Characteristics of Pica Behaviors Among Women in Western Kenya
Authors: Chung Esther O. , Fiorella Katie , Omollo Dan O. , Mattah Brian , Brashares Justin , Fernald Lia C.H. 
Published: November 2023

BACKGROUNDPica, the craving and purposeful consumption of substances not commonly identified as food, is often reported among pregnant women; though, the etiology of pica is not well understood. Given that pica has been associated with both positive (e.g. relief from gastrointestinal distress and protection against harmful pathogens) and negative (e.g. anemia and helminth infections) health effects, we investigated the prevalence of pica and cross‐sectional correlates among women with children <2 on Mfangano Island, Kenya.METHODSWe examine pica prevalence using a cross‐sectional household survey conducted in December 2012 – March 2013. The survey included 303 randomly sampled households with a child <2 years. Women self‐reported pica behaviors (geophagy, consumption of earth; amylophagy, consumption of raw starches; and consumption of charcoal/ash) in the previous 24 hours and sociodemographic characteristics, food security, and illness in study questionnaires. We used logistic regression models to assess associations between age, food security, pregnancy status, breastfeeding status, and morbidity score and pica behavior. Sociodemographic variables were included based on previous research that showed associations with pica.RESULTSEighty‐two women (27.1%) engaged in pica the previous day, with women reporting amylophagy (16.2%), geophagy (12.5%), and charcoal/ash (4.3%) (Table 1). Compared to women who did not engage in pica behavior, women who engaged in any form of pica were younger (26.63 ± 6.54 vs. 28.64 ± 8.95, p=0.035), currently pregnant (10.98% vs. 3.62%, p=0.049) and were less often in food secure households (1.22% vs. 5.43%, p=0.032). In logistic regression models (Table 2) adjusting for marital status, assets, education levels, and number of people in the household, any pica behavior was associated with age and there were limited associations between any pica behavior and food security, pregnancy status, and breastfeeding. In adjusted models, the odds that a woman was pregnant were 4.28 times higher for amylophagous women compared to non‐amylophagous women (Table 2). Adjusting for covariates, charcoal/ash consumption was strongly associated with food security and breastfeeding status (Table 2).CONCLUSIONWe find a high prevalence (27.1%) of any pica behavior in the previous 24 hours among women with young children (<2 years). Our finding compares to previous studies that report a 45–75% prevalence of pica behavior among Kenyan pregnant and antenatal women.(1–4) While high pica prevalence has previously been observed in pregnant women, our results indicate the extent of pica behavior following pregnancy. However, we find limited associations between pica behavior and food security and no associations with illness. Due to the extent of pica behavior, understanding the motivations for and the consequences of pica is a public health concern and merits further study.
Prevalence of Pica Among Women with Children Under 2, Mfangano Island, Kenya (N=303)

Type of Pica
Population Prevalence, N (%)

Any Pica
82 (27.1%)

Geophagy
38 (12.5%)

Odowa
21 (6.9%)

Soil
17 (5.6%)

Amylophagy
49 (16.2%)

Raw Cassava
28 (9.9%)

Raw Potato
11 (3.6%)

Raw Sweet Potato
3 (1.0%)

Raw Rice
3 (1.0%)

Other Pica
13 (4.3%)

Charcoal
9 (3.0%)

Ash
4 (1.3%)

Multiple Logistic Regression Models for Any Pica, Geophagy, Amylophagy, and Charcoal/Ash Among 303 Women with Children Under 2

Any Pica*
Geophagy*
Amylophagy*
Charcoal/Ash*

OR (95% CI)
P‐value
OR (95% CI)
P‐value
OR (95% CI)
P‐value
OR (95% CI)
P‐value

Age
0.94 (0.91–0.99)
0.03
0.99 (0.93–1.05)
0.76
0.96 (0.91–1.01)
0.14
0.92 (0.81–1.04)
0.18

Food Security
1.06 (0.99–1.13)
0.09
1.01 (0.93–1.10)
0.84
1.03 (0.95–1.11)
0.48
1.18 (1.02–1.36)
0.03

Currently Pregnant
2.57 (0.83–7.90)
0.10
1.86 (0.50–6.90)
0.36
4.28 (1.28–14.35)
0.02
0.33 (0.03–3.93)
0.38

Currently Breastfeeding
0.54 (0.29–1.03)
0.06
0.57 (0.25–1.28)
0.17
1.04 (0.45–2.38)
0.93
0.24 (0.06–0.88)
0.03

Morbidity Score
1.02 (0.99–1.05)
0.17
1.02 (0.98–1.06)
0.40
1.01 (0.98–1.05)
0.47
1.05 (0.98–1.12)
0.21

Controlling for marital status, assets, education levels, number of people in the household