Introduction

Iodine is essential for thyroid function, necessary for the normal growth, development and functioning of the brain and body¹. Iodine deficiency is one of the most common preventable causes of mental retardation and brain damage in the world today. About 1.5 billion people worldwide live at risk of IDD of which more than 655 million people are already affected with IDD. In India, about 200 million people live at risk of IDD, whereas more than 71 million people are suffering from goiter and other IDDs². Organized efforts to deal with the problem of IDD were intensified in 1992 under National Iodine deficiency disorder Control Programme. But the progress of the programme needs to be monitored using the quantifiable indicators as recommended by International Council for the control of Iodine deficiency disorders, WHO and UNICEF³. Goitre prevalence was assessed clinically by standard palpation method and grading of goitre was done according to the criteria recommended by the joint WHO/UNICEF/ICCIDD as follows ^{3, 4}:

Grade 0: No palpable or visible goitre

Grade 1:  A mass in the neck that is consistent with an enlarged thyroid that is palpable but not visible when neck is in the normal position. It moves upward in the neck as the subject swallows.

Grade II: A swelling in neck that is visible when the neck is in a normal position and is consistent with an enlarged thyroid when neck is palpated.

The sum of grade II and I provides Total Goitre Rate.

 Indicators recommended by ICCIDD, WHO and UNICEF: –

In last 50 years, many countries in North America, Asia, Europe and Oceania have successfully eliminated Iodine deficiency disorders or made substantial progress in their control, largely as a result of salt iodization with potassium iodide or potassium iodate and through dietary diversification⁵. In India, keeping in view the magnitude of the problem and technical, administrative, financial and operational feasibility on the recommendations of the Central Council of Health Government of India in 1984, took a policy decision for USI. I.e. all edible salt in the country would be fortified with iodine⁶. Other detrimental effects of iodine deficiency includes increased incidence of stillbirth, abortion and congenital abnormalities including endemic cretinism⁷.

Goitre Resurvey is conducted every five year for monitoring of programme.   Due to reformation of the districts in the year 2001, Patan district was created from the part of Mahesana and Banaskantha districts. So this Goitre survey was carried out in Patan district by Community Medicine Department of B.J. Medical College.

Materials and Methods

Survey was done amongst the school children registered at various primary schools run by Zilla Panchayat in March 2005. A PHC wise list of schools for the entire district was obtained from the Chief District Health Officer. This list contained number of schools per PHC, number of students per school and their cumulative totals. As per GOI guidelines, 5 % of total children in the age group of 6 – 13 years were the sample size. The cluster sampling method was followed. 15 clusters were selected. Each cluster would represent one PHC. Survey was started from school in the PHC headquarters village and covered other schools in a concentric manner till the adequate sample size was achieved. During the survey, investigators ensured approximately equal representation of gender. Goitre prevalence was assessed clinically by standard palpation method and was graded as grade 0, I and II. 20 salt samples were collected from the students (preferably from different schools) and were tested on the spot with UNICEF kit.

Ten Samples of Urine in each cluster were collected from students of different Standard for Iodine estimation. These samples were collected in plastic bottles (50 ml capacity with screw cap with Thymol crystal as preservative) with a label. These samples were sent to Regional IDD Laboratory at Government Medical College, Surat for measurement of Iodine excretion in urine by Laboratory testing.

Data were collected in pre-designed and pre-tested proforma. Data analysis was done in EPI INFO and various apparent statistical tests were applied.

Results

Table 1 shows that the prevalence of goiter was higher in 10-13 years old school children than in younger children though difference was statistically insignificant (c² = 3.47, df=1, p= 0.062). Females have more prevalence of goitre than males, however difference was not significant (c² = 1.68, df=1, p= 0.194).

Table 1: Prevalence of goiter according to age and sex group.

Table 2: Taluka wise distribution of salt iodine level

Salt samples from school children’s home can gives idea about consumption pattern of iodized salt in community. A total of 400 salt samples collected from children were analyzed. Salt samples from School Children’s home can gives idea about consumption pattern of iodized salt in community. There were no iodine in 29.25% salt samples, 25.25% salt samples, iodization was found < 15 ppm and while 45.5% samples were iodized adequately (≥ 15 ppm). In Harij taluka, only 5% salt samples are adequately iodized. Harij (80%), Radhanpur (45%) Sami (41.3%) and Patan (40%) taluka shows no iodization of salt which is consumed (Table 2).

Table 3: Urinary Iodine in various Taluka of Patan District.

