Bridging the vitamin A and deworming coverage gap among underserved populations in India through government and civil society organization partnerships.

BACKGROUND: Vitamin A deficiency (VAD) is a major public health problem in India, where approximately 62% of children under five have low retinol levels (< 70 µmol/L). This study aims to (1) evaluate vitamin A supplementation (VAS) and deworming (VAS + D) coverage in Nagaland state through government and civil society organization (CSO) partnerships, (2) examine socio-demographic barriers and facilitators to VAS + D coverage, (3) examine associations between socio-demographic characteristics and source of VAS coverage (i.e., government vs. CSOs), and (4) estimate the impact of VAS on health outcomes due to increased coverage through government and CSO partnerships. METHODS: A cross-sectional statewide coverage survey was conducted in Nagaland, India with 1,272 caregivers of children 6-59 months. Household socio-demographic data and VAS + D exposure variables were collected via quantitative survey. Univariate analyses were used to assess the associations between the independent and outcome variables; odds ratios were computed to measure the strength of the association at a significance level of < 0.05. The Lives Saved Tool (LiST) was used to estimate the impact of increased VAS coverage on child undernutrition, morbidity and mortality. RESULTS: Most children (77.2%) received VAS in the past six months, with 28.1% receiving VAS in capsule form (provided primarily by CSOs) and 70.2% received VAS in syrup form (provided primarily by government). Total deworming coverage was 74.2%, with 43.5% receiving both VAS and deworming. Lower pre-school enrollment was a barrier to receiving VAS (47.4% not enrolled vs. 80.9% enrolled, p < 0.001). A barrier to receiving VAS + D was lack of knowledge of benefits (p < 0.001). Based on LiST modeling, increasing VAS coverage by 22% through CSOs resulted in an estimated 114 stunting cases averted, 25,017 diarrhea cases averted, and 9 lives saved in 2019 in Nagaland State. CONCLUSIONS: Government and CSO partnerships can reduce disparities in VAS coverage and decrease under-five child morbidity and mortality.

Mulitphase Atmospheric Chemistry in Liquid Water: Impacts and Controllability of Organic Aerosol.

Liquid water is a dominant and critical tropospheric constituent. Over polluted land masses low level cumulus clouds interact with boundary layer aerosol. The planetary boundary layer (PBL) is the lowest atmospheric layer and is directly influenced by Earth's surface. Water-aerosol interactions are critical to processes that govern the fate and transport of trace species in the Earth system and their impacts on air quality, radiative forcing, and regional hydrological cycling. In the PBL, air parcels rise adiabatically from the surface, and anthropogenically influenced hygroscopic aerosols take up water and serve as cloud condensation nuclei (CCN) to form clouds. Water-soluble gases partition to liquid water in wet aerosols and cloud droplets and undergo aqueous-phase photochemistry. Most cloud droplets evaporate, and low volatility material formed during aqueous phase chemistry remains in the condensed phase and adds to aerosol mass. The resulting cloud-processed aerosol has different physicochemical properties compared to the original CCN. Organic species that undergo multiphase chemistry in atmospheric liquid water transform gases to highly concentrated, nonideal ionic aqueous solutions and form secondary organic aerosol (SOA). In recent years, SOA formation modulated by atmospheric waters has received considerable interest.Key uncertainties are related to the chemical nature of hygroscopic aerosols that become CCN and their interaction with organic species. Gas-to-droplet or gas-to-aqueous aerosol partitioning of organic compounds is affected by the intrinsic chemical properties of the organic species in addition to the pre-existing condensed phase. Environmentally relevant conditions for atmospheric aerosol are nonideal. Salt identity and concentration, in addition to aerosol phase state, can dramatically affect organic gas miscibility for many compounds, in particular when ionic strength and salt molality are outside the bounds of limiting laws. For example, Henry's law and Debye-Hückel theory are valid only for dilute aqueous systems uncharacteristic of real atmospheric conditions. Chemical theory is incomplete, and at ambient conditions, this chemistry plays a determining role in total aerosol mass and particle size, controlling factors for air quality and climate-relevant aerosol properties.Accurate predictive skill to understand the impacts of societal choices and policies on air quality and climate requires that models contain correct chemical mechanisms and appropriate feedbacks. Globally, SOA is a dominant contributor to the atmospheric organic aerosol burden, and most mass can be traced back to precursor gas-phase volatile organic compounds (VOCs) emitted from the biosphere. However, organic aerosol concentrations in the Amazon Rainforest, the largest emitter of biogenic VOCs, are generally lower than in U.S. national parks. The Interagency Monitoring of Protected Visual Environments (IMPROVE) air quality network, with sites located predominantly in national parks, provides the longest continuous record of organic aerosol measurements in the U.S. Analysis of IMPROVE data provides a useful chemical climatology of changing air resources in response to environmental rules and shifting economic trends. IMPROVE data provides an excellent test bed for case studies to assess model skill to accurately predict changes in organic aerosol concentrations in the context of a changing climate.

