malnutrition in the world. Pregnant women are particularly at risk for anaemia. Insufficient attention has been paid to the reasons underlying the only moderate success of iron supplementation. In this article an additional factor that can affect the use of iron supplements is proposed: their relevance to 'traditional' or nonbiomedical treatments of anaemia. This paper represents what is to our knowledge the first ethnographic description of nonbiomedical treatments for maternal anaemia. The research was conducted over several months on Pemba, one of the islands of the Zanzibar archipelago. Data were collected using a variety of qualitative methods, including in-depth interviews, focus group discussions and participant observation. Informants included 25 mothers and 27 traditional and biomedical health care workers. The resulting ethnography elucidates Pembans' beliefs about the relationship of food, traditional medicine, spirits and biomedical medicine in relation to anaemia. In the analysis of the ethnography, both anthropology and public health perspectives are incorporated to suggest how the understanding of these beliefs is useful for increasing iron supplement use.
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Affiliation(s)
- Sera L Young
- Division of Nutritional Sciences, Savage Hall, Cornell University, Ithaca, NY 14853, USA.
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Adam I, Khamis AH, Elbashir MI. Prevalence and risk factors for anaemia in pregnant women of eastern Sudan. Trans R Soc Trop Med Hyg 2005; 99:739-43. [PMID: 16024057 DOI: 10.1016/j.trstmh.2005.02.008] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2004] [Revised: 01/12/2005] [Accepted: 02/07/2005] [Indexed: 11/19/2022] Open
Abstract
The prevalence and possible risk factors for anaemia were investigated in 744 pregnant Sudanese women attending the antenatal clinic of New Halfa teaching hospital, eastern Sudan between October 2003 and April 2004. Of those, 466 (62.6%) had anaemia (haemoglobin [Hb]: <11 gm/dl); 52.4% had mild anaemia (Hb: 9.0-10.9 gm/dl); 8.1% had moderate anaemia (Hb: 7.0-8.9 gm/dl); and 2.2% had severe anaemia (Hb: <7 gm/dl), respectively. The prevalence of anaemia (73.2%) was significantly high in grandmultigravidae. Univariate and multivariate analysis showed that age and parity were not significantly associated with anaemia. Malaria (OR = 4.5, 95% CI 2.5-8.1; P < 0.0001) and pica (OR = 1.6, 95% CI 1.05-2.6; P = 0.03) were the risk factors for anaemia. Thus, preventive measures against malaria (chemoprophylaxis and insecticide-treated bednets) may be needed for all pregnant women irrespective of their age or parity.
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Affiliation(s)
- Ishag Adam
- New Halfa Teaching Hospital, Obstetric and Gynecology, Kassala, Sudan.
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Hartini TNS, Padmawati RS, Lindholm L, Surjono A, Winkvist A. The importance of eating rice: changing food habits among pregnant Indonesian women during the economic crisis. Soc Sci Med 2005; 61:199-210. [PMID: 15847972 DOI: 10.1016/j.socscimed.2004.11.043] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2004] [Accepted: 11/17/2004] [Indexed: 11/22/2022]
Abstract
This article presents qualitative and quantitative research findings on food habits of pregnant Indonesian women in relation to the economic crisis that arose in 1997. Between 1996 and 1998, dietary intakes were estimated for 450 pregnant women in Central Java. Between January and June 1999, four focus group discussions, 16 in-depth interviews and four non-participant observations were held with women, two in-depth interviews were held with traditional birth attendants, and four with midwives. Women were categorized as urban or rural, rich or poor, and according to rice field ownership. The women reported that before the crisis they bought more foods and cooked more meals and snacks. During the crisis, cooking methods became simpler and cooking tasty foods was more important than cooking nutritious foods. This involved using plenty of spices and cooking oil, but reducing the use of expensive nutritious foods. The herbal drink jamu was drunk by 15% of pregnant women; its consumption was lower during than before the economic crisis. Twenty-six percent of the women avoided certain foods due to food taboos, and most of these women avoided beneficial foods; this phenomenon decreased during the crisis among the rich and the rural, poor, landless women. In spite of increased prices for rice, women did not decrease their rice consumption during the crisis because rice was believed to have the highest value for survival, to provide strength during pregnancy and delivery, and to be easier to store and cook. Finally, children and husbands had highest priority in being served food, and women were the last to eat.
