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pica/geophagia--R

Here is a little information on geophagia:

LITERATURE ON PICA
Twenefour D., Koduah G. and Francis Tayie

Department of Nutrition and Food Science, University of Ghana

History of pica
The term pica is derived from the Latin word for magpie, a bird that is notorious for its habit of gathering a variety of objects due to curiosity or for food (Walker et al, 1997). The habit can be traced back to ancient times, in the days of the philosophers Aristotle and Hippocrates, whose interest had been in the danger of the excessive consumption of ice-water and snow (Walker et al, 1997). The Roman physician Soranus is also noted for describing how pica was used to alleviate the unpredictable appetite and other symptoms associated with pregnancy. He noted that some unusual food items, were being consumed by pregnant women and that the craving for such unusual items began around the fortieth day of pregnancy and persisted for at least four months (Coltman, 1969). Soranus identified that these unusual foods could harm both the mother and child if not checked (Coltman, 1969).

Some specific forms of pica like geophagia can be traced back to the 18th century when it was learned that the Sultan of Turkey ate a special clay from the island of Lemnos; this resulted in Europeans adopting the product as a health food (Deutsch, 1977). In Africa, explorers and missionaries reported on clay eating dating from the 18th to the early 20th century as observed in Nigeria, Ghana and Sierra-Leone (Hunter, 1993). In the early part of the 20th Century, miners in Austria were reportedly eating earth and mountain tallow, which they spread onto bread as a substitute for butter and in Southern Germany, quarrymen developed “ stone butter” derived from Clay and used as a food supplement (Hawass et al, 1987).

Pica Around the World

Some people around the world eat clay, dirt and or other pieces of the lithosphere for a variety of reasons. Commonly, it is a traditional cultural activity, which takes place during pregnancy, religious ceremonies or as a remedy for disease (Jordan and Rowntree, 1990). Many studies on pica and especially geophagia have been conducted over the years and around the world. As early as 1825, it was reported as a health hazard in the Southern States of North America (Makhobo, 1986). In 1992 a study was conducted on the dietary habits of rural Jamaican women during pregnancy and 15 out the 38 pregnant women questioned reported cravings, common amongst which were cravings for cigarette ash and drinking soda (Melville and Francis, 1992). In Australia, some aborigines eat white clay found mostly in the billabounds of the coastal areas of the North territory, fresh water springs and riverbeds mainly for medicinal purposes (Beteson and Lebroy, 1978)

Many reasons exist for pica around the world. In the Southern parts of the United States of America, pregnant women who traditionally ate substances like clay, corn starch and baking soda believed that such substances helped to prevent vomiting, helped babies to thrive, cured swollen legs and ensured beautiful children (Mcloughlin, 1987). In Malawi, it is reported to be surprising for a pregnant woman not to practice Pica since it is their way of identifying if she is really pregnant. The taste of clay is claimed to diminish the nausea, discomfort and vomiting in “morning sickness” during pregnancy. Clay eating in this case is seen as normal during pregnancy and not between pregnancies (Hunter, 1993). The practice of pica is widespread in Africa and is associated with medicinal treatment and spiritual and ceremonial behavior (Walker et al, 1997). Clay eating is wide spread among women in five African countries namely Malawi, Zambia, Zimbabwe, Swaziland and South Africa, an estimated prevalence level in the rural areas of these countries is 90% (Walker et al, 1997). Poverty, starvation and famine have also been associated with pica practice (Hawass et al, 1987), in which case the substances function as a bulking agent to supplement insufficient food or a poor diet (Mclouglin, 1987).

In a study reported by Tayie and Lartey, (1999), on Pica practice among pregnant women: Relationship with infant birth weight and maternal haemoglobin level, it was found that of 502 pregnant women studied, 48.01% had pica habit with clay eating forming the major form of pica (28.49%), followed by the chewing of wooden sponge or wooden stick (9.76%), cola nut (4.98), uncooked maize dough (2.79%), chalk (1.20%) and fresh starch (0.80%).

