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The Impact of Geophagia on the Iron Status of Black South African Women

Authors: A. van Onselen, C. M. Walsh, F. J. Veldman, C. Brand


Objectives: To determine the nutritional status and risk factors associated with women practicing geophagia in QwaQwa, South Africa. Materials and Methods: An observational epidemiological study design was adopted which included an exposed (geophagia) and nonexposed (control) group. A food frequency questionnaire, anthropometric measurements and blood sampling were applied to determine nutritional status of participants. Logistic regression analysis was performed in order to identify factors that were likely to be associated with the practice of geophagia. Results: The mean total energy intake for the geophagia group (G) and control group (C) were 10324.31 ± 2755.00 kJ and 10763.94 ± 2556.30 kJ respectively. Both groups fell within the overweight category according to the mean Body Mass Index (BMI) of each group (G= 25.59 kg/m2; C= 25.14 kg/m2). The mean serum iron levels of the geophagia group (6.929 μmol/l) were significantly lower than that of the control group (13.75 μmol/l) (p = 0.000). Serum transferrin (G=3.23g/l; C=2.7054g/l) and serum transferrin saturation (G=8.05%; C=18.74%) levels also differed significantly between groups (p=0.00). Factors that were associated with the practice of geophagia included haemoglobin (Odds ratio (OR):14.50), serumiron (OR: 9.80), serum-ferritin (OR: 3.75), serum-transferrin (OR: 6.92) and transferrin saturation (OR: 14.50). A significant negative association (p=0.014) was found between women who were wageearners and those who were not wage-earners and the practice of geophagia (OR: 0.143; CI: 0.027; 0.755). These findings seem to indicate that a permanent income may decrease the likelihood of practising geophagia. Key Findings: Geophagia was confirmed to be a risk factor for iron deficiency in this community. The significantly strong association between geophagia and iron deficiency emphasizes the importance of identifying the practice of geophagia in women, especially during their child bearing years.

Keywords: Anthropometry, anaemia, geophagia, dietary intake, iron deficiency

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[1] Ghorbani H. 2008. Geophagia, a Soil- Environmental Related Disease. International Meeting on Soil Fertility, Land Management and Agro climatology, Turkey, 957-967.
[2] Brand CE, De Jager L and Ekosse GIE 2009. Possible health effects associated with human geophagic practise: an overview. Medical Technology South Africa, 23(1): 11-13.
[3] Sing D and Sing CF. 2010. Impact of Direct Soil Exposures form Airborne Dust and Geophagy on Human Health. International Journal of Environmental Research and Public Health, 7(3):1205-1223.
[4] Reid RM. 1992. Cultural and medical perspective on geophagia, Medical Anthropology 13:337-351.
[5] Vermeer DE and Ferrell RE Jr. 1985. Nigerian geophagical clay: a traditional antidiarrheal pharmaceutical. Science, 227:634-636.
[6] Hunter J.M. 1973. Geophagy in Africa and the United States: A culture– nutrition hypothesis. Geographical review, vol. 63, pp. 170-195.
[7] Callahan GN. 2003. Eating Dirt. Emerging Infectious Diseases, 9(8): 1016-1021.
[8] Songca SP, Ngole V, Ekosse G, De Jager L. 2010. Demographic characteristics associated with consumption of geophagic clays among ethnic groups in the Free State and Limpopo provinces South Africa. Indilinga African Journal of Indigenous Knowledge Systems, 9(1):110- 123.
[9] Ngozi PO. 2008. Pica practices of pregnant women in Nairobi, Kenya. East African Medical Journal, 85(2):72-79.
[10] Aufreiter S, Hancock RGV, Mahaney WC, Stambolic-Robb A, Sanmugadas K. 1997. Geochemistry and mineralogy of soils eaten by humans. International Journal of Food Science and Nutrition, 48(5): 293-305.
[11] Simon SL. 1998. Soil ingestion by humans: a review of history, data and aetiology with application to risk assessment of radioactively contaminated soil. Soil Physics, 74:647-672.
