Geophagy: a survey on the practice of soil consumption in N'Djamena, Chad

# Background Geophagy, the recurrent intentional eating of soil, is well documented in many African countries, but little or nothing is known about this practice in Chad. We conducted a cross-sectional study among inhabitants of N'Djamena to assess: (i) source, type, and form of geophagic soil at purchase; (ii) event, daily frequency, daily cost, and duration of soil eating; (iii) habits at consumption and storage; (iv) specific motivation of soil eating and habit-forming events; (v) expected health benefits and awareness of health risks; and (vi) chance for intervention. # Methods One main food market was randomly selected in each of the 10 districts of N'Djamena. In each food market, 10 vending points of geophagic soil were randomly selected. In each vending point, one geophagist was interviewed. A total of 100 geophagists (residents in N'Djamena) completed a self-reported structured questionnaire on hard copy. Outcomes were analyzed using IBM SPSS statistics 20.0 software. # Results The main group of geophagists in Chad is represented by women in childbearing age (30.4 years old). Geophagic soil is generally locally extracted and easily available at the food market (77%). Kaoline is the most consumed soil (63%) followed by laterite (29%). Soil is preferentially consumed granulated (66%) or crushed (23%), but also in powder. Protective effect against cancer and gastritis figures out as main (35%) expected benefit of the practice, followed by protection against nausea and vomiting (25%) and pain (19%). One in 4 geophagists eats soil due to pleasure at taste, and some (2%) just follow the habit without specific purpose of pleasure. Geophagy in Chad is a culturally-transmitted form of pica. Interestingly, even if the vast majority of geophagists (94%) is unaware and uninformed about health risks of soil eating, the 43% were against the option of recommending it. # Conclusions Based on these findings, we recommend awareness campaigns on: (i) the health risk of soil eating, (ii) erroneous beliefs, e.g., the protective effect of geophagic soil against cancer, and (iii) the misleading communication subtended by the vending of soil among food items

Nutrition in relation to organic aquaculture: Sources and strategies

Organic production is a system of farm management and food production that combines best environmental practices, a high level of biodiversity, the preservation of natural resources, the application of high animal welfare standards and a production method in line with the preference of certain consumers for products produced using natural substances and processes. Mie et al. (2017) reviewed existing evidence on the impact of organic food on human health and compared organic versus conventional food production with respect to parameters important to human health. The review emphasised several documented human health benefits associated with organic food production and production methods and concluded that it is likely to be beneficial within the conventional agriculture, for example, in integrated pest management and antibiotics. This chapter covers aspects of current use of formulated feeds, feed composition, aquafeed technology, sustainable alternatives to common feed ingredients, nutritional physiology and general nutritional principles and product quality in the context of the organic aquaculture. It reviews new knowledge and presents research results to update and may modify the criteria and standards for organic aquaculture in relation to nutrition and thus to provide high-quality products for the consumers. This chapter is based on the current European regulation on organic aquaculture, as well as on the proposed revision of the European regulation, which is currently being approved after a long process for getting the agreement of the European Parliament, European Council and the European Commission

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially