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Objective:To learn about the knowledge and practice of iodine deficiency disorders (IDD) prevention and control among main caregivers of pregnant women in trimester and its related influencing factors, so as to provide a scientific basis for effectively improving the iodine nutrition level of pregnant women.Methods:In April 2020, using the stratified sampling method, 2 districts and counties were selected in the urban, suburban and rural areas of Hangzhou City, respectively, and 5 maternal and child health care institutions were selected as the survey sites in each district and county according to the five directions of East, West, South, North and Middle. A face-to-face questionnaire investigation was used to investigate the knowledge and practice of IDD prevention and control among main caregivers of pregnant women.Results:Totally 601 caregivers of pregnant women were investigated. Among them, 68.9% (414/601) knew that eating iodized salt was the best way to prevent IDD. However, 15.0% (90/601) thought that eating seafood was the best way to prevent IDD. And 41.9% (252/601) caregivers of pregnant women would actively purchase iodine-rich food for cooking, and 63.6% (382/601) would choose iodized salt. There were statistically significant differences in the knowledge and practice of IDD prevention and control among caregivers of pregnant women in urban, suburban and rural areas ( P < 0.05). And 50.3% (87/173) male caregivers would actively purchase iodine-rich food for cooking, which was higher than that of female caregivers [38.6% (165/428)], the difference was statistically significant (χ 2 = 6.97, P = 0.008). There was a statistically significant difference between the caregivers of pregnant women of different ages in actively purchasing iodine-rich food for cooking (χ 2 = 12.61, P = 0.013). And there were statistically significant differences between the caregivers of pregnant women with different educational levels in actively purchasing iodine-rich food for cooking and choosing iodized salt (χ 2 = 29.34, 39.42, P < 0.001). Conclusions:The awareness of knowledge about IDD prevention and control and the formation of prevention and control behavior among caregivers of pregnant women in Hangzhou City are poor. Active education of caregivers of pregnant women should be strengthened to promote maternal and infant health.
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Objective:To investigate the situation of salt sales and education on prevention and treatment of iodine deficiency disorders in salt sales outlets in Hangzhou after the reform of salt industry system, and provide a basis for promotion of scientific iodine supplementation for the public.Methods:In 2020, 4 townships (towns, streets) were selected from 13 districts (counties, cities) of Hangzhou by stratified sampling method. Each township (town, street) delimited 5 survey areas according to the directions of east, west, south, north and middle, and a salt sales place was selected as the survey site in each investigation area. A face-to-face questionnaire was used to investigate the sales of salt in sales outlets and the publicity and education of iodine deficiency disorders prevention and treatment.Results:A total of 238 edible salt sales outlets were effectively investigated, including 113 urban outlets, 78 suburban outlets, and 47 rural outlets; 55.9% (133/238) of the outlets sold non-iodized salt. A total of 68 072 bags of small packaged salt were sold every month, the overall sales of iodized salt was significantly higher than that of non-iodized salt ( Z = - 2.865, P < 0.05), and the sales of iodized salt in urban and suburban sales outlets were higher than that of non-iodized salt ( Z = - 2.313, - 2.237, P < 0.05). The sales of salt in urban and suburban sales outlets were the highest with the price of 2-5 yuan of salt, accounting for 78.6% (33 562/42 705) and 82.3% (13 970/16 979), respectively; in rural sales outlets, with the price of 1-2 yuan of salt was the highest, accounting for 72.8% (6 110/8 388). Among the 238 salt sales outlets, 29.4% (70/238) of the outlets had set up a prevention and treatment of iodine deficiency disorders sign, and 39.9% (95/238) of the outlets salt sales staff known "recommended salt for pregnant women", 31.1% (74/238) of the outlets whose salt sales staff had actively informed salt buyers about the prevention and treatment of iodine deficiency disorders. The total monthly sales of salt and the sales of iodized salt at outlets where the prevention and treatment of iodine deficiency disorders signs were set up and the salt sales staff were aware of the "recommended salt for pregnant women" were higher than outlets where no signs were set up and the sales staff were not aware ( Z = - 3.733, - 3.722, - 2.109, - 2.324, P < 0.05). Conclusions:After the reform of salt industry system, the iodized salt supply of salt sales outlets in Hangzhou is sufficient. With the increase of non-iodized salt supply channels, we should strengthen the active publicity and education on prevention and treatment of iodine deficiency disorders in the sales section.
