Prevalence of geophagia and its contributing factors among pregnant women at Dr. George Mukhari Academic Hospital, Pretoria

Mineral composition and heavy metal risk assesment of selected geophagic soils from Tanzania

Geophagy or Pica is the unintentional traditional behavior of eating soil by indigenous people in different countries. practiced in many countries due to nausea among pregnant women and mineral deficiencies without knowing the associated health risks. In this study the mineral composition of geophagic soil and its associated health risk among consumers was determined. Dry soil sticks consumed by women were obtained from open markets in Morogoro, Njombe and Mwanza regions in Tanzania. The elemental concentration of geophagic soil was analyzed using Flame Atomic Absorption spectrophotometer. Health risk assessment methods were used to obtain health information after chronic exposure to geophagic soils. The tests used were Target Hazard Quotients (THQ), Total Target Hazard Quotients (TTHQ) and Cancer Risks (CR). The concentration range of metals in samples obtained from three different regions were 16,335.7-47,773.7 mg/kg for Fe, 46.2-1073.5 mg/kg for Ca, 155.3-514.9 mg/kg for K, 44.5-112.4 mg/kg for Zn, 40.7-95.1 mg/kg for Na, 2.4-66.7 mg/kg for Cu, 109.5-572.6 mg/kg for Mn, 3.8-6.85 mg/kg for Pb, 3.1-93 mg/kg for Ni, 62.7-638.6 mg/kg for Cr and 0.4 mg/kg for Cd. The Provisional Daily Intake (PDI), THQ, TTHQ and CR ranged between 3.0 × 10-3 -34.12 mg/kg/day bw, 0.043-48.75, 34.52-77.36 and 2.55×10-5- 0.23 respectively. The TTHQ>1 was evident for metals in all sampling sites which is indicative of non-carcinogenic health effects. Prolonged exposure to Pb at low concentrations in samples from all the sites can cause pathological effects. The cancer risk values for Pb, Ni, Cr and Cd were <1 in which the consumer is likely not to develop cancer in a life time. Essential minerals - Fe, Ca, Zn, Na, K and toxic metals Pb, Cr, Ni and Cu were detected in all the samples. Cd occurred only in samples from Mwanza region that was below the tolerable daily intake. According to WHO/FAO expert's joint committee any amount of Pb consumption is not permitted. Given the presence of essential minerals in the geophagic soils which are however accompanied by toxic minerals in some cases which might have carcinogenic effects, prolonged consumption should be discouraged to avoid risks of serious adverse effects to the health of the general population.

Prevalence and associated factors of symptoms of pica among adolescent schoolchildren in northern Sudan: a cross-sectional study

BACKGROUND

Pica, the craving for and purposive eating of non-food items, is a common worldwide problem, especially among children and pregnant women. There are few published data on pica among adolescents in sub-Saharan Africa, and no study has been carried- out in Sudan. This study was conducted to determine the prevalence and associated factors of symptoms of pica among adolescent schoolchildren in northern Sudan.

METHODS

A school‑based cross‑sectional study was conducted from July to September 2022 among adolescent students (aged 10-19 years) in four public primary and secondary schools in Almatamah locality in north Sudan. Sociodemographic information (age, sex, mother's education, mother's occupation, and father's education) was collected through a questionnaire. Weight and height were measured using a standard procedure, and the body mass index Z-score was computed using the World Health Organization's reference values. Logistic regression analysis was performed.

RESULTS

Of the 384 enrolled adolescents, 180 (46.9%) were male and 204 (53.1%) were female. Their median (interquartile range) age was 15.1 (13.1‒16.3) years. The prevalence of symptoms of pica was found to be 30.7%, accounting for 118 adolescents. The most common type of pica was geophagia (eating clay and sand; 102 adolescents, 86.4%), followed by pagophagia (eating ice; 14 adolescents, 11.8%) and flour (starch; two adolescents, 1.6%). In the logistic regression analysis, females (adjusted odds ratio = 3.52, 95% confidence interval (CI) = 2.15‒5.78) and a lower level of father's education (adjusted odds ratio = 2.05, 95% CI = 1.26‒3.34) were associated with symptoms of pica.

