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Pica is Associated with Lower Hemoglobin Concentration in a Cohort of Pregnant Kenyan Women of Mixed HIV Status
Author(s) -
Miller Joshua D.,
Collins Shalean,
Krumdieck Natalie R.,
Wekesa Pauline,
Oo Maricianah,
Young Sera L.
Publication year - 2016
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.30.1_supplement.1149.26
Subject(s) - pica (typography) , medicine , cohort , center for epidemiologic studies depression scale , anemia , depression (economics) , demography , psychiatry , anxiety , depressive symptoms , sociology , world wide web , computer science , economics , macroeconomics
Pica is the craving and purposeful consumption of non‐food substances. Although the practice has been well documented globally, its social, psychological, and biological covariates are not well understood. Further, little is known about the relationship between pica and HIV. Therefore, in a cohort of pregnant Kenyan women of mixed HIV status (n=370), we sought to 1) assess the prevalence and types of pica; 2) describe the sociodemographic characteristics associated with pica; 3) describe psychological covariates; and 4) understand its relationship with physiological outcomes including HIV status, anemia, and symptoms of gastrointestinal distress at enrollment into the study. Survey data were collected by clinic‐based study nurses and included information about: pica behavior (both current and during childhood), sociodemographic background, depression (using the Center for Epidemiologic Studies‐Depression Scale, CES‐D), stress (using the Perceived Stress Scale, PSS), hemoglobin (Hb, using Hemocue), and gastrointestinal distress (nausea, vomiting, or diarrhea in the prior 24 hours). Pica was operationalized as a dichotomous variable, based on 24‐hour dietary recall. Of the 370 participants, 22.4% had engaged in pica in the previous 24 hours. Eating earth was the most common form of pica (geophagy, 19.5%), followed by raw starches (amylophagy, 2.4%), and other non‐food items, e.g. ash, charcoal (0.5%). There were no significant differences in pica behavior by demography (tribe, religion, relationship status) or household asset index. However, urban women were more likely to practice any pica (25.9% vs 16.7%, p=0.04). A greater proportion of women who reported practicing pica as children engaged in it during pregnancy (35.0% vs 20.7%, p=0.01). In terms of psychological covariates, CES‐D and PSS scores among women with pica were higher than those without, (mean±SD, 20.5±7.8 vs 17.8±8.4, p=0.009) and (20.9±4.2 vs 19.7±4.4, p=0.02), respectively. Women practicing pica had lower Hb levels than those who did not (10.5 g/dL ±1.89 vs 11.3±1.71, p<0.005). A greater proportion of HIV positive women practiced pica (28.6% vs 17.9%, p=0.02). Gastrointestinal symptoms did not differ by pica. In a multivariate logistic model of any pica, only Hb (OR=0.78, p=0.008) and pica during childhood (OR=2.42, p=0.009) were significant. In sum, we observed strong, biologically significant relationships between current pica and both physiological (Hb) and behavioral (pica in childhood) covariates. Indeed, for each g/dL lower of Hb, the odds of a woman engaging in pica increased by 22%. This relationship between pica and lower Hb, together with the prevalence during pregnancy, suggests that discovering the etiology is a public health priority, and that inquiry into the consequences of pica should be biocultural. Support or Funding Information NIH K01 MH098902