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Objective:To understand the iodine deficiency disorders (IDD) knowledge, attitude and practice (KAP) among population in and near salts marketing areas of Hangzhou urban areas, so as to provide the evidence for making effective health education and health promotion models.Methods:A face to face KAP questionnaire investigation was conducted in 5 salts marketing survey points of 5 urban areas according to the north, south, east, west and center locations in 2018. The survey included basic information, awareness of the harm of iodine deficiency disorders (IDD), ways to acquire knowledge of IDD prevention and control, knowledge of IDD prevention, and attitudes towards iodized salt and iodine-free salt. The survey results were analyzed.Results:Totally 991 people completed the investigation; and 80.8% (801/991) of the population surveyed knew that iodine deficiency will cause endemic goiter, and 41.7% (413/991) of them knew that IDD could lead to varying degrees of mental impairment; 62.1% (615/991) obtained IDD prevention knowledge from TV, radio, Internet and newspaper; 76.8% (761/991) knew that IDD can be prevented by taking iodized salt. However, 8.9% (88/991) thought eating seafood was the best way to prevent IDD; 50.9% (504/991) thought iodized salt may not cause excessive iodine intake, but 56.5% (560/991) considered that there was a correlation between iodized salt and thyroid nodules. 56.2% (557/991) believed that the supply of iodized salt should be opened.Conclusions:The population in and near salts marketing areas of Hangzhou urban areas remains relatively lack of knowledge on IDD and salt iodization. The routes people obtaining IDD knowledge are very limited and the health education should be highlighted.
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Objective To investigate the effects of administrative region changes on prevention and control of fluorosis,in order to provide a scientific basis for evaluation and improvement of prevention and control measures.Methods An investigation was conducted in all drinking water-born endemic fluorosis areas in Hangzhou in 2017,to evaluate the status quo of water-improving defluoridation projects,measure the water fluoride content with "the Standard Detection Methods for Domestic Drinking Water" (GB/T 5750.7-2006),detect the dental fluorosis with Dean method and the urinary fluoride content by fluoride selective electrode method in children aged 8 to 12 years old.Results The historical endemic fluorosis areas in Hangzhou now involved 38 natural villages of 22 administrativevillages in 8 townships of 5 counties (cities and districts).All villages had completed water-improving projects which were running well as the fluoride contents of drinking water were less than 1.00 mg/L.The detection rate of dental fluorosis was 1.13％ (9/795) among children aged 8-12 years.A total of 198 urine samples were tested,the urinary fluoride content varied from 0.12 to 2.90 mg/L,and the geometric mean was 0.77 mg/L.Conclusion Administrative region changes do not influence the effect of water-improving defluoridation projects,but management and monitoring of the water-improving projects still should be strengthened.
