Nutritional status and risk factors associated with women practicing geophagia in Qwaqwa, South Africa
| dc.contributor.advisor | Walsh, C. M. | |
| dc.contributor.advisor | Brand, C. E. | |
| dc.contributor.advisor | Veldman, F. J. | |
| dc.contributor.author | van Onselen, Annette | |
| dc.date.accessioned | 2015-08-12T09:36:38Z | |
| dc.date.available | 2015-08-12T09:36:38Z | |
| dc.date.issued | 2013-12 | |
| dc.description.abstract | 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. | en_ZA |
| dc.description.abstract | Afrikaans: Geofagie is die algemeenste vorm van pika wat gekenmerk word deur 'n sterk drang om grond te eet. QwaQwa huisves 'n dig bevolkte swart Afrika bevolking en beslaan 'n area van 254.2 km2. Hierdie Suid-Afrikaanse plattelandse gebied bestaan hoofsaaklik uit Basotho's wat gekenmerk word deur 'n sterk fokus op tradisionele oortuigings en gewoontes, en dus dit 'n gunstige area is om die verskynsel van geofagie te ondersoek. Die hoofdoel van die studie was om die voedingstatus en risikofaktore te bepaal wat geassosieer word met vroue wat geofagie in QwaQwa, Suid-Afrika beoefen. Sosio-demografiese faktore, voedselinname, antropometrie, fisiese aktiwiteit en bloed-waardes was tydens basislynopname ondersoek. Na 'n intervensie is die impak daarvan op die kennis en gewoontes wat met geofagie geassoseer word, bepaal. Die studie-ontwerp het bestaan uit 'n observerende epidemiologiese studie wat uit 'n eksperimentele (met geofagie) en kontrole (sonder geofagie) groep bestaan het, gevolg deur 'n intervensiefase. 'n Bepaling van die impak van die intervensie was ook uitgevoer. 'n Logistieke regressiewe analise is uitgevoer om faktore te identifiseer wat waarskynlik met die praktyk van geofagie geassosieer word. Met die basislynopname was daar 'n totaal van 69 vrouens, waarvan 42 in die groep met geofagie (G) geval het en 27 in die kontrole groep (K). Die meerderheid vroue, in beide groepe (G=77.5%; C= 70.4%) was ongetroud. Sotho was die spreektaal in 90% en meer van die deelnemers. 'n Groot persentasie deelnemers in beide groepe het 'n onderwysvlak van graad 11 - 12 voltooi (G = 42.9% en K = 51.9%) en was werkloos (G = 90.48% en K = 74.1%). Elektrisiteit was deur beide groepe as hoofbron van energie vir kookdoeleindes gebruik (G = 83.3% and K = 85.2%), gevolg deur paraffien (G = 11.9% en C = 7.4%). Die primêre bron van werk in die groep met geofagie (54.8%) was deeltydse en stukwerk, terwyl in die kontrole groep 'n voltydse loonwerker in 48.15% van huishoudings voorgekom het. 'n Logistieke regressie het aangedui dat vrouens wat loonwerkers was en 'n yskas besit (en dus 'n hoër sosio-ekonomiese status gehad het), waarskynlik minder geneig sal wees om geofagie te beoefen. 'n Voedselfrekensie-vraelys is gebruik om die voedselinname van deelnemers te bepaal. Die gemiddelde energie-inname in die groep met geofagie en die kontrole groep was dieselfde (10324.3 ± 2755.0 kJ en 10763.9 ± 2556.3 kJ onderskeidelik), wat as hoog beskou word. Die makro voedingstof verspreiding was binne die aanbevole vlakke. Die gemiddelde totale proteïeninname was ook soortgelyk tussen albei groepe (G = 75.6 ± 20.1 g; K = 85.6 ± 29.1 g) met 12.5% (G-groep) en 13.6% (K-groep) van die totale energie-inname. Die totale persentasie energie afkomstig vanaf vetinname was 33.1% vir die groep met geofagie en 31.5% vir die kontrole groep. Beide groepe het hoër innames as die geskatte gemiddelde aanbevelings vir yster (G = 11.6 mg; C = 13.5 mg) gehad. Die inname van nutriënt wat heel moontlik met ystermetabolisme geassosieer word, is vitamien A, vitamien C en folaat. Standaardtegnieke is gebruik om antropometriese metings, naamlik ligaamsmassa indeks (LMI), middelomtrek en heupwydte te bepaal. Die gemiddelde LMI in beide groepe het in die oormassa kategorie geval (G = 25.6 kg/m2; K = 25.1 kg/m2). Die fisiek aktiwiteitsvlak van deelnemers is bepaal deur die vorige dag se fisiek aktiwiteite te herroep. Die gemiddelde fisiek aktiwiteitsvlak van albei groepe het in die lae aktiewe kategorie geval en was nie betekenisvol verskillend nie (p = 0.45). 