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Scott WC, Dean JR. An assessment of the bioavailability of persistent organic pollutants from contaminated soil. ACTA ACUST UNITED AC 2005; 7:710-5. [PMID: 15986051 DOI: 10.1039/b500298b] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A procedure to assess the bioavailability of persistent organic pollutants (POPs) from soil samples has been developed. The procedure is based on the use of simulated in vitro gastrointestinal extraction to remove POPs from soil matrices. The level of recovery, using this approach, is assessed following liquid-liquid extraction (LLE) and analysis by gas chromatography-mass selective detection (GC-MSD). The remaining soil residue is then extracted using pressurised fluid extraction (PFE) followed by GC-MSD analysis to assess the residual fraction. The residual fraction is monitored to determine the unavailable fraction i.e. not available for absorption in the gastrointestinal tract of humans. The procedure was applied to four soil samples i.e. an aged, spiked soil and three certified reference materials (CRMs) contaminated with POPs. Recoveries of pesticides (lindane, endosulfan I, endrin, DDE, DDD and endosulfan II), phenols (cresol, TCP and PCP), and base neutral compounds (hexachloroethane, acenaphthene, dibenzofuran, fluorene and hexachlorobenzene) from aged, spiked soil following extraction with gastric fluid ranged from 0.8 to 8.3% while following intestinal extraction ranged from 5.5 to 13.5%, irrespective of POP. Recoveries of pesticides (lindane, endosulfan I, endrin, DDE, DDD and endosulfan II) from CRM 805-050 following extraction with gastric fluid were below the limit of detection while following intestinal extraction ranged from 5.3 to 12.8%. Recoveries of phenols (cresol, TCP and PCP) from CRM 401-225 following extraction with gastric fluid ranged from 1.6 to 2.0% while following intestinal extraction ranged from 4.1 to 5.4%. Recoveries of base neutral acid analytes (hexachloroethane, acenaphthene, dibenzofuran, fluorene and hexachlorobenzene) from CRM 107-100 following extraction with gastric fluid ranged from 1.4 to 4.0% while following intestinal extraction ranged from 6.6 to 12.7%. It has been found that the majority of POPs present i.e. >75%, would be excreted if consumed and not be absorbed in the gastrointestinal tract of humans.
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Affiliation(s)
- W C Scott
- School of Applied Sciences, Northumbria University, Ellison Building, Newcastle upon Tyne, UKNE1 8ST
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Mathole T, Lindmark G, Majoko F, Ahlberg BM. A qualitative study of women's perspectives of antenatal care in a rural area of Zimbabwe. Midwifery 2004; 20:122-32. [PMID: 15177855 DOI: 10.1016/j.midw.2003.10.003] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2003] [Revised: 06/25/2003] [Accepted: 10/03/2003] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the perspectives and experiences of women in their use of antenatal care and in their reasoning on specific antenatal care routines. DESIGN Two qualitative methods including focus group discussions and individual interviews were combined. SETTING : a rural district in Zimbabwe where a randomised control trial had been undertaken to introduce a new antenatal care package. PARTICIPANTS Forty-four women and twenty-four men participated in the study. FINDINGS Women were observed to take actions contrary to those assumed professionally acceptable in antenatal care generally and in some specific changed routines. Visits were to be reduced and weighing was to be omitted, but women, especially younger women, said they preferred more than the stipulated five goal oriented visits. One reason for this was the importance of being assured that the fetus was growing well. They considered that visits spaced too widely would make it difficult for service providers to help, should complications develop. On the other hand, older women (above 35 years old), a group professionally considered to be at high risk, were not so concerned with the visits. All the women said they wanted to be weighed at all the visits. The antenatal care visits are simply known as 'going for scale'. The health care providers complied by weighing the women without recording. Cultural beliefs had great influence, especially on the time a pregnancy is acknowledged and reported. It is believed that pregnant women and the pregnancy are vulnerable to witchcraft during the early period of pregnancy. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE We concluded that, whether in its traditional or new form, antenatal care ignores the experiences and views of women and the way they make sense of pregnancy and the care of pregnancy. The importance of understanding the perspectives of different stakeholders as the key to effective change is underlined.
