Presentation on theme: "Imtiyaz A Bhat, Iqbal M Pandit , S Mudassar"— Presentation transcript:
1Imtiyaz A Bhat, Iqbal M Pandit , S Mudassar Study on Prevalence of Iodine Deficiency Disorder and Salt Consumption Patterns in Jammu RegionImtiyaz A Bhat, Iqbal M Pandit , S MudassarIndian Journal of Community Medicine Vol.33,No1, January 2008Dr.Ramesh PawarModerator: Dr.B.S.Garg
2Learning ObjectivesTo study epidemiology of Iodine deficiency disorder.To study how to read a journal article.To study sampling method.
3IntroductionIodine is an essential element for thyroid function, necessary for normal growth, development and functioning of the brain and body.Endemic goiterMild brain dysfunction, irreversible intellectual impairment.Single most common cause of preventable mental retardation and brain damage in the world today.
4ObjectivesTo assess the magnitude of Iodine Deficiency disorder(IDD) in Jammu region.To assess the salt consumption pattern in the region.
5Materials and MethodsStudy area:- six districts in Jammu :region,Jammu, Udhampur, Kathua, Rajouri, Poonch and DodaStudy population:-School children in age group of 6-12 yrsStudy type:- Cross- sectional.
6Sample sizeThe sample size of 768 was estimated expecting goiter prevalence of 40% and accepted error of 5% using the formulaStudy population was selected using the WHO recommended EPI 30-cluster methodology.A multistage sampling procedure was adopted to select the clusters( school) for the study
7Sample size cont…In the first stage, a frame of educational zones in each district was drawn.Using random numbers, five educational zones were selected from each six districts in the region.Thus, a total of 30 educational zones were selected.
8Sample size cont…Finally ,using population proportion to size method, 30 schools(clusters), one from each educational zone, were selected as final sampling unit.A total of 30 students 15Boys & 15 Girls)from each school were studied after being selected by systematic random sampling.
9Material & Method cont..A selected children were examined for thyroid enlargement, as recommended by ICMR bulletin 1986.Thyroid enlargement i.e. goiter was graded asG0-No enlargementG1-A Palpable enlargementG2-A visible and palpable enlargement
10Urine sample were collected in wide mouthed 100 ml plastic bottle On spot casual urine sample were collected from 134 of selected subjects in the school.CASULRINEMPUrine sample were collected in wide mouthed 100 ml plastic bottleFew drops of toluene were added; bottle closed with an inner lidtransported under cold condition to laboratory at Dept. of Biochemistry (SKIMS)The urine sample were analyzed by Ammonium Persulphate Method for Urinary Iodine And Result express in ug/l
11Salt sample analyzed for Iodine Content Study subject were asked about the type of salt consumed at Home5% of subjects were asked to bring 50g salt from home in polythene pouches for the purposeThe Salt were analyzed for iodine content by trimetric analysis & result were expressed as Iodine ppm
12ResultsA total of 943 SAC were examined in the region ; in that 113 had goiter giving prevalence of 11.90%No student had grade two goiter
13Prevalence of Goiter across various districts in Jammu region Name of DistrictNo. of students examinedG0G1G2Total (%)RemarkJammu173167(96.5)6(3.5)3.5Gtr not a PH problemKathua155139(89.2)16(10.3)10.3Gtr PH problemRajouri156139(89.7)17(10.8)10.8Poonch163141(86.6)22(13.4)13.4Doda146115(78.6)31(21.2)21.2Udhampur150129(86)21(14.0)14.0Total943830(881)113(11.9)11.9A total 943 std. examine in the region; 113 has goiter giving prevalence of %. No student has Grd 2 goiter.the prevalence of goiter varies from lowest 3.5 in Jammu region to 21.2% in district Doda. Except a main district jammu goiter is problem of PH importance in all other districts of jammu region.
14Prevalence of goiter according to sex and age group GenderNo. of students examinedG0G1G2% Gtr.Male4754274810.1Female4684036513.0Age group (yrs)6-8 yrs3753354010.69-12+5684957312.8Prevalence of goiter was higher in females than in males(16.12% vs 10.10%) and higher in 9-12yrs old children than in younger children though the difference was statistically insignificant.
