Geophagy and Parasitic Infections in Pregnant Women attending an Ante-Natal Clinic in Thika Level-5 Hospital, Kiambu County, Central Kenya

Abstract

Geophagy, the regular and deliberate consumption of non-food substances like soil is said to be common among pregnant women in Sub-Saharan Africa. This study aimed to investigate geophagy among pregnant women who attended the antenatal care clinic at Thika Level-5 Hospital, in relation to parasitic infections. Study objectives were to determine the prevalence of geophagy and intestinal parasitic infections among the study women, and association between geophagy and intestinal parasitic infections. A total of four hundred and ten (410) study participants were enrolled in this cross-sectional, hospital-based study. A questionnaire was administered to collect personal and behavioural information; faecal samples were collected for microscopic diagnosis of intestinal parasitic infections on direct faecal smears and Kato-Katz smears, and finger prick blood taken for haemoglobin determination. Out of the 410 participants enrolled, 26.1% (n=107) practiced geophagy, majority of whom practiced it only occasionally. It was observed that 92.5% of the study participants preferred soil purchased from market places and 11% of the study women examined were infected with intestinal parasitic infections. The parasites detected in faecal samples were Entamoeba histolytica (8.8%), Trichuris trichiura (1%), Ascaris lumbricoides (1%), Schistosoma mansoni (0.7%), and Strongyloides stercoralis (0.2%). None of the 5 intestinal parasites detected were, however associated with geophagy, P>0.05. Interestingly, only E. histolytica (8.4%) was found in women who practised geophagy. Furthermore, gestation period was associated with E. histolytica infection, p=0.049, with those who ate soil from the garden being more likely to have an E. histolytica infection, (p=0.026). Also closely associated with geophagy were level of education (p=0.009), feeding problems (p=0.000) and history of practising geophagy (p=0.000). Majority of the women (64.9%, n=266) had normal levels of haemoglobin (11gm/dl and above), (32.7%, n=134) were mild anaemic (Hb levels 10.0-10.9gm/dl), 1.5% (n=6) were moderately anaemic (Hb levels 7-9.9gm/dl), and 1% (n=4) were severely anaemic (<7gm/dl). Those who practised geophagy (34.6%) had mild anaemia, while <5% had moderate or severe anaemia based on the WHO classification for anaemia in pregnant women. While geophagy was not significantly associated with parasitic infections in the pregnant women attending Thika Hospital, geophagy was found to be significantly associated with education and feeding problems. Besides, pregnancy trimester and the source of soil were found to be associated with E. histolytica infection. This study recommends a need for extensive and intensive public health education to advocate for the necessity of hygiene and sanitation and also impact knowledge on the risks and benefits of geophagy, provision for a mineral supplementation program, formulation of a policy on the routinely deworming of pregnant women in their 2nd trimester, have a routine testing of amoebiasis in pregnant women and treatment of the infected especially in the 2nd trimester and need for the Bureau of Standards to ensure that soil sold in markets, supermarkets or by the vendors is 100% safe from parasites and heavy metals, also set rules and regulations on sterilization and packaging. Further studies are recommended to determine the role played by soil from different sources in the transmission of parasitic infections in pregnant women practicing geophagy and to compare the immune systems of pregnant women in the different gestation trimesters.