[12] Abrahams PW. 2012. Involuntary soil ingestion and geophagia: A source and sink of minerals, nutrients and potentially harmful elements to consumers of earth materials. Applied Geochemistry, 27(5): 954-968.
[13] Young SL. 2011. Pica in Response to Food Storage. In Craving Earth, Understanding Pica, the Urge to Eat, Clay, Starch, Ice & Chalk. New York: Columbia University Press.
[14] World Health Organization. 2008. World prevalence of anaemia 1993 – 2005. WHO Global Database on Anaemia. Geneva. Available from Accessed 22 Nov, 2013.
[15] Yadav D and Chandra, J. 2011. Iron Defeciency: Beyond Anemia. Indian J Pediatr, 78:65-72.
[16] MacIntyre UE, Venter CS, Vorster HH, Steyn HS. 2001a. A combination of statistical methods for the analysis of the relative validation data of the quantitative food frequency questionnaire used in the THUSA study. Transition, Health and Urbanisation in South Africa. Public Health Nutrition, 4(1):45-51.
[17] Nelson M. 2000. Methods and validity of dietary assessment. In Human Nutrition and Dietetics. Edited by JS Garrow, WPT James, Ralph A. 10th Ed. Harcourt Publishers, Limited, Edinburgh, UK: 311-331.
[18] Nakamine A. 2004. ABX Pentra user manual. Product no. RAB080FA. Montpellier, Horiba Group: 2-13.
[19] UCSF Clinical Labs-Chemistry. Ferritin: Advia Centaur System. 2010. Available from: Centaur_Ferritin.pdf
[20] Alberti, K.G.M.M., Zimmet, P. and Shaw, J. 2006. Metabolic syndrome – a new world-wide definition. A consensus statement from the International Diabetes Federation. Diabetetic Medicine, 23(5): 476.
[21] Koryo-Dabrah A, Nti CA and Adanu R. 2012. Dietary practices and Nutrient Intakes of Pregnant women in Accra, Ghana. Current Research Journal Biological Sciences 4(4): 358-365.
[22] Young SL. 2010. Pica in pregnancy: new ideas about an old condition. Annu Rev Nutr, 30:403-422.
[23] Nyaruhucha CN. 2009. Food cravings, aversions and pica among pregnant women in Dar es Salaam, Tanzania. Tanzania Journal of Health Research, 11(1): 29-34.
[24] Corbett R, Ryan C & Weinrich S. 2003. Pica in pregnancy: does it affect pregnancy outcomes? The American Journal of Maternal Child Nursing (MCN), 28(3): 190-191.
[25] Karimi MR, Kadivar R, Yarmohammadi H. 2002. Assessment of the prevalence of iron deficiency anemia, by serum ferritin, in pregnant women of Southern Iran. Medical Science Monitor, 8: CR448-492.
[26] Tayie FAK and Lartey A. 1999. Pica practice among pregnant Ghanaians: Relationship with infant birth weight and maternal haemoglobin level. Ghana Medical Journal, 33:67-76.
[27] Prentice A. 2007. Mining the depths: metabolic insights into mineral nutrition. The Proceedings of the Nutrition Society, 66(4): 512-521.
[28] Popkin BM and Gordon-Larsen P. 2004. The nutrition transition: worldwide obesity dynamics and their determinants.International Journal of Obesity and Related Metabolic Disordorders, Suppl 3: S2-S9.
[29] Steyn NP, Nel JH, Parker W, Ayah R, Mbithe D. 2012. Urbanisation and the nutrition transition: a comparison of diet and weight status of South African and Kenyan women. Scandanavian Journal of Public Health, 40 (3): 229-238.
[30] MacIntyre UE, Kruger HS, Venter CS, Vorster HH. 2002. Dietary intakes of an African population in different stages of transition in the North West Province, South Africa: The THUSA study. Nutrition Research, 22:230-256.
[31] Vorster HH. 2010. The link between poverty and malnutrition: A South African perspective. Health SA Gesondheid 15(1) 1-6. Available from: Accessed: Dec 15, 2014.
[32] Lysen LK and Israel DA. 2012. Nutrition in Weight management. In Krause’s Food and the Nutrition Care Process. Edited by LK Mahan, S Escott-Stump and JL Raymond. 13th Ed. Philadelphia: WB Saunders Company: 462-484.
