Persistence of iodine deficiency in Gangetic flood-prone area, West Bengal, India

In 2000, India revoked the ban on production and sale of non-iodised salt. We conducted a study in the north 24 Parganas district in the state of West Bengal to assess the prevalence of goitre, status of urinary iodine excretion (UIE) level and to estimate iodine content of salts at the household level. We surveyed 363 school children aged eight to ten years selected using a multistage cluster sampling technique. We estimated goitre prevalence and urinary iodine excretion (UIE) using methods and criteria recommended by the World Health Organization. We estimated the iodine content of salt samples collected from the households of the study subjects using spot iodine testing kit. Of the 363 children, 73 (20%) had goitre. The median UIE was 160 micro g/l (normal: > or =100 micro g/l) and only 6% children had a level below 50 micro g/l. Only 253 of 363 salt samples (70%) were sufficiently iodised. The combination of high goitre prevalence with normal median urinary excretion indicates that the North 24 Parganas district is in transition from iodine deficient to iodine sufficient state. However, the persistence of non-iodised salt consumption indicates that an intensification of universal salt iodisation program is needed. In 2000, India revoked the ban on production and sale of non-iodised salt. We conducted a study in the north 24 Parganas district in the state of West Bengal to assess the prevalence of goitre, status of urinary iodine excretion (UIE) level and to estimate iodine content of salts at the household level. We surveyed 363 school children aged eight to ten years selected using a multistage cluster sampling technique. We estimated goitre prevalence and urinary iodine excretion (UIE) using methods and criteria recommended by the World Health Organization. We estimated the iodine content of salt samples collected from the households of the study subjects using spot iodine testing kit. Of the 363 children, 73 (20%) had goitre. The median UIE was 160 micro g/l (normal: > or =100 micro g/l) and only 6% children had a level below 50 micro g/l. Only 253 of 363 salt samples (70%) were sufficiently iodised. The combination of high goitre prevalence with normal median urinary excretion indicates that the North 24 Parganas district is in transition from iodine deficient to iodine sufficient state. However, the persistence of non-iodised salt consumption indicates that an intensification of universal salt iodisation program is needed.     

2018年天津市水源性高碘地区学龄儿童碘营养现况调查

目的 了解水源性高碘地区学龄儿童碘营养现状及甲状腺肿大情况,为开展高碘危害防治工作提供参考依据。方法 从水源性高碘地区5个街/镇中,选择2 207名学龄儿童作为调查对象,采集儿童尿样测定尿碘含量,检测儿童甲状腺容积。结果 调查地区水碘含量范围是100.4～175.1 μg/L,各街/镇水碘中位数差异有统计学意义（χ2 = 19.422,P = 0.001）。儿童尿碘中位数为215.96 μg/L（141.88～307.66 μg/L）,男童尿碘中位数高于女童（Z = -2.768,P = 0.006）,各街/镇儿童尿碘中位数差异有统计学意义（χ2 = 71.981,P＜0.001）。儿童甲状腺容积中位数为3.2 mL（2.5～4.1mL）,甲肿率为3.7%。各街/镇儿童甲状腺容积中位数差异有统计学意义（χ2 = 311.402,P＜0.001）,甲肿率差异无统计学意义（χ2 = 7.117,P = 0.130）。水碘与尿碘（rs = -0.037,P = 0.084）、甲状腺肿大（rs = - 0.022,P = 0.302）,尿碘与甲状腺肿大（rs = - 0.027,P = 0.209）之间相关性均无统计学意义。结论 本次调查研究暂未发现水碘、尿碘与甲状腺肿大之间的关联性。水源性高碘地区学龄儿童碘营养处于超足量水平,甲肿率高于我国多个省份,有关部门应当引起重视,因地制宜的制定防治方案。     

Benefits and risks from the national strategy for improvement of iodine nutrition: A community-based epidemiologic survey in Chinese schoolchildren

