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

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Iodine Deficiency and Toxicity Among School Children in Damoh District, Madhya Pradesh, India R E S E A R C H P A P E R Iodine Deficiency and Toxicity Among School Children in Damoh District, Madhya Pradesh, India SURYA BALI1, AKASH RANJAN SINGH1 AND PRITISH KUMAR NAYAK2 From 1Department of Community and Family Medicine, All India Institute of Medical Sciences; and 2Independent Public Health Consultant; Bhopal, Madhya Pradesh, India. Correspondence to: Dr Surya Bali, Objective: To estimate the prevalence of Iodine Deficiency Disorders, and household Associate Professor, Department of consumption of adequately iodized salt in Damoh district, Madhya Pradesh in 2016. Community and Family Medicine, All Methods: Cross-sectional study with cluster sampling method was used among school- India Institute of Medical Sciences, 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 Bhopal, Madhya Pradesh 462 024, and 270 on the spot urine samples were collected to estimate Urine Iodine Excretion level. India. [email protected] Results: TGR was 2.08%. The prevalence of iodine deficiency, adequate iodine nutrition, Received: May 24, 2017; and either more than adequate or toxic level of Iodine was 26%, 28% and 46 %, respectively. Initial review: June 21, 2017; 72.4% people were consuming adequately iodized salt. Conclusions: Damoh district is no Accepted: May 09, 2018. more an endemic area for iodine deficiency. We recommend continuous monitoring to assess IDDs as well Iodine-induced toxicity in future. Keywords: Cluster sampling, Endemic goiter, Urinary iodine excretion. ational Iodine Deficiency Disorder Control from children and consent was obtained from their legal Programme (NIDDCP) emphasizes five-yearly guardians after explaining them the purpose of study. district level surveys for the estimation of the NIodine Deficiency Disorders (IDDs) [1]. Studies Thirty schools were selected from Damoh district by in Madhya Pradesh (MP) suggest Total goiter rate (TGR) of cluster sampling technique, using the method of 2.4% to 21.3%, and estimated median Urine Iodine Excretion Probability proportionate to size sampling in each school. (UIE) level of 109 µg/L. Approximately, 21% households A sample of 90 children (45 boys) were selected from each consume adequately Iodized salt and only 8% salt samples school. Thus a total of 2700 children were clinically were reported to be non-iodized [2-5]. As per the revised examined for goiter by technical persons specially trained guidelines of NIDDCP, Damoh district was categorized as for the survey [7,8]. The household of every fifth child one of the fourteen endemic districts for goiter in MP in year selected from the sample of 90 children in the earlier steps, 2006 [6]. However, no district-wise monitoring and was visited for collection of salt sample. These salt evaluation of IDDs has been carried out in the last decade. samples were tested qualitatively on the spot with MBI kits Monitoring and evaluation of Iodine level in population is (MBI Kits Intt., Chennai) and iodine concentration was essential, not only to estimate the prevalence of IDDs but recorded. On-the-spot urine samples were collected from also the potential toxic effects of excess Iodine intake. The every alternate child from those 18 selected children in the present study was conducted with the objective to previous step, for the estimation of UIE level by wet estimate the prevalence of IDDs in among school-going digestion method from each school, and the samples were children (age 6-12 years) in Damoh district of Madhya transported to an accredited laboratory at Human Nutrition Pradesh, India and to determine the prevalence of adequate Unit, AIIMS, New Delhi. Socio-demographic information, iodine in salt samples at consumer level. goiter examination and on-the-spot urine samples were obtained during school visits and salt samples for METHODS estimation of iodine were obtained by visiting This study was conducted at Damoh district of MP from corresponding houses of the selected children. 150 May to June 2016 among school-going children aged 6-12 households and 30 shopkeepers were interviewed with the years. Ethics approval was obtained from the Institutional help of pre-designed semi-structured interview guide to Ethics Committee of the All India Institute of Medical understand the knowledge and practices on iodized salt Sciences, Bhopal, India. The written assent was obtained during house visit to collect the salt samples. INDIAN PEDIATRICS 579 VOLUME 55__JULY 15, 2018 BALI, et al. IODINE-DEFICIENCY IN DAMOH, MP Data were entered into Microsoft Excel 2010 and TABLE I SOCIO-DEMOGRAPHIC DETERMINANTS OF CHILDREN analyzed using Epi Info version 7.2.1.0. The key analytic WITH IODINE DEFICIENCY DISORDERS IN DAMOH outputs were presence of Goiter (Grade I and