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Earth-eating and reinfection with intestinal helminths among pregnant and lactating women in western Kenya

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We conducted a longitudinal study among 827 pregnant women in Nyanza Province, western Kenya, to determine the effect of earth-eating on geohelminth reinfection after treatment. The women were recruited at a gestational age of 14–24 weeks (median: 17) and followed up to 6 months postpartum. The median age was 23 (range: 14–47) years, the median parity 2 (range: 0–11). After deworming with mebendazole (500 mg, single dose) of those found infected at 32 weeks gestation, 700 women were uninfected with Ascaris lumbricoides, 670 with Trichuris trichiura and 479 with hookworm. At delivery, 11.2%, 4.6% and 3.8% of these women were reinfected with hookworm, T. trichiura and A. lumbricoides respectively. The reinfection rate for hookworm was 14.8%, for T. trichiura 6.65, and for A. lumbricoides 5.2% at 3 months postpartum, and 16.0, 5.9 and 9.4% at 6 months postpartum. There was a significant difference in hookworm intensity at delivery between geophagous and non-geophagous women (P = 0.03). Women who ate termite mound earth were more often and more intensely infected with hookworm at delivery than those eating other types of earth (P = 0.07 and P = 0.02 respectively). There were significant differences in the prevalence of A. lumbricoides between geophagous and non-geophagous women at 3 (P = 0.001) and at 6 months postpartum (P = 0.001). Women who ate termite mound earth had a higher prevalence of A. lumbricoides, compared with those eating other kinds of earth, at delivery (P = 0.02), 3 months postpartum (P = 0.001) and at 6 months postpartum (P = 0.001). The intensity of infections with T. trichiura at 6 months postpartum was significantly different between geophagous and non-geophagous women (P = 0.005). Our study shows that geophagy is associated with A. lumbricoides reinfection among pregnant and lactating women and that intensities built up more rapidly among geophagous women. Geophagy might be associated with reinfection with hookworm and T. trichiura, although these results were less unequivocal. These findings call for increased emphasis, in antenatal care, on the potential risks of earth-eating, and for deworming of women after delivery.
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Keywords: Ascaris; Kenya; Trichuris; deworming; geophagy; hookworm; nutrition; pica; pregnancy; reinfection; women

Document Type: Research Article

Affiliations: 1: Division of Vector-borne Diseases, Ministry of Health, Kisumu, Kenya 2: London School of Hygiene and Tropical Medicine, London, UK 3: Department of Microbiology, University of Nairobi, Nairobi, Kenya 4: Maseno University, Maseno, Kenya 5: Kenya Medical Research Institute, Nairobi, Kenya 6: Danish Bilharziasis Laboratory, Charlottenlund, Denmark 7: Institute of Public Health, University of Copenhagen, Copenhagen, Denmark

Publication date: March 1, 2005

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