A case-control study on the association of mineral elements exposure and thyroid tumor and goiter.

Thyroid tumor and thyroid goiter are prevalent disease around the world. In this case-control study, we investigated the association between exposure to a total of twelve mineral elements and thyroid disease as well as thyroid functions. Participants with thyroid tumor or goiter (N = 197) were matched with a healthy population (N = 197) by age (± 2 years old) and same sex. Questionnaires were used to collect data about the demographic characteristics and information of subjects. Serum and urine samples were collected simultaneously for each of the subjects. Mineral elements, iodine level of urine and levels of the total seven thyroid function indexes in serum were detected respectively. Conditional logistic regression was applied to estimate the associations between mineral elements and the risk of thyroid tumor and goiter through single-element models and multiple-element models. Multiple linear regression was used to evaluate relationships between mineral elements and percentage changes of thyroid functions. Higher concentrations of mineral elements in the recruited population were found in this study than other comparable studies, and the levels of chromium (Cr), manganese (Mn), nickel (Ni), arsenic (As), cadmium (Cd), selenium (Se), antimony (Sb), thallium (Tl) and lead (Pb) in the case group were lower than the control group. According to the single-element models, Cr, Mn, Ni, Sb and Tl showed significant negative associations with the risk of thyroid tumor and goiter, and, Cd showed nonmonotonic dose response. Cd and mercury (Hg) showed a nonmonotonic percentage change with T4, while Tl was associated with the increased FT4 in the control group. Therefore, Cd, Hg and Tl may disturb the balance of thyroid function to some extent, and Cr, Mn, Ni, Cd, Sb, and Tl may become potential influencing factors for the risk of thyroid tumor and goiter.

Stopping the supply of iodized salt alone is not enough to make iodine nutrition suitable for children in higher water iodine areas: A cross-sectional study in northern China.

BACKGROUND: For the sake of children's health, iodized salt supply has been stopped in many areas with excessive iodine in the drinking water, but children's iodine nutrition status and thyroid function after terminating the iodized salt supply is unknown. Objective We assessed the iodine nutrition, thyroid function and influencing factors for thyroid abnormalities in children from areas with different concentrations of water iodine; the supply of iodized salt has been stopped in high water iodine areas. This study aimed to evaluate whether the strategy of stopping the supplies of iodized salt alone is enough to avoid thyroid dysfunction in all areas with excess water iodine while still meeting the iodine nutrition needs of children. METHODS: A cross-sectional study was conducted in children from four areas with different drinking water iodine concentrations in Tianjin, China. The drinking water samplings and spot urine samples were collected to estimate the external and internal iodine exposure levels. The thyroid volume was measured, and blood samples were collected to assess thyroid function. Logistic regression analysis was used to analyze risk factors for thyroid abnormalities. A dietary survey was conducted to determine the sources of iodine nutrition among the areas with different iodine concentrations in the drinking water. RESULTS: In the area with a drinking water iodine concentration ≥300 µg/L, the median urinary iodine concentration (UIC) in children was 476.30 (332.20-639.30) µg/L, which was higher than that in other groups (all P < 0.05), and the prevalence of thyroid nodules and the thyroid goiter rate were higher than those in the <100 µg/L, 100-150 µg/L and 150-300 µg/L areas (all P < 0.01). Binary logistic regression analysis indicated that the risk of thyroid abnormalities was significantly increased in the UIC 200-299 µg/L group (OR: 4.534; 95% CI: 1.565, 13.135; bootstrapped 95% CI: 1.689, 21.206, P = 0.004) and in the UIC ≥ 300 µg/L group (OR: 6.962; 95% CI: 2.490, 19.460; bootstrapped 95% CI: 2.838, 32.570, P = 0.001) compared to the 100-199 µg/L group. The iodine contribution rates from water in areas with water iodine concentrations ≥300 µg/L are up to 63.04%. CONCLUSIONS: After termination of the iodized salt supply, the level of iodine nutrition of children in the area with drinking water iodine concentrations ≥300 µg/L is still excessive. The water source needs to be replaced in this area. In the area with a water iodine concentration of 150-300 µg/L, it is proposed that stopping the supply of iodized salt is sufficient to achieve the proper iodine nutrition status in children.