II), house- DISTRICT, MADHYA PRADESH, 2016 (N=2700) hold with ‘inadequate iodized salt’, and child with Variable Goiter Households Insufficient ‘insufficient UIE’. The UIE <200 µg/L was considered as with Urine Iodine ‘insufficient, and <15 ppm of Iodine in household salt was inadequately Excretion considered as household with ‘inadequate iodized salt’ Grade I Grade II iodidised salt* (n=70) [1,9]. (n=45) (n=11) (n=432) Age (y) RESULTS 6-9 25 (55.6) 6 (54.5) 265 (61.3) 40 (57.1) A total of 2700 primary school children (aged 6-12 years) 10-12 20 (44.4) 5 (45.5) 167 (38.7) 30 (42.9) were examined for TGR. Overall, its prevalence was Gender 2.08%, with Grade I as (45) 1.67% and Grade II as (11) 0.41%. About one-fourth (27.6%) households were Male 21 (46.7) 4 (36.4) 215 (49.8) 30 (42.9) consuming inadequately iodized salt. Out of 270 urine Religion samples, median UIE level was 175 µg/L, and 25.9% Hindu 44 (97.8) 11 (100) 423 (97.9) 65 (92.9) children had insufficient UIE in their samples. The Caste frequency of insufficient UIE was more in older children General 4 (8.9) 0 20 (4.6) 2 (2.9) (age 10-12 years), females, children of Hindu religion, OBC 33 (73.3) 7 (63.6) 297 (68.8) 49 (70) OBC and SC caste (Table I). All the households interviewed (150) were using packed salt, and all 30 SC 7 (15.6) 3 (27.2) 87 (20.1) 13 (18.6) shopkeepers interviewed were selling packed salt. ST 1 (2.2) 1 (9.0) 28 (6.5) 6 (8.6) Majority of families [117 (78%)] and shopkeepers [20 Values in No. %; OBC: Other backward caste; SC: Scheduled caste; (66.7%)] were aware about iodized salt. ST: Scheduled tribe; Inadequately iodised salt <15 ppm of iodine in salt; Insufficient UIE: values < 200 µg/L. On the basis of UIE level, the proportion of children with mild, moderate and severe iodine deficiency were (45) 17%, (23) 8% and (2) 0.7%, respectively. Total (76) during data collection. Prof Umesh Kapil, Human Nutrition Unit, 28% children were found to be ‘Adequate’ in Iodine AIIMS, New Delhi for providing laboratory support for urinary Nutrition. The proportion of children with more than iodine analysis. adequate Iodine intake was (27) 10%, and (97) 36% of Contributors: All authors have contributed, designed and children had toxic levels of iodine in urine. approved the study. Funding: Department of Public Health and Family Welfare, DISCUSSION Government of Madhya Pradesh; Competing interest: None stated. The present study found a TGR of 2.08% in Damoh district, MP, which suggests that this district is no more an REFERENCES endemic area for IDDs [6]. About one-fourth population 1. IDD and Nutrition Cell. Revised Policy Guidelines on is having ‘Iodine deficiency’ but at the same time about National Iodine Deficiency Disorders Control Programme. half (46%) of the population had more than adequate Directorate General of Health Services, Ministry of Health iodine intake. and Family Welfare, Government of India, New Delhi; 2006. Available from: http://dghs.gov.in/content/1348_3_ Studies from different parts of globe have also NationalIodine Deficiency. aspx. Accessed May 21, 2017. reported iodine toxicity associated with USI [10-12]. The 2. Gakkhar RK, Bhardwaj VK, Chansoria M, Jain S, Visnoi R. limitations of the study were that the clinical evaluation of Prevalence of goitre in school-going children in Jabalpur. goiter might have led to misclassification of grades of Indian J Pediatr. 2001;68:229-33. goiter, and that we could not compare the prevalence of 3. Andersson M, Takkouche B, Egli I, Allen HE, Benoist B IDDs of district with previous years as this information de. Current global iodine status and progress over the last was not available. decade towards the elimination of iodine deficiency. Bull World Health Organ. 2005;83:518-25. On the basis of present study, we emphasize on repeat 4. UNICEF. Sustainable Elimination of Iodine Deficiency: surveys to assess IDDs and the impact of iodized salt once Progress since the 1990 World Summit for Children. in every 5 years in the districts. There has to be inbuilt UNICEF 3 United Nations Plaza New York 2008. mechanism in the program to monitor iodine toxicity. Available from: https://www.unicef.org/publications/files/ Sustainable_Elimination_of_Iodine_Deficiency.pdf. Acknowledgements: Department of Education for the support Accessed May 21, 2017. INDIAN PEDIATRICS 580 VOLUME 55__JULY 15, 2018 BALI, et al. IODINE-DEFICIENCY IN DAMOH, MP 5. Indian Council of Medical Research. Tribal Health in 9. World Health Organization. Urinary Iodine Concentrations Retrospect experiences from multidisciplinary research for Determining Iodine Status in Populations. Vitamin and activities: AT RMRCT. Jabalpur: Director Regional Mineral Nutrition Information System. WHO/NMH/NHD/ Medical Research Centre for Tribals; 2009. EPG/131 2013:3-4. Available from: http://apps.who.int/ 6. Directorate General of Health Services.
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