Nutritional perspectives on sickle cell disease in Africa: a systematic review.

BACKGROUND: Sickle cell disease (SCD) is an inherited blood disorder that predominantly affects individuals in sub-Saharan Africa. However, research that elucidates links between SCD pathophysiology and nutritional status in African patients is lacking. This systematic review aimed to assess the landscape of studies in sub-Saharan Africa that focused on nutritional aspects of SCD, and highlights gaps in knowledge that could inform priority-setting for future research. METHODS: The study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Inclusion criteria comprised original, peer-reviewed research published between January 1995 and November 2020 involving individuals in Africa with any phenotypic variant of SCD and at least one nutritional status outcome. Nutritional status outcomes were defined as those that assessed dietary intakes, growth/anthropometry, or nutritional biomarkers. Databases used were Ovid Embase, Medline, Biosis and Web of Science. RESULTS: The search returned 526 articles, of which 76 were included in the final analyses. Most investigations (67%) were conducted in Nigeria. Studies were categorized into one of three main categories: descriptive studies of anthropometric characteristics (49%), descriptive studies of macro- or micronutrient status (41%), and interventional studies (11%). Findings consistently included growth impairment, especially among children and adolescents from sub-Saharan Africa. Studies assessing macro- and micronutrients generally had small sample sizes and were exploratory in nature. Only four randomized trials were identified, which measured the impact of lime juice, long-chain fatty acids supplementation, ready-to-use supplementary food (RUSF), and oral arginine on health outcomes. CONCLUSIONS: The findings reveal a moderate number of descriptive studies, most with small sample sizes, that focused on various aspects of nutrition and SCD in African patients. There was a stark dearth of interventional studies that could be used to inform evidence-based changes in clinical practice. Findings from the investigations were generally consistent with data from other regional settings, describing a significant risk of growth faltering and malnutrition among individuals with SCD. There is an unmet need for clinical research to better understand the potential benefits of nutrition-related interventions for patients with SCD in sub-Saharan Africa to promote optimal growth and improve health outcomes.

Potential health risk assessment of toxic metals contamination in clay eaten as pica (geophagia) among pregnant women of Ho in the Volta Region of Ghana.

INTRODUCTION: Geophagia although pleasurable and somewhat a necessity among pregnant women, also comes along with its own attendant problems such as exposure to potentially hazardous substances like bacteria, fungi, helminthes and ova, radioactive materials, and toxic elemental minerals in the soil depending on the geographical location. METHODOLOGY: This study evaluated the potential health risk involved during the exposure of pregnant women to toxic elemental minerals via the consumption of clay as pica (geophagia). Elemental mineral analysis was carried out using Buck Scientific 210VGP Flame Atomic Absorption Spectrophotometer (Buck Scientific, Inc. East Norwalk, USA). Risk assessment methods were also used to ascertain the various risks factors and the overall risk level. RESULTS: Concentrations of the macro elements investigated were 1.38 ± 1.5, 2.40 ± 1.5, 7.74 ± 1.5, 4.01 ± 1.0, 13.24 ± 2.2 and 13.76 ± 2.1 mg/Kg for iron (Fe), copper (Cu), zinc (Zn), potassium (K), magnesium (Mg) and sodium (Na) respectively. While that for the micro elements were 1.63 ± 0.03 µg/Kg, 4.72 ± 0.8, 0.53 ± 0.02 and 1.85 ± 0.3 mg/kg respectively for arsenic (As), manganese (Mn), lead (Pb) and nickel (Ni). Estimated Daily Intake (EDI), Hazard Quotient (HQ), Target Hazard Quotient (THQ) and Total Target Hazard Quotient (TTHQ) values ranged 0.611-5.44 (mg/kg Bw/day), 6.26 × 10- 4 - 106.5, 0.067-10.34 and 15 respectively. CONCLUSION: There is the likelihood of posing adverse health problems when clay samples obtained from Anfoega which is sited in the Volta region of Ghana is consumed due to the fact that the HQ's of these elemental minerals were > 1 which points to high content of Manganese (Mn) and Nickel (Ni). It is also likely to cause adverse health problems in an individual's life time since THQ for Arsenic, Lead and Nickel were above 1. Ultimately, the cumulative effect of these toxicants were exceedingly great (≤ 15) which implied a high level of unsafety associated with this clay. Per the results from this study, it is not safe for pregnant women to consume clay as pica since these toxic elements may cause detrimental effects on the foetus of the unborn child.

Elemental minerals and microbial compositions as well as knowledge and perceptions regarding kaolin (clay) consumption by pregnant women in the Ho municipality of Ghana.

INTRODUCTION: Kaolin is a type of clay consumed mostly by women especially pregnant women of which the act of clay eating is termed geophagy. Different people use this type of clay for diverse purposes. Notwithstanding, most Ghanaians consume this clay out of cravings, taste and smell. There have been some attendant problems with the consumption of clay especially by pregnant women. This research sought to assess the mineral and microbial contents of kaolin and address the perceptions of pregnant women on geophagy. METHODS: This study employed a cross-sectional convenient sampling method to sample 217 pregnant women and sellers of clay (Ayilo). A face-to-face interview was conducted to administer a structured questionnaire to respondents. Mineral and microbial analyses were also conducted on the ore of the kaolin mined from Anfoega in the Volta Region of Ghana using standardized procedures. RESULTS: Results from this study suggests geophagy prevalence of 48.4% (n=217) among pregnant women in the Ho municipality of Ghana. Results obtained also suggest smell and taste of the clay, influenced the consumption by these pregnant women to a large extent. Strikingly, majority of the respondents had no knowledge on the adverse health implications clay consumption had on the human body. The physiological state of pregnancy also cause many to use it to treat nausea, other accompanying discomfort and in some instances to quench their hunger. Traces of Lead, Nickel and Arsenic were found in the clay. Common microorganisms identified were Bacillus, Pseudomonas, Mucor and Aspergillus spp. CONCLUSION: Geophagy is a common practice among pregnant women living in the Ho municipality in the Volta region, Ghana. Most of them consumed it for varied reasons. Although there are beneficial minerals, accumulated effects of these heavy metals can lead to various complications in pregnancy. The clay also contained pathogenic microorganisms. These pathogens have a whole range of deleterious effects on the human body ranging from gastrointestinal infections to cancer and so may not be safe to consume clay products from Anfoega, Ghana.