Prevalence of goiter and its association with iodine status among the women of reproductive age group in coastal villages of Udupi Taluk, Karnataka, India.

BACKGROUND: Iodine deficiency is one of the most prevalent micronutrient deficiencies globally. Women in reproductive age group are vulnerable to develop iodine deficiency as there is an increase in demand for iodine, especially during pregnancy. OBJECTIVES: The objective is to assess the prevalence of goiter and its association with iodine status and salt usage practices among the women of reproductive age group. METHODS: A community-based cross-sectional study was conducted from August 2015 to July 2017 among 1500 women of reproductive age group in five villages of Udupi Taluk. Stratified sampling design and proportion to population size of the reproductive age women in the study area was used to select the study participants. A pretested semi-structured questionnaire was used for data collection. Goiter was assessed clinically and graded as per the recommended criteria of the WHO. Salt samples from every household were collected for iodine estimation. Blood and urine samples were collected from subsample to estimate thyroid-stimulating hormone levels and urinary iodine excretion levels, respectively. RESULTS: The overall prevalence of goiter was 13% with 11.5% being Grade 1 and 1.5% being Grade 2. No significant association of goiter with urinary iodine, salt iodine levels, and salt usage practices was found. CONCLUSIONS: Median urinary iodine among the women with goiter indicates iodine sufficiency and no significant difference observed in urinary iodine levels between women with and without goiter.

Dietary pattern and its association with iodine deficiency among school children in southwest Ethiopia; A cross-sectional study.

BACKGROUND: Despite the universal iodization of salt in Ethiopia, iodine deficiency disorder remains a major public health problem and continued to affect a large segment of the population. It is thus essential to assess factors contributing to the unacceptably high endemic goiter rate in the country and avail evidence for further additional interventions. In line with this, we examined the association of dietary pattern and iodine deficiency among school-age children in Ethiopia. METHOD: We conducted a school-based cross-sectional study among 767 children aged 6 to 12 in southwest Ethiopia. We collected socio-demographic and other important health related information using a pre-tested structured questionnaire through the interview. Dietary pattern of children was measured using modified Hellen Keller's food frequency questionnaire. We measured iodine deficiency using urinary iodine concentration level and total goiter rate, according to the World Health Organization threshold criteria. We used a multivariate linear regression model to identify dietary and sociodemographic factors that affect urinary iodine level among children. RESULT: Out of the 767 children included in the study, 12% and 4% of children have grade 1 and grade 2 goiter respectively, making the total goiter rate 16%. While the prevalence of iodine deficiency based on urinary iodine concentration is 58.8% of which 13.7% had severe, 18.6% had moderate and 26.5% had mild form. The proportion of children who consumed godere/taro root/, banana, corn, Abyssinian cabbage, and potato, respectively at daily basis 57.8%, 53.1%, 37.9%, and 31.2%, respectively. Age (ß = -0.7, 95%CI = -1.1, -0.4), sex (ß = -22.3, 95%CI = -33.8, -10.8), consumption of taro root (ß = -27.4, 95%CI = -22.9, -31.8), cabbage (ß = -11.7, 95%CI = -5.7, -17.6), Abyssinian cabbage (ß = 12.4, 95%CI = 6.7, 18.2), and banana (ß = 5.6, 95%CI = 0.01, 11.2) significantly associated with urinary iodine level. CONCLUSION: Iodine deficiency remains an important public health problem in southwest Ethiopia. Over-consumption of goitrogenic foods and under-consumption of iodine-rich foods were prevalent and associated with lower urinary iodine level. Therefore, dietary counseling apart from universal salt iodization is recommended.

Goiter Prevalence and Interrelated Components from Coastal Karnataka.

OBJECTIVE: To assess prevalence of goiter and associated factors among school going children in Udupi district. METHODS: A school based cross-sectional survey was conducted among 6-12 year old children. A sample of 30 villages was selected from the entire district by probability proportionate to size. One school was then randomly selected from each of the 30 villages. Goiter was assessed clinically and was graded as per the recommended criteria of World Health Organization (WHO)/ United Nations Children's Fund (UNICEF)/ International Council for the Control of Iodine Deficiency Disorders (ICCIDD). Salt and urine samples were collected from a subsample for iodine estimation. RESULTS: A total of 2703 children were examined. The mean (±SD) age of the participants was 9.6 y (±1.9). The overall prevalence of goiter in Udupi district was found to be 9.3% with 7.0% and 2.3% having grade 1 and grade 2 goiter respectively. Prevalence of goiter was significantly higher among females [153(11.1%)] as compared to males [98(7.4%)] (p = 0.001). Of the 543 salt samples analyzed, 379 (69.8%) salt samples had adequate salt iodine content (> 15 ppm); while among the children with goiter 32 (8.4%) had inadequate salt iodine. Median iodine value was 202.12 mcg/l among the 270 urine samples tested for iodine levels. CONCLUSION: Goiter prevalence at 9.3% in the coastal district contributes to the endemicity of the public health problem. The district had adequate iodine nutrition based on median urinary iodine levels. Hence, other contributing factors for the persistence of endemic goiter need to be explored.

ASSESSMENT OF ADEQUATE IODINE AVAILA-BILITY TO THE POPULATION OF WEST KAZAKHSTAN BASED ON THE DATA OF INORGANIC IODINE IN URINARY EXCRETION.

Aim of research - to study the iodine supply of the region according to the degree of urinary iodine excretion in the West region of the Republic of Kazakhstan. Of 6493 schoolchildren participating in the study of the frequency of goiter, random sampling was applied to select 884 children to determine UIC. To establish the excretion of inorganic iodine in a single portion of urine in the field, express diagnostics, the "Iodine test" kits (manufactured in Ukraine), was applied. The collection of urine for the determination of UIC was carried out in disposable cups, hermetically sealed with stoppers to prevent the entry of iodine vapors into the test samples. The test was carried out immediately after urine collection. The concentration of iodine in the urine was expressed in µg/l. The method is semiquantitative and makes it possible to distinguish urine samples with iodine content below 70, from 70 to 100, from 100 to 300 and above 300 µg/L. The obtained data on the study of UIC in schoolchildren in the West Kazakhstan showed that the proportion of children with optimal urinary excretion of iodine (100-300 µg/L) is 62.67% (95% CI: 59.48-65.86%). Indices ranging from 100 to 200 µg/L were detected in 27.15% (95% CI: 24.22-30.08%, more than 200 µg/L and up to 300 µg/L - in 35.52% (95% CI: 32.37-38.68%) of schoolchildren. UIC exceeds 300 µg/L - in 18.89% (95% CI: 16.31-21.47%) of schoolchildren. Concentration of iodine in the urine of more than 400 µg/L was determined in 1.81% (95% CI: 0.93-2.69%) of children. Low excretion rates of iodine, less than 70 µg/L, were detected in 2.83 % (95% CI: 1.74-3.92%) of schoolchildren, and from 70 µg/L to 100 µg/L - in 13.8 % (95% CI: 11.53-16.07%). Thus, in 62.67% (95% CI: 59.48-65.86%) there is an optimal allocation of iodine in the urine, it can be considered that iodine status of the population of West Kazakhstan is adequate. In West Kazakhstan, in the absence of iodine deficiency, a strained goiter endemia remains.The formation of goiter endemia in the region does not exclude the influence of other strumogenic factors, which need further study.

Urinary iodine concentration and thyroid volume of pregnant women attending antenatal care in two selected hospitals in Ashanti Region, Ghana: a comparative cross-sectional study.

