Pica Disorder among African American Women: A Call for Action and Further Research.

Pica is simply defined as the consumption of none food products such as laundry starch, clay dirt, ice, soap, and chalk. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies Pica as the habitual consumption of nonfood and non-nutritive substances for at least one year. Pica disorder is usually unnoticed, under-reported, causes serious harm to clients especially African American women, and seldom discussed in social work scholarship. It is, therefore, important to begin to sensitize social workers to the harmful effects of Pica, especially because it is often unrecognized and misdiagnoses can cause harm. This article provides a panoramic overview of Pica, the signs and symptoms of the disorder specifically among African American women and also address some of the adverse effects, and highlights some of the evidence-based effective treatment strategies. Finally, an urgent clarion call to social workers to conduct more research on Pica disorders among African American women is articulated.

Prevalence of geophagy and knowledge about its health effects among native Sub-Saharan Africa, Caribbean and South America healthy adults living in France.

Geophagy is widespread among women from Sub-Saharan Africa, South America and the Caribbean and may persist in western countries. This practice may be associated with adverse effects such as anaemia, constipation or intestinal occlusion. We aimed to determine the prevalence of geophagy and the level of knowledge about its health effects among healthy adults originating from these countries and attending a travel medicine and international vaccination consultation in France. Among 101 travellers enrolled in the study, 83 (82.1%) were born in Sub-Saharan Africa and 13 (12.8%) in South America or the Caribbean. The mean duration of residence in France was 15.6 ± 10.4 years. Previous or current geophagy was present in 42 travellers [previous geophagy in 31 (30.7%) and current consumption in 11 (10.9%)]; 38 (90.5%) were women. The rate of awareness of harmful effects of geophagy as the risk of iron-deficient anaemia (18.8%) and soil-transmitted intestinal parasitic infections (11.9%) was low overall. Women with previous or current geophagy more often had history of iron therapy compared to those who never consumed, both during pregnancy (50.0 versus 14.3%; p = 0.0009) and outside pregnancy (47.4 versus 2.8%; p < 0.0001). Despite a long period of residence in France, geophagy was still a current practice among 10.9% of Sub-Saharan, South American and Caribbean travellers, who are poorly informed of its harmful effects. Therefore, specific information tailored to Sub-Saharan, South American and Caribbean about the risks of geophagy should be implemented in western countries.Level of evidence Level V, descriptive cross-sectional survey.

Death of a Female Prostitute Due to Intestinal Obstruction by an Unknown Substance.

A young adult black female, known to be a prostitute and suspected of smuggling narcotics, was found dead in her apartment in a state of early decomposition. Oval-shaped gray-white masses of exogenous origin protruded from the anus. The autopsy showed dilatation of the folds of the large intestine, which were almost completely filled with these oval-shaped gray-white masses of foreign material. The uterus was enlarged with multiple large leiomyomas. Toxicological tests of blood and the foreign material revealed no toxicologically relevant substances. Kaolin was detected in a sample of the foreign material from the large intestine. The immediate cause of death was intestinal obstruction due to the formation of a kaolin bezoar with simultaneous compression of the large intestine by the enlarged myomatous uterus. Subsequent revelation of a habit the deceased had brought from her native country led to the conclusion that this exotic custom was responsible for her death.

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

INTRODUCTION: Geophagia is very common among pregnant women, particularly in Africa. There are many reasons given for geophagia such as cultural, medicinal and religious, making it an acceptable norm regardless of health risks involved. OBJECTIVES: The study explored prevalence and factors influencing geophagia among women visiting an antenatal clinic in Pretoria. METHODS: A quantitative survey was done on a convenience sample of 597 pregnant women and structured interviews conducted. Statistical analysis was done using simple percentage and interview data analyzed using Epi Info statistical software. RESULTS: Geophagia was reported by 54.0% of the women (n=323) and of these, 75.2% (n=243) ate at least 3 teaspoons per day. Reasons for the practice ranged from simple unexplained craving to belief that soil acts as an iron supplement. The study revealed that education levels did not act as a contributing factor as both literate and illiterate women were consumers. Partners of consumers played a key role in influencing the practice as most consumers were not married. CONCLUSION: Geophagia is practiced by a considerable proportion of pregnant women in this area. Greater vigilance may be needed as part of the antenatal classes to avoid potentially harmful effects of the habit.

