Efficacy of oral iron therapy in geophagic women with iron deficiency anaemia residing in Botshabelo, South Africa

Abstract

Background: Iron deficiency anaemia is the most commonly encountered form of anaemia in females worldwide. This form of anaemia is, amongst others, associated with geophagia that is defined as the consumption of soil. The two main reasons for the association of geophagia with anaemia are that soil is thought to supplement mineral deficiency and geophagia is seen as a symptom of the anaemia. However, it is hypothesised that soil consumption interferes with iron absorption instead of supplementing it. The first line of therapy for iron deficiency anaemia is oral iron. Therefore, if soil consumption interferes with iron absorption it could interfere with oral iron therapy leading to patients being burdened with symptoms of anaemia as treatment is not effective. The aim of the study was to evaluate the efficacy of oral iron therapy in female participants afflicted with iron deficiency anaemia associated with geophagia.
Methods: In this prospective randomised intervention study, 84 geophagic women with iron deficiency anaemia were divided into two groups. One group continued with soil consumption while the other stopped consumption. Oral iron therapy was administered for ten weeks at increasing therapy doses for both groups. Red cell and iron study parameters were evaluated at different time intervals to ascertain the efficacy of iron replacement therapy.
Results: The group that stopped soil consumption showed a statistically significant change in haemoglobin (9.4 to 10.0 g/dL, p = 0.029), mean corpuscular volume (73.6 to 75.7 fl), mean corpuscular haemoglobin (23.7 to 24.6 pg), serum iron (22.5 to 28 µg/dL, p < 0.001, transferrin saturation (4.8 to 6.9%, p < 0.001) and total iron-binding capacity (467 to 441 µg/L, p = 0.001). These findings were contrary to the group that continued with consumption, where the statistical changes were only observed for the iron study parameters (serum iron: 21 to 28 µg/dL, p = 0.038; transferrin saturation: 4.3 to 6.9%, p = 0.011; total iron-binding capacity: 496 to 421 µg/L, p = 0.002). Nevertheless, the changes for both groups were clinically insignificant. Oral iron therapy did not correct the anaemia in geophagic females of both groups, this could be explained by two hypotheses where soil affected the gastrointestinal lining and soil directly interfered with therapy iron absorption. This is evidenced by the group that continued with consumption showing fewer changes than the group that abstained from soil consumption. These results were consistent with a case study where oral iron therapy was implemented. 
Conclusion: Oral iron therapy was not effective in geophagia cases of iron deficiency anaemia.