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Affiliation(s)
- Thubelihle Mathole
- Department of Women's and Children's Health, Section for International Maternal and Child Health, Uppsala University, University Hospital, Entrance 11, SE-751 85 Uppsala, Sweden.
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Wiles M, Huebner H, Afriyie-Gyawu E, Taylor R, Bratton G, Phillips T. Toxicological evaluation and metal bioavailability in pregnant rats following exposure to clay minerals in the diet. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2004; 67:863-874. [PMID: 15205041 DOI: 10.1080/15287390490425777] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Silicate clays are frequently added to animal feeds to bind and reduce the bioavailability of mycotoxins in the gastrointestinal tract. However, the bioavailability of trace metals in these clay feed additives has not been thoroughly investigated. Clays that act nonselectively may interact with nutrients, minerals, and other feedborne chemicals to pose significant hidden risks. In this study, a calcium montmorillonite clay (Novasil Plus, NSP) commonly used as an enterosorbent for aflatoxins and a sodium montmorillonite clay (Swy-2) (Source Clay Minerals Repository, Columbia, MO) were examined. Clays were supplemented in the balanced diet of Sprague-Dawley rats during pregnancy at a level of 2% (w/w). Evaluations of toxicity were performed on gestation d 16 and included maternal body weights, maternal feed intakes, litter weights, and embryonic resorptions. Liver, kidneys, tibia, brain, uterus, pooled placentas, and pooled embryonic mass were collected and weighed. Tissues were lyophilized and neutron activation analysis (NAA) was performed. Elements considered by NAA included Al, Ba, Br, Ca, Ce, Co, Cr, Cs, Cu, Dy, Eu, Fe, Hf, K, La, Lu, Mg, Mn, Na, Nd, Ni, Rb, S, Sb, Sc, Se, Sm, Sr, Ta, Tb, Te, Th, Ti, Tl, U, V, Yb, Zn, and Zr. Inductively coupled plasma-mass spectroscopy further confirmed that Al was below detection limits (<0.5 ppm) in the brain. Animals supplemented with either NSP or Swy-2 were similar to controls with respect to toxicity evaluations and metal analysis, with the exception of decreased brain Rb following clay supplementation. Overall, the results of this study suggest that neither NSP nor Swy-2, at relatively high dietary concentrations, influences mineral uptake or utilization in the pregnant rat.
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Affiliation(s)
- Melinda Wiles
- Faculty of Toxicology, Department of Veterinary Anatomy and Public Health, College of Veterinary Medicine, Texas A and M University, College Station, Texas 77843, USA
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Aufreiter S, Mahaney WC, Milner MW, Huffman MA, Hancock RG, Wink M, Reich M. Mineralogical and chemical interactions of soils eaten by chimpanzees of the Mahale Mountains and Gombe Stream National Parks, Tanzania. J Chem Ecol 2004; 27:285-311. [PMID: 14768816 DOI: 10.1023/a:1005628405321] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Termite mound soils eaten by chimpanzees of the Mahale Mountains and Gombe National Parks, Tanzania, have mineralogical and geochemical compositions similar to many soils eaten by higher primates, but release very low levels of either toxic or nutritional inorganic elements to solution at acid pH. Comparison with control (uneaten) soils from the same areas showed lower levels of carbon and nitrogen in the eaten soils, a relationship confirmed by surface analysis. Surface analysis also revealed lower levels of iron on particle surfaces versus interiors, and higher levels of iron on ingested versus control soil particle surfaces. The soils can adsorb dietary toxins, present in the plant diet or those produced by microorganisms. Taking the toxic alkaloids quinine, atropine, sparteine, and lupanine as examples, it is evident that soils from Mahale have a very good adsorptive capacity. A new adaptive advantage of geophagy is proposed, based on the prevention of iron uptake. The behavior of the soils in vitro is consistent with the theory that geophagy has a therapeutic value for these chimpanzees.