A survey of the traditional food consumption that may contribute to enhanced soil ingestion in a Canadian First Nation community.

Soil ingestion rates in the order of 400 mg d(-1) have been proposed and considered plausible for use in human health risk assessments (HHRA) of Aboriginal populations and justified by qualitative assessments of the traditional subsistence activities that could enhance soil ingestion. The purpose of this study was to assess and document the subsistence activities and food consumption practiced by a First Nation Community living in a wilderness community in Canada to allow for a comparison with the previous qualitative assessments of Aboriginal populations and a quantitative mass balance tracer element study of the community conducted concurrently. An ethno-cultural survey was conducted of the Xeni Gwet'in First Nations community living in the Nemiah Valley, approximately 230 km west of Williams Lake, British Columbia. The community diet was observed to consist mainly of fish and big game, and was supplemented by berries and roots. Outdoor cultural gatherings, hunting and food gathering trips and sporting events, with their attendant potential for enhanced soil exposure, were observed to be an important facet of community life. The survey concluded that a significant portion of the Xeni Gwet'in practise a lifestyle similar to the subsistence lifestyles of other indigenous communities, where soil exposure scenarios in the order of hundreds of mg d(-1) have been proposed.

A soil ingestion pilot study of a population following a traditional lifestyle typical of rural or wilderness areas.

The relatively few soil ingestion studies underpinning the recommended soil ingestion rates for contaminated site human health risk assessments (HHRAs) that have been conducted to date assessed soil ingestion in children living in urban or suburban areas of the United States, and to a lesser extent, Europe. However, the lifestyle of populations living in North American urban and suburban environments is expected to involve limited direct contact with soil. Conversely, many populations, such as indigenous and Aboriginal peoples residing in rural and wilderness areas of North America and worldwide, participate in activities that increase the frequency of direct contact with soil. Qualitative exposure of Aboriginal populations inhabiting wilderness areas suggest that high levels of soil ingestion may occur that are many times greater than those recommended by regulatory agencies for use in HHRAs. Accordingly, a study of subjects selected from a wilderness community in Canada was conducted using mass balance tracer methods to estimate soil ingestion and the results compared with previous soil ingestion studies and regulatory guidelines for the soil ingestion rates used in HHRA of contaminated sites. A pilot study of 7 subjects living in the Nemiah Valley of British Columbia was conducted over a 3-week period. The mean soil ingestion rate estimated in this study using the 4 elemental tracers with the lowest food-to-soil ratios (i.e., Al, Ce, La, Si), was observed to be approximately 75 mg d(-1) (standard deviation 120 mg d(-1)), the median soil ingestion rate was 50 mg d(-1), and the 90th percentile was 211 mg d(-1). These soil ingestion rate estimates are higher than the soil ingestion estimates currently recommended for HHRAs of adults, and higher than those obtained in most previous studies of adults. However, the estimates are lower than the earlier qualitative assessments of subsistence lifestyles.

Geophagia in Transkei region of South Africa: case reports.

BACKGROUND: Soil has been eaten by humans under various names all over the world. It was used as a spread on the bread instead of butter in Austria known as 'mountain tallow' and in German known as 'stone butter'. Earth is tasty in various countries, termed as 'American earth', 'Earth of Samos' and 'Nishapoor earth', continues to make geophagia habit. OBJECTIVE: To highlight the problem of geophagia in the Transkei region of South Africa. CASE REPORTS: First, one is (XM) of a 35 years woman who divulges her history of geophagia at Sinawe Center. She consumed fresh earthworm dig-out soil after smelling it. This has happened in her first pregnancy in her first trimester. The second, one is an adult women 55-years; she had consumed red bricks for last 15 years. It is not related with her pregnancy. She keeps bricks close her bed and eats when she feels to eat. She used to complain abdominal pain and off and on loose motions. She had bladder stones, which passed through urethra. The history of geophagia, mechanism of craving for soil, and associated cultural belief has discussed in this case report. CONCLUSION: There is geophagia in the Xhosa community is prevalent and socially accepted.

