Association of pica with anemia and gastrointestinal distress among pregnant women in Zanzibar, Tanzania

Sera L. Young, Sabra S. Khalfan, Tamer H. Farag, Justine A. Kavle, Said M. Ali, Hamad Hajji, Kathleen M. Rasmussen, Gretel H. Pelto, James M. Tielsch, Rebecca J. Stoltzfus

Research output: Contribution to journalArticlepeer-review

57 Scopus citations


The etiology of pica, the purposive consumption of non-food substances, is not understood, despite its ubiquity among gravidae. We examined correlates of pica in a representative obstetric population (n = 2,368) on Pemba Island, Zanzibar, Tanzania to examine proposed etiologies. Cross-sectional data were collected on socioeconomic characteristics, food intake, geophagy (earth consumption), amylophagy (raw starch consumption), anthropometry, iron status, parasitic burden, and gastrointestinal morbidities. Amylophagy was reported by 36.3%, geophagy by 5.2%, and any pica by 40.1%. There was a strong additive relationship of geophagy and amylophagy with lower hemoglobin (Hb) concentration and iron deficiency anemia. By multivariate logistic regression, any pica was associated with Hb level (odds ratio [OR] = 0.76, 95% confidence interval [CI] = 0.72-0.81), nausea (OR = 1.45, 95% CI = 1.20-1.73), and abdominal pain (OR = 1.22, 95% CI = 1.01-1.48). These striking results indicate that the nature of the relationship between pica, pregnancy, gastrointestinal distress, and iron deficiency anemia merits further investigation.

Original languageEnglish (US)
Pages (from-to)144-151
Number of pages8
JournalAmerican Journal of Tropical Medicine and Hygiene
Issue number1
StatePublished - Jul 2010
Externally publishedYes

ASJC Scopus subject areas

  • Parasitology
  • Virology
  • Infectious Diseases


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