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Objective To establish a normal reference range of thyroid-related indicators of early pregnant women in Hangzhou,and investigate the prevalence of thyroid disease among them after the implementation of a new standard of salt iodine content, in order to provide reference for monitoring of thyroid disease in pregnant women.Methods A total of 582 women in early pregnancy(0 - 13 weeks of gestation) in Hangzhou were selected via the stratified random sampling method as the subjects of the study and for detection of serology thyroid function. The levels of serum thyroid stimulating hormone (TSH), free thyroxine (FT4), thyroid peroxidase antibody(TPOAb) and thyroglobulin antibody (TgAb) were measured by chemiluminescence method. According to the standard American Academy of Clinical Biochemistry (NACB), 359 women in early pregnancy were strictly screened to establish the normal reference value of TSH, FT4, and the reference range using the 95% confidence interval (95%CI). At the same time, the newly establish reference interval was used to evaluate the thyroid function of 582 early pregnant women. Results The reference interval of TSH in early pregnant women of Hangzhou was 0.048 -3.354 mU/L.The reference interval of FT4was(13.023 ± 3.316) pmol/L, and the tenth percentile of FT4was 11.030 pmol/L. Eighty-four persons' thyroid function was abnormal in 582 and the rate of abnormal was 14.4% (84/582), in which the rates of abnormal in clinical hypothyroidism, subclinical hypothyroidism, subclinical hyperthyroidism and hypothyroxinemia were 0.2% (1/582), 3.4% (20/582), 1.9% (11/582) and 8.9% (52/582), respectively. The case with clinical hyperthyroidism was not detected. The positive rate of TPOAb and TgAb were 10.8% (63/582) and 11.7%(68/582). The abnormal rate of hypothyroxinemia and the positive rate of TPOAb in early pregnant women in the city(11.4%,13.5%)were significantly higher than that in the rural areas(6.3%,8.1%,χ2=4.708,4.309, P < 0.05). Conclusions The normal reference value of thyroid hormones in early pregnant women in Hangzhou is established, and it is found that the incidence of thyroid disease is higher in pregnant women in Hangzhou after the implementation of the new standard of salt iodine content, therefore, it is imperative to carry out monitoring (or screening)of thyroid function in early pregnant women.
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Objective To explore the impact of iodine nutrition on pregnant women before and after adjusting the iodine content in iodine salt.Methods Twelve counties (areas,cities) in Hangzhou were divided into urban,suburban and rural areas before and after adjusting the iodine content of salt.One survey spot was selected in each district and one hundred pregnant women were selected;family salt and urinary samples of each pregnant woman were collected.The levels of salt and urinary iodine were measured by the methods of picric sodium thiosulfate titrimetric (GB 13025.7-2012) and spectrophotometer (WS/T 107-2006),respectively.Results One thousand two hundred and thirty-nine and one thousand two hundred and thirty-three household salt samples were collected before and after adjusting the iodine content in iodine salt.The median of salt iodine of pregnant women (23.30 mg/kg) before adjusting the iodine content in iodine salt was lower than that after adjusting the iodine content in iodine salt (30.09 mg/kg,x2 =-4.71,P ＜ 0.01).The iodine salt coverage rate and the consumption rate of qualified iodized salt after adjusting the iodine content in iodine salt [93.92％ (1 158/1 233),93.84％ (1 157/1 233)] were higher than those before adjusting the iodine content in iodine salt [91.85％ (1 138/1 239),91.37％ (1 132/1 239),x2 =4.01,5.51,all P ＜ 0.05].The iodine salt coverage rate and the consumption rate of qualified iodized salt in urban and suburb areas after adjusting the iodine content in iodine salt [99.42％ (510/513),100.00％ (203/203),97.86％ (5021513),100.00％ (203/203)] were higher than those before adjusting the iodine content in iodine salt [86.71％ (450/519),98.00％ (196/200),77.26％ (401/519),85.00％ (170/200)],but the iodine salt coverage rate and the consumption rate of qualified iodized salt in rural area before adjusting the iodine content in iodine salt [94.62％ (492/520),86.92％ (452/520)] were higher than those after adjusting the iodine content in iodine salt [85.69％(443/517),76.98％ (398/517),x2=64.22,2.32,100.02,32.90,23.31,17.33,all P ＜ 0.05].One thousand two hundred and thirty-four and one thousand two hundred and thirty-one household urine samples were collected before and after adjusting the iodine content in iodine salt.The median of urinary iodine (MUI,114.80 μg/L) of pregnant women after adjusting the iodine content in iodine salt was lower than that before adjusting the iodine content in iodine salt (168.60 μg/L,x2 =36.92,P ＜ 0.01).The MUIs of pregnant women in urban,suburban,and rural areas (171.30,170.20 and 162.40 μg/L) before adjusting the iodine content in iodine salt were higher than those after adjusting the iodine content in iodine salt (101.00,149.48 and 119.90 μg/L,x2 =-7.78,-2.63,-6.28,all P ＜ 0.01).The differences of urinary iodine between groups were statistically significant in urban,suburban and rural areas after adjusting the iodine content in iodine salt (x2 =32.86,P ＜ 0.01),the MUI of pregnant women in urban areas was lower than those in the suburban and rural areas (x2 =6.70,8.13,all P ＜ 0.05).Conclusions After adjusting the iodine content of salt in Hangzhou,the iodine-nutrition level of pregnant women is decreased.But the consumption rates of qualified iodized salt and the MUIs in urban,suburb,rural areas are different,so the coverage of iodized salt at household level needs to be enhanced and the health education should be highlighted.
