Iodine deficiency disorders in 15 districts of India

Methods : A multicentre study to assess iodine deficiency disorders (goitre and deaf-mutism/cretinism) in 1,45, 264 children (6-<12 years old) from 15 districts of ten states was carried out during 1997-2000. Urinary iodine excretion was also determined in 27481 children, while iodine content was estimated in 5881 samples of edible salt. The sampling methodology followed was a “30 cluster survey”.Results : The overall prevalence of goitre was 4.78% (4.66% of grade I and 0.12% of grade II) amongst the children examined. The highest prevalence of 31.02% goitre was observed in Dehradun district, while the lowest prevalence of 0.02% goitre was recorded in Bishnupur and Badaun districts. The overall prevalence of cretinism among children examined from seven districts was 0.072% whereas that of deaf-mutism was 0.27% among children examined from 8 districts. Median urinary iodine values was marginally less than the WHO cut-off values only in children of the 3 out of the 15 districts surveyed. Iodine content was found to be adequate in 55.45% of the salt samples.Conclusion : The results suggested a significant decline in the prevalence of goitre in most parts of the country.     

Iodine deficiency in urban slums of Bhubaneswar

Objective The present study aimed at assessing the population prevalence of goiter and iodine deficiency in school children of 6–12 yr living in urban slums of Bhubaneswer, the capital city of Orissa. Methods A cross-sectional study was performed using the 30-cluster sampling methodology and surveillance methods for iodine deficiency as recommended by WHO/ICCIDD/UNICEF. The total goitre rate (n=1248), urinary iodine concentration (UIC) (n=411) and iodine content of edible salt (n=368) were measured. Results The goitre prevalence was 23.6% (grade 1=18.9%, grade 2=4.7%) with no significant gender variation. Goitre prevalence was significantly higher in children of 10–12 yr (P=0.012) and scheduled caste and tribe (P=0.003). Median urinary iodine concentration was 50.0 μg/l with 85.7% of children having values less than 100 μg/l, indicating as biochemical iodine deficiency. Median UIC was inversely in association with gradations of goitre. Children of 10–12 yr and scheduled caste/tribe communities had significantly higher median UIC (P=0.001) than their counterpart peers. About 51% of children were consuming salt having stipulated iodine content of 15 ppm. Conclusion The study indicates moderate iodine deficiency in the population, despite a mandatory salt iodization programme in Orissa that has been in force since 1989. There is a need to improve the situation through enforcing monitoring of salt iodization to ensure quality and increasing the level of awareness about the iodized salt for sustainable prevention and control of iodine deficiency.     

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 in Turkey

Turkey is an iodine deficiency area. The overall goitre prevalence is thought to be 30%, and most epidemiological studies give figures compatible with mild to moderate iodine deficiency. However, it is suspected that there are regions where iodine deficiency might be more severe than previously known. In this study the goitre prevalence and iodine status in a mountain village in Central Anatolia were investigated and the results compared to those of an urban area with mild iodine deficiency. Parameters of iodine status in the mountainous region showed severe iodine deficiency comparable to that in Central Africa. It seems that there are regions in Turkey where current programmes of salt iodization will be inadequate to correct the problem of iodine deficiency. Conclusions Our observations suggest that regional variations in iodine status may impede the success of salt iodization programmes, which alone may not be adequate for correction of the problem country-wide. Alternative sources of iodine should be considered in addition to expanded and more efficient salt iodization programmes. Received: 17 August 1998 / Accepted: 30 November 1998     

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.     

Knowledge beliefs and practices regarding iodine deficiency disorders among the tribals in car nicobar

It is estimated that 1,570 million people are at risk of lodine deficiency. Because of the wide spectrum of disorders that IDD includes, and lack of any obvious association between iodine deficiency and its health effects, IDD is not perceived as a major public health problem. For any disease to be effectively controlled, awareness at all levels from community to policy makers is necessary. This study was conducted to assess knowledge, beliefs and practices regarding lodine deficiency Disorders in Car Nicobar districts of Andaman and Nicobar Islands. The population is predominantly tribals involved in coconut plantations. All the village heads of the sixteen villages and parents of 10% of the school children examined for goiter were interviewed. Initial focus group discussions were conducted as no prior knowledge about local names for goitre or other related IDD information was available. The interview schedule was designed in English which was then translated into Hindi and Nicobarese and back translated into Hindi and English. A total of 114 persons were interviewed, 60 males, 54 females. The local name for goiter was “Rulo” and 44% felt that it only affected females. No one had correct knowledge of the cause of goiter. About half of the respondents believed that these swellings caused problems. Sixty three (55.3%) of respondents believed that there was treatment, of which 33 said there was medical treatment, 18 respondents said traditional treatment by “LAM-EEN” and 12 felt that both therapies are required. Majority (85%) brought salt samples from the Government canteen. They did not now whether this salt was iodised. Salt was not washed before use and storage practice was satisfactory. The awareness about IDD needs reinforcement. At present the community is a passive participant in the I.D.D. Control Programme.     

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.     

Iodine status in pregnancy and household salt iodine content in rural Bangladesh

Adequate maternal iodine intake is essential during pregnancy for the development of the foetus. To assess the extent of iodine insufficiency and its association with household iodized salt in rural Bangladesh, we measured urinary iodine and household salt iodine content among pregnant women in early (≤16 weeks, n = 1376) and late (≥32 weeks, n = 1114) pregnancy. Salt (～20 g) and a spot urine sample (～10 mL) were collected from women participating in a randomized, placebo‐controlled trial of vitamin A or beta‐carotene supplementation in rural northwestern Bangladesh during home visits in early and late pregnancy. Salt iodine was analyzed by iodometric titration, and urinary iodine by the Ohashi method. Almost all salt samples had some detectable iodine, but over 75% contained <15 ppm. Median (interquartile range) urinary iodine concentrations were 66 (34–133) and 55 (28–110) µg L^?1 in early and late pregnancy, respectively; urinary iodine <150 µg L^?1 was found in ～80% of women at both times in pregnancy. Although the risk of iodine insufficiency declined with increasing iodine content of household salt (P for trend <0.05), median urinary iodine did not reach 150 µg L^?1 until iodine in household salt was at least 32 ppm and 51 ppm during early and late pregnancy, respectively. Despite a national policy on universal salt iodization, salt iodine content remains insufficient to maintain adequate maternal iodine status throughout pregnancy in rural northern Bangladesh. Alternative measures like direct iodine supplementation during pregnancy could be considered to assure adequate iodine status during this high‐risk period of life.     

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.     

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     

Prevalence of goitre in school-going children in Jabalpur

To determine the prevalence of goitre in school going children in Jabalpur city and critically evalute clinical, biochemical and hormonal profile of goitrous children, 1205 children (800 boys and 405 girls) between 6 to 15 years of age were enrolled from 6 different schools located within the Jabalpur city limits. Conducting a Cross-sectional survey relevant family variables, eating habits (including type of salt used), anthropometry and general physical details were recorded in a pre-designed proforma. Thyroid gland was examined and graded as per standard technique. Spot urinary iodine excretion (UIE) of all goitrous children (n=26) and randomly selected age and sex matched normal non-goitrous children (n=63) was determined by dry-ashing method. Thyroid hormone profile of goitrous children was assessed by radio-immuno-assay. Student’s t-test, z-test and proportionate test were employed to evaluate the statistical significance of the observations. It has been drawn a result that there was low prevalence of goitre in school going children of Jabalpur city. (2.4%, 26/1205). Girls had a higher prevalence (3.2%) than boys (1.6%), however the difference was statistically not insignificant. All goitrous children had small goitre (Grade I) 88.76% children had spot UIE>100 mcg/l with as many as 13.4% having spot UIE>150 mcg/l. No child had spot UIE < mcg/l. 11.23% of children had spot UIE of < 100 mcg/l with higher proportion of goitrous children (7/26, 26.92%) than the age matched, non-goitrous controls (3/63, 4.76%). The mean UIE of goitrous children was 109.6+/-22.1 mcg/l (range 80–150 mcg/l) and that of control children was 122.9 ± 17.0 mcg/l (range 90–150 mcg/ I). Thyroid hormone profile of goitrous children was in euthyroid range. Salt iodine content could not be done due to non-availability of kit. Jabalpur city is not endemic for iodine deficiency both by clinical as well biochemical criteria. The observed goitre cases are of sporadic variety.     

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.     