BACKGROUND: Iodine deficiency is a major public health problem affecting people worldwide, particularly pregnant women. Iodine requirements increase substantially during pregnancy making pregnant women vulnerable to iodine deficiency and its disorders such as abortions, stillbirths and pregnancy goitre as well as congenital abnormalities, cretinism and mental retardation in their children. The primary aim of this study was to evaluate the prevalence of iodine deficiency and goitre among pregnant women attending antenatal sessions at two selected hospitals in Ashanti region, Ghana. METHODS: A cross-sectional study was carried out in 239 pregnant women who attended the antenatal clinic at Kwame Nkrumah University of Science and Technology (KNUST) Hospital or Ejura District Hospital, both in Ashanti Region, Ghana. Socio-demographic data and information related to iodine were captured using a questionnaire. Urinary iodine concentration (UIC) was determined on spot urine samples using the Sandell-Kolthoff reaction with ammonium persulfate as digesting agent. Each woman's thyroid volume was also measured by ultrasonography. RESULTS: The overall median UIC was 155.9 µg/L, indicating adequate iodine intake in the study population. However, goitre prevalence in the pregnant women was 11.3%, denoting mild iodine deficiency. The median UIC for pregnant women who attended KNUST Hospital was higher (163.8 µg/L) than that of Ejura District Hospital (149.0 µg/L). The proportion of women who did not consume iodised salt was significantly higher (p < 0.001) in Ejura District Hospital (71.2%) than KNUST Hospital (28.0%). In total, 47.3% of the pregnant women studied had a UIC < 150 µg/L. Only 16.3% knew about the increase in iodine requirement during pregnancy and 21.3% of them had knowledge of the effects of iodine deficiency during pregnancy with most (81.8%) knowing of pregnancy goitre. CONCLUSION: There is generally adequate iodine intake among the pregnant women, however, iodine deficiency and goitre still exist among some pregnant women. Thus, assessment and continuous monitoring of iodine nutritional status in pregnant women in the country are warranted. Also, intensification of effective public health campaigns (through radio and television) with regard to iodine utilization and its benefits in pregnancy are still recommended among Ghanaian pregnant women.

Continuously sustained elimination of iodine deficiency: a quarter of a century success in the Islamic Republic of Iran.

BACKGROUND: Iodine deficiency and related disorders were very common in Iran prior to 1996, when universal salt iodization (USI) was implemented and in 2000 Iran was declared iodine deficiency disorders (IDD) free. The aim of this study was to evaluate the adequacy of iodine intake by Iranian households in all 30 provinces of Iran, a quarter of a century after the intervention. METHODS: A total of 18,000 school-aged children (8-10 years with mean 8.7 ± 1 year) were included in this study. Urine samples were collected from all children for measurement of urinary iodine excretion and 1800, 210 and 3000 salt samples were randomly collected from the family kitchen, production site of 73 salt factories and distribution circles of 30 provinces, respectively. RESULTS: The median urinary iodine concentration (UIC) of participants was 161 µg/L. The proportion of children with UIC of, 20-49, 50-99 and ≥ 100 µg/L were 10.3, 15.9 and 73.7%, respectively. The mean (± SD) and median salt iodine values were 28.2 (± 12.6) and 31.7 ppm, at the production site, and 31.5 (± 13.6) and 29.6 ppm at the distribution circles, respectively. About 80% of factory salts had more than 20 ppm iodine. 98% of households consumed iodized salt, 80% had appropriate salt storage, and 83% of the household salts contained ≥ 20 ppm. CONCLUSIONS: Based on the results of this study, Iranian populations are consuming adequate iodine. The well-maintained and monitored USI program has improved the dietary iodine intakes of the population, and the country has achieved all criteria of a well-controlled IDD program.

iTRAQ analysis of urinary proteins: Potential use of gelsolin and osteopontin to distinguish benign thyroid goiter from papillary thyroid carcinoma.