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Objective To explore the impact of iodine nutrition on pregnant women after adjusting the iodine content in iodized salt in Hangzhou and provide a scientific basis for supplementation of iodine to pregnant women.Methods After adjusting the iodine content of salt from 2012 to 2014,proportional probability sampling method was used to select 300 families and 100 pregnant women from every county (area,city) of Hangzhou City,and the household salt and urine samples were collected to detect iodine.Results Totally 3 904,3 900 and 3 900 samples of household salts were collected with the medians of salt iodine concentration of 23.77,22.75 and 23.30 mg/kg of each year from 2012 to 2014,respectively.The qualified rate of iodized-salt was 95.87％ (3 550/3 703),97.04％ (3 510/3 617) and 96.53％ (3 564/3 692) and the consuming rate of qualified iodized salt was 90.92％ (3 550/3 904),90.01％ (3 510/3 900) and 91.38％ (3 564/3 900),respectively,from the year 2012 to 2014.Totally 1 300,1 217 and 1 315 urine samples of pregnant women were collected and the median of urinary iodine (MUI) of each year from 2012 to 2014 was 119.90,136.40 and 124.00 μg/L,respectively.Conclusion After adjusting the iodine content of salt in Hangzhou,the salt iodine consumption levels of pregnant women's family are stable,but the level of urinary iodine is low,which should be pay attention to.
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Objective To explore the impact of iodine nutrition on children in areas with different iodized-salt covering rate after adjusting the iodine content in iodized salt in Hangzhou.Methods After adjusting the iodine content of salt,every county (area,city) of Hangzhou was divided into east,west,south,north and middle districts;one school was selected in each district,40 children aged 8-10 years old in each school were selected.The goiter rates of 8-10 years old students were examined (WS 276-2007).The family salt and urine samples of each student were collected.The levels of salt and urinary iodine were measured by picric sodium thiosulfate titrimetric (GB 13025.7-2012) and spectrophotometer method (WS/T 107-2006),respectively.Areas were classified according to the coverage rate of iodized salt ＜95％ and ≥95％,and their urinary iodine levels were compared.Results A total of 2 395 samples were collected with a median salt iodine concentration of 23.50 mg/kg and a urinary iodine level of 167.45 μg/L.The goiter rate of children 8-10 years old was 1.75％ (42/2 395).The total iodized-salt covering rate was 93.15％ (2 231/2 395) and the difference was statistically significant between different districts and towns (x2 =153.13,P ＜0.01),but the level was less than 95％ in 6 areas.The urinary median iodine was 151.00 μg/L in the areas where the iodized-salt covering rate was less than 95％,lower than 173.50 μg/L in the areas where the iodized-salt covering rate was more than or equal to 95％ (x2 =-5.28,P ＜0.01).Conclusions After adjusting the iodine content of salt in Hangzhou,the iodine-nutrition status of 8 to 10 years old students is optimal.But the urinary iodine levels are different in areas with different iodized-salt covering rates,so the coverage of iodized salt at household level need to be enhanced and the health education should be strengthen.
