Geophagy and its association with geohelminth infection in rural schoolchildren from northern KwaZulu-Natal, South Africa

The social pattern of geophagy (soil-eating) and its possible role in the transmission of Ascaris lumbricoides, Trichuris trichiura and hookworm were investigated in a rural area of South Africa between March 1998 and July 1999. Schoolchildren (median age = 10.7 years; interquartile range 8.3-14.8 years) were examined for geohelminth infection at baseline and re-examined 3 and 29 weeks after treatment with albendazole. Interviews were conducted with the pupils in order to find out about their socio-economic background and their behaviour regarding geophagy. Soil-eating was less frequent in boys (39%), where it decreased with age, than in girls (53%), where no such age trend was apparent. The habit was more common in children from families of higher socio-economic status. The baseline prevalence of A. lumbricoides infection was higher in pupils who regularly ate soil from termite mounds (28%) when compared with non-geophageous pupils (19%; prevalence ratio (PR) = 1.46; 95% confidence interval (95% CI) 1.04-2.03). In contrast it was markedly lower in the groups who preferred eating tree termite soil (13%; PR = 0.67; 95% CI 0.43-1.04) or soil from other sources (8%; PR = 0.40; 95% CI 0.15-1.04). This pattern was still apparent after adjusting for possible confounders and was also found when analysing A. lumbricoides reinfection. In contrast, differences in prevalence of T. trichiura and hookworm infection between groups with different soil preference were small.