BACKGROUND: Benign thyroid goiter (BTG) and papillary thyroid carcinoma (PTC) are often interchangeably misdiagnosed. METHODS: Pooled urine samples of patients with BTG (n=10), patients with PTC (n=9) and healthy controls (n=10) were subjected to iTRAQ analysis and immunoblotting. RESULTS: The ITRAQ analysis of the urine samples detected 646 proteins, 18 of which showed significant altered levels (p<0.01; fold-change>1.5) between patients and controls. Whilst four urinary proteins were commonly altered in both BTG and PTC patients, 14 were unique to either BTG or PTC. Amongst these, four proteins were further chosen for validation using immunoblotting, and the enhanced levels of osteopontin in BTG patients and increased levels of a truncated gelsolin fragment in PTC patients, relative to controls, appeared to corroborate the findings of the iTRAQ analysis. CONCLUSION: The data of the present study is suggestive of the potential application of urinary osteopontin and gelsolin to discriminate patients with BTG from those with PTC non-invasively. However, this needs to be further validated in studies of individual urine samples.

Has iodized salt reduced iodine-deficiency disorders among school-aged children in north-west Iran? A 9-year prospective study.

OBJECTIVE: Low iodine intakes are associated with goitre and other iodine-deficiency disorders (IDD) that have affected billions of people worldwide. We aimed to assess total goitre rate (TGR) and urinary iodine concentration (UIC) in schoolchildren between 2007 and 2015, percentage of iodized salt consumption by households, and salt iodine content at production, distribution and household levels in north-west Iran. Design/Setting/Subjects UIC assessed among schoolchildren in nine consecutive years; 240 schoolchildren aged 8-10 years selected by systematic random sampling each year in the West Azerbaijan Province. RESULTS: Median UIC was >100 µg/l in all years. More than 50 % of children had iodine deficiency (UIC≤99 µg/l) in 2010 and 2011, while this rate was approximately 15-35 % in other years. Proportion with UIC below 50 µg/l was <20 % in all years except 2010 and 2011. Excessive UIC (≥300 µg/l) rate was between 5·4 and 27·5 %. TGR decreased from 44 % in 1996 to 7·6 % and 0·4 % in 2001 and 2007, respectively. Regular surveys from 2002 to 2015 showed that 98 % or more of households consumed iodized salt. Iodine level ≥20 ppm was observed in 87·5, 83 and 73 % of salt at production, distribution and household level, respectively (data from national study in 2007). The last national study in 2014 showed that median iodine level in household salt was 27 ppm. CONCLUSIONS: Our focused data suggest that the universal salt iodization programme is improving the iodine status of schoolchildren in the West Azerbaijan Province of Iran. Reduction of TGR to less than 5 % in schoolchildren indicates successful elimination of IDD as a major public health problem.

Urinary iodine concentration (UIC) could be a promising biomarker for predicting goiter among school-age children: A systematic review and meta-analysis.

OBJECTIVES: To evaluate whether urinary iodine concentration (UIC) can predict goiter among school-age children, and to assess the association between UIC and goiter prevalence. METHODS: We searched the MEDLINE, EMBASE, Cochrane Library (Cochrane Database of Systematic Reviews), Web of Science, CNKI, VIP, and Wan Fang databases for relevant reports in both English and Chinese up to August 25, 2016. The mean differences (MD) and 95% confidence intervals (CI) were calculated for the UIC and goiter prevalence assessments. Pooled odds ratios and 95% CIs were used to compare the prevalences of goiter in the different UIC groups. RESULTS: We identified 11 case-control studies, and found that children with goiter had lower UIC values, compared to children without goiter (MD: -1.82, 95% CI: -3.24, -0.40, p < 0.05). An increased risk of goiter was associated with UIC values of < 20 µg/L or > 200 µg/L. CONCLUSION: The results of our meta-analysis suggest that lower UIC values were associated with an increased risk of goiter, and that iodine deficiency may lead to an increased risk of goiter. Furthermore, we observed U-shaped relationships between UIC and the prevalence of goiter, which suggests that both severe iodine deficiency and excessive iodine intake may lead to increased risks of goiter.

