Effectiveness of community-based treatment programs for treatment of uncomplicated severe acute malnourished children aged 6-59 months using locally produced nutrient dense foods: protocol for a multicentric longitudinal quasi-experimental study.

BACKGROUND: Severe acute malnutrition (SAM) is a major underlying cause of mortality among children. Around one third of the world's acutely malnourished children live in India. The WHO recommends community-based management of acute malnutrition (CMAM) for managing children with SAM. In India, different states are implementing community-based SAM treatment programme, hereinafter called CSAM, using varieties of locally produced nutrient dense food items with different nutrient compositions. The study will assess the effectiveness of these state specific CSAM interventions. METHODS: The longitudinal quasi-experimental study will be undertaken in two purposively selected blocks of one district each in the four intervention states and one comparison state. From each state, 200 SAM children identified using weight-for-length/height z-score (WHZ) < - 3 criteria will be enrolled in the study. Their anthropometric data and skinfold thickness will be taken on admission, at sixth week and at discharge by trained field investigators. Other child details, incidence of morbidity and socio-economic details will be collected on admission. To assess food consumption pattern including consumption of locally produced nutrient dense food supplements, dietary assessment, using 24-h dietary recall will be conducted on admission, at sixth week and at discharge. In addition, body composition parameters will be assessed for a sub-set of children using bio-electrical impedance analysis on admission and at discharge to analyse changes in total body water, fat-free mass, and fat mass. Post discharge, all study participants will be followed up monthly until 6 months. Atleast 10% of the sample will be checked for quality assessment. The study's primary outcome is cure rate defined as children attaining WHZ ≥ -2. Secondary outcomes include mean weight gain, mean length of stay, body composition parameters, relapse and mortality rates. Additionally, process evaluation and cost effectiveness analysis will be conducted. DISCUSSION: There is a shortage of robust evidence regarding the effectiveness of locally produced nutrient dense food supplements provided as part of the CSAM intervention in India. This study will contribute to evidence on effective strategies to manage children with uncomplicated SAM in India. The study protocol has all necessary ethical approvals. Written informed consent will be obtained from caregivers of the children. TRIAL REGISTRATION: The study is registered with Clinical Trial Registration of India (Registration No.: CTRI/2020/09/028013 ) Date of registration 24/09/2020.

Iodine nutritional status and prevalence of goitre among school going children: a cross-sectional study to assess progress towards universal salt iodization in Tikamgarh district of Madhya Pradesh.

BACKGROUND AND OBJECTIVES: Iodine deficiency disorders (IDD) has been a major public health challenge for the Indian subcontinent over many years. Our study was conducted in Tikamgarh district of Madhya Pradesh, an iodine deficiency disorders-endemic district, with the objective to estimate total goitre rate and iodine nutrition status. METHODS AND STUDY DESIGN: A cross-sectional study with 30 cluster sampling was conducted between June to July 2016 among school-going children in the age group of 6-12 years. Ninety children from each school (30x90=2700) were selected for the assessment of Goitre. Total 540 salt samples and 270 urine samples were collected to estimate salt iodine content from their house-hold and urine iodine excretion (UIE) respectively. A total of 150 households and 30 shopkeepers were interviewed to understand the awareness level for salt iodization. RESULTS: Goitre rate in Tikamgarh district was 1.9% with prevalence of grade I & II was 1.7% and 0.2% respectively. The median UIE level was 200 mcg/L. The 20% the population had iodine deficiency, 28.9% population had adequate iodine nutrition and 51.1% population had either more than adequate level of iodine. The 72.4% of the population consume adequately iodized salt (>=15 ppm). CONCLUSIONS: Our study concludes that Tikamgarh district is non-endemic for IDDs against the earlier classification as an IDD-endemic district. About 20% population has 'iodine deficiency' and approximately 51.1% population has 'more than adequate iodine intake'. We recommend stringent programme monitoring, undertake periodic assessment of IDD and explore manifestations of excess iodine intake (>=300 mcg/L) such as Iodine-induced hyperthyroidism in future.

Goitre Is No Longer Prevalent and Urinary Iodine Excretion Is above Normal among School Going Children in Jabalpur, India: Is This Major Health Problem Already Solved?

Iodine deficiency disorder (IDD) is a major public health problem in India. We conducted this study to assess goitre prevalence, urinary iodine excretion (UIE) among school children and to determine iodine concentration in salt samples at consumer level, in Jabalpur district. We adopted "30 cluster" sampling, recommended by joint WHO/UNICEF/ICCIDD Consultation. A total of 2700 children were examined and 540 salt samples and 267 urine samples were collected. Also 150 households and 30 shopkeepers were interviewed for awareness about salt iodization. Total goitre prevalence rate was 2.2% with median UIE level as 218 µg/l and 19.1% of population had adequate iodine intake. About 90.6% of studied population consumed adequately iodized salt. Jabalpur is now no more an endemic area for goitre. The district has achieved the target of universal salt iodization (USI) but now proceeding towards toxicity. Hence the concern is the need of sustainability of the policy of USI.

Iodine Deficiency and Toxicity Among School Children in Damoh District, Madhya Pradesh, India.

OBJECTIVE: To estimate the prevalence of Iodine Deficiency Disorders, and household consumption of adequately iodized salt in Damoh district, Madhya Pradesh in 2016. METHODS: Cross-sectional study with cluster sampling method was used among school-going children. 30 clusters, each with 90 children were selected to access Total Goiter rate (TGR). 540 salt samples were collected to estimate salt iodine content from their household and 270 on the spot urine samples were collected to estimate Urine Iodine Excretion level. RESULTS: TGR was 2.08%. The prevalence of iodine deficiency, adequate iodine nutrition, and either more than adequate or toxic level of Iodine was 26%, 28% and 46 %, respectively. 72.4% people were consuming adequately iodized salt. CONCLUSION: Damoh district is no more an endemic area for iodine deficiency. We recommend continuous monitoring to assess IDDs as well Iodine-induced toxicity in future.