WASH practices and its association with nutritional status of adolescent girls in poverty pockets of eastern India.

BACKGROUND: Water, Sanitation, and Hygiene (WASH) practices may affect the growth and nutritional status among adolescents. Therefore, this paper assesses WASH practices and its association with nutritional status among adolescent girls. METHODS: As a part of an intervention programme, this study is based on baseline cross-sectional data. It was conducted between May 2016-April 2017 in three Indian states (Bihar, Odisha, and Chhattisgarh). From a sample of 6352 adolescent girls, information on WASH practices, accessibility to health services and anthropometric measurements (height, weight and mid upper arm circumference (MUAC)) was collected. Descriptive statistics were used to examine WASH practices, and nutritional status among adolescent girls. Determinants of open defecation and menstrual hygiene were assessed using logistic regression. Association between WASH and nutritional status of adolescent girls was determined using linear regression. RESULTS: Findings showed 82% of the adolescent girls were practicing open defecation and 76% were not using sanitary napkins. Significant predictors of open defecation and non use of sanitary napkin during menstruation were non Hindu households, households with poorer wealth, non availability of water within household premise, non visit to Anganwadi Centre, and non attendance in Kishori group meetings. One-third of adolescent girls were stunted, 17% were thin and 20% had MUAC < 19 cm. Poor WASH practices like water facility outside the household premise, unimproved sanitation facility, non use of soap after defecation had significant association with poor nutritional status of adolescent girls. CONCLUSIONS: Concerted convergent actions focusing on the provision of clean water within the household premise, measures to stop open defecation, promotion of hand washing, accessibility of sanitary napkins, poverty alleviation and behavior change are needed. Health, nutrition and livelihood programmes must be interspersed, and adolescents must be encouraged to take part in these programmes.

Delivering an Integrated Package of Maternal Nutrition Services in Andhra Pradesh and Telangana (India).

BACKGROUND: Maternal spot feeding programs operational in southern Indian States are providing a package of nutrition services (food, micronutrient supplementation, deworming, gestation weight gain monitoring, and fortnightly nutrition health education) to pregnant women. These remain to be evaluated. OBJECTIVE: We evaluated the maternal spot feeding programs in 2 Southern Indian states. METHODS: Study design was cross-sectional entailing primary data collection (July to November 2016) on 360 pregnant and lactating women (of infants aged 0-6 months) per state and a review of the scheme's management information system (MIS) beneficiaries' records for the time period April 2014 to August 2017. To gain program functioning insights, open-ended interviews (n = 252) with state, district, and block program managers a state-level open space technology workshop was conducted. RESULTS: Average days of meal consumption ranged from 19 to 21 days per month; spot meal enhanced high dietary diversity (≥6 food groups; 57%-59%) and consumption of eggs and milk (74%-96%) among pregnant and lactating women. On-the-spot consumption of iron, folic acid, calcium, and deworming was 18%, 87%, and 56%, respectively; 94% attended at least 1 of the 2 nutrition monthly counseling sessions. Majority (68%) of the beneficiaries were motivated to enroll by self-help groups or family members, suggesting the crucial persuasive role of peers and family members. CONCLUSION: Maternal spot feeding schemes can potentially deliver nutrition interventions outlined in the World Health Organization antenatal care guidelines 2016 for a positive pregnancy outcome. Research on schemes' impact on birth outcomes, maternal depression, social norms, and its cost-effectiveness is needed.

Incidence of Side-effects After Weekly Iron and Folic Acid Consumption Among School-going Indian Adolescents.

OBJECTIVE: To estimate incidence of side effects after weekly iron and folic acid supplementation (WIFS) in Delhi and Haryana. METHODS: In this cross-sectional school-based study, data were collected from 4,183 adolescents on WIFS consumption and side effects experienced first time of receipt of WIFS (week 1), and in last two consecutive weeks (week 2,3). Week 3 was 48 hours preceding the survey. RESULTS: WIFS consumption in week 1, 2 and 3 was 85%, 63% and 52%, respectively. Side effects reported were highest in first week (25%) and reduced to 7% (week 2) and 5% (week 3). Side effects most reported were abdominal pain (80%) and nausea (10%). Adolescents (45%) who faced a side-effect in week 1 did not consume WIFS in subsequent week. CONCLUSIONS: Incidence of side effects was low, but it affected compliance. Positive reinforcement to students who face side effects requires strengthening by teachers.

Prevalence of metabolic syndrome and associated risk factors among geriatric population living in a high altitude region of rural Uttarakhand, India.

INTRODUCTION: Metabolic syndrome (MetS) is responsible for 2.5-fold increase in cardiovascular mortality and a 5-fold higher risk of developing diabetes. MATERIALS AND METHODS: A community-based cross-sectional study was conducted during 2015-2016 in District Nainital. A list of all villages was developed. From this list, thirty villages were identified using population proportionate to size sampling method. From each village, thirty geriatric subjects (GSs) were selected. The study population included 979 GSs aged 60 years and above. The data were collected on anthropometry, blood pressure, blood glucose, and lipid profile from all the enrolled subjects. The prevalence of MetS was estimated using International Diabetes Federation criteria. Univariate and multivariate analysis was done to identify factors associated with MetS. RESULTS: The prevalence of MetS was found to be 28.6%. Step-wise multivariate logistic regression analysis found that female gender, higher income, and body mass index ≥25 were significant and independent risk factors of MetS amongst GP. CONCLUSION: There is a need for screening of GP living in high altitude region so that efforts can be initiated to prevent complications of MetS.

Prevalence of Pediatric Metabolic Syndrome and Associated Risk Factors among School-Age Children of 10-16 Years Living in District Shimla, Himachal Pradesh, India.

INTRODUCTION: Recently, an increasing trend in the prevalence of pediatric metabolic syndrome (PMS) among school-age children has been documented in different parts of India. There is lack of data on the prevalence of PMS and its associated risk factors among school-age children living in district Shimla, Himachal Pradesh. Hence, to fill in the gap in the existing knowledge, the present study was conducted. METHODOLOGY: A cross-sectional study was conducted during 2015-2016. Thirty clusters (schools) were identified from a list of all schools using population proportionate to size sampling methodology. From each school, 70 children in the age group of 10-16 years were selected. Data was collected on the sociodemographic characteristics, anthropometry, waist circumference, blood pressure, and physical activity. Fasting venous blood samples were collected for estimation of blood glucose, triglycerides, and high-density lipoprotein levels. RESULTS: The prevalence of PMS using International Diabetes Federation classification was 3.3% and using modified-adult treatment panel classification criteria was 3.5%. Risk factors identified to be associated with PMS among school-age children were (i) male gender, (ii) high family monthly income, (iii) sedentary lifestyle, (iv) consumption of evening snack, (v) television/computer viewing, and (vi) motorized transportation for commuting to school. CONCLUSION: The PMS prevalence was 3.3% in school-age children residing in District Shimla. There is a need to formulate interventions to prevent and correct metabolic syndrome among them for reducing early onset of cardiovascular disease during adulthood.

Prevalence and risk factors of underweight, overweight and obesity among a geriatric population living in a high-altitude region of rural Uttarakhand, India.

OBJECTIVE: To assess the prevalence and risk factors of underweight, overweight and obesity among a geriatric population living in a high-altitude region of India. DESIGN: Community-based cross-sectional study. Data were collected on sociodemographic profile and anthropometric parameters. Weight and height measurements were utilized for calculation of BMI. Nutrient intake data were collected using 24 h dietary recall. SETTING: High-altitude region of Nainital District, Uttarakhand State, North India. SUBJECTS: Community-dwelling geriatric subjects (n 981) aged 60 years or above. RESULTS: We found that 26·6 % of the elderly subjects were underweight (BMI<18·5 kg/m2). Overweight (BMI 25·0-29·9 kg/m2) and obesity (BMI≥30·0 kg/m2) was seen among 18·0 % and 4·6 %, respectively. After controlling for potential cofounders, risk factors such as low level of education and income, chewing problems and lower number of daily meals were found to be associated with underweight. On the other hand, risk factors for overweight/obesity were lower age, high income and unskilled work. CONCLUSIONS: There is a need to develop and implement intervention strategies to prevent underweight, overweight and obesity among the geriatric population of India.

Mid-upper arm circumference in detection of weight-for-height Z-score below -3 in children aged 6-59 months.

OBJECTIVE: To evaluate the predictive ability of mid-upper arm circumference (MUAC) for detecting severe wasting (weight-for-height Z-score (WHZ) <-3) among children aged 6-59 months. DESIGN: Cross-sectional survey. SETTING: Rural Uttar Pradesh, India. SUBJECTS: Children (n 18 456) for whom both WHZ (n 18 463) and MUAC were available. RESULTS: The diagnostic test accuracy of MUAC for severe wasting was excellent (area under receiver-operating characteristic curve = 0·933). Across the lower range of MUAC cut-offs (110-120 mm), specificity was excellent (99·1-99·9 %) but sensitivity was poor (13·4-37·2 %); with higher cut-offs (140-150 mm), sensitivity increased substantially (94·9-98·8 %) but at the expense of specificity (37·6-71·9 %). The optimal MUAC cut-off to detect severe wasting was 135 mm. Although the prevalence of severe wasting was constant at 2·2 %, the burden of severe acute malnutrition, defined as either severe wasting or low MUAC, increased from 2·46 to 17·26 % with cut-offs of <115 and <135 mm, respectively. An MUAC cut-off <115 mm preferentially selected children aged ≤12 months (OR=11·8; 95 % CI 8·4, 16·6) or ≤24 months (OR=23·4; 95 % CI 12·7, 43·4) and girls (OR=2·2; 95 % CI 1·6, 3·2). CONCLUSIONS: Based on important considerations for screening and case detection in the community, modification of the current WHO definition of severe acute malnutrition may not be warranted, especially in the Indian context.

Prevalence of Vitamin D Deficiency in Children (6-18 years) Residing in Kullu and Kangra Districts of Himachal Pradesh, India.

OBJECTIVE: To assess the prevalence of Vitamin D deficiency (VDD) and associated risk factors amongst children in the age group of 6-18 y residing at an altitude of 1000 mts and above. METHODS: A community based cross-sectional study was conducted in the year 2015-2016. Two districts (namely: Kangra and Kullu) of Himachal Pradesh state, India was selected for the present study. In each district thirty clusters/schools were identified using Population Proportionate to Size (PPS) sampling methodology. In the identified school, all the children in schools were enlisted. Twenty children per school were selected by using random number tables. A total of 1222 children (Kangra: 610; Kullu: 612) in the age group of 6-18 y were enrolled. The data on socio economic status, physical activity and sunlight exposure was collected. The blood samples were collected and serum 25-hydroxyvitamin D, intact parathyroid hormone, serum calcium, phosphorous, albumin and alkaline phosphate were assessed using standard procedures. RESULTS: Eighty one percent (Kangra) and 80.0% (Kullu) of school age children were found Vitamin D deficient as per serum 25(OH) D levels (less than 20 ng/ml). CONCLUSIONS: A high prevalence of VDD was found in children residing in 2 districts located at high altitude regions of Himachal Pradesh, India.

Reproductive factors, nutritional status and serum 25(OH)D levels in women with breast cancer: A case control study.

The study was conducted with an objective to investigate the association between reproductive factors, nutritional status and serum 25(OH)D levels among women diagnosed with breast cancer (BC). A total of 200 women with BC attending a tertiary healthcare institute of Delhi, India matched with 200 healthy women for age (±2years) and socio economic status were included in the study. Data was collected on socio-demographic profile, reproductive factors, physical activity and dietary intake (24h dietary recall and food frequency questionnaire) using interviewer administered structured questionnaires and standard tools. Non fasting blood samples (5ml) were collected for the biochemical estimation of serum 25(OH)D and calcium levels by chemiluminescent immunoassay and colorimetric assay technique. Data was analyzed by univariable conditional logistic regression and significant variables with (p<0.05), were analyzed in final model by conditional multivariable logistic regression analysis. The mean age of patients at diagnosis of BC was 45±10years. Results of multivariable conditional logistic regression analysis revealed significantly higher odds of BC for reproductive factors like age at marriage (more than 23 years), number of abortions, history or current use of oral contraceptive pills (OCP), with [OR (95% CI)] of [2.4 (1.2-4.9)], [4.0 (1.6-12.6)], [2.4 (1.2-5.0)]. Women with physically light activities and occasional consumption of eggs were found to have higher odds of BC [4.6 (1.6-13.0)] and [3.2 (1.6-6.3)]. Women with serum 25(OH)D levels less than 20ng/ml and calcium levels less than 10.5mg/dl had higher odds of having BC [2.4 (1.2-5.1)] and [3.7 (1.5-8.8)]. A protective effect of urban areas as place of residence and energy intake greater than 50% of Recommended Dietary Allowance (RDA) per day against BC was observed (p<0.05). The findings of the present study revealed a significant association of reproductive and dietary factors in addition to sedentary physical activity and low serum 25(OH)D levels in women diagnosed with BC.