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Objective To explore the impact of iodine nutrition on 8-10 years old children after adjusting the iodine content in iodized salt in Hangzhou.Methods Twelve counties (areas,cities) were divided into urban,suburban and rural areas in Hangzhou.By population proportion survey (PPS),every county(area,city) was divided into east,west,south,north and middle districts; one school was selected in each district; forty children (half male and half female) aged 8-10 years old in each school were selected; family salt and urine samples of each student were collected.The levels of salt and urinary iodine were measured by picric sodium thiosulfate titrimetric (GB 13025.7-2012) and spectrophotometer method (WS/T 107-2006),respectively.Results Two thousand seven hundred and twenty-five household salt samples were collected.The median of salt iodine,the iodized salt coverage rate,the qualification rate of iodized salt and the consumption rate of qualified iodized salt were 24.00 mg/kg,4.35％(2 571/2 725),91.02％(2 340/2 571) and 85.87％(2 340/2 725),respectively.The medians of salt iodine in urban,suburb and rural areas were 24.10,22.12,24.30 mg/kg,respectively.A total of 2 664 children urine samples were collected.The median of urinary iodine (MUI) of the children was 177.24 μg/L.The MUIs in urban,suburb and rural areas were 175.00,178.55,178.00 μg/L,respectively; in male was 183.00 μg/L and female was 170.50 μg/L.When non-iodized and unqualified iodized salt were taken,the differences of urinary iodine within groups were statistically significant in urban,suburb and rural areas(x2 =18.652,14.686,all P ＜ 0.05).In rural area,the difference of urinary iodine of 8-10 years old children who ingested different types of iodized salt was statistically significant(x2 =39.07,P ＜ 0.05).Conclusion After adjusting the iodine content of salt in Hangzhou,the iodine-nutritional status of 8-10 years old students is at a appropriatelevel.
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Objective To investigate the prevalence of thyroid disease in early pregnancy women of Hangzhou,and further to discuss the necessity of screening thyroid function in early pregnant women.Methods From March to October 2013,1 165 cases of women in the center of community health service (or health) for routine prenatal care during early pregnancy were used as research subjects.Household salt,fasting morning urine and serum samples were collected.The salt iodine level was measured by direct titration of sodium thiosulfate.The urinary iodine level was measured by arsenic-cerium contact process method.The levels of serum TSH,FT4,and thyroid peroxidase antibody (TPOAb) were measured by chemiluminescence method.Results The median of urinary iodine of the early pregnancy women was 135.2 μg/L,and only 26.7％ of early pregnancy women' s iodine-nutrition status were optimal.These were no significant difference in median urinary iodine as well as the frequency distribution between urban and suburban(P＞0.05).The abnormal rates of TSH and FT4 in early pregnancy women with negative TPOAb were 6.8％ (71/1 039) and 8.9％ (92/1 039),and the abnormal rates of TSH and FT4 in suburban areas were higher than those in urban areas(P=0.035,P =0.001).The prevalences of hypothyroidism,subclinical hypothyroidism,and hypothyroxinemia in early pregnant women of Hangzhou were 0.3％ (3/1 165),2.0％ (23/1 165),and 4.8％ (56/1 165) respectively,and the prevalence of hypothyroxinemia in suburban areas was significantly higher than that in urban areas (6.1％ vs 3.5％,P =0.040).The positive rate of TPOAb was 9.9％ (114/1 153).The early pregnant women with positive TPOAb have an increased risk of thyroid dysfunction,the ratio of TSH over the reference values was significantly higher than that in the negative group and more prone to subclinical hypothyroidism (OR =3.34,95％ CI 1.29-8.65).Conclusion The early pregnant women in rural areas or with positive TPOAb have an increased risk of abnormal thyroid function,thyroid function and iodine nutrition screening or monitoring should be highlighted.