ObjectiveMild to severe iodine deficiency has been documented in China since 1960. To eliminate this persisting iodine deficiency, legislation on universal salt iodization was introduced in 1995 as a long-term public health intervention strategy. We examined the urinary iodine excretion and the iodine content of drinking water and salt samples to assess the benefits and risks of this national strategy.MethodsWe examined the urinary iodine excretion of 1594 schoolchildren 8 to 10 y old from the 16 counties of China. The iodine content of 1097 drinking water and 4501 table salt samples also was assessed in these counties. The study was conducted from April 2009 through October 2010. Urinary iodine excretion and iodine levels in drinking water and table salt samples were measured based on the Sandell–Kolthoff reaction. Data were interpreted according to World Health Organization criteria.ResultsThe median urinary iodine levels of the schoolchildren were 198.2, 277.2, 336.2, and 494.8 μg/L in areas with iodine levels lower than 10, 10 to 150, 150 to 300, and higher than 300 μg/L in the drinking water, respectively. The mean iodine level in the table salt specimens was 30.4 mg/kg, the coverage rate was 98.6%, and the qualified rate was 96.7%. The goiter prevalence was 8.0% in the areas with an iodine level higher than 150 μg/L in the drinking water.ConclusionIn each area, the median urinary iodine of schoolchildren was nearly or above 200 μg/L, which confirmed the effectiveness of the iodization strategy. However, in areas with an iodine content higher than 150 μg/L in the drinking water, the schoolchildren had more than adequate or excessive iodine intake, which was associated with the prevalence of goiter. Therefore, it is important to adjust the strategy of universal salt iodization control in China.     

Iodine deficiency status and iodised salt consumption in Malaysia: findings from a national iodine deficiency disorders survey

A nationwide cross-sectional school-based survey was undertaken among children aged 8-10 years old to determine the current iodine deficiency status in the country. Determination of urinary iodine (UI) and palpation of the thyroid gland were carried out among 18,012 and 18,078 children respectively while iodine test of the salt samples was done using Rapid Test Kits and the iodometric method. The results showed that based on WHO/ ICCIDD/UNICEF criteria, the national median UI was 109 μg/L [25th, 75th percentile (67, 166)] showing borderline adequacy. The overall national prevalence of iodine deficiency disorders (IDD) with UI<100 μg/L was 48.2% (95% CI: 46.0, 50.4), higher among children residing in rural areas than in urban areas. The highest prevalence of UI<100 μg/L was noted among the aborigines [(81.4% (95% CI: 75.1, 86.4)]. The national total goitre rate (grade 1 and grade 2 goitre) was 2.1%. Of 17,888 salt samples brought by the school children, 28.2% (95% CI: 26.4, 30.2) were found to have iodine content. However, the overall proportion of the households in Malaysia using adequately iodised salt as recommended by Malaysian Food Act 1983 of 20-30 ppm was only 6.8% (95% CI: 5.1, 9.0). In conclusion, although a goitre endemic was not present in Malaysia, almost half of the states in Peninsular Malaysia still have large proportion of UI level <100 μg/L and warrant immediate action. The findings of this survey suggest that there is a need for review on the current approach of the national IDD prevention and control programme.     

Goitre decline in Italy and contribution of the silent and active prophylaxis

Goitre has been declining in Italy since the 1970s and because active prophylaxis (AP) has been very limited, it has been suggested that in most places the decline was due to silent prophylaxis (SP). SP is related to the natural increase in iodine intake because of higher consumption of iodine-rich products associated with socioeconomic development. The hypothesis tested in the present study is that SP has increased iodine intake in Italy with subsequent reduction of goitre and that such changes can be quantified. The analysis is based on surveys carried out between the 1970s and the 1990s where goitre and urinary iodine, a proxy of consumption, were measured in schoolchildren. The contribution of the SP can be quantified in an annual increase in urinary iodine excretion between 2.1 and 4 microg/l, and an annual decline in goitre prevalence between 2.1 and 3.6 %. In the few areas with AP, there was an annual increase in urinary iodine between 6.5 and 13.1 microg/l, while the average annual decline of goitre was between 4.4 and 10 %. The present results could be used by policy-makers to predict the future trends in the excretion of urinary iodine and prevalence of goitre in Italy with and without AP. AP is about three times faster than SP in increasing iodine intake, but policy-makers should estimate the incremental cost-effectiveness of AP net of the iodine increase already occurring naturally with the SP.     