'n Logistieke regressie het aangedui dat vrouens met 'n middel:heup-verhouding van bo 0.8 (androïede kategorie), minder geneig was om geofagie te beoefen. Die gemiddelde serumysterwaardes in die groep met geofagie was betekenisvol laer (p = 0.000) teenoor die kontrole groep (G = 6.92 μmol/L; K = 13.75 μmol/L). Daar was ook 'n betekenisvolle verskil in die serumhemoglobien (G = 11.23 g/L; K = 13.26 g/L; p = 0.00) en serumferritienvlakke (G = 11.98 μg/L; K = 42.31 μg/L; p = 0.00) tussen die groep met geofagie en die kontrole groep. Serumtransferrien en serum- transferrin-versadigingsvlakke het ook betekenisvol verskil tussen die twee groepe (G = 3.21; 7.97 en K = 2.68; 7.78; p = 0.00). Die logistieke regressie het bepaal watter bloedwaardes betekenisvol deur geofagie geaffekteer word. 'n Hoogs betekenisvolle assosiasie is gevind tussen die gewoonte van geofagie en die cluster van metaboliese indikatore van ysterstatus, wat serumyster, heem-yster, nie-heemyster, hemoglobien, ferritien, transferrien en transferrien-versadigingsvlakke insluit. Die meerderheid deelnemers (57.1%) het grond een keer per dag geëet en 42.9% meer as een keer per dag. Die sterk drang na grond is deur die meeste deelnemers (97.6%) as rede vir die beoefening van geofagie gegee en ook verkieslik wit klei. 'n Aantal gewoontes wat met geofagie geassosieer word, het wel na die intervensie verander. In hierdie studie was die voedingsonderrigprogram suksesvol in sekere aspekte deurdat die deelnemers se kennis en praktyke wat met geofagie geassosieer word, verbeter het, terwyl ander aspekte onveranderd gebly het. Die intervensie was suksesvol deurdat ongeveer veertig persent van deelnemers die praktyk van geofagie laat vaar het. Meer as vyftig persent van deelnemers het voor die intervensie aangedui dat hulle nie kennis dra dat vrouens en kinders nie geofagie moet beoefen nie. Daarenteen was meer as sestig present in die kontrole groep en al die vrouens in die geofagie groep na die intervensie daarvan bewus. Geofagie is bevestig as 'n risikofaktor vir ystergebrek in swart vroue tussen die ouderdom van 18 en 45 jaar. Faktore wat geïdentifiseer is om nie geofagie te beoefen nie, was deur 'n loonwerker te wees, 'n yskas te besit, om 'n verhoogde (>0.8) middel-tot-heup verhouding te hê (androide vet verspreiding) en nie aan ystergebrek te lei nie. Die betekenisvolle verband tussen geofagie en ystergebrek beklemtoon die belangrikheid om die praktyk van geofagie in vrouens te identifiseer, veral gedurende hul fertiliteitsjare. Die intervensie wat vir hierdie studie ontwikkel is, kan in 'n groter mate toegepas word om die probleem en uitwerking van geofagie op gesondheid aan te spreek. | |
| dc.identifier.uri | http://hdl.handle.net/11660/817 | |
| dc.language.iso | en | en_ZA |
| dc.publisher | University of the Free State | en_ZA |
| dc.rights.holder | University of the Free State | en_ZA |
| dc.subject | anthropometry | en_ZA |
| dc.subject | Thesis (Ph.D. (Dietetics))--University of the Free State, 2013 | en_ZA |
| dc.title | Nutritional status and risk factors associated with women practicing geophagia in Qwaqwa, South Africa | en_ZA |
| dc.type | Thesis | en_ZA |