Efficacy and safety of hydroxychloroquine when added to stable insulin therapy in combination with metformin and glimepiride in patients with type 2 diabetes compare to sitagliptin

Background: The trial was done to evaluate the efficacy and tolerability of hydroxychloroquine when added to stable insulin therapy in combination with metformin and glimepiride in patients with type 2 diabetes (T2DM) compare to sitagliptin.Methods: After two weeks run in period, eligible patients inadequately controlled on long acting, intermediate acting or premixed insulin (HbA1c ?7.5% and ?10%), in combination with metformin and glimepiride were randomised 1:1 to the addition of once daily hydroxychloroquine 400mg or sitagliptin 100mg over 24weeks study period. The primary endpoint was HbA1c change from baseline at week 24. Home based glucometer was used to determine finger stick glucose value to detect hypo or hyperglycemia periodically.Results: At 24 weeks, the addition of hydroxychloroquine significantly (p <0.001) reduced HbA1c by 1.3% compared with Sitagliptin which was 0.9%. A greater proportion of patients achieved an HbA1c level <7% while randomised to Hydroxychloroquine as compared with sitagliptin (31 vs. 18% respectively; p <0.001). The addition of hydroxychloroquine significantly (p<0.001) reduced fasting plasma glucose by 31.0mg/dl (vs 23.2mg/dl with sitagliptin) and post prandial plasma glucose by 52.1mg/dl (vs 41mg/dl with sitagliptin) relative to sitagliptin. The difference in mean value of total daily insulin dose showed a highly significant decrease (P <0.0001) from baseline to end of the treatment with hydroxychloroquine i.e. from 41±10.2 to 31.87±16.49 IU as compare to sitagliptin i.e. from 41±10.6 to 37.91±11.71 IU. And also highly significant (P <0.0001) decrease in mean weight was observed at the end of trial with hydroxychloroquine.Conclusions: Hydroxychloroquine decreases HbA1c in patients whose type 2 diabetes is poorly controlled with stable-dose insulin therapy with metformin and glimepiride.

Prevalence of high-risk human papilloma virus types and cervical smear abnormalities in female sex workers in Chandigarh, India.

Purpose: Cervical cancer is the most common cancer among women in developing nations. Nearly 90% of the cases have been linked to the presence of high-risk human papillomavirus (hrHPV) types 16 and 18. The risk of cervical cancer may be high in female sex workers (FSWs) due to multiple sexual partners. This study aimed to determine the prevalence of cytological abnormalities and hrHPV types 16 and 18 in FSWs in Chandigarh, North India using the liquid-based cytology (LBC) approach. Materials and Methods: The cervical brush samples were collected from 120 FSW and 98 age-matched healthy controls (HCs). These were subjected to pap smear using conventional method, LBC and the detection of hrHPV types 16 and 18 was carried out using polymerase chain reaction. Results: The LBC samples showed better cytological details and also reduced the number of unsatisfactory smears from 11% in Pap to 1.5% in the LBC. A significantly higher number of inflammatory smears were reported in FSWs (51.7% vs. 34.7%, P = 0.01). The hrHPV types 16/18 were detected in 33/120 (27.5%) FSW versus 23/98 (23.5%) HCs. The risk of acquiring hrHPV was higher in FSWs, who had age at first sex ≤25 years, higher income and the habit of smoking. Conclusion: The high prevalence of hrHPV among FSWs and HCs suggests the need for the implementation of effective National Screening Programme for early detection of hrHPV types to decrease the burden of cervical cancer, especially in high-risk population.

A Study Of Reproductive Health Needs Of Adolescent Girls Of UHTC Field Practice Area, Govt. Medical College, Bhavnagar.

Background and Aim: The World Health Organization (WHO) defines an Adolescent as “an individual between 10-19 years of age”. As adolescents are not a homogenous group, their needs vary with their sex, stage of development, life circumstances & their socioeconomic conditions. Inspite of existing Adolescent Friendly Health Services (AFHS), adolescents are reluctant to utilize them because of lack of privacy & confidentiality. Aims of this study are (1) To study reproductive health needs of adolescent girls (2) To assess awareness & utilization of AFHS. Methodology: Community based cross sectional study was conducted in Urban Health Training Centre (UHTC) field practice area of Govt. Medical College, Bhavnagar among 532 Adolescent girls during February 2014 to August 2014. Information about their reproductive health needs, awareness about AFHS & its utilization were collected by pretested prestuctured questionnaire. Data entry & analysis done in Epi info software (version3.2). Results: In the present study regarding reproductive health needs, more than half (54.71%) girls desired correct information about reproductive health system , problems & hygiene & most of the girls (53.20%) choose seminar as best source to provide such information. 21.99% girls desired supply of sanitary pads at lower cost than market. An important finding was that very few (14.1%) girls were aware of AFHS. Among those who were aware of AFHS, 38.67% girls had visited & satisfied with services. The major reason for not utilizing AFHS was shyness among 54.35% girls. Conclusion: Information about reproductive health (54.71%) & supply of sanitary pad at lower prices than market (21.99%) are two important reproductive health needs of adolescent girls. Awareness & utilization of AFHS is very less among adolescent girls due to various barriers.

Outbreak of chickenpox in a Union Territory of North India.

Purpose: Primary infection with a varicella‑zoster virus (VZV) leads to chickenpox. Though the incidence of the disease has decreased in many developed countries due to the introduction of the varicella vaccine, outbreaks continue to occur in developing countries. Materials and Methods: The present study reports an outbreak of varicella in an urbanised village in the vicinity of Chandigarh City in North India in November 2013. The outbreak was confirmed by the detection of VZV IgM antibodies in serum samples of clinically suspected patients. Vesicular fluid samples were collected from 8 patients with active lesions and tested for VZV DNA by polymerase chain reaction. Blood samples were also collected from 17 healthy controls residing in the same locality and tested for the presence of VZV IgM and IgG antibodies. Results: A total of 18 cases occurred, and the majority of them (67%) were <15 years of age. Of 17 samples collected from patients with the clinically suspected disease, 13 (76.5%) showed the presence of VZV IgM antibodies. Of the healthy controls, 6 were VZV IgM positive and 4 of them developed symptomatic disease on follow‑up. VZV DNA was positive in 5/8 (62.5%) of the patients. In one patient, VZV DNA was detected in the absence of an IgM antibody response. Conclusion: The introduction of varicella vaccine in the universal immunisation programme of India may help to prevent these outbreaks; however, the cost‑benefit analysis needs to be carried out before making such policies.

Quantitative evaluation of apical extrusion of intracanal bacteria using rotary ProTaper, K3XF, twisted and hand K‑file system: An ex vivo study.

Aims: The aim of this study was to evaluate the number of intracanal bacteria extruded apically during root canal preparation using rotary ProTaper, K3XF, twisted, and hand K‑file system. Subjects and Methods: Seventy extracted single‑rooted human mