Tracking progress towards sustainable elimination of lodine deficiency disorders in Bihar

Objectives To assess the status of the iodine deficiency in the population of Bihar and track progress of the elimination efforts. Methods A community based field survey was conducted. Using quantitative and qualitative research methods, data was collected by following internationally recommended protocol and methodology. Thirty clusters were selected using population proportionate to size technique. School age children (6 to 12 years) were the target group studied. Urinary iodine in target children and iodine content of salt at households were the indicators used. Results Total of 1169 children were studied. The median urinary iodine concentration was found to be 85.6 μg/L. Urinary iodine concentration was less than 50 μg/L in 31.5% of the subjects. Only 40.1% of the household salt samples were found to be adequately iodised as determined by titration method (>=15 ppm iodine). Conclusions Study results show existence of iodine deficiency in the state. There is need to accelerate our efforts to achieve iodine sufficiency and this should be done on a war-footing.     

Assessment of iodine deficiency disorders in district Bharatpur,Rajasthan

Iodine deficiency disorders (IDD) is a public health problem in India. A ban on the sale of uniodised salt for household consumption has been introduced in Rajasthan State since 1992. The present study was conducted in the district of Bharatpur, Rajasthan with the objective to assess the prevalence of iodine disorders in school children as no data is available on this aspect. A total of 3072 children in the age group of 6-12 years were included in the study and were clinically examined. On the spot urine samples were collected randomly from 450 children. A total of 1064 salt samples were collected randomly from the families of the children. The total goiter prevalence was found to be 7.2% in the subjects studied. It was found that the percentage of children with urinary iodine excretion <20.0; 20.0-49.9, 50.0-99.9 and 100 mcg/L and above was 1.1, 1.1, 7.8 and 90.0% respectively. The assessment of iodine content of salt revealed that 56% of the families were consuming iodised salt. The findings of the present study indicated that the population is in a transition phase from iodine deficient (as revealed by the TGR) to iodine sufficient (as revealed by the medium UIE of 200.0 mcg/L) nutriture.     

Assessment of iodine deficiency disorders in urban areas of Udaipur District,Rajasthan

The present study was conducted on 6-12 years school going children of urban areas of Udaipur to assess the prevalence of iodine deficiency disorders. The study revealed a goiter prevalence of 8.4 percent and biochemical deficiency of nearly 8 per cent but the median iodine levels of the study population was 20 mcg/dL. Iodometric titration of salt samples collected from the beneficiaries revealed that more than 85 per cent of the salt samples had within or more than the stipulated levels of iodine 15 ppm. It appears that the population is in the transition phase from iodine deficiency to iodine sufficiency due to successful implementation of salt iodisation program.     

Iodine deficiency in district Kinnaur, Himachal Pradesh

The state of Himachal Pradesh is a known iodine deficiency endemic region since the last 40 years. The state government is supplying iodised salt to the district since 1970 No recent survey has been conducted on the prevalence of iodine deficiency from the district Kinnaur which is located at an average altitude of 10,000 feet above sea level. A total of 1094 children in the age group of 6–10 years were included in the study and clinically examined. The total goitre prevalence of 6.1% was found in the subjects studied. Urine samples were collected from 226 children and were analysed using standard laboratory procedures. It was found that the percentage of children with <2 mcg/dl, 2–4.9 mcg/dl, 5–9.9 mcg/dl and 10 and above mcg/dl of urinary iodine excretion (UIE) level was 1.3, 5.8, 10.6 and 82.3 respectively. A total of 242 salt samples were collected and analysed using the standard iodometric titration method. Results showed that almost 90% of the families were consuming salt with an iodine content of 15 ppm and more which is the stipulated level of iodisation of salt. The findings of the study indicate that iodine nutrition is in the transition phase from iodine deficient to iodine sufficient. Findings revealed a need for further strengthening the monitoring of the quality of salt being distributed in Kinnaur to achieve elimination of iodine deficiency.     