15Urine analysis results:- Urinary iodine excretion in various district in Jammu region:DistrictNo.student examinedMedian (UI ug/L)Jammu23120Poonch99Rajouri21102Udhampur91Kathua98Doda2587When UI values were graded as recommended by WHO (box-1);Forty-nine percent of subjects in Jammu region had biochemical iodine deficiency, in which 6.7% have moderate and 42.5% mild deficiency, respectively.Urinary iodine excretion% urine sampleDeficiency Grade<20 ug/L0.00%Sever20-40ug/L6.7%Moderate50-99ug/L42.53%Mild
16Salt analysis:- mean I2 content of powder salt Mean I2 content of crystalline saltOverall mean20.9(SD 6.64)4.75(SD 2.4)16.95±7.07( ppm)Salt consumption pattern in Jammu regionType of salt% studentIodine content > 15ppmPowder salt consumption74.47%98.17Crystalline salt consumption25.02%3.87A total of 99 salt samples collected from children were analyzed for I2 contents by iodometric method. Oval mean I2 contents of salt was 16.95±7.07( )ppm . Mean iodine contents of powder salt was 20.9ppm higher than crystelline salt 4.75ppm
17Discussion: Name of study Place Author Results Present study Six districts of Jammu regionImtiyaz A BhattGoiter prevalence 11.98%On behalf of ICMRSub Himalayan belt15 district of 10 statesToteja et al.Goiter prev. of 4.78%Study from orisaOrissaSahu et al.13.1%Study from west BengalWest BengalBiswas et al.11.3%Himachal pradeshKangra districtUmesh kapil et al.12.1%The present study based on clinical examination of 943SAC from six district in Jammu region indicates a Goiter prevalence of 11.98%.The goiter prevalence reported by this study was consistent with recent studies from the sub- Himalayan belt. Todeja et al.,on behalf of ICMR , reported an overall goiter prevalence of 4.78% in 15 district of 10 states.sahu et al. reported a goiter prevalence of 13.1%from orissa.Biswas et al.reported a goiter prevalence of 11.3% from west Bengal and Umesh kapil et al. reported goiter prevalence of 12.1%from kangra district of himachal pradesh.
18Goiter prevalence by sex: Name of studyPlaceGoiter prev. BoysGoiter pre.GirlsPresent studySix districts of Jammu region10.1%13.0%GOI surveyPilibhit district29.3%47.2%Puranpur7.3%17%Sahu et alOrrisa17.3%23.124%In this study we observed higher goiter prevalence 13.0% in girls than in boys (10.1%) .Survey conducted by GOI revealed a prevalence of 29.3% in Boys and 47.2% in girls in district philibit and prevalence of in dist puranpur. Sahu et al. showed a prev. of % in girls and 17.3% in boys
19Goiter prevalence by age: Name of studyAreaPrev.older childs9-12yr oldPrev. young childrn6-8 yr oldPresent studySix district of Jammu region12.8%10.6%Zargar et al.-50.6%30.2%
20Discussion:There has been marked improvement in the goiter situation in the region, this could be due toIncrease in awareness about benefits of iodized saltWide availability of iodized saltImproved socio-economic condition of the population with better purchasing power>75% consumes powder salt , 98.5% powder salt having iodine contents > 15ppmThe goiter prevalence reported by this study was consistence with recent studies from the region
21Conclusion :The study has shown that the region is in a state of nutritional transition from iodine deficiency to iodine sufficiency, yet complementary should not be allowed to overtake the measure to sustained drive to eliminate the menace.
22References:Degroot and Jameson (Endocrinology) IDD 4 Edition Vol. page No.Citizen Charter. National Iodine deficiency disorder control program and nutrition. Available from:Measuring change in nutritional status. WHO: Geneva;1983, Annexure - 2, p. 51.WHO/UNICEF/ICCIDD, Joint consultation: Progress towards elimination of Iodine Deficiency Disorders (IDD).Toteja GS, Singh, P, Dillon BS, Saxena BN. Central Coordinatin unit Kashmir (India): IDD in 15 districts of India. Indian J Pediatr 2004;7:25- 8.Sahu T, Sarani NC, Satpathy DM, Behorar TR. Prevalence of Goiter in year old children of Kandhamal district in Orissa. Indian J Community Med 2005;30:51-2.Biswas AB et al., Chakraburaty I Das DK. IDD Among school children of Malda, West Bengal. J Health PopulationNutrition 2002;20(2):180-3.