Prevalence of iodine deficiency disorders in adolescents

In the present study the iodine status of 300 adolescent boys and girls was assessed by clinical examination and biochemical tests. The clinical examination revealed the total goitre rate (TGR) to be 65.2% among boys, and 69.6% among girls. The visible goitre rate (VGR) was 17.7% among boys and 21.1% among girls. Nutritional status of all adolescents was found to be poor as compared to their well-nourished counterparts. Using discriminant analysis it was found that age, height and weight of the adolescents were significantly related to goitre grade (p<0.001), and they are important in prediction of goitre. Mild and moderate iodine deficiency were found to be prevalent among the adolescents. On the basis of urinary iodine/creatinine ratio, 38% of the adolescents were found to be suffering from mild iodine deficiency, i.e. average urinary iodine excretion between 50–100 mcg iodine/g creatinine. Moderate iodine deficiency (<50 mcg iodine/g creatinine) was found to be prevalent among 12.4% of the adolescents. The results of this study indicate a high prevalence of mild and moderate IDD among the adolescents studied.     

Iodine deficiency disorders in school children of Sikkim

Sikkim is a small state in the eastern Himalayas. A survey was conducted to determine the prevalence of iodine deficiency disorders in the state. A two stage sampling procedure was adopted. In stage one, all villages in the state were listed and 249 were randomly selected for the survey. In stage two, households, were randomly selected from the selected villages using the electoral lists. The basic sampling unit was a household and all members of the households were studied. A total of 17,837 subjects were studied from 3,197 households of 249 villages. Overall prevalence of goitre and cretinism in the community as a whole, were 54,03% and 3.46% respectively. Of the population studied, 5939 were children in the age group of 5 to 16 years. There were 3,005 boys and 2,934 girls. Goitre was detected in 3,381 (56.9%). Goitre prevalence in the boys was 55.4% and in girls it was 58.5% (p=<0.05). Grade I goitre was seen in 2,472 (73.1%), grade II in 888 (26.3%) and grade III in 21 (0.6%). Endemic cretinism was diagnosed in 175 subjects (2.9%). Cretinism prevalence in the boys was 3.1%, and in girls in was 2.8% and this difference was not significant. Neurological; cretinism was the predominant form (98.3%). Estimation of urinary iodine concentration in 167 subjects revealed the mean concentration to be 3.64 u/dl (SD 2.47). The median value was ug/dl indicating the skewed distribution of the urinary iodine concentration. The study shows the existence of severe iodine deficiency in the school-aged children of Sikkim. The iodine deficiency disorders status in this age group is representative of the community as a whole and can be used as the target group for surveys.     

Profile of iodine content of salt and urinary iodine excretion levels in selected districts of Tamil Nadu

Objective. Iodine deficiency disorders (IDD) is the most common cause of preventable mental retardation in world today. Out of 29 districts in Tamil Nadu, 24 have been surveyed and all have been found to be endemic to IDD. There is a complete bah on the sale of non iodised salt in the state since 1995. The present study was conducted to assess the iodine content of salt and urinary iodine excretion levels amongst the beneficiaries in the state to help the government to strengthen the existing Universal salt iodisation (USI) programme activities.Methods:The study was undertaken in 24districts of Tamil Nadu during the year 2001. The guidelines recommended by WHO/UNICEF/ICCIDD for a rapid assessment of salt iodisation in a district was adopted. A minimum of 150 salt samples were collected from each district by utilising the uniform sampling methodology. The iodine content of salt samples was analysed using the standard iodometric titration method. At least 60 children from each school were randomly selected and were requested to provide “on the spot” casual urine samples. The urinary iodine excretion (UIE) levels were analysed using the wet digestion method.Results: It was observed that 62.3% of the families were consuming iodised salt with more than 5 ppm of iodine. It was found that district Perambalour had deficient iodine nutriture as revealed by the median UIE levels less than 100 μg/l.Conclusion: The findings of the present study reveals the success of USI programme and highlights need for continued monitoring of the quality of salt provided to the population in order to achieve the goal of IDD elimination.     

Risks of alternative nutrition in infancy: a case report of severe iodine and carnitine deficiency

A 7.5-month-old infant with failure to thrive, developmental delay, muscular hypotonia, a visible goitre and severe osteopenia is described. Laboratory examination revealed a markedly increased serum TSH with low free T4, severe iodine and carnitine deficiency. The infant was breastfed until the age of 2.5 months and was then given a mixture of almond extract in water. The mother is a strict vegan and the father a lactovegetarian. The nutritional intake of the child was severely depleted in calories (–46%), calcium (–73%) and iodine (–88%). The restrictive alternative nutrition was responsible for the various deficiency disorders.