Assessment of iodine deficiency disorders using the 30 cluster approach in district Kangra, Himachal Pradesh, India

Iodine deficiency is an important public health problem in Himachal Pradesh. District Kangra is a known iodine deficiency endemic area. A survey conducted in 1956 reported a goitre prevalence of 55 per cent in the district. A more recent pilot study (1994) in four blocks of the district reported the total goitre rate (TGR) as 7 per cent. A continued prevalence of goitre in more than 5 per cent of school-aged children was found in pilot study, in spite of the distribution of iodised salt. The present study was conducted to assess the prevalence of iodine deficiency disorders (IDD) and to estimate the iodine content of salt consumed by the population in district Kangra. The '30 cluster' sampling methodology and indicators for assessment of IDD, as recommended by the joint WHO/UNICEF/ICCIDD consultation, were utilized for the survey. A confidence level of 95 per cent, a relative precision of 10 per cent and a design effect of three were taken into account for calculation of the sample size. A total of 23,348 school children in the age group 6-11 years were included in the study. The total goitre prevalence rate was found to be 12.1 per cent. The median urinary iodine excretion of the children studied was found to the 15.00 mcg/dl. About 12.7 per cent of families consumed salt with an iodine content of less than 15 ppm. The results of the present study indicated that the population of district Kangra is in a transition phase from iodine deficient to iodine sufficient nutrition and that there is a need for further strengthening of the system of monitoring the quality of iodised salt made available to the population to eliminate IDD from the Kangra Valley.     

Iodine status in pre‐school children prior to mandatory iodine fortification in Australia

The iodine status of children between the ages of 5 and 15 years has been routinely assessed in many countries, but few studies have examined iodine status in pre‐school children. We conducted a cross‐sectional study of pre‐school children living in Adelaide, South Australia, between 2005 and 2007. Children 1–5 years old were identified using a unique sampling strategy to ensure that the study population was representative. A 3‐day weighed diet record, a blood sample and a urine sample were obtained from each child. The median urinary iodine concentration (UIC) of the children (n = 279) was 129 µg L^?1, indicating iodine sufficiency (normal range: 100–199 µg L^?1), but 35% of the children had a UIC < 100 µg L^?1. The median thyroglobulin concentration of children (n = 217) was 24 µg L^?1 and thyroglobulin concentration declined with increasing age (P = 0.024). The mean daily iodine intake was 76 µg. The intake of iodine was lower than expected and highlights difficulties in accurately assessing iodine intakes. Further studies are needed to monitor dietary changes and iodine status in this age group since the implementation of mandatory fortification of bread with iodised salt in Australia in 2009.     

Iodine deficiency status amongst school children in Pauri,Uttarakhand

Objective

To assess the iodine deficiency status amongst school age children in district Pauri, Uttarakhand.

Methods

2067 children (age of 6–12 years) were included. Clinical examination of thyroid gland of each child was conducted. On-the-spot urine and salt samples were collected from children.

Results

Total Goitre Rate was found to be 16.8% and median Urinary Iodine Concentration level was 115 μg/L. Only 40.4% of salt samples had e 15 ppm of iodine.

Conclusion

There is a mild degree of iodine deficiency in school age children in district Pauri. There is a need of strengthening the National Iodine Deficiency Disorder Control Program.     

Iodine status and goiter prevalence after 40 years of salt iodisation in the Kangra district, India

Thirty primary schools were selected in district Kangra utilizing the population proportionate to size cluster sampling methodology in the year 2004. A total of 6939 children were included in the study. The clinical examination of the thyroid of each child was conducted. On the spot casual urine sample and salt samples were collected from a ‘sub set of’ children included in the study. The Total goiter rate (TGR) was found to be 19.8%. The median Urinary iodine excretion level was 200 μg/l and only 64% of the salt samples had the stipulated level of iodine. The findings of the present study revealed that current iodine status of population is adequate, however, TGR showed mild iodine deficiency (chronic), and there is a need of continued monitoring the quality of iodised salt provided to the beneficiaries under the Universal salt iodisation programme in order to achieve the goal of elimination of lodine deficiency disorders from district Kangra.     

Changes in thyroid morphology and function in children in western Poland as a result of intensified iodine prophylaxis

AIM: To determine the changes in thyroid pathology resulting from obligatory salt iodization in a group of children aged 8-12 years from the rural and urban areas of Wielkopolska Region, Poland. POPULATION AND METHODS: The survey was conducted on 1215 children, of both sexes, 402 of whom were examined in 1992 (before salt iodization), 408 in 2000, and 405 in 2005 (after salt iodization beginning in 1996). Thyroid ultrasound, urinary iodine, FT4, FT3, TSH and antithyroid antibodies were measured. RESULTS: A significant drop in goiter cases was observed (35.4% in 1992 vs 6.3% in 2005), coupled with a marked increase of urinary iodine. There were also changes in ultrasonography and elevated levels of antibodies. CONCLUSIONS: The study proves the high efficacy of iodine prophylaxis. Despite a growing number of children with elevated antithyroid antibody titers, only a slight increase of autoimmune thyroid disorders was observed.     

Elimination of iodine deficiency disorders in Delhi

Objective: The present study was conducted in year 2002 in NCT of Delhi with the objective to re-assess the prevalence of iodine deficiency disorders.Methods : A total of 7009 children in the age group of 6–11 years were clinically examined for presence of goiter. A total of 991 salt samples were also collected randomly. On the spot casual urine samples were collected from 1395 children.Results : The total goiter prevalence was found to be 6.2 %. The percentage of children with urinary iodine excretion (UIE) of <20.0, 20.0-<50.0, 50.0–99.9 and 100.0 Μg/l and above was 0.8, 1.8, 8.7 and 88.7%, respectively. The median UIE level was 200 Μg/L The assessment of iodine content of salt revealed that only 16% of the families were consuming salt with iodine content less than 5 ppm.Conclusion : The findings of the present study indicated that the population is in a transition phase from iodine deficient (as revealed by Total Goiter Prevalence) to iodine sufficient nutriture (as revealed by median UIE 200 Μg/l). A significant progress has been achieved towards elimination of IDD from NCT of Delhi.     

Iodine deficiency disorder in children aged 6–12 years of Ambala, Haryana

We conducted this study to assess the prevalence of goitre among 2700 children (6–12 yr) of district Ambala in Haryana. Children were examined as per standards laid by National iodine deficiency disorder control programme (NIDDCP). Multi stage cluster sampling method was used. Urine and salt samples were also studied for iodine concentration. The overall prevalence of goitre in the studied subjects was 12.6%. The median urinary iodine excretion in the study sample was more than 100μg/L Iodine content was found to be adequate in 88% of salt samples. We conclude that there was a high prevalence of goitre in young children despite iodine repletion. This calls for identification of factors to strengthen NIDDCP and the need to emphasize use of iodized salt in Haryana.     

营养及微量元素在防治缺碘地区儿童智力低下中的作用

对山西省一个经碘盐防治15年的缺碘地区1028名0～12岁儿童进行儿童智力低下现况调查，并以非缺碘地区3071名同龄儿童做对照。结果发现，两个地区儿童智力低下患病率分别为1．36％及1．17％，差异无显著意义（X2=0．23，P＞0．05）。对两个地区216名儿童进行营养调查发现，如果缺碘地区儿童膳食中总能量、蛋白质、铁、锌摄人量达到或接近我国推荐的供给量标准，补碘后儿童智力可望达到非缺碘地区水平。提示为了防治因缺碘造成的儿童智力低下，除补碘以外，尚应注意儿童膳食中总能量、蛋白质等的供给量。     

Iodine deficiency in school going children of Pondicherry

Objective To assess the status of iodine deficiency in Pondicherry by finding out the urinary excretion of iodine and the prevalence of goiter among school children. Methods 315 children between the age group of 9–13 yr from 30 schools in Pondicherry were examined for the presence of goiter and their urine samples were subjected to biochemical analysis to find out the urinary iodine levels (UIE). Results The percentage of children who had inadequate iodine intake and showed urinary iodine level of less than 100 mcg/L was 44.4%. Amongst them, 14.3% had a greater degree of iodine deficiency with less than 50 mcg/L of iodine in urine. The prevalence of goiter was 15.24%. Conclusion The prevalence of goiter is high. The iodine intake is quite low as exhibited by the UIE levels of <100mcg/L in the children in Pondicherry, which might have had an unseen impact on the intelligence and school performance of these children.     