不同孕期妇女尿碘水平与甲状腺功能相关性研究

目的研究全民食盐加碘后杭州市孕妇在不同孕期碘营养和甲状腺功能状况,为今后实施孕妇甲状腺功能监测的必要性和可能性提供依据。方法随机抽取杭州市5个调查点395人进行尿碘、水碘、盐碘、促甲状腺素(TSH)、游离三碘甲状腺原氨酸(FT3)、总甲状腺素(FT4)实验室检测,采用酸消化砷-铈接触法测定尿碘、水碘,采用硫代硫酸钠直接滴定法测定盐碘,化学发光法测定TSH、FT3、FT4水平。统计学处理采用SPSS13.0统计软件,率的比较用χ2检验,P0.05为差异有统计学意义。结果①孕早、中、晚期妇女的尿碘中位数分别为170.3,170.2,162.4μg/L,均显著低于对照组(251.9μg/L,均P0.05);②孕中期妇女中FT4低于下限值者占8.7%,FT3低于下限值者占9.6%;孕晚期妇女中FT4低于下限值者占22.7%,FT3低于下限值者占17.5%;③孕晚期甲状腺激素指标异常的妇女尿碘值300μg/L者(36.6%)明显高于正常组(8.8%)(χ2=12.54,P=0.002)。结论①从群体的角度来看,杭州市孕妇的碘营养处于适宜水平;②建议在孕妇中开展尿碘监测,对于尿碘值150μg/L或300μg/L的孕妇要进行甲状腺功能的筛查。     

The use of sugar as a vehicle for iodine fortification in endemic iodine deficiency

The use of sugar as a vehicle for iodine supplementation was explored in a study of iodine deficiency in the Sudan. A survey of sugar consumption was conducted and established a widespread and uniform intake of sugar in all ages with no differences among socio-economic groups. The daily intake among adults varied from 48 g to 78 g as examined in five different geographical areas in the country. Iodinated sugar was produced by addition to sugar solution prior to crystallisation in an evapocrystallizer or sprayed on the conveyor of cured sugar before it entered the dryers. Subsequently, the iodinated sugar was given to members of 18 and 60 families in a mildly (urinary iodine <5.1 μg/dl) and moderately (urinary iodine <3 μg/dl) iodine deficient areas, respectively, over a 1-month and a 6-month period, respectively. In both tests, improvements were recorded, i.e. the rates of goitre decreased, urinary iodine levels increased significantly (from 5.1 to 14.4 μg/dl and from 3 to 9.8 μg/dl, respectively) and thyroid hormones values rose. No side effects were noted. The results indicate that fortification of sugar with iodine may serve as a new alternative approach in attempts to eradicate iodine deficiency related disorders in endemic areas.     

饮水碘含量5～150μg/L居民户停供碘盐前后人群尿碘水平变化的干预试验研究

目的 通过现场干预试验,对比观察饮用水碘含量为5～150μg/L人群停供碘盐前后碘营养水平的变化.方法 选择生活饮用水碘含量5～150μg/L的居民户作为目标居民户,用无碘盐替换其家中正在食用的碘盐,干预60 d后采集家庭成员尿样.结果 干预前学龄儿童、育龄妇女、成年男子的尿碘中位数均在370μg/L以上,频数分布≥300 μg/L的比例均在70%以上,三类人群的碘营养状况处于碘过量水平.干预后三类人群的尿碘中位数均较干预前明显下降,其中生活饮用水碘含量为5.0～99.9μg/L的人群碘营养水平下降到碘营养适宜水平或基本适宜水平;生活饮用水碘含量为100～150μg/L时,三类人群干预后的尿碘中位数仍接近300 μg/L,处于碘营养偏高状态.结论 生活饮用水水碘含景为5～100μg/L的地区为适碘地区,不需要供应碘盐;生活饮用水水碘含量为100～150μg/L的地区应划分为高碘地区.     

碘与人群中甲状腺肿流行关系的观察

根据对山区、半山区、平原、沿海几个调查点四万人的甲状腺检查和尿碘、水碘的分析,揭示了从“低碘”、“中碘”到“高碘”地区的碘和人群中甲状腺肿流行的关系:①尿碘在50 μg/g肌酐,水碘在5 μg/l以下时,碘越少甲状腺肿流行率越高;②尿碘从50 μg/g肌酐,到400 μg/g肌酐,水碘从5 μg/l到40 μg/l,甲状腺肿流行率降到最低水平;③尿碘400 μg/g肌酐,水碘40 μg/l以上时,甲状腺肿 流行率又缓慢上升,所以水碘、尿碘含量和人群中甲状腺肿流行呈现底部较宽阔的“V”字形曲线的关系。本资料揭示尿碘400 μg/g肌酐,水碘40μg/l是人群中流行率最低水平的数值。当以甲状腺肿患病率3%做为判定地方性甲状腺肿的标准(1978年我国的地方性甲状腺肿防治工作标准)时,则尿碘的安全范围为50-1000 μg/g肌酐,水碘的安全范围为5-200 μg/l,低于或高于这个范围都可引起人群中甲状腺肿的流行。     