Risk of human exposure to arsenic and other toxic elements from geophagy: trace element analysis of baked clay using inductively coupled plasma mass spectrometry.

BACKGROUND: Geophagy or earth-eating is common amongst some Bangladeshi women, especially those who are pregnant, both in Bangladesh and in the United Kingdom. A large proportion of the population in Bangladesh is already exposed to high concentrations of arsenic (As) and other toxic elements from drinking contaminated groundwater. Additional exposure to As and other toxic elements from non-food sources has not been adequately addressed and here we present the first study to monitor As levels in baked clay (known as sikor). METHODS: Sikor samples originating from Bangladesh were digested using a microwave digester and analysed for their As, Pb, Cd, Mn, Fe and Zn levels using ICP-MS. Detailed As speciation analysis was performed using HPLC-ICP-MS. RESULTS: Of particular concern were the levels of As (3.8-13.1 mg kg(-1)), Cd (0.09-0.4 mg kg(-1)) and Pb (21-26.7 mg kg(-1)) present in the sikor samples and their possible impact on human health. Speciation analysis revealed that sikor samples contained mainly inorganic As. Modest consumption of 50 g of sikor is equivalent to ingesting 370 µg of As and 1235 µg of Pb per day, based on median concentration values. This level of sikor consumption exceeds the permitted maximum tolerable daily intake (PMTDI) of inorganic As by almost 2-fold. CONCLUSION: We conclude that sikor can be a significant source of As, Cd and Pb exposure for the Bangladeshi population consuming large quantities of this material. Of particular concern in this regard is geophagy practiced by pregnant women concurrently exposed to As contaminated drinking water. Future studies needs to evaluate the bioavailability of As and other elements from sikor and their impact on human health.

Pica: sorting it out.

Pica, a culture-bound illness, has occurred for centuries. The ingestion of nonfood substances such as starch, cornstarch, clay, dirt, and other material is fairly common, although the distribution of the condition varies by cultural and socioeconomic factors. The underlying cause of pica is not known, although the condition often is associated with pregnancy. There is conflicting evidence about the association of nutrient deficiencies and pica. This article presents a clinical example of pica in a pregnant 33-year-old African American woman. Implications for culturally appropriate care are discussed.

Chalk eating in middle Georgia: a culture-bound syndrome of pica?

BACKGROUND: Although geophagia (earth eating) has been observed and documented in many areas of the world, the specific preference for consuming kaolin is less well known. The ingestion of kaolin, also known as white dirt, chalk, or white clay, is a relatively common type of pica found in the central Georgia Piedmont area. METHODS: We reviewed the literature, made informal contacts with Georgia physicians, and arranged semistructured interviews with 21 individuals with a history of chalk eating; we gathered both quantitative and qualitative information. RESULTS: Kaolin ingestion appears to be a culturally-transmitted form of pica, not selectively associated with other psychopathology. CONCLUSION: Kaolin ingestion appears to meet the DSM-IV criteria for a "culture-bound syndrome."

Geophagy, iron status and anaemia among primary school children in Western Kenya.

