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Health and social impacts of geophagy in Panama
– Reported, March 28, 2012
There is no cultural or religious element to the practice; rather it seems to be driven by physiological desires tied to the smell of the material. prevalence is higher among women with lower education levels and poorer nutritional status suggesting that the practice is associated with low socioeconomic status. soil analysis did not indicate presence of parasites, but there are potential nutritional benefits of the practice by providing essential minerals missing in the diet.
We find that geophagy in panama may offer nutritional benefits. however, without a clearer understanding of specific effects of soil in the gastrointestinal tract, it is difficult to determine direct biophysical impacts of geophagy.
Pica is generally described as the act of habitually eating nonfood substances. There is inconsistency in the literature about the precise definition of pica; it has been described as an eating disorder, as an obsessive-compulsive behaviour, or as a normal
adaptive response to numerous physiological or environmental conditions. Geophagy is a type of pica that involves the ingestion of earthy substances such as soil, clay, mud, ash or stones.Humans and animals on almost all continents practice geophagy
in a variety of forms, making it one of the most common types of pica.
Health Impacts
The best-studied potential consequence of geophagy is the risk of ingesting soil-borne infectious parasites. Two organisms that
are of concern during pregnancy are hookworm and Toxoplasma gonii, associated respectively with malnutrition and fetal nervous system damage . Another proposed consequence of geophagy is lead poisoning, with numerous reported case studies
suggesting the co-occurrence of lead poisoning and geophagy . Lead exposure can lead to maternal and fetal kidney
damage, encephalopathy and impaired cognitive function. Other documented health impacts include constipation, bowel
obstruction, hypokalemia, poisoning due to other toxins present in the environment and a possible exacerbation of malnutrition
. Additionally, some studies have hypothesized possible associations of maternal geophagic behaviour with negative birth
outcomes such as low birth weight, neural tube defects, small head circumference, premature birth, and elevated perinatal
mortality, likely due to heavy metal toxicity and maternal malnutrition . Finally, others have concluded there is no specific
pregnancy outcome associated with geophagy .Many studies have treated geophagy as a behaviour that may provide nutrients otherwise absent in the diet . The types of soil most commonly consumed tend to be high in calcium or iron. Studies comparing the micro-nutritional value of geophagic material and pharmaceutical supplements for pregnancy show surprising comparability for several important nutrients including calcium, magnesium and iron . Although the extent of soil absorption in the intestinal tract is unknown, it is possible that geophagists receive nutrients from the soil.
Thus, there are potential benefits of geophagy that cannot be discounted, and must be explored to understand the implications
of this behavior. The practice of human geophagy, particularly during pregnancy, clearly has substantial and pertinent implications for maternal and child health as well as effects on social interaction and behaviour patterns in poor, rural communities. Studying the
prevalence and impacts of this behaviour is becoming increasingly important, as the growing widespread use of agrochemicals
in Panamanian agriculture is causing high levels of toxic chemicals in soils that may be ingested. This study was developed to assess the causes as well as the social and biophysical impacts of human geophagy during pregnancy in Panama in order
to understand its general context in a country where it has not previously been documented. Components of the study included
informal interaction and observation within rural communities,structured individual interviews, and analysis of soil composition
of confirmed geophagic materials.
The prevalence of confirmed geophagy among women interviewed was 22.5%. The most commonly consumed materials were
red non-porous clay, red dry soil and yellow dry soil, with more infrequent reports of termite mound soil, river rocks and wet ash.
Although some women practiced geophagy throughout their lives, it was most common during childhood and pregnancy. The
average amount consumed was shown as handfuls by geophagists and approximated as 50g per event, ingested about once a week. Discussions revealed a strong stigma associated with the behaviour: almost all geophagists practiced in complete solitude and expressed embarrassment in response to their actions. Those that admitted to a desire to partake in geophagy without having done so (12.2%) explained that they did not do so because the staff at the local Centro de Salud (health centre) told them it was dangerous. As well, geophagists reported an intense desire to ingest the material associated with its smell, and an increased likelihood of engaging in geophagy after heavy rainfall. Overall, confirmed geophagists had more children, lower estimated infant survival (calculated by dividing the number of children to survive past age 5 by the total number of births in the mothers lifetime), were older in age, ate animal protein less frequently and had fewer years of formal education than non-geophagists.
Interviews with health care workers in the regional urban government hospital in Soná and rural non-government health center in San Félix revealed a perception that geophagy is an unhealthy vice that should be discouraged. The head nurse of obstetrics in the regional hospital believed geophagy used to be more common but is now almost unheard of due to the improvement of access to healthcare in Panama since the 1980s. Conversely, the worker at the small health center maintained it was very common in rural and indigenous areas and is recognized as one of the first symptoms of pregnancy. Both health care workers believed geophagy could lead to premature birth, maternal and fetal malnutrition and peri-natal complications.
Laboratory analysis of geophagic material samples revealed that no sample contained any human parasite eggs or any detectable
amounts of lead or nickel; however they did contain considerable amounts of essential minerals such as copper, iron and magnesium.
In this study, we show that geophagy exists in modern day Panama among the rural poor. Women carry out this highly stigmatized behavior in private, primarily during pregnancy and childhood. Soil samples of confirmed geophagic materials indicate no presence of parasites or acutely dangerous levels of heavy metals,and the potential for nutritional benefits. Within rural communities, geophagy was most notably linked to lower levels of education, and may be linked to poorer nutritional status, more
children, and older age. The multifaceted nature of this topic of research calls for an interdisciplinary team of researchers in order to effectively evaluate its prevalence and potential health impacts. Further studies are needed to investigate the physiological
impact of soil ingestion on mineral status, to increase the sample size, and delve into causative pathways and health outcomes of
this under-studied behaviour in rural Panama.
Credits:
Lachlan Crawford & Katherine Bodki
More Information at:http://msurj.mcgill.ca/vol6/iss1/crawford2011.pdf
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