[The iodine intake in a female population of an Apennine valley (Italy) in years 2003-2013]. / L'assunzione di iodio in una popolazione femminile di una valle appenninica negli anni 2003-2013.

OBJECTIVES: to assess if the iodine intake of pregnant women had increased or not after the introduction of Law no. 55 of March 2005 («Provisions aimed at the prevention of endemic goitre and other diseases from iodine deficiency¼) and if it reached the levels recommended by the World Health Organisation (WHO). DESIGN: evaluation of ioduria values in the female local population enrolled. SETTING AND PARTICIPANTS: in 4 different years, 100 women per year (400 women in all) were enrolled in this study. All women were residing in the same Apennine valley; 200 of them were pregnant, the other 200 were in childbearing age but not pregnant. MAIN OUTCOME MEASURES: comparison of the median values of ioduria among the 4 groups of women examined. RESULTS: in 2003, in blood-donor women examined for ioduria the median value was 68.48 µg/L; in blood-donor women examined in 2013 the median value for ioduria was 130 µg/L; the difference between the two groups is statistically significant. In the 100 pregnant women examined in the middle of 2011 the median value for ioduria was 64 µg/L, while for those recruited in the middle of 2013 it was 107 µg/L; the difference is statistically significant. CONCLUSIONS: from the introduction of the Law No. 55/2005 the median value of ioduria is strongly increased in all groups examined. It should be noted that in 2013 fertile non-pregnant women have attained a median that falls within the range recommended by WHO, while pregnant women in the first trimester have not yet reached the median recommended by WHO, although attaining a significant increase compared to the middle of 2011.

Association of serum selenium with thyroxin in severely iodine-deficient young children from the Amhara region of Ethiopia.

BACKGROUND/OBJECTIVES: Selenium (Se) as part of glutathione peroxidase and iodothyronine deiodinase enzymes influences thyroid metabolism. This study investigated the association of serum Se levels with thyroid metabolism of severely iodine-deficient young children from the Amhara region of Ethiopia. SUBJECTS/METHODS: In a cross-sectional study, Se, thyroid-stimulating hormone, total thyroxin, total triiodothyronine and thyroglobulin in serum of children (N=628) 54-60 months of age from the Amhara region, Ethiopia, were analyzed. In addition, iodine in urine and household salt was analyzed, and the presence of goiter was assessed. RESULTS: The median serum Se concentration was 61.4 µg/l (10.7-290.9 µg/l). Selenium deficiency (serum Se <70 µg/l) was detected in 57.8% (N=349) of the children. The median urinary iodine concentration (UIC) was 9.8 µg/l. The majority (86.6%, N=449) of children had UIC below the recommended value (100 µg/l). In addition, 59.8% (N=310) of children were severely iodine deficient (UIC<20 µg/l). Only 12.7% of salt samples had iodine. Goiter was present in 44.6% (N=280) of the children. Selenium-deficient children had higher serum thyroxin (T4) than children with normal serum Se concentration (P<0.001). CONCLUSIONS: Serum Se was negatively associated with T4 level in young children from the Amhara region of Ethiopia and may endanger the effectiveness of the salt iodization program.

Consumption of iodized salt may not represent a reliable indicator of iodine adequacy: Evidence from a cross-sectional study on schoolchildren living in an urban area of central Italy.