2013-2017年渭南市重点人群尿碘检测结果分析

目的 分析渭南地区重点人群的碘营养状况,为有针对性的防治碘缺乏病提供对策。方法 2013-2017年每年分别选取渭南市10个县的1所小学,从每所小学选取42名学生采集尿液测定尿碘;对抽中的街道/乡镇随机选取21名孕妇采集尿样测定尿碘。结果 2013-2017年 共计检测儿童7 400份尿样,尿碘中位数是269.4 μg/L,儿童尿碘小于100 μg/L的样本占检测总数的10.0％,尿碘大于100 μg/L的样本占检测总数的90.0％,其中尿碘大于300 μg/L的样本占检测总数的38.3%;共计检测孕妇4 300份尿样,尿碘中位数是 219.6μg/L,孕妇尿碘小于150 μg/L的样本占检测总数的35.6%,尿碘大于150 μg/L的样本占检测总数的64.4%,其中尿碘大于500 μg/L的样本占检测总数的8.6%。结论 渭南市10个县市区儿童人群碘营养水平总体仍处于超适量摄入状态,特需人群碘营养水平总体处于适宜状态,孕妇碘摄入量可以满足人体需要,碘营养状况良好。     

Endemic goitre in the Sudan despite long-standing programmes for the control of iodine deficiency disorders

Objective

To describe the status of iodine deficiency disorders (IDDs) in the Sudan more than 25 years after the initiation of IDD control programmes and to explore the causes of endemic goitre in the country.

Methods

Testing for IDDs was carried out in 6083 schoolchildren 6 to 12 years of age from the capital cities of nine states in different areas of the country using the three indicators recommended by the World Health Organization: the prevalence of goitre, laboratory measurements of urinary iodine concentration in casual urine samples and serum thyroglobulin (Tg) levels. Serum levels of thyroxine (T4), triiodothyronine (T3) and thyroid-stimulating hormone (TSH), as well as urinary secretion of thiocyanate, which can affect the transport of iodine into thyrocytes, were also measured.

Findings

The prevalence of goitre in the different samples ranged from 12.2% to 77.7% and was 38.8% overall. The overall median urinary iodine concentration was 6.55 μg/dl, with the lowest median value having been found in Kosti city (2.7 μg/dl), situated in the centre of the country, and the highest (46.4 μg/dl) in Port Sudan, on the Red Sea coast. The highest mean serum Tg level (66.98 ng/ml) was found in Kosti city, which also had the highest prevalence of goitre.

Conclusion

IDDs still constitute a public health problem throughout urban areas in the Sudan and iodine deficiency appears to be the main etiological factor involved.     

黔东南州农村地区水碘及8～10岁儿童碘营养调查

目的 了解和掌握黔东南州农村地区生活饮用水水碘含量,监测分析8～10岁儿童碘营养状况,为采取针对性防治措施和科学调整干预策略提供依据。方法 2017年对黔东南州农村地区203个乡镇992个村的2 325个生活饮用水监测点采集水样测定水碘含量;2017－2020年每年随机抽取黔东南州农村地区80个乡镇80所小学的3 200名8～10岁非寄宿儿童,检测尿碘、家中盐碘含量,并进行甲状腺容积B超检测。结果 本次共检测水样2 325份,水碘中位数为2.20 μg/L,范围0.1～9.9 μg/L,不同地区水碘水平差异有统计学意义(χ2 = 318.401,P＜0.05)。共采集13 003份8～10岁儿童尿样和盐样,尿碘中位数210.00 μg/L;不同地区、不同性别尿碘中位数差异有统计学意义（χ2 = 1 972.362,P＜0.05)（χ2 = 16.752,P = 0.358＞0.05）,各年龄段尿碘中位数差异无统计学意义（χ2 = 2.056,P＞0.05）。盐碘中位数27.10 mg/L,碘盐覆盖率99.92%、合格碘盐食用率95.82%,不同地区盐碘水平差异有统计学意义(χ2 = 850.64,P＜0.05 )。B超检查6 507名8～10岁儿童,甲状腺肿大率1.55%,不同年龄阶段儿童甲状腺肿大率无统计学差异（χ2 = 2.597,P = 0.273＞0.05）。结论 黔东南州农村地区8～10岁儿童碘营养状况良好,但由于外环境长期缺碘,消除碘缺乏病必须长期坚持适宜于自身特点的补碘措施,使儿童碘营养处于一个较适宜水平,才能保证儿童免受碘缺乏病的危害。     