Iodine nutritional status and risk factors for iodine deficiency in infants and children of the french North department]

INTRODUCTION: Iodine deficiency is responsible for a higher mortality and morbidity in neonates and infants. It has not yet disappeared in European countries, especially in Southern and Eastern Europe. OBJECTIVES: The present study aimed at evaluating the status of iodine nutrition of infants living in the North department (France) and at studying risk factors for iodine deficiency. METHODS: The study was conducted in primary health care centres in 160 healthy infants aged ten days to six years (mean +/- SD: 17.7 +/- 2.5 months). Data included: familial thyroid disease history, type of feeding at inclusion, timing of introduction of complementary foods, nutritional status (weight, height, head and arm circumference), as well as maternal education level and family socio-economical status. Iodine status was assessed by urinary iodine excretion. RESULTS: Urinary iodine concentration ranged from 4 to 1042 microg/l (median +/- SD: 195,5 +/- 21,6 microg/l). Thirty-eight (24%) of 160 children were iodine deficient (urinary iodine < 100 microg/l): mild iodine deficiency (50-99 microg/l: 17%), moderate iodine deficiency (20-49 microg/l: 5%), severe iodine deficiency (<20 microg/l: 2%). No relationship was found between iodine status and age, sex, geographic origin of the children, as well as social and occupational group of the parents. Breast-feeding did not prevent from iodine deficiency. Iodine status did not differ between the cow's milk fed group and the group that was not fed cow's milk. Formula feeding was associated with iodine deficiency (p = 0,02). CONCLUSIONS: Prevalence of severe iodine deficiency was very low in this population. However, iodine status was not optimal.     

Excessive iodine intake during pregnancy in Somali refugees

Iodine deficiency and excess are both associated with adverse health consequences, with fetuses, children and pregnant women being most vulnerable to the devastating effects of severe deficiency. It is often assumed that the iodine status of a population if displaced or in a remote or emergency situation is low. However, there is little evidence available to support this assumption, especially among long-term food-aid-dependent pregnant women. An effectiveness trial of a prenatal multiple-micronutrient supplement that contained 150 μg day(-1) iodine was conducted in two refugee camps in the North Eastern Province of Kenya in 2002. Urinary iodine concentration (UIC) was measured in a subsample of pregnant women attending antenatal care in Dagahaley (control camp) (n = 74) and Ifo (intervention camp) (n = 63). There was no significant difference in median UIC between the two camps (P = 0.118). The combined median UIC was 730 μg L(-1) (interquartile range, 780) (5.77 μmol L(-1)) and exceeded the upper safe limit of 500 μg L(-1) (3.95 μmol L(-1)) for pregnant women (P < 0.001), indicating excessive iodine intake. About 20% of the study subjects had 'more than adequate' urinary iodine, while over 71% had excessive UIC. Salt iodine content varied between 5.1 and 80.1 ppm in the five market salt samples analysed. In conclusion, excessive iodine intake was evident in the Dadaab refugee camps. Further research needs to be conducted to investigate the source of excess iodine, to determine the measures needed to address excessive iodine intake and to reconsider the World Health Organization/World Food Programme/United Nations Children's Fund guidance on supplementation of vulnerable groups in emergencies.     

Dietary supplies of iodine and thiocyanate in the etiology of endemic goiter in Tripura

In the post-salt iodization phase, a study on iodine nutriture status was conducted in Tripura of North East India. The clinical variable of the study was goiter and the biochemical variables were urinary iodine and thiocyanate. Random sampling methodology was followed for selecting the study areas in the State. In each study area, the studied population consisted of school children of both sexes in the age group 6–15 years. The total study areas were 22 and the total number of the population was 10,801. The total number of urine samples were analysed for iodine and thiocyanate were 1,032 (about 10%). The total goiter rate was 21.63%. Population of most of the studied areas had no biochemical iodine deficiency as evidenced by median urinary iodine excretion levels. However, the per capita consumption of iodine of about 40% population was inadequate. A large number of cyanogenic plants (SCN precursors) are used as common vegetables. This study ensures that the existing goiter prevalence in the region could possibly due to non-uniform adequate iodine supply along with the thiocyanate load.     