As part of a cross-sectional study among 156 primary school children (median age 13 years, range 10-18) in Western Kenya, geophagy was assessed through interviews. 114 (73.1%) of these children reported eating soil daily. Haemoglobin levels were determined in all 156 children and serum ferritin concentrations in 135. The mean haemoglobin (Hb) concentration was 12.7 g/dl, and median ferritin concentration 27.2 microg/l. Both the proportion of anaemic (Hb < 11.0 g/dl) and of iron-depleted (ferritin < 12 microg/l) children was significantly higher among the geophageous children than among the nongeophageous (9.6% vs. 0% anaemia; P = 0.037; 18.4% vs. 5.4% iron depletion; P = 0.046). Serum ferritin and haemoglobin concentrations were not correlated (r = 0. 13 5; P = 0. 100). Multiple regression analysis showed that geophagy, hookworm eggs per gram faeces and malaria parasite counts per microl blood were independent predictors of serum ferritin, when controlling for other helminth infections, age and sex, and socio-economic and educational background of the children's families and family size (y = 36.038-11.247(geophagy) -- 0.010(hookworm epg) + 0.001(malaria parasite counts); R2 = 0.17). Multiple regression analysis with haemoglobin as dependent variable and the same independent variables did not reveal any significant predictors. Analysis of the soil eaten by the children revealed a mean HCl-extractable iron content of 168.9 mg/kg (SD 44.9). Based on the data on the amounts eaten daily and this mean iron content, soil could provide on average 4.7 mg iron to a geophageous child (interquartile range 2.1-7.1 mg), which is equivalent to 32% of the Recommended Nutrient Intake (RNI) for girls (interquartile range 14-48%) or 42% of the RNI for boys (interquartile range 19-63%). Iron depletion and anaemia are associated with geophagy, but only serum ferritin concentrations were shown to be dependent upon geophagy in the regression model. From the cross-sectional data no inference about causality can be made. To clarify the possible causal relationships involved, longitudinal studies and iron-supplementation intervention studies are needed.

Pica and olfactory craving of pregnancy: how deep are the secrets?

The practice of pica during pregnancy is described in contemporary literature as the ingestion of nonfood substances and food staples in response to craving. A previously unnamed practice, olfactory craving of pregnancy, is the smelling by pregnant women of selected substances in response to craving, which may occur alone or with pica. Observations and descriptions of women's experiences of pica and olfactory craving were documented during individualized postpartum bedside instruction of 300 women at a midwestern hospital between 1992 and 1994. Most women were African American and low income. Eight themes about pica of pregnancy were keeping practices secret, singularity of the experience, obtaining the craved substance, fears for effects on the fetus, yielding or not yielding to cravings, use of substances as medication, pica and food intake, and sensory experiences other than taste. Three themes about olfactory craving of pregnancy were changes in sense of smell during pregnancy, types of craved substances and settings, and escalation in use during pregnancy. The clinical stages of pica and olfactory craving require further investigation, and perinatal caregivers have to seek and remove the barriers that cause pregnant women to isolate themselves with the practices that stem from these cravings.

Pica in an urban environment.

The practice of pica, the compulsive ingestion of nonfood substances over a sustained period of time, was studied in 553 African American women who were admitted to prenatal clinics in Washington, D.C. Dietary, biochemical, and psychosocial correlates of the pica practices of a subset of this urban population are presented in this paper. Geophagia, compulsive eating of clay or dirt, was not observed in these women; pagophagia, or the ingestion of large quantities of ice and freezer frost, was self reported in 8.1% of the women, who consumed 1/2 to 2 cups a day from 1 to 7 days per week. Serum ferritin concentrations of pica women 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 hemoglobin were significantly lower in pica women than their nonpica counterparts (P = 0.0001 and P = 0.017, respectively). Although not significantly different, the iron (66 vs. 84% RDA) and calcium (60 vs. 75% RDA) contents of the diets of pica women were less those of nonpica women. Gestational age, body length, and body weight were not different, but head circumferences of infants delivered to pica women who consumed freezer frost and/or ice were smaller than those of nonpica women (P = 0.012). The hypothesis is presented that pica in African American women may be a mediator of stress, acting through the immune system. The size of the social support network of pica women was significantly less than that of nonpica women.(ABSTRACT TRUNCATED AT 250 WORDS)