A dinuclear copper(i) thiodiacetate complex as an efficient and reusable 'click' catalyst for the synthesis of glycoconjugates.

We report herein the facile synthesis and structural characterization of a highly stable dinuclear Cu(i) complex, [(PPh3)2Cu(µ-tda)Cu(PPh3)2]·6H2O 1 (tda = thiodiacetate anion), in which the Cu-Cu distance is 7.197 Å. This "pre-formed" complex serves as an extremely efficient and recyclable homogeneous catalyst (2 mol%, 30 min) for CuAAC in dichloromethane solvent. The synthesis of a variety of glycoconjugates under ambient conditions is successfully achieved using 1 as a catalyst. The products are obtained in high yields and very short reaction times while complying with the "click protocols". A simpler procedure solely involving the mixing of substrates with 1 (i.e. base free and solvent free) gave the corresponding glycoconjugate in 10 min using 2 mol% of the catalyst.

Survival and Recovery in Severely Wasted Under-five Children Without Community Management of Acute Malnutrition Programme.

OBJECTIVE: To evaluate recovery and survival of severely wasted children without community management of acute malnutrition programme. DESIGN: Single time point follow-up (24th December 2013 - 2nd April, 2014) of severely wasted children identified in a community-based cross-sectional survey (September 2012 - October 2013). SETTING: Rural Meerut District, Uttar Pradesh, India. PARTICIPANTS: 409 severely wasted (WHO weight-for-height <-3Z), 6- to 59-month-old children. OUTCOME MEASURES: Survival and recovery (weight-for-height ≥-2Z). RESULTS: Median (IQR) follow-up contact duration was 7.4 (6.6, 10.1) months. Among 11 deaths, there were 5 (case-fatality 1.2%), 6 (1.5%), 8 (2.0%) and 10 (2.4%) events within 1, 1.5, 4 and 6 months of enrolment, respectively. Ten deaths occurred in children aged between 6 and 24 months. Younger age (P=0.04), poorer household-head occupation (P=0.04) and lower enrolment anthropometry (any variable; P<0.001) were significant predictors of mortality. Children below 18 months of age had higher adjusted mortality risk (HR 4.7; 95% CI 0.95, 22.51; P=0.053). At follow-up, 30% of survivors were still severely wasted, 39% were moderately wasted (weight-for-height -3 to <-2Z) and 31% had recovered spontaneously. Younger age (P<0.001), female gender (P=0.04) and longer follow-up duration (P=0.003) were significant independent predictors of recovery. The adjusted OR (95% CI) for recovery <24 months was 2.81 (1.70, 4.65). CONCLUSION: Without community management of acute malnutrition in rural Meerut District, severely wasted children had low (1.2%-2.7%) case-fatality with long-term spontaneous recovery of around 25-30%.

Prevalence of Vitamin D deficiency and associated risk factors among children residing at high altitude in Shimla district, Himachal Pradesh, India.

INTRODUCTION: Vitamin D is important for bone development in children. A high prevalence of Vitamin D deficiency (VDD) has been documented from different parts of India. However, limited data are available on VDD among children residing at high altitude region of country. OBJECTIVES: To assess the prevalence of VDD and associated risk factors among children in the age group of 6-18 years in Shimla, Himachal Pradesh. METHODS: A community-based cross-sectional study was conducted in the year 2014-2015. A total of 626 children in the age group of 6-18 years were enrolled from 30 clusters which were identified using population proportionate to size sampling method. A minimum of 20 children in the age group of 6-18 years per cluster were selected using random number tables. The data on socioeconomic status, physical activity, sunlight exposure, and biochemical parameters of bone and mineral metabolism were assessed. RESULTS: Ninety-three percent of school-age children were found Vitamin D deficient as per serum 25(OH) D levels of <20 ng/ml. The prevalence was significantly higher among females. CONCLUSION: A high prevalence of VDD was found in children residing in high altitude region.