Iodine and goiter in children.

Goiter examination was performed on 7,785 children aged 9 to 16 years in four areas of the United States--Michigan, Kentucky, Texas, and Georgia. Urinary iodine and creatinine, thyroxine, protein-bound iodine, and plasma inorganic iodide determinations were made on 377 matched pairs of goitrous and nongoitrous control children. The overall prevalence of goiter was 6.8%. Most children with goiter had palpably but not visibly enlarged thyroids and showed no evidence of clinical or biochemical thyroid abnormalitymmean urinary iodine excretion was 452 mug/gm of creatinine, many times the 50 mug/gm of creatinine level used to define deficiency. Children with goiter and areas with high goiter prevalence tended to have higher rather than lower iodine excretion. These findings are consistent with other data indicating high iodine intakes in the United States and suggest that goiter in American children cannot be assumed to be related to iodine deficiencymthe possible role of high iodine intake in the causation of goiter is discussed.     

Assessment of iodine deficiency disorders in Purulia district, West Bengal, India

Iodine deficiency disorders IDD are major public health problems in India, including West Bengal. Existing programme to control IDD needs to be continuously monitored through recommended methods and indicators. The objective of this study was to assess the prevalence of goitre, status of urinary iodine excretion UIE level and to estimate iodine content of salts at the household level in Purulia district, West Bengal. A school-based, cross-sectional study was conducted during June-September 2005; among 2,400 school children, aged 8-10 years. The "30 cluster" sampling methodology and indicators for assessment of IDD, as recommended by the joint WHO/UNICEF/ICCIDD consultation, were utilized for the study. Goitre was assessed by standard palpation technique, urinary iodine excretion was analyzed by wet digestion method and salt samples were tested by spot iodine testing kit. The total goitre rate TGR was 25.9% (95% Cl=24.1-27.1%) with grade I and grade II (visible goitre) being 19.5% and 6.4% respectively. Goitre prevalence did not differ by sex but significant difference was observed in respect of age. Median urinary iodine excretion level was 9.25 microg/dl and 31.6% children had value less than 5 microg/dl. Only 33.4% of the salt samples tested had adequate iodine content of > or = 15 ppm, High goitre prevalence (25.9%) and median urinary iodine (9.25 microg/dl) below normal range indicate existence of current iodine deficiency in Purulia district. The district is still in the iodine-deficient state. Moreover, salt iodisation level far below the recommended goal highlights IDD as major public health problems in the district. Intensified information, education and communication activities along with sustained monitoring are urgently required.     

Prevalence of goitre among school children in coastal Karnataka

Objective A cross sectional study was conducted in the rural field practice area of Department of Community Medicine, KMC, Manipal to find out the prevalence of goitre among school children in the age group of 8–10 years.Methods: A total of 722 children were selected from the study population by the method of probability proportion to size (PPS) stratified sampling giving due representation to both Government and private schools. Children were clinically examined for the presence of goitre and graded according to WHO guidelines. Urine and salt samples were collected from subsample to estimate the urinary iodine excretion level and iodine content in the salt respectively.Results:Over all prevalence of goitre was 30 percent. Prevalence among males was 28.8 percent and among females it was 31.2 percent. In the both sexes goitre rate increased with the advancement of age. Prevalence of grade I and grade II goitre was 29.4 and 0.6 percent respectively. Prevalence of goitre was significantly higher among children who had urinary iodine excretion level less than optimum (<10 mcg/dl). Estimation of iodine content in the salt sample revealed that 48.3 percent of samples had adequate iodine content (>=15 ppm). There was significant increase in the goitre rate as the iodine content in the salt decreased (p=0.01).Conclusion: Prevalence of goitre among school children was high and therefore constituted a public health problem in this region