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. 2012;7(10):e47129.
doi: 10.1371/journal.pone.0047129. Epub 2012 Oct 17.

Pica and amylophagy are common among Malagasy men, women and children

Christopher D Golden  1 , B J Rodolph Rasolofoniaina, Rakoto Benjamin, Sera L Young
Affiliations

Pica and amylophagy are common among Malagasy men, women and children

Christopher D Golden et al. PLoS One. 2012.

Abstract

Pica, the craving and purposive consumption of non-food substances, is of public health concern for its potential deleterious and salubrious health consequences. However, neither its prevalence nor demographic correlates have been well characterized. Therefore, we conducted the first population-based study of pica and amylophagy in Madagascar. From February to December 2009, we surveyed pica and amylophagy behaviors in a random sample of 760 individuals >5 years in 167 households among two ethnic groups in 16 villages in the Makira Protected Area of Madagascar. Of the 760 individuals interviewed, 62.5% were children (5-11 years), 5.4% were adolescents (12-16 years), and 35.1% were adults (≥ 17 years). Thirteen non-food items were reported being consumed. Across the entire population in the prior year, the prevalence of geophagy was 53.4%, of amylophagy, 85.2%, and of other pica substances (e.g. charcoal, chalk) was 19.0%. The prevalence of these behaviors was not higher during pregnancy. These findings differ from previous studies in terms of the higher overall prevalence of these behaviors, the high prevalence among men, and the absence of any peak in behaviors during pregnancy. However, there are two categories of substances that elevate our estimates but fall outside the strict definition of pica as a craving: 1) substances consumed for self-medication and 2) substances viewed as food, such as all amylophagic substances in this case. Our results suggest that population-based studies of pica should include males of all ages. Further, the prevalence of the behavior underscores the importance of understanding the etiology and health consequences of these ingestive behaviors (Abstract S1).

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Geophagic substances.
The two most commonly consumed geophagic substances are tany manara and vato malemy. A local healer prepares a bolus of tany manara, a white clay-like substance that has high content of calcium carbonate (top). A child holding vato malemy, reddish clods of earth that form along riverbeds (bottom).
Figure 2
Figure 2. Prevalence of pica and amylophagy behavior by sex, age and pregnancy status among 760 individuals in rural, northeastern Madagascar.
There were no significant differences of pica behavior by sex within age categories but adults practiced all pica behaviors significantly more than children or adolescents. Across all age and sex categories, amylophagy was practiced more widely than geophagy.
Figure 3
Figure 3. Motivations for pica behavior and amylophagy.
Geophagy is largely motivated by the texture of the substances (as well as medicinal use, see Table 3) whereas amylophagy was almost entirely driven by taste. Other non-foods were jointly motivated by taste and texture. Olfactory cues played only a small role in pica behavior.
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Grants and funding

This study was supported by the Margot Marsh Biodiversity Fund #023815, the National Geographic Society Conservation Trust #C135-08, and the National Science Foundation Doctoral Dissertation Improvement Grant- DEB- 1011714. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.