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Brief Reports

Indian Pediatrics 2003; 40:147-149 

Assessment of Iodine Deficiency Disorders in District Bharatpur, Rajasthan


Umesh Kapil, Preeti Singh, Priyali Pathak and Charan Singh

From the Department of Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India.

Correspondence to: Dr. Umesh Kapil, Additional Professor, Department of Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India.
E-mail: [email protected]

Manuscript received: March 5, 2002; Initial review completed: June 25, 2002; Revision accepted: September 30, 2002.

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.

Key words: Goiter, iodine deficiency, iodised salt.

Iodine deficiency disorders (IDD) is a public health problem in India. Out of 282 districts surveyed, 241 have been found to be endemic for IDD(1-3). The deficiency of iodine not only leads to goiter but also to a spectrum of health consequences(4). It is generally presumed that iodine deficiency does not exist in desert areas. However, earlier studies conducted in Rajasthan, a desert state, have documented a Total goiter rate (TGR) of 23%, 14% and 11 % in the districts of Bikaner (1990), Kota (1987) and Udaipur (1989), respectively(5). A ban on the sale of uniodised salt for household consumption has been introduced in the state since 1992. The present study was conducted in district Bharatpur, Rajasthan with the objective to assess the prevalence of iodine deficiency disorders in school children (6-12 years) as no data is available on this aspect.

Subjects and Methods

The study was conducted on 6-12 years old school going children of Bharatpur District, Rajasthan. Keeping in view the anticipated prevalence of 15%, a confidence interval of 95%, relative precision of 15% and with a design effect of 3, a total sample size of 2904 children was calculated(6). Thirty schools were selected using PPS cluster sampling methodology(7). The identified schools were contacted and children were briefed about the objectives of the study and informed consent was undertaken. The date and time for the survey was decided as per the convenience of the school. In each identified school unit (cluster), 96 children were enrolled for the study. If the sample could not be covered from one school, the adjoining school was included to complete the minimum sample size.

The clinical examination of each child was conducted. The grading of goiter was done according to the criteria recommended by the joint WHO/UNICEF/ICCIDD Consultation. When in doubt, investigators recorded the immediate lower grade. Intra and Inter-observer variation was controlled by repeated training and random examinations of goiter grades by the first author. The results were recorded in a pre-designed questionnaire. The sum of grades I and II provided the TGR of the study population(6).

On-the-spot urine samples were collected in wide mouthed screw capped plastic bottles from 10% of the enrolled subjects randomly. A drop of toluene was added in each bottle to inhibit bacterial growth and to minimize odor. Urinary Iodine Excretion (UIE) levels were estimated in the urine samples utilizing the standard Wet Digestion method(8).

Salt was collected from 35% of the school children included in the study. Every third child was requested to bring about 20 g of salt that was routinely being consumed in his/her respective home. The children were provided with auto-seal polyethylene pouches to bring the salt samples. The iodine content of salt was estimated utilizing the Spot Testing Kit(9).

Results

A total of 3072 schoolchildren were studied comprising of 1787 (58.2%) males and 1285 (41.8 %) females. Table I shows the distribution of children according to their various grades of goiter. 92.8% subjects were normal i.e., had grade 0 goiter, 7.0% and 0.2% of the children had grade I and grade II goiter, respectively. The Total Goiter Rate (TGR) i.e., sum of percentages of goiter grade I and II was found to be 7.2% indicating an existence of public health problem of mild degree. Iodine nutriture/requirement is not dependent on gender for children in the age group of 6-12 years(5). Thus, separate analysis for boys and girls was not done.

Table IDistribution of Children According to Various Grades of Goiter (n = 3072)

Goiter 
Grade
Males
n(%)
Females
n(%)
Total 
n(%)
0
1640 (91.8)
1212 (94.3)
2852 (92.8)
I
142 (7.9)
73 (5.7)
215 (7.0)
II
5 (0.3)
0 (0.0)
5 (0.2)
Total
1787 (58.3)
1285 (41.7)
3072 (100.0)

 

Urine samples were collected randomly from 10% of the study subjects. Of the 450 urine samples, the proportion of children with <20.0, 20.0-49.9, 50.0-99.9, 100.0 mcg/L and more was 1.1, 1.1, 7.8 and 90%, respectively. The median urinary iodine excretion of the subjects in the present study was 200 mcg/L. The urinary iodine values from populations are usually not normally distributed, and therefore the median value is used rather than the mean. Hence, we did not calculate the mean and the standard error of UIE levels of children(6).