CONCLUSION

In Sudan, symptoms of pica are common among adolescents, especially females. Caregivers need to assess pica in adolescents. Further research is needed to develop guidelines, medical training, and practice.

Current status of research and gaps in knowledge of geophagic practices in Africa

This article synthesises current knowledge and identifies research gaps on the still intriguing aspects of the subject of geophagy as practised in Africa. Despite the voluminous research literature that exists on the subject, geophagy in Africa is still a largely misunderstood phenomenon. Although the practice is not confined to any particular age group, race, gender, or geographical region, in Africa it is most commonly recorded among pregnant women and children. Till now, the precise aetiology of geophagy remains obscure; but the practice is thought to have both beneficial effects such as having a role as a nutrient supplement, as well as several demerits. An updated critical review of human geophagy in Africa - with a section on (other) animal geophagy -, highlights several aspects of the practice that need further research. A comprehensive bibliography is assembled, comprising some of the more pertinent and recently published papers (mostly post-dating the year 2005), as well as older seminal works, providing a baseline and robust framework for aiding the search process of Medical Geology researchers and those from allied fields wanting to explore the still poorly understood aspects of geophagy in Africa.

Concentrations of Pb and Other Associated Elements in Soil Dust 15 Years after the Introduction of Unleaded Fuel and the Human Health Implications in Pretoria, South Africa

Leaded fuel has been reported to contain certain amounts of toxic trace metals such as Pb and Cadmium (Cd), which may have negative impacts on humans and the environment. Unleaded fuel was introduced to South Africa in 2006 with the aim of reducing and eventually eliminating the negative impact of leaded fuel on the environment. However, trace metals are usually nonbiodegradable, and it may therefore be necessary to monitor their presence in the environment so as to evaluate their possible impact on human health. The present study evaluated the levels of Pb and other heavy metals in soil samples collected from petrol (gas) filling stations and from busy roads just around the filling stations in Pretoria, South Africa, fifteen years after the introduction of unleaded fuel. A total of twenty-four (24) soil samples were analysed for lead (Pb), chromium (Cr), copper (Cu), zinc (Zn), arsenic (As), iron (Fe), manganese (Mn), nickel (Ni), titanium (Ti), and cadmium (Cd) using Inductively Coupled Plasma Mass Spectrometry (ICP-MS). The results showed that the concentrations of the trace metals were in the following ranges: Pb, 0.08 ± 0.02−188.36 ± 15.32 ug/g; Mn, 5.35 ± 0.34−6842.43 ± 1.35 ug/g; Zn, 1.82 ± 0.22−9814.89 ± 22.32 ug/g; As, 0.21 ± 0.00−8.42 ± 2.44 ug/g; Cu, 10.51 ± 3.41−859 ± 0.09 ug/g; Cr, 5.80 ± 2.21−417.70 ± 9.08 ug/g; Ti, 19.94 ± 4.99−1036.12 ± 1.49 ug/g; and Fe, 3.06 ± 7.87−674.07 ± 12.22 mg/g. The highest concentrations from all the elements were recorded for Fe in all the collected soil samples. The concentrations of Pb in the soils collected from sites associated with high traffic and industrial areas were higher than for those from all other sites, and the differences were significant (p < 0.05). The pollution index (PI), which is the anthropogenic influence of the trace metals, and the geoaccumulation (Igeo), which allows for the removal of possible variations as regards the studied element in the soil due to the possible differences in the background value, showed that some samples were enriched anthropogenically. The PI for Ni, Pb, Cu, and Cr indicated highly anthropogenically contaminated soils, especially at sites associated with high traffic volumes and in industrial areas. The Igeo showed moderately polluted areas for Pb and Cu in high-traffic areas. The exposure routes for the toxic trace metals that were of concern in the study were either through ingestion or dermal contact. The calculated hazard quotient showed both noncarcinogenic and carcinogenic risks for Fe and Mn via ingestion and through dermal contact for both children and adults, respectively. The concentrations of Pb were high and similar to those that were previously reported in the study and pointed to vehicular emission as one of the contributors. The study also noticed an increase in the presence of Mn and Fe in all soil samples.

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

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

Manual emptying of ventilated improved pit latrines and hygiene challenges - a baseline survey in a peri-urban community in KwaZulu-Natal, South Africa

The presence of Escherichia coli and Staphylococcus spp. was determined on the skin, personal protective equipment, the municipal vehicle, and various surfaces at ten households in a peri-urban community (KwaZulu-Natal, South Africa) before and after manual emptying of ventilated improved pit latrines. Surface samples (n = 14) were collected using sterile wet wipes, and target bacteria were detected using standard procedures. Additionally, E. coli was enumerated in soil samples from an area of open defecation (log₁₀ 3.7 MPN/g) and areas where geophagia occurred (log₁₀ 2.7 - log₁₀ 3.3 MPN/g), using a most probable number (MPN) method. The detection frequency for the target bacteria on household surfaces (e.g., the walkway between the pit latrine and the municipal vehicle) and on municipal workers' hands (which were frequently contaminated before pit emptying), occasionally increased after the pits were emptied, indicating that manual pit emptying might pose a potential health risk to workers and community members.

Geophagia: A case series

Geophagia, a form of pica, is often associated with iron and zinc deficiency. However, a number of environmental, cultural, and psychological factors are also implicated. Pica in children is common with those having intellectual disability. In adults, it is most commonly associated with pregnancy. No specific screening tests for pica exist, but many nutritional and psychological complications can be avoided by accurate and timely diagnosis. Even when pica is diagnosed, no proven treatments exist. Two patients who reported to the psychiatry outpatient department with habit of eating nonnutritive substances for a prolonged period associated with apprehension and decreased appetite are reported. Both the patients were diagnosed with adult pica and were treated with selective serotonin-reuptake inhibitors and psychotherapy with considerable improvement.

Evaluation of radionuclide concentrations and average annual committed effective dose due to medicinal plants and soils commonly consumed by pregnant women in Osukuru, Tororo (Uganda)

The intention of the study was to establish the activity concentrations and the annual committed effective dose due to ingestion of medicinal plants and soils by pregnant women and their probable effects to infants. The samples of medicinal plants and soils were collected from Osukuru, Tororo District (Uganda). The naturally occurring radionuclides investigated were ²²⁶Ra, ²³²Th and ⁴⁰K and their activity concentrations were determined using NaI gamma detector. In the medicinal plants, the average activity concentrations of ²²⁶Ra, ²³²Th and ⁴⁰K were found to be 6.04 Bq/kg, 9.65 Bq/kg and 359.59 Bq/kg respectively. African Basil registered the highest activity concentration of ²²⁶Ra of 10.02 Bq/kg, spider plant had the highest activity concentration of ²³²Th of 18.60 Bq/kg whereas the pumpkin registered the highest activity concentrations of ⁴⁰K of 437.92 Bq/kg. The average activity concentrations of ²²⁶Ra, ²³²Th and ⁴⁰K in 'medicinal soils' were 68.87 Bq/kg, 78.20 Bq/kg and 477.44 Bq/kg respectively. The soils from the anthills registered the highest activity concentration of ²²⁶Ra and ⁴⁰K while the one from bricks registered the highest activity concentration of ²³²Th. The annual committed effective dose due to the ingestion of medicinal plants varied from 0.096 to 0.297 mSv/y with an average of 0.194 mSv/y in infants, 0.016-0.040 mSv/y with an average of 0.029 mSv/y for individuals of age range 12-17 years and 0.007-0.018 mSv/y with an average of 0.013 mSv/y for individuals older than 17 years. Whereas the annual committed effective dose due to the ingestion of 'medicinal soils' varied from 1.28 to 1.65 mSv/y with an average of 1.46 mSv/y in infants, 0.23-0.30 mSv/y with an average of 0.26 mSv/y (12-17 years) and 0.07-0.09 mSv/y with an average of 0.08 mSv/y for individuals older than 17 years. In medicinal plants, the annual committed effective dose for the all age groups examined were below 0.3 mSv/y (maximum world permissible as reported UNSCEAR, 2000) while that due to the ingestion of 'medicinal soils' had values higher 0.3 mSv/y in infants. The results of this study show that there is inherent danger to the infants in consuming soils during pregnancy and this should be discouraged.