Potential of Aerosol Liquid Water to Facilitate Organic Aerosol Formation: Assessing Knowledge Gaps about Precursors and Partitioning.

Isoprene epoxydiol (IEPOX), glyoxal, and methylglyoxal are ubiquitous water-soluble organic gases (WSOGs) that partition to aerosol liquid water (ALW) and clouds to form aqueous secondary organic aerosol (aqSOA). Recent laboratory-derived Setschenow (or salting) coefficients suggest glyoxal's potential to form aqSOA is enhanced by high aerosol salt molality, or "salting-in". In the southeastern U.S., aqSOA is responsible for a significant fraction of ambient organic aerosol, and correlates with sulfate mass. However, the mechanistic explanation for this correlation remains elusive, and an assessment of the importance of different WSOGs to aqSOA is currently missing. We employ EPA's CMAQ model to the continental U.S. during the Southern Oxidant and Aerosol Study (SOAS) to compare the potential of glyoxal, methylglyoxal, and IEPOX to partition to ALW, as the initial step toward aqSOA formation. Among these three studied compounds, IEPOX is a dominant contributor, ∼72% on average in the continental U.S., to potential aqSOA mass due to Henry's Law constants and molecular weights. Glyoxal contributes significantly, and application of the Setschenow coefficient leads to a greater than 3-fold model domain average increase in glyoxal's aqSOA mass potential. Methylglyoxal is predicted to be a minor contributor. Acid or ammonium - catalyzed ring-opening IEPOX chemistry as well as sulfate-driven ALW and the associated molality may explain positive correlations between SOA and sulfate during SOAS and illustrate ways in which anthropogenic sulfate could regulate biogenic aqSOA formation, ways not presently included in atmospheric models but relevant to development of effective control strategies.

Controversies Continue: Universal Supplementation of Megadose of Vitamin A to Young Children in India.

The universal megadose of vitamin A (MDVA) supplementation program was started in the year 1970. The program is presently in continuation for the prevention of nutritional blindness and possibly reduction in under-five mortality rate (U5MR). Presently, blindness due to vitamin A deficiency (VAD) has disappeared and the difference between U5MR and infant mortality rate (IMR) is less than 10 thus MDVA is unlikely to have any impact on mortality. The continuation of universal MDVA needs to be modified based on the current scientific evidence.

Iodine nutritional status in Uttarakhand State, India.

INTRODUCTION: Uttarakhand (UK) state is a known endemic region to iodine deficiency (ID). OBJECTIVE: To assess the current status of iodine nutrition in a population of UK. METHODOLOGY: Three districts, namely Udham Singh Nagar (USN), Nainital (N), and Pauri Garhwal (PG) were selected. In each district, 30 clusters were identified by utilizing the population proportional to size cluster sampling methodology. Total of 6143 school age children (SAC) (USN; 1807, N; 2269, PG: 2067), 5430 adolescent girls (AGs) (USN; 1823, N; 1811, PG: 1796), 1727 pregnant mothers (PMs) (USN; 632, N; 614, PG: 481), and 2013 Neonates (USN; 649, N; 670, PG: 694), were included in the study. Clinical examination of thyroid of each child, AG and PM was conducted. Spot urine and salt samples were collected from children, AGs and PMs. Cord blood samples were collected from neonates for estimation of thyroid stimulating hormone (TSH). RESULTS: In SAC, total goiter rate (TGR) was 13.2% (USN), 15.9% (N), and 16.8% (PG). Median urinary iodine concentration (UIC) level was 150 µg/l (USN), 125 µg/l (N), and 115 µg/l (PG). In AGs, TGR was 6.8% (USN), 8.2% (N) and 5.6% (PG). Median UIC level was 250 µg/l (USN), 200 µg/l (N), and 183 µg/l (PG). In PMs, TGR was 16.1% (USN), 20.2% (N), and 24.9% (PG). Median UIC level was 124 µg/l (USN), 117.5 µg/l (N) and 110 µg/l (PG), respectively. In Neonates, TSH levels of >5 mIU/L were found in 55.3 (USN), 76.4 (N) and 72.8 (PG) percent of neonates. CONCLUSION: UIC level in PMs and TSH levels among neonates indicate the prevalence of ID in three districts surveyed.