1. Imtiyaz A Bhat, Iqbal M Pandit , S Mudassar
Study on Prevalence of Iodine Deficiency Disorder and Salt Consumption Patterns in Jammu Region
Imtiyaz A Bhat, Iqbal M Pandit , S Mudassar
Indian Journal of Community Medicine Vol.33,No1, January 2008
Dr.Ramesh Pawar
Moderator: Dr.B.S.Garg

2. Learning Objectives
To study epidemiology of Iodine deficiency disorder.
To study how to read a journal article.
To study sampling method.

3. Introduction
Iodine is an essential element for thyroid function, necessary for normal growth, development and functioning of the brain and body.
Endemic goiter
Mild brain dysfunction, irreversible intellectual impairment.
Single most common cause of preventable mental retardation and brain damage in the world today.

4. Objectives
To assess the magnitude of Iodine Deficiency disorder(IDD) in Jammu region.
To assess the salt consumption pattern in the region.

5. Materials and Methods
Study area:- six districts in Jammu :region,Jammu, Udhampur, Kathua, Rajouri, Poonch and Doda
Study population:-
School children in age group of 6-12 yrs
Study type:- Cross- sectional.

6. Sample size
The sample size of 768 was estimated expecting goiter prevalence of 40% and accepted error of 5% using the formula
Study 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

7. Sample 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.

8. Sample 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.

9. Material & Method cont..
A selected children were examined for thyroid enlargement, as recommended by ICMR bulletin 1986.
Thyroid enlargement i.e. goiter was graded as
G0-No enlargement
G1-A Palpable enlargement
G2-A visible and palpable enlargement

10. Urine 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. C A S U L R I N E M P
Urine sample were collected in wide mouthed 100 ml plastic bottle
Few drops of toluene were added; bottle closed with an inner lid
transported 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

11. Salt sample analyzed for Iodine Content
Study subject were asked about the type of salt consumed at Home
5% of subjects were asked to bring 50g salt from home in polythene pouches for the purpose
The Salt were analyzed for iodine content by trimetric analysis & result were expressed as Iodine ppm

12. Results
A 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

13. Prevalence of Goiter across various districts in Jammu region
Name of District
No. of students examined G0 G1 G2
Total (%)
Remark
Jammu
173
167(96.5)
6(3.5)
3.5
Gtr not a PH problem
Kathua
155
139(89.2)
16(10.3)
10.3
Gtr PH problem
Rajouri
156
139(89.7)
17(10.8)
10.8
Poonch
163
141(86.6)
22(13.4)
13.4
Doda
146
115(78.6)
31(21.2)
21.2
Udhampur
150
129(86)
21(14.0)
14.0
Total
943
830(881)
113(11.9)
11.9
A 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.

14. Prevalence of goiter according to sex and age group
Gender
No. of students examined G0 G1 G2
% Gtr.
Male
475
427 48
10.1
Female
468
403 65
13.0
Age group (yrs)
6-8 yrs
375
335 40
10.6
9-12+
568
495 73
12.8
Prevalence 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.

15. Urine analysis results:-
Urinary iodine excretion in various district in Jammu region:
District
No.student examined
Median (UI ug/L)
Jammu 23
120
Poonch 99
Rajouri 21
102
Udhampur 91
Kathua 98
Doda 25 87
When 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 sample
Deficiency Grade
<20 ug/L
0.00%
Sever
20-40ug/L
6.7%
Moderate
50-99ug/L
42.53%
Mild

16. Salt analysis:- mean I2 content of powder salt
Mean I2 content of crystalline salt
Overall mean
20.9(SD 6.64)
4.75(SD 2.4)
16.95±7.07( ppm)
Salt consumption pattern in Jammu region
Type of salt
% student
Iodine content > 15ppm
Powder salt consumption
74.47%
98.17
Crystalline salt consumption
25.02%
3.87
A 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

17. Discussion: Name of study Place Author Results Present study
Six districts of Jammu region
Imtiyaz A Bhatt
Goiter prevalence 11.98%
On behalf of ICMR
Sub Himalayan belt
15 district of 10 states
Toteja et al.
Goiter prev. of 4.78%
Study from orisa
Orissa
Sahu et al.
13.1%
Study from west Bengal
West Bengal
Biswas et al.
11.3%
Himachal pradesh
Kangra district
Umesh 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.

18. Goiter prevalence by sex:
Name of study
Place
Goiter prev. Boys
Goiter pre.Girls
Present study
Six districts of Jammu region
10.1%
13.0%
GOI survey
Pilibhit district
29.3%
47.2%
Puranpur
7.3%
17%
Sahu et al
Orrisa
17.3%
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

19. Goiter prevalence by age:
Name of study
Area
Prev.older childs
9-12yr old
Prev. young childrn
6-8 yr old
Present study
Six district of Jammu region
12.8%
10.6%
Zargar et al. -
50.6%
30.2%

20. Discussion:
There has been marked improvement in the goiter situation in the region, this could be due to
Increase in awareness about benefits of iodized salt
Wide availability of iodized salt
Improved socio-economic condition of the population with better purchasing power
>75% consumes powder salt , 98.5% powder salt having iodine contents > 15ppm
The goiter prevalence reported by this study was consistence with recent studies from the region

21. Conclusion :
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.

22. References:
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.

23. Thank you!
Ganapati Bappa Moraya…