GEOPHAGY AND PARASITIC INFECTIONS IN PREGNANT WOMEN ATTENDING AN ANTE-NATAL CLINIC IN THIKA LEVEL-5 HOSPITAL, KIAMBU COUNTY, CENTRAL KENYA ALICE WAIRIMU MUTURA MASTER OF SCIENCE (Medical Parasitology and Entomology) JOMO KENYATTA UNIVERSITY OF AGRICULTURE AND TECHNOLOGY 2017 Geophagy and Parasitic Infections in Pregnant Women attending an Ante-Natal Clinic in Thika Level-5 Hospital, Kiambu County, Central Kenya Alice Wairimu Mutura A Thesis Submitted in Partial Fulfilment for the Degree of a Master of Science in Medical Parasitology and Entomology in the Jomo Kenyatta University of Agriculture and Technology 2017 DECLARATION This thesis is my original work and has not been presented for a degree in any other University Signature…………………………………. Date………………………… Alice Wairimu Mutura This thesis has been submitted for examination with our approval as University Supervisors: Signature…………………………………. Date………………………… Dr. Gerald M. Mkoji, PhD KEMRI, Kenya Signature…………………………………. Date………………………… Dr. Jesca O. Wesongah, PhD JKUAT, Kenya ii DEDICATION This thesis is dedicated to my family for their support, encouragement and prayers throughout the period of this study. iii ACKNOWLEDGEMENTS I am grateful to the Almighty God who has brought me this far. My sincere gratitude’s go to my supervisors, Dr. Gerald M. Mkoji of the Centre for Biotechnology, Research and Development (CBRD), Kenya Medical Research Institute (KEMRI), and Dr. Jesca O. Wesongah of the Department of Medical Laboratory Sciences, at the Jomo Kenyatta University of Agriculture and Technology (JKUAT), whose mentorship, guidance, support and invaluable advice has brought this work this far. Without their constructive critiques and recommendations, this thesis would not have materialized. My special thanks go to the Medical Superintendent Dr. Patrick Nyaga of Thika Level 5 Hospital and the entire laboratory staff for their professional support, flexible collaboration and entertaining company they provided during the entire period, in particular I thank Mr David Ngaruma the lab Manager, Mr Samuel Kimita, Mr Simon Gathogo and Mr Aphia Chege. My special thanks also go to the Nurse in-charge of the Ante-Natal Clinic (ANC), Sister Jane Mwangi (Munyambu) and her staff. I am also highly indebted to Nurse Lucy Thuo and Dr. Njenga who provided helpful comments, encouragement and support in the final stages of this work. I sincerely acknowledge the support of all the study participants without whom this study wouldn’t have been conducted. I also, appreciate the support of Dr. James Mutunga and Mr. Moses Kamita for their advice and help with statistical analysis. This research was approved for implementation through the KEMRI Scientific Steering Committee (SSC), the Ethics Review Committee (ERC) and the Thika Level 5 Hospital. Last but not least, my sincere appreciations, to all my classmates and to my family, for their generous support, encouragement and deep understanding throughout my study leave. iv TABLE OF CONTENTS DECLARATION............................................................................................................ ii DEDICATION ............................................................................................................. iii ACKNOWLEDGEMENTS ............................................................................................. iv TABLE OF CONTENTS .................................................................................................. v LIST OF TABLES ....................................................................................................... viii LIST OF FIGURES ....................................................................................................... ix LIST OF APPENDICES .................................................................................................. x ABBREVIATIONS AND ACRONYMS ............................................................................ xi ABSTRACT .............................................................................................................. xiii CHAPTER ONE ........................................................................................................... 1 INTRODUCTION AND BACKGROUND ......................................................................... 1 1.1 Introduction .............................................................................................................. 1 1.2 Statement of the Problem ....................................................................................... 4 1.3 Justification of the Study ......................................................................................... 4 1.4 Null Hypothesis ........................................................................................................ 5 1.5 Research Questions ................................................................................................. 5 v 1.6 Objectives of the Study ........................................................................................... 5 CHAPTER TWO .......................................................................................................... 7 LITERATURE REVIEW ................................................................................................. 7 2.1 Geophagy and Pregnancy ........................................................................................ 7 2.2 Geophagy and Parasitic Infections .......................................................................... 9 2.3 Geophagy and Anaemia ........................................................................................ 