2011年桂林市8~10岁儿童尿碘含量检测结果分析

目的 监测分析桂林市区及所辖县8~10岁儿童尿碘含量的频数分布,为制定相应的干预措施提供科学依据。 方法 依据中华人民共和国卫生行业标准WS/T107-2006收集儿童尿样本进行检测。 结果 1 400份儿童尿碘检测值结果显示,8~10岁儿童尿碘水平＜50 μg/L的比率为1.29%,＜100 μg/L的比率为5.29%,达到国家碘缺乏病消除标准。 尿样本中尿碘水平≥200 μg/L的占73.64%(1 031/1 400),市区儿童样本≥200 μg/L的占66.20%(331/500),县城儿童样本中≥200 μg/L的占77.78%(700/900),其中有四个县的儿童样本≥200 μg/L的占86.75%(347/400)。 结论 桂林市8~10岁儿童尿碘样本检测的总体指标已达到国家标准,但县城儿童存在儿童尿碘含量偏高现象。     

Association between Serum Ferritin and Goitre in Iranian School Children

Despite long-standing supplementation of iodine in Iran, the prevalence of goitre among general people remains high in some regions. The study investigated the role of iron status in the aetiology of goitre in school children in Isfahan, Iran. Two thousand three hundred and thirty-one school children were selected by multi-stage random sampling. Thyroid size was estimated by inspection and palpation. Urinary iodine concentration (UIC) and serum ferritin (SF) were measured. Overall, 32.9% of the children had goitre. The median UIC was 195.5 μg/L. The mean±SD of SF in the goitrous and non-goitrous children was 47.65±42.51 and 44.55±37.07 μg/L respectively (p=0.52). The prevalence of iron deficiency in goitrous and non-goitrous children was 9.6% and 3.1% respectively (p=0.007). Goitre is still prevalent in school children of Isfahan. However, their median UIC was well in the accepted range. Iron deficiency is associated with goitre in a small group of goitrous children. The role of goitrogens should also be investigated in this region.Key words: Cross-sectional studies, Goitre, Iodine, Iron deficiency, Serum ferritin, Iran     

2011年江苏省碘缺乏重点地区居民碘营养现状调查

目的了解碘缺乏重点地区不同人群的碘营养现状。方法在23个碘缺乏重点县(市、区),随机抽取2 303份盐样,2 239份儿童、育龄妇女及孕妇和哺乳妇女尿样,检测盐碘含量和尿碘浓度。结果碘盐覆盖率,碘盐合格率,合格碘盐食用率分别为98.3%、97.6%、95.0%;学龄儿童和育龄妇女尿碘中位数分别为240.1μg/L、231.8μg/L,略高于适宜范围但未过量,孕妇和哺乳妇女尿碘中位数均在150～249μg/L适宜范围。结论碘缺乏重点地区重点人群碘营养总体上充足,建议加强对各类特需人群的碘营养水平监测。     

Survey of iodine deficiency in a rural area near Tehran: association of food intake and endemic goitre

Goitre is endemic in many parts of Iran. This study was undertaken first to obtain the base line data and identify the nature of the problem and then to take measures to ameliorate it. Shahryar, an endemic area near the capital city, was selected as the pilot field. The sample size was 368 families. Sixty-six per cent of females and 54 per cent of males were goitrous. A food consumption survey revealed that 38 per cent and 62 per cent of the families had failed to receive at least 80 per cent of their requirement for energy and vitamin A, respectively. Free T4 index was normal but significantly lower in grade 2 goitre than the non-goitrous subjects (P less than 0.01). Significant reverse correlations were found between goitre prevalence and vitamin A and protein intakes (P less than 0.05). Supplementation with 40 micrograms iodine/g salt raised urinary iodine excretion significantly (P less than 0.001). We conclude that although iodine deficiency plays the key role in goitre, the association of other dietary factors observed in this study needs further consideration.     