OBJECTIVE: It has been established that iodine prophylaxis prevents endemic goiter. In this study we reported the amount of iodized salt sold by the retailers of Cassino, a city of central Italy. The aim of the study was to evaluate the effects of an iodine prophylaxis program started in 2005 on urinary iodine concentration (UIC) and thyroid volume (TV), and their correlation with anthropometric parameters in a population of schoolchildren. METHODS: The study included 234 schoolchildren (119 girls and 115 boys) ages 13 to 14 y. Each student provided a morning urine sample for UIC determination, and TV was evaluated by ultrasonography. Body weight and height also were measured. Each participant completed a questionnaire reporting the presence of thyroid disease and the consumption of iodized salt and iodine-rich food. RESULTS: The percentage of iodized salt sold by local markets was 42.4%. Median UIC in schoolchildren was 133.9 µg/L (range 33.2-819.5 µg/L), with 71 children having mild (range 50.1-99.9 µg/L) and 10 moderate (range 33.2-48.8 µg/L) iodine deficiency. Eleven children showed excessive iodine intake (range 300.4-819.5 µg/L). Median UIC was higher in children using iodized salt or consuming milk. Goiter prevalence was 3.8%. A positive correlation between TV and body weight, height, and surface was observed. CONCLUSIONS: The data reported may suggest the presence of an adequate iodine intake in the population of Cassino despite the low percentage of iodized salt sold by local retailers. This indicates that silent iodine prophylaxis through the consumption of iodine-rich or iodine-enriched food is of importance in the prevention of iodine deficiency disorders.

Effect of reducing iodine excess on children's goiter prevalence in areas with high iodine in drinking water.

The purpose of the study was to evaluate the effect of removing iodized salt on children's goiter prevalence in high iodine area (HIA). A total of 452 and 459 children aged 8-10 years old were selected by simple random sampling method before and after removing iodized salt from their diet in three towns with median water iodine content of 150-300 µg/l in Hengshui city of Hebei province of China. Their goiter status was judged using the thyroid volume (Tvol) reference for body surface area recommended by the WHO. After removing iodized salt, children's overall median urinary iodine content (MUIC) decreased from 518 (IQR 347,735) µg/l to 416 µg/l (IQR 274,609). Children's MUIC across sex and age group decreased significantly. The overall goiter prevalence in the three towns significantly decreased from 32.96 % (149/452) to 6.54 % (30/459) (P < 0.001). The goiter prevalence in 8-, 9-, and 10-year-old children decreased, respectively, from 38.04 % (35/92), 30.57 % (59/193), and 32.93 % (55/167) to 6.10 % (10/164), 6.75 % (11/163), and 6.82 % (9/132). The goiter prevalence in boys and girls decreased from 34.01 % (83/244) and 31.73 % (66/208) to 6.19 % (14/225) and 6.87 % (16/234), respectively. The decreases in children's goiter prevalence across gender and age groups were all statistically significant. The present study revealed that children's goiter prevalence decreased significantly after removing iodized salt from their diet for about one and half years in the HIA in Hebei province.

Increasing Awareness and Use of Iodised Salt in a Marginalised Community Setting in North-West Pakistan.

Iodine deficiency is still prevalent in parts of Pakistan, despite the introduction of a national Iodine Deficiency Disorder Control Programme in 1994. The purpose of this study was to gain an understanding of the knowledge, attitudes and practice regarding the use of iodised salt in a brick kiln community, and to use this information to design an intervention to increase its consumption. A cross-sectional survey was used to assess the use of iodised salt and focus group discussions explored the attitudes and barriers to its use. Thematically analysed transcripts informed the design of a 4-month intervention. Iodised salt sales and urine iodine concentration (UIC) were monitored to assess the effectiveness of the intervention. At baseline, 2.6% of households reported use of iodised salt and barriers included its higher cost and belief about a negative impact on reproduction. During the intervention, sales of salt labelled as iodised increased by 45%, however this was not reflected in an increase in UIC. This study highlighted the positive impact of education and awareness raising on iodised salt consumption in a hard to reach, marginalised community. However, issues regarding adequate iodisation by local producers and appropriate storage also need to be urgently addressed at a provincial level.

Iodine deficiency among goiter patients in rural South Sudan.