A total of 150 urine samples were collected and analyzed. Laboratory findings of Urinary excretion of iodine showed that 64 (42.7%) samples had 100µg / L or more iodine level. Rest of samples of urine (57.3%) showed insufficient excretion of iodine which reflect deficit intake of iodine. Median of urinary iodine of Patan district was 83.75 µg / L, which was very low as compared to minimum standard of 100µg / L.  Gender wise median urinary iodine concentration is 92.5µg / L in males and 80µg / L in females.

Taluka wise median urinary iodine concentration shows that only two talukas having a median urinary iodine concentration more than 100µg / L (Patan 101.25 and Sidhapur 188.5) which suggest that these two talukas have adequate iodine intake. Other talukas had mild iodine deficiency.

Discussion

The term Iodine deficiency Disorders (IDD) as proposed in 1983 refers to all effects of Iodine deficiency on growth and development in human and animal population, which can be prevented by correcting iodine deficiency⁸.

The present study based on clinical examination of 9139 students in Patan district indicated a goiter prevalence of 7.5%. While studying the relationship of goiter prevalence with age, we observed that goiter prevalence was insignificantly higher in older children: 8.11% in 10-13 year old children against 7.05% in 6-9 year old children. Imtiyaz et al⁹ reported a similar pattern: 12.8 % in 9-12 year old children as against 10.6% in 6-8 year old children. This may be expected, due to pubertal age and during this phase of life spurt in growth of body organ may cause enlargement of Thyroid gland.

In our study, we observed a slight higher prevalence in girls (7.81%) than in boys (7.1%). Females had slightly more prevalence of Grade I goitre as compared to males, while grade II goitre was recorded slightly more in case of male. Sahu et al¹⁰  showed a prevalence of 23.1% in girls and 17.3% in boys in Orissa. Another study¹¹ revealed a prevalence of 7.3% in boys and 17.0% in girls in Puranpur district

Taluka wise sami and Chanasma had higher prevalence rate followed by Radhanpur and other. In district, out of 400 samples, only 182 (45.5%) salt samples were adequately iodize, shows need for strengthening of distribution network for Iodized salt at a affordable rate that community can accept.

Conclusion

Present report suggests that still IDD is a health problem in Patan District and Program activities need to be strengthened. Health education can help in increasing public awareness about the nutritional value of iodized salts in the prevention of this disorder in order to ensure that IDD remains under control. Also, availability of iodized salt in open market as well as Public Distribution shop round the year should be ensured followed by close monitoring of Programme by District Health authority.

References

1. Degroot and Jameson (Endocrinology); Iodine Deficiency Disorders, 4^th Edition Vol. 2, 1529
2. “Citizen Charter” National Iodine deficiency disorder control programme and nutrition, http://www.negahealth.nic.in
3. Joint WHO/ UNICEF/ICCIDD Consultation: Indicators for assessing IDD and their control programme (1992), WHO Geneva.
4. Kumar S., Indicators to monitor progress of national Iodine deficiency Disorders control programme (NIDDCP) & some observation on iodized salt in West Bengal (1995) Indian Journal of Public Health, 39(4), 141-147.
5. Sooch S.S., M.G. Deo, M.G. Kumarkar (1973) Prevention of endemic goiter with Iodized salt, Bull. WHO, 49, 307-312.
6. Tiwari, B.K., I Ray and R. L. Malhotra (1998) Policy guidelines on National Iodine deficiency disorders control programme. Nutrition and IDD Cell, Directorate of Health Services, Ministry of Health & Family Welfare, Government of India, New Delhi, 1-22.
7. Delange F. The disorders induced by iodine deficiency Thyroid (1994) spring 4(1) 107-28.
8. Status of Iodine content of salt in selected district of Uttar Pradesh, Report of a rapid survey, Department of Human Nutrition, AIIMS, New Delhi, 1999.
9. Imtiyaz B, Iqbal M, S Mudassar, Prevalence of Iodine Deficiency Disorders, Indian J of Community Medicine; Vol. 33 No. 1, January 2008;11-13
10. Sahu T, Sarani N C, Satpathy D M, Behorar T R, Prevalence of goiter in 6-12 year old children of Kandhamal district in Orissa, Indian J Community Medicine, 2005; 30: 51-2
11. Agarwal KN, Agarwal DK, Current status of endemic goiter in some areas of sub Himalayan Belt, Indian Pediatrics, 1983; 20:471-7.