17 CHAPTER THREE ....................................................................................................... 19 MATERIALS AND METHODS ..................................................................................... 19 3.1 Study Site ................................................................................................................ 19 3.2 Study Design ...................................................................................................... 19 3.3 Study Population ............................................................................................... 19 3.4 Study Eligibility .................................................................................................. 20 3.5 Sample Size Determination ............................................................................... 21 3.6 Study Procedures............................................................................................... 22 3.7 Data Management and Analysis ........................................................................ 23 3.8 Study Approvals ................................................................................................. 24 3.9 Ethical Considerations ....................................................................................... 24 vi CHAPTER FOUR ........................................................................................................ 26 RESULTS .................................................................................................................. 26 4.1 Overview ................................................................................................................ 26 4.2 Geophagy and the Soil Types Consumed by the Study Women ........................... 37 4.3 Prevalence and Intensity Patterns of Infection ..................................................... 38 4.4 Prevalence of Anaemic Condition ......................................................................... 39 4.5 Prevalence and Intensity of Parasitic Infection by Geophagy ............................... 41 4.6 Perceived Knowledge of Risks and Benefits of Geophagy .................................... 46 CHAPTER FIVE: ......................................................................................................... 47 DISCUSSION, CONCLUSION AND RECOMMENDATIONS ............................................ 47 5.1 Discussion ............................................................................................................... 47 5.2 Conclusion .............................................................................................................. 50 5.3 Recommendations ................................................................................................. 51 REFFERENCES ........................................................................................................... 52 APPENDICES ............................................................................................................ 65 vii LIST OF TABLES Table 4.1: Age Bracket of the Respondents .................................................................... 27 Table 4.2: Prevalence of Parasitic Infections in the Respondents .................................. 38 Table 4.3: Classification of Infection Intensities by the Kato Katz (WHO, 2002) ......... 39 Table 4.4: Infection Intensity of STH’s and S. mansoni in the Study............................. 39 Table 4.5: Prevalence of Parasitic Infections by Geophagy........................................... 41 Table 4.6: Prevalence of Parasitic Infections by Age .................................................... 42 Table 4.7: Association between Occupation and the Parasites ...................................... 43 Table 4.8: Association between Gestation period and Parasitic Infections ................... 43 Table 4.9: Association between the source of Soil and the Parasites ............................ 44 Table 4.10: Association between Deworming and the Parasitic Infections ................... 45 Table 4.11: Association between the Source of Water and Parasitic Infections ............ 46 viii LIST OF FIGURES Figure 4.1: Residence of the Respondents ...................................................................... 27 Figure 4.2: Marital Status of the Respondents ................................................................ 28 Figure 4.3: Occupation of the Respondents .................................................................... 29 Figure 4.4: Number of Children owned by the Respondents .......................................... 29 Figure 4.5: Academic Levels of the Respondents........................................................... 30 Figure 4.6: Gestation Period of the Respondents ............................................................ 31 Figure 4.7: Feeding Issues experienced by the Respondents during the Gestation Period .................................................................................................................... 32 Figure 4.8: Last Deworming Date by the Respondents .................................................. 33 Figure 4.9: Source of Water for the Respondents Domestic Use ................................... 34 Figure 4.10: Defecation Sites used by the Respondents ................................................. 35 Figure 4.11: Frequency of Walking Barefooted ............................................................. 36 Figure 4.12: Sources of Soil Consumed by the Geophagus Women .............................. 37 Figure 4.13: Prevalence of Anaemic Condition in the Respondents .............................. 40 ix