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Affiliation(s)
- S Aufreiter
- SLOWPOKE Reactor Facility and Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Canada M5S 3E5.
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Corbett RW, Ryan C, Weinrich SP. Pica in pregnancy: does it affect pregnancy outcomes? MCN Am J Matern Child Nurs 2003; 28:183-9; quiz 190-1. [PMID: 12771697 DOI: 10.1097/00005721-200305000-00009] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To discover the prevalence of pica, the documentation of pica on medical records, and any relationship of pica to pregnancy outcomes in rural socioeconomically disadvantaged pregnant women. STUDY DESIGN AND METHODS Prospective, descriptive, correlational investigation with 128 women who sought prenatal care from two rural community health agencies. Demographic and sociocultural variables, pica practices, pica substances ingested, and pregnancy outcomes were collected. RESULTS Thirty-eight percent of these pregnant women practiced pica. African-American women reported practicing pica more often than other ethnicities. Substances ingested included ice (>1 cup/day), freezer frost, laundry starch, cornstarch, clay dirt, and baked clay dirt. Polypica (ingestion of more than one substance) was practiced by 11 women. Women practicing pica were more likely to have been underweight prior to pregnancy, and smoked fewer cigarettes. Women reporting daily pica practice were significantly more likely to have lower prenatal hematocrits than women who did not practice pica, or who practiced pica less frequently than daily. No specific pregnancy complication was associated with the practice of pica. CLINICAL IMPLICATIONS Pica exists, and might be more common than healthcare providers assume. Although this study did not show specific pregnancy complications associated with pica, other studies have shown anemia and lead poisoning among women who practice pica. It is not clear that patients volunteer information about pica, so it would be helpful if nurses queried patients at each prenatal visit regarding pica practice. Discussion of pica practices should be based on a nonjudgmental model, for pica may have strong cultural implications, and may be practiced for cultural reasons unknown to the nurse.
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Affiliation(s)
- Robin Webb Corbett
- School of Nursing, East Carolina University, Rivers Building, Greenville, NC 27858, USA.
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Access and utility as reflections of cultural constructions of pregnancy. PRIMARY CARE UPDATE FOR OB/GYNS 2000; 7:98-104. [PMID: 10840212 DOI: 10.1016/s1068-607x(00)00029-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Health care providers can give their patients better care if they understand how their patients view pregnancy and birth. This article provides some examples of how women from various cultural backgrounds understand pregnancy and how these beliefs affect women's decisions to seek prenatal care and to utilize prenatal services regularly throughout their pregnancies. These concepts-access and utility-provide the frame for this article, and the case studies from diverse ethnic groups provide examples of a variety of cultural beliefs and women's decisions to seek and to value biomedical direction during pregnancy. The conclusion includes several recommendations that health care providers can employ to enhance the quality and effectiveness of care.
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Prince RJ, Luoba AI, Adhiambo P, Ng'uono J, Geissler PW. Geophagy is common among Luo women in western Kenya. Trans R Soc Trop Med Hyg 1999; 93:515-6. [PMID: 10696407 DOI: 10.1016/s0035-9203(99)90355-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- R J Prince
- Danish Bilharziasis Laboratory, Copenhagen, Denmark
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