未加碘食盐地区不同水碘浓度下居民碘营养状况

  目的  调查供应未加碘食盐地区居民碘营养状况,为探讨未加碘食盐供应范围提供依据。  方法  调查4个水碘浓度(100~<150 μg/L、90~<100 μg/L、80~<90 μg/L、70~<80 μg/L)村18~<60岁成人、8~<10岁儿童和孕妇的尿碘水平、甲状腺容积和结节、成人和孕妇甲状腺激素与抗体进行检测。  结果  共调查822名成人、793名儿童和87名孕妇,儿童和成人的尿碘水平在4个水碘组均超出适宜水平,孕妇尿碘除70~<80 μg/L水碘组处于适宜水平外,其他3组均处于大于适宜量水平。儿童组(χ2=25.703,P < 0.001)和成人组(χ2=13.139,P=0.004)尿碘值与饮用水含碘量均呈正向关系。不同水碘组孕妇尿碘浓度差异无统计学意义(χ2=5.178,P=0.159)。儿童甲状腺肿大率为20.8%,不同水碘组儿童甲状腺肿大率差异无统计学意义(χ2=6.361,P=0.095);成人甲状腺结节发生率为16.0%,不同水碘组成人甲状腺结节发生率差异无统计学意义(χ2=2.863,P=0.413)。不同水碘组孕妇和成人的全血促甲状腺激素(thyroid stimulating hormone, TSH)、游离甲状腺激素(free thyroxine, FT4)、甲状腺球蛋白抗体(thyroglobulin antibodies, TGAb)和甲状腺过氧化物酶抗体(thyroid peroxidase antibodies, TPOAb)异常率差异均无统计学意义(Fisher检验,均有P>0.05)。  结论  饮用水碘>70 μg/L的地区应食用未加碘食盐,水碘>100 μg/L的行政村应严格落实未加碘食盐供应,水碘含量为70~<80 μg/L地区的孕妇可适当进食富碘食物补碘。     

2015 - 2016年江苏省镇江市碘缺乏病现状调查

目的 了解2015 - 2016年镇江市居民碘营养状况,为制定有针对性的碘缺乏病防治措施提供依据。方法 采用随机抽样法,在镇江市6个所辖市区中随机抽取共2 700名8～10岁儿童、1 200名孕妇和300名哺乳期妇女,检测儿童、孕妇和哺乳期妇女尿碘含量,家庭食用盐盐碘含量以及学生甲状腺肿大情况;随机抽取900名五年级学生和150名家庭妇女进行健康知识问卷调查,同时监测农村生活饮用水水碘含量。结果 镇江市8～10岁儿童甲肿率为0.44%,尿碘中位数225.00 μg/L,儿童碘营养轻度超标,不同地区、性别间比较差异具有统计学意义（P＜0.05）;孕妇和哺乳妇女尿碘中位数分别为161.50 μg/L和124.50 μg/L,均达碘营养适宜水平。家庭食用碘盐覆盖率为99.71%,碘盐合格率为96.74%,合格碘盐食用率达96.74%,盐碘均数为（22.60±3.39） mg/kg,该地区盐碘质量合格。农村饮用水水碘含量中位数为6.54 μg/L,属缺碘状态。学生和家庭主妇碘缺乏病防治知识知晓率分别为86.62%和87.83%,不同市区间差异无统计学意义（P＞0.05）。结论 镇江市居民碘营养状况符合江苏省持续消除碘缺乏病行动计划与消除碘缺乏病达标考核要求,今后仍需继续加强该市碘营养状况的监测工作。     

Prevalence of goitre and urinary iodine status of primary-school children in Lesotho

OBJECTIVE: To estimate the prevalence of goitre, urinary iodine status, coverage of supplementation of iodized oil capsules, and current use of iodized salt in children in Lesotho. METHODS: Cross-sectional study of children from 50 primary schools in Lesotho. Thyroid glands of children aged 8-12 years were measured by palpation and graded according to the WHO, UNICEF, and the International Council for the Control of Iodine Deficiency's (ICCIDD) joint criteria. The use of iodized oil capsules was determined by a structured questionnaire and verified with the children's health booklets. Iodine content of household salt samples was analysed. Casual urine samples were analysed for urinary iodine. FINDINGS: Median urinary iodine concentrations of 26.3 microg/l (range 22.3-47.9 microg/l) indicated moderate iodine deficiency. More children in the mountains than in the lowlands were severely iodine deficient (17.7% vs 1.9%). Adjusted prevalence of goitre (4.9%) increased with age, was higher in girls than boys, and ranged from 2.2% to 8.8% in the different districts; this indicated no public health problem. Overall, 94.4% of salt samples were iodized, and coverage of supplementation with iodized oil capsules was 55.1%. CONCLUSION: Mild-to-moderate iodine deficiency exists in Lesotho. Iodine deficiency was more severe in the mountains than the lowlands and is still a concern for public health. Use of iodized salt coupled with iodized oil supplementation effectively controls iodine deficiency disorders. Effective monitoring programmes would ensure the use of adequately iodized salt throughout Lesotho and serve to evaluate progress towards optimal iodine nutrition. Iodized oil capsule supplementation should continue in the mountains.