BACKGROUND: It is estimated that 2.2 billion or approximately 30% of the world's population live in iodine-deficient areas. In a 2005 study households consuming iodized salt in South Sudan increased from 40% to 73%. Despite this achievement, there are still many goiter cases in rural South Sudan and iodine deficiency remains as a major public health problem in this part of sub Saharan Africa.The purpose of this study therefore was to determine the prevalence of iodine deficiency among rural Southern Sudan goiter patients. METHODS: A cross-sectional study was carried out in three South Sudan counties, adults with goiter were from three centers following a mobilization campaign that lasted 4 weeks for free medical care. They were clinically evaluated and completed interviewer administered questionnaires to determine their age, gender, diet, family history, drug history, and medical history. Urine samples were then taken for urinary iodine levels. The outcome was iodine deficiency measured as urinary iodine less than 100 µg per/ L. Multiple logistic regression was used to establish the factors associated with iodine deficiency in South Sudan. Ethical approval was obtained. RESULTS: A total of 286 goitre patients were recruited. The mean age was 38 years (SD 9), 262(92%) were females (F: M ratio 11:1), and 257(90%) were rural- peasants, 25% (20/286) had moderate to severe iodine deficiency. 174(62%) consumed non-iodized salts. CONCLUSION: Iodine deficiency is highly prevalent among rural South Sudan communities and a likely cause for goiters. Rural poor women are highly vulnerable.

Assessment of iodine deficiency in school age children in Nainital District, Uttarakhand State.

Iodine deficiency disorder (IDD) is a major public health problem in Uttarakhand. The present study was conducted in district Nainital, Uttarakhand state with an objective to assess the prevalence of IDD in school age children. A total of 2269 children in the age group of 6-12 years were included. Clinical examination of thyroid of all children was undertaken. "On the spot" urine samples were collected from 611 children. Salt samples were collected from the family kitchen for 642 children. The Total Goitre Rate (TGR) was 15.9%. The proportion of children with urinary iodine excretion levels <20, 20-49, 50-99, 100-199 and 200 µg/L and above, was nil, 11.8, 24.9, 38.3 and 25.0 percent, respectively. The median Urinary Iodine Excretion level was 125µg/L. About 57.7% of the children were consuming salt with iodine content of 15 ppm and more. Findings of the present study indicates that the population is possibly in transition phase from iodine deficient as revealed by Total Goitre Rate of 15.9% to iodine sufficient as revealed by median urinary iodine excretion level of 125 µg/L. There is a need to further strengthen the existing monitoring system for the quality of iodized salt in the district in order to achieve the elimination of IDD.

Goiter prevalence, urinary iodine, and salt iodization level in sub-Himalayan Darjeeling district of West Bengal, India.

National iodine deficiency disorders control program needs to be continuously monitored. Hence, a cross-sectional study was conducted during the period from April-May 2011 to assess the prevalence of goiter, status of urinary iodine excretion (UIE) level and to estimate iodine content of salts at the household level in Darjeeling district, West Bengal. Study subjects were 2400 school children, aged 8-10 years selected through "30 cluster" sampling methodology. Goiter was assessed by standard palpation technique, UIE was estimated by wet digestion method and salt samples were tested by spot iodine testing kit. Overall goiter prevalence rate was 8.7% (95% confidence intervals = 7.6-9.8) and goiter prevalence was significantly different with respect to gender. Median UIE level was 15.6 mcg/dL (normal range: 10-20 mcg/dL). About 92.6% of the salt samples tested had adequate iodine content of ≥15 ppm. Findings of the present study indicate that the district is in a transition phase from iodine-deficiency to iodine sufficiency.

Iodine deficiency disorders in school age children in Kullu District, Himachal Pradesh.

Iodine deficiency disorder is a major public health problem in Himachal Pradesh. A study was conducted in district Kullu to assess the prevalence of IDD in school age children. Clinical examination of the thyroid of 1986 children was conducted. On the spot urine and salt samples were collected. The Total Goiter Rate was found to be 23.4% and median urinary iodine excretion was 175 ug/L. The population is possibly in transition phase from iodine deficient to iodine sufficient nutrition.