pica and Ascariasis

The practice of geophagy (soil-eating) is widespread among pregnant and breast-feeding women in sub-Saharan Africa. To assess some of the potential risks accompanying the consumption of geophagic material, we analysed contamination with bacteria, fungi, and geohelminths as well as heavy metals (lead, mercury and cadmium) in 88 African geophagic soil samples, which were purchased in Central, West and East Africa, Europe and the United States. Median microbial viable counts of positive samples were 440 cfu/g (maximum 120,000 cfu/g). The median metal concentrations were 40 mg/kg lead (up to 148 mg/kg), 0.05 mg/kg mercury (up to 0.64 mg/kg), and 0.055 mg/kg cadmium (maximum 0.57 mg/kg). No geohelminth eggs were found in these samples. Our results suggest that geophagic soil samples can be highly contaminated with microbes and may contain high levels of lead. Geophagy, however, is not a cause of adult helminth infection. The periodic consumption of geophagic materials at high dosages might be problematic particularly during pregnancy.

Topics: Adult; Africa South of the Sahara; Animals; Ascariasis; Ascaris lumbricoides; Europe; Female; Health Knowledge, Attitudes, Practice; Humans; Infectious Disease Transmission, Vertical; Metals, Heavy; Pica; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Risk Factors; Soil; Soil Microbiology; United States

Geophagy, the regular and deliberate consumption of soil, is prevalent among pregnant women in sub-Saharan Africa. We examined the associations of geophagy with anemia and helminth infection among 971 human immunodeficiency virus (HIV)-positive pregnant women in Tanzania. About 29% of pregnant women regularly consumed soil. Occupation, marital status, and gestational age were associated with geophagy. Ascaris lumbricoides infection was associated with the prevalence of geophagy (adjusted-prevalence ratio 1.81; 95% confidence interval [CI] = 1.37-2.40); however, hookworm, Trichuris trichiura, and Strongyloides stercoralis showed no association. Anemia and red blood cell characteristics suggestive of iron deficiency were strongly correlated with geophagy at baseline. In longitudinal analyses, we found evidence suggesting that soil consumption may be associated with an increased risk of anemia (adjusted-relative risk 1.16; 95% CI = 0.98-1.36) and a lower hemoglobin concentration (adjusted-mean difference -3.8 g/L; 95% CI [-7.3, -0.4]). Pregnant women should be informed about the potential risks associated with soil consumption.

Topics: Adult; Anemia; Animals; Ascariasis; Ascaris lumbricoides; Female; Helminthiasis; HIV Infections; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Longitudinal Studies; Pica; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Risk Factors; Socioeconomic Factors; Soil; Tanzania; Vitamin A

We conducted a longitudinal study among 827 pregnant women in Nyanza Province, western Kenya, to determine the effect of earth-eating on geohelminth reinfection after treatment. The women were recruited at a gestational age of 14-24 weeks (median: 17) and followed up to 6 months postpartum. The median age was 23 (range: 14-47) years, the median parity 2 (range: 0-11). After deworming with mebendazole (500 mg, single dose) of those found infected at 32 weeks gestation, 700 women were uninfected with Ascaris lumbricoides, 670 with Trichuris trichiura and 479 with hookworm. At delivery, 11.2%, 4.6% and 3.8% of these women were reinfected with hookworm, T. trichiura and A. lumbricoides respectively. The reinfection rate for hookworm was 14.8%, for T. trichiura 6.65, and for A. lumbricoides 5.2% at 3 months postpartum, and 16.0, 5.9 and 9.4% at 6 months postpartum. There was a significant difference in hookworm intensity at delivery between geophagous and non-geophagous women (P=0.03). Women who ate termite mound earth were more often and more intensely infected with hookworm at delivery than those eating other types of earth (P=0.07 and P=0.02 respectively). There were significant differences in the prevalence of A. lumbricoides between geophagous and non-geophagous women at 3 (P=0.001) and at 6 months postpartum (P=0.001). Women who ate termite mound earth had a higher prevalence of A. lumbricoides, compared with those eating other kinds of earth, at delivery (P=0.02), 3 months postpartum (P=0.001) and at 6 months postpartum (P=0.001). The intensity of infections with T. trichiura at 6 months postpartum was significantly different between geophagous and non-geophagous women (P=0.005). Our study shows that geophagy is associated with A. lumbricoides reinfection among pregnant and lactating women and that intensities built up more rapidly among geophagous women. Geophagy might be associated with reinfection with hookworm and T. trichiura, although these results were less unequivocal. These findings call for increased emphasis, in antenatal care, on the potential risks of earth-eating, and for deworming of women after delivery.

Topics: Adolescent; Adult; Animals; Ascariasis; Ascaris lumbricoides; Feeding Behavior; Female; Helminthiasis; Hookworm Infections; Humans; Intestinal Diseases, Parasitic; Lactation; Longitudinal Studies; Middle Aged; Pica; Pregnancy; Pregnancy Complications, Parasitic; Recurrence; Risk Factors; Soil; Trichuriasis

Topics: Ascariasis; Child, Preschool; Diagnosis, Differential; Hemoglobin SC Disease; Humans; Lead Poisoning; Male; Pica; Toxocariasis

Topics: Age Factors; Animals; Ascariasis; Child, Preschool; Dog Diseases; Dogs; Feces; Humans; Infant; Pica; Toxocariasis; West Indies

Topics: Ascariasis; Child, Preschool; Eosinophilia; Humans; Male; Pica; Radiography, Abdominal; Toxocariasis

Topics: Adolescent; Antibodies; Ascariasis; Child; Child, Preschool; Epilepsy; Female; Humans; Infant; Male; Pica; Toxocariasis

Topics: Animals; Ascariasis; Biopsy; Child, Preschool; Diethylcarbamazine; Dogs; Eosinophilia; Hepatomegaly; Humans; Hypergammaglobulinemia; Infant; Larva Migrans, Visceral; Liver; Male; Parasite Egg Count; Pica; Prognosis; Toxocara; Zoonoses

Topics: Animals; Ascariasis; Cat Diseases; Cats; Child; Child, Preschool; Dog Diseases; Dogs; Humans; Infant; Pica; Skin Tests; Toxocara; Zoonoses