Geophagia: A Scientific Approach to a Historical Practice to Sustainably Treat Endemic Iron Deficiency in a Rural Community in Nepal

Geophagia is the practice of eating earth or clay and is nearly universal around the world in traditional rural societies. Many animals across genera are known to eat mineral rich soil. Some animals travel long distances to seek specific soils that are rich in minerals that they are deficient. According to the WHO dietary iron deficiency is a documented threat to public health in Nepal and iron deficiency anaemia affects 60-85% in the general population. Iron deficiency holds developing communities back with reduced growth, reduced academic achievement and reduced physical productivity. While it would be possible to simply provide iron medications, the long term delivery to remote areas would make this logistically difficult to be sustainable and in our view would provide the wrong sort of aid.

We analysed local Nepalise hill clays in Kavre District to assess feasibility of use as an iron supplement. Providing a manual pill press would allow communities to make their own clay iron tablets facilitating more precise dosing in a truly sustainable way at ongoing zero cost. 23 mineral elements were measured by Inductively Coupled Mass Spectrometry in the two common clays, white and red, following a protocol based on the UK Environmental Protection Agency method "Acid digestion of sediments, sludges and soils (Method 3050B)".

Iron was present in useful amounts in both white and red clays; 33,485 μg/g and 35,091 μg/g respectively. All other mineral elements were present at low levels and unlikely to pose a health threat, with the exception of aluminium. Aluminium was present at 20,577 μg/g in white clay and 53,125 μg/g in red clay, which is above UK recommended dietary intake levels. However, in the absence of dialysis dependant renal failure, excess aluminium is excreted in urine and there are no documented cases of environmental aluminium toxicity. Aluminium levels in antacid tablets can be 20% with no toxicity documented even with chronic use.

This is a project with local Nepali community leaders working together with UK laboratories and haematologists. Further work will assess the homogeneity of the clay composition over a wider area. We are currently developing methods to facilitate the production of clay pills with a hand press alongside developing a school based education and iron supplementation programme. Iron deficiency is a worldwide problem in developing countries. We believe this approach could be used to empower communities to improve iron nutrition across the globe.