[33] Thomas B and Bishop J. 2007. General dietetic principles and practices. In The Manual of Dietetic Practice. 4th Ed. Wiley-Blackwell.
[34] Sanhanes-1: Shisana O, Labadarios D, Rehle T, Simbayi L, Zuma K, Dhansay A, Reddy P, Parker W, Hoosain E, Naidoo P, Hongoro C, Mchiza Z, Steyn NP, Dwane N, Makoae M, Maluleke T, Ramlagan S, Zungu N, Evans MG, Jacobs L, Faber M, & Sanhanes-1 Team. 2013. South African National Health and Nutrition Examination Survey (Sanhanes-1). Cape Town: HSRC Press.
[35] Goedecke JH, Jennings CL, Lambert EV. Obesity in South Africa. 2006. in Chronic Diseases of Lifestyle in South Africa: 1995-2005. Edited by K Steyn, J Fourie, N Temple. Medical Research Council, South Africa.
[36] López LB, de Portela, ML. and Soler CR. 2007. Nutrient intake in women with pagophagia and other forms of pica during the pregnancy. Nutrition Hospital, 22(6):641-647.
[37] Baig-Ansari N, Badruddin SH, Karmaliani R., Harris H, Jehan I, Pasha O, Moss N, McClure EM, Goldenberg RL. 2008. Anemia prevalence and risk factors in pregnant women in an urban area of Pakistan. Food and Nutrition Bulletin, 29(2)|; 132 – 139.
[38] George G and Abiodun A. 2012. Physiological Effects of Geophagy (Soil Eating) with Reference to Iron Nutritional Status in Pregnant women: - A study in Selected Antenatal Clinics in KSD Municipal Area of the Eastern Cape, South Africa. 3rd International Conference on Biology, Environment and Chemistry. IPCBEE, 46: 96-98.
[39] Louw VJ, Du Preez P, Malan A, Van Deventer L, Van Wyk D and Joubert, G. 2007. Pica and food craving in adult patients with iron deficiency in Bloemfontein, South Africa. South African Medical Journal, 97(11):1069-1071.
[40] Kettaneh A, Eclache V, Fain O, Sontag C, Uzan M. et al. 2005. Pica and food craving in patients with iron-deficiency anemia: A case-control study in France. American Journal of Medicine, 118:185-188.
[41] Geissler PW, Shulman CE, Prince RJ, Mutemi W, Mnazi C, Friis H, Lowe B. 1998. Geophagy, Iron Status and anaemia among pregnant women in the coast of Kenya. Transactions of the Royal Society of Tropical Medicine and Hygiene, 92 (5):793-796.
[42] Adam I, Khamis AH and Elbashir MI. 2005. Prevalence and risk factors for anaemia in pregnant women of eastern Sudan. Transaction of the Royal Society of Tropical Medicne and Hygiene, 99(1): 739-743.
[43] Young SL, Khalfan SS, Farag TH, Kavle JA, Ali SM, Hajji H, Rasmussen KM, Pelto GH, Tielsch JM, Stolzfus RJ. 2010. Association of Pica with Anemia and Gastrointestinal Distress among Pregnant Women in Zanzibar, Tanzania. American Journal of Tropical Medicine and Hygiene, 83(1):144-151.
[44] Kawai K, Saathoff E, Antelmann G, Msamanga G and Fawzi WW. 2009. Geophagy (Soil-eating) in relation to anemia and helminth infection among HIV-infected pregnant women in Tanzania. American Journal of Tropical Medicine and Hygiene, 80: 36 – 43.
[45] Mogongoa LF, Brand CE, de Jager L and Ekosse GE. 2011. Hematological Status of QwaQwa women who Ingest Clays. South Africa Medical Technology, 25(1):33-37.
[46] Barton JC, Barton JC, Bertoli LF. 2010. Pica associated with iron deficiency or depletion: clinical and laboratory correlates in 262 nonpregnant adult outpatients. BMC Blood Disorders, 10(9):1-11.