Practice of pica among pregnant women in Khartoum, Sudan

Abstract

Pica, the eating of non-food materials, is widely practiced in countries with limited resources, such as Sudan [1]. Pica can lead to poor maternal and fetal outcomes such as anemia [1]. A cross-sectional study was conducted at the prenatal care clinic of Soba Hospital, Sudan, from June to August 2010 to investigate the epidemiology of pica among pregnant women. The study was approved by the Sudan Medical Specialization Board. After informed consent had been obtained, the participants were given pretested questionnaires to gather information on sociodemographics, obstetric history, medical history, and characteristics of pica, such as type, duration, frequency, reasons for pica, family history, and childhood pica. It was determined that a sample size of 396 patients would have 80% power to detect the difference of 5% at α=0.05. Means and proportions were compared between pregnant women who practiced pica and those who did not, using the t test and χ test as appropriate. Statistical analysis was performed using SPSS version 16.0 (SPSS, Chicago, IL, USA). Univariate and multivariate analyses were performed, with pica as the dependent variable and age, parity, educational levels, residence, childhood pica, family history of pica, nausea, and vomiting as the independent variables. Pb0.05 was considered statistically significant. The mean age, parity, and gestational age of the 396 participants was 27.0±5.9 years, 1.6±1.6, and 31.7±6.5 weeks, respectively. Of the 396 women, 160 (40.4%) practiced pica. Earth was the most commonly consumed substance (46.8%) followed by ice (24.1%), ground coffee/tea (1.9%), freezer frost (0.6%), charcoal (0.6%), ash (0.6%), and lemon peel (0.6%); 25.6% of women consumed more than 1 of these substances. Various reasons were given for practicing pica, for example, to alleviate pregnancy-associated gastrointestinal symptoms (33.8%), to relieve stress (7.5%), and to satisfy hunger (0.6%). Ice and freezer frost were used to feel cool (7.5%). No reason was given by the majority of women who practiced pica (50.6%). Multivariate analysis showed that younger age (OR 1.8; 95% CI, 1.1–2.8; P=0.01) and family history of pica (OR 1.6; 95% CI, 1.6–2.4; P=0.02) were significantly associated with pica practice (Table 1). A higher prevalence of pica among pregnant women has been reported in some African countries: Tanzania (63.7%), Kenya (73%), and Nigeria (50%) [2,3]. Earth was the main substance consumed by pregnant women practicing pica in eastern Sudan and in Tanzania [1,3]. Women who experienced nausea and vomiting were less likely to practice pica in the present study. These symptoms might serve an