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

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

Practices of pica among pregnant women in a tertiary healthcare facility in Ghana

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.

Potential health risk assessment of toxic metals contamination in clay eaten as pica (geophagia) among pregnant women of Ho in the Volta Region of Ghana

INTRODUCTION

Geophagia although pleasurable and somewhat a necessity among pregnant women, also comes along with its own attendant problems such as exposure to potentially hazardous substances like bacteria, fungi, helminthes and ova, radioactive materials, and toxic elemental minerals in the soil depending on the geographical location.

METHODOLOGY

This study evaluated the potential health risk involved during the exposure of pregnant women to toxic elemental minerals via the consumption of clay as pica (geophagia). Elemental mineral analysis was carried out using Buck Scientific 210VGP Flame Atomic Absorption Spectrophotometer (Buck Scientific, Inc. East Norwalk, USA). Risk assessment methods were also used to ascertain the various risks factors and the overall risk level.

RESULTS

Concentrations of the macro elements investigated were 1.38 ± 1.5, 2.40 ± 1.5, 7.74 ± 1.5, 4.01 ± 1.0, 13.24 ± 2.2 and 13.76 ± 2.1 mg/Kg for iron (Fe), copper (Cu), zinc (Zn), potassium (K), magnesium (Mg) and sodium (Na) respectively. While that for the micro elements were 1.63 ± 0.03 μg/Kg, 4.72 ± 0.8, 0.53 ± 0.02 and 1.85 ± 0.3 mg/kg respectively for arsenic (As), manganese (Mn), lead (Pb) and nickel (Ni). Estimated Daily Intake (EDI), Hazard Quotient (HQ), Target Hazard Quotient (THQ) and Total Target Hazard Quotient (TTHQ) values ranged 0.611-5.44 (mg/kg Bw/day), 6.26 × 10^- 4 - 106.5, 0.067-10.34 and 15 respectively.

CONCLUSION

There is the likelihood of posing adverse health problems when clay samples obtained from Anfoega which is sited in the Volta region of Ghana is consumed due to the fact that the HQ's of these elemental minerals were > 1 which points to high content of Manganese (Mn) and Nickel (Ni). It is also likely to cause adverse health problems in an individual's life time since THQ for Arsenic, Lead and Nickel were above 1. Ultimately, the cumulative effect of these toxicants were exceedingly great (≤ 15) which implied a high level of unsafety associated with this clay. Per the results from this study, it is not safe for pregnant women to consume clay as pica since these toxic elements may cause detrimental effects on the foetus of the unborn child.

Review of the nature of some geophagic materials and their potential health effects on pregnant women: some examples from Africa

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.

Not a Common Rectosigmoid Perforation

Gastrointestinal perforation is a common complication arising due to homicidal injuries, trauma or intake of medications like aspirin. Intestinal perforation caused by chronic intake of mud, clay or soil is a rare phenomenon and very few cases have been reported in the literature. We hereby present the first case of rectosigmoid perforation from Pakistan which was caused by chronic mud intake in a female patient. Diagnosis of this condition in its early stage is important because it can be fatal if not addressed urgently.