Pica and Medicine

The practice of geophagia and more specifically clay eating is strongly connected to folk medicine, social customs and obsessive-compulsive behavior (Crosby, 1976). The eating of some clays have been used as a remedy for diarrhea and stomach discomfort a practice that has been attributed to the presence of kaolin in these clays, (Wiaz, 1997), and it’s absorptive ability (Bateson and Lebroy, 1978, Morgan 1984). Clay has been identified as having the ability to absorb dietary toxins and bacterial toxins associated with gastro-intestinal disturbances that arise during pregnancy (Hunter, 1993). In some third world countries, clay is eaten to ‘line the stomach’ before eating yam or fish which may be poisonous, to reduce hunger and treat hook-warm infestation.

In a study conducted on 156 primary school children in Western Kenya by Geissler et al (1998), the proportion of anaemic and iron depleted children was significantly higher among those with geophagia than in those without it. Geophagy among 204 primary school children aged between 10 and 18 years and relationship with helminthes (Ascaris lumbricoides, Trichuris trichiura, Schistosoma mansoni and hookworm) load was studied and results showed that 77% of the children ate soil daily and 48% of all soil samples were contaminated with eggs of the round worm - Ascaris lumbricoides (Geissler et al, 1998).

Pica, especially clay eating has often been associated with lead poisoning abdominal problems, hypokalemia, hyperkalemia, phosphorous intoxication and dental injury (Federman et al, 1997). The high aluminium content of the clays eaten may increase the risk for Alzheimer’s disease (Alzheimers Society, 2002). A study in Washington DC among Afro-American women reported that large quantities of ice and freezer frost, about half to two cups a day, were consumed by women at a frequency of between one and seven times a week, resulting in low serum ferritin levels among those who are pregnant especially in the second and third trimesters (Edwards et al, 1994).

In a study conducted on 553 African American women admitted to prenatal clinics in Washington, geophagia was not observed. However, pagophagia (the ingestion of large quantities of ice and freezer frost) was reported. Some of the women were found to consume as much as 2 cups of frost a day (Edwards et al, 1994). In this study, the findings were well correlated with that of more recent ones by the likes of Geissler et al (1998) and Tayie and Lartey (1999). The serum ferritin concentrations for women with pica habit were significantly lower during the second and third trimesters of pregnancy; the average values for three trimesters of pregnancy for both ferritin and mean corpuscular haemoglobin were lower in pica women than their non-pica counterparts (Edwards et al, 1994).

The types of clay eaten in most countries could contribute some mineral nutrients. About 100g of white copper belt clay could contribute 15mg of calcium, 48 mg of iron, 42mg of zinc and small amounts of copper, chromium nickel and molybdenum, which may be significant amounts where deficiency exists (Hunter, 1993).

In South Africa as in other parts of Africa, the eating of clay is mostly observed among pregnant women (Walker et al). The prevalence of pica among urban and rural South African women was reported to be 38.3% and 44.0% respectively as compared to the prevalence among the Indian, coloured and white women at 2.2%, 4.4% and 1.6% respectively (Walker et al, 1985). In some studies such as that reported by Vermeer and Frate (1979), the average daily intake of clay consumed by women in rural Holmes County, Mississippi, was 50g.

In Malawi, pica habit is used as a marker for pregnancy (Walker et al 1997). In a recent cross sectional study at in an antenatal clinic at Kilifi District Hospital, Coast Province, Kenya, low iron status and high anaemia prevalence was present among 154 out of 275 pregnant women (56%) and were reported to eat soil regularly (Geisslier et al, 1998). In an accompanying interview on the said study at Kilifi District hospital, soil eating was found to be more than just a physiologically induced practice and involved a rich cultural practice favoured by most females with strong relations to fertility and reproduction (Geissler et al, 1999 ). Geophagia is a natural habit among infants who crawl and eat whatever they can pick up and though usually the total amount of earth eaten is small and insignificant, carelessness or indifference on the part of parents may contribute to the continuation of this habit as the child matures (Hawass et al 1987). The phenomenon of pica is reported to be more prevalent than commonly believed. Women at high risk of pica are more likely to be of African origin, to live in rural areas, and to have a family history of pica (Horner et al, 1991).

REFERENCES

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