The salt samples were analyzed using the Spot Testing Kit. It was found that 44% of the salt samples had nil iodine and 56% of the samples had iodine.

Discussion

According to WHO/UNICEF/ICCIDD, if more than 5% school age children (6-12 yrs) are suffering from goiter, the area should be classified as endemic to iodine deficiency. In the present study, a total goiter prevalence rate of 7.2% was found, signifying that Bharatpur district had mild iodine deficiency. Earlier studies conducted in the state of Rajasthan have documented a TGR of 23%, 14% and 11% in the districts of Bikaner (1990), Kota (1987) and Udaipur (1989), respectively(5).

The median UIE levels of the children studied was found to be 200.0 mcg/L indicating that there was no biochemical deficiency of iodine. Only 2.2% of the urine samples had UIE levels <50 mcg/L. Results of the present study indicated that the population is possibly in a transition phase from iodine deficient (as revealed by TGR) to iodine sufficient (as revealed by median UIE) nutriture, possibly because of consumption of iodized salt due to ban on sale of non iodized salt for edible purposes. To eliminate iodine deficiency disorders, there is a need to monitor iodine content of salt regularly so that the entire population of the district receives adequately iodized salt.

Acknowledgement

We would like to thank all the Principals and the School Teachers for the help extended during the study. We are also thankful to all the paramedical staff members of the schools for their most valuable support in the implementation of the study. We would also like to thank all the students for their kind cooperation in the data collection. We are grateful to Director, AIIMS, for providing the financial facilities for conducting the survey.

Contributors: UK coordinated the study, participated in data collection and drafted the paper, he will act as the guarantor. PS and PP participated in data collec-tion, data analysis and coordinating. CS participated in data collection.

Funding: All India Institute of Medical Sciences, Ansari Nagar, New Delhi.

Competing interests: None.

Key Messages

• District Bharatpur, Rajasthan State, India is endemic to IDD.

• The total goiter rate was 7.2% and median urinary iodine excretion level was 200.0 mcg/L.

 

 References


 

1. Venkatesh Mannar MG. Control of Iodine Deficiency Disorders in India through Iodisation of Salt, UNICEF, New Delhi, 1991.

2. Kapil U. Iodine deficiency in India. Nat Med J India, 1989; 3: 98-99.

3. Kapil U. Status of Nutrition Programs in India. Report of National Seminar on "Towards a National Nutritional Policy". National Institute of Public Co-operation and Child Development, New Delhi, 1989, pp 75-101.

4. Vir S. Universal Iodization of salt: a mid-decade goal. In: Nutrition in Children-Developing Country Concerns. Eds. Sachdev HPS and Choudhary P. Cambridge Press, New Delhi, 1994, pp 525-535.

5. Global prevalence of IDD. Micronutrient Deficiency Information System, WHO/UNICEF/ICCIDD, 1993, pp 7, 68.

6. Report of a Joint WHO/UNICEF/ICCIDD Consultation on Indicators for Assessing IDD and their Control Programs. World Health Organization, Geneva, 1992.

7. Blinkin NJ, Sullivan K, Staehling N, Nieburg P. Rapid nutrition surveys: how many clusters are enough? Disasters 1992; 16: 97-103.

8. Dunn JT, Crutchfield HE, Gutekunst R, Dunn D. Methods for measuring iodine in urine. A joint publication of WHO/UNICEF/ICCIDD 1993, 18-23.

9. Dwivedi SN. Comparison of spot testing kit with iodometric titration method in the estimation of iodine content of salt. Indian J Physiol Pharmcol 1996; 40: 279-280.

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