Doctoral Degrees (Nutrition and Dietetics)

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Browsing Doctoral Degrees (Nutrition and Dietetics) by Author "Brand, C. E."

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    Nutritional status and risk factors associated with women practicing geophagia in Qwaqwa, South Africa
    (University of the Free State, 2013-12) van Onselen, Annette; Walsh, C. M.; Brand, C. E.; Veldman, F. J.
    English: Geophagia is the most common type of pica, characterized by the urge to consume clay or soil. QwaQwa houses a very dense black African population and covers 254.2 km2. This rural area with the largest concentration of Basotho's in South Africa is characterized by a strong focus on traditional beliefs and practices, making it a favourable area to investigate the phenomenon of geophagia. The main aim of this study was to determine the nutritional status and risk factors associated with women practicing geophagia in QwaQwa, South Africa. Socio-demographic factors, dietary intake, anthropometry, physical activity and blood measures were investigated at baseline. After the intervention, the impact of the nutrition education on knowledge and habits related to geophagia were determined. The study design comprised of an observational epidemiological study which included an exposed (geophagia) and non-exposed (control) group followed by an intervention phase. An assessment of the impact of the intervention was also conducted. A logistical regression analysis was performed in order to identify factors that were likely to be associated with the practice of geophagia. At baseline, the sample consisted of 69 participants, of whom 42 were in the geophagic group (G) and 27 in the control group (C). The majority of participants in both groups (G=77.5%; C=70.4%)were unmarried. Sotho was spoken by more than 90% of participants. A large percentage of participants in both groups had an education level of grade 11 - 12 (G = 42.9% and C = 51.9%) and were unemployed (G = 90.48% and C = 74.1%). Electricity was used by both groups as the main source of energy for cooking (G = 83.3% and C = 85.2%), followed by paraffin (G = 11.9% and C = 7.4%). The primary employment status of the group with geophagia was part-time or piece jobs (54.8%), while in the control group a full-time wage earner was present in 48.15% of households. The logistic regression showed that women who were wage earners and those that owned a refrigerator (and thus had a higher socio-economic status), were less likely to practice geophagia. A food frequency questionnaire was implemented to determine dietary intakes of participants. The mean total energy intake for the group with geophagia and the control group were similar at 10324.31 ± 2755.00 kJ and 10763.94 ± 2556.30 kJ respectively, which was considered high. The macronutrient distribution was within the recommended levels. Mean total protein intake was also similar in both groups (G = 75.59 ± 20.12 g; C = 85.55 ± 29.07 g) at 12.5% (G group) and 13.6% (C group) of total energy intake. The percentage total energy intake from fat was 33.1% for the geophagia group and 31.5% for the control group. Both groups had intakes that were higher than the estimated average requirement (EAR) for dietary iron (G = 11.60 mg; C = 13.49 mg). The intake of nutrients that may be related to iron metabolism, are vitamin A, vitamin C and folate. Standardized techniques were used to determine anthropometric measurements namely body mass index (BMI), waist circumference, and hip circumference. The mean BMI of both groups of participants fell within the overweight category (G = 25.59 kg/m2; C = 25.14 kg/m2). The physical activity levels of participants were determined by recalling the physical activity of the previous day. Mean levels of physical activity fell in the low active category for both groups. Logistic regression indicated that women with a waist:hip ratio above 0.8 (android category) were less likely to practice geophagia. The mean serum iron levels of the geophagia group were significantly lower (p = 0.000) than that of the control group (G = 6.92 μmol/L; C = 13.75 μmol/L). There was also a significant difference in the serum haemoglobin (G = 11.23 g/L; C = 13.26 g/L; p = 0.00) and serum ferritin levels (G = 11.98 μg/L; C = 42.31 μg/L; p = 0.00) between the geophagia and control groups. Serum transferrin and serum transferrin saturation levels also differed significantly between groups (G = 3.21; 7.97 and C = 2.68; 7.78; p = 0.00). The logistic regression also established which of the measured blood variables were significantly affected by the practice of geophagia. A highly significant association between the practice of geophagia and the cluster of metabolic indicators of iron status, including serum iron, haem-iron, non-haem iron, haemoglobin, ferritin, transferrin, and transferrin saturation was identified. The majority (57.1%) of participants consumed soil once a day and 42.9% more than once a day. The craving for soil was reported by most of the participants as the reason that they practiced geophagia (97.6%) and a preference for whitish clay was also found. A number of habits related to geophagia changed after the intervention. In this study the nutrition education programme was effective in improving some aspects of a participant's knowledge and practices related to geophagia, while others remained unchanged. The intervention was successful in reducing the consumption of soil per day and almost forty per cent of participants in the group with geophagia stopped consuming soil after the intervention. Before the intervention, more than fifty per cent of participants did not know that pregnant women and children should not consume soil, while more than sixty per cent knew in the control group and all the partiipants in the geophagia group after the intervention. Geophagia was confirmed to be a risk factor for iron deficiency in black women between 18 and 45 years of age. Factors that were identified as decreasing the likelihood of having geophagia included being a wage earner, owning a refrigerator, having a greater WHR (waist-to-hip ratio) and not having iron deficiency. The significantly strong association between geophagia and iron deficiency emphasizes the importance of identifying the practice of geophagia in women, especially during their child bearing years. The intervention that was developed for this study could be applied in a wider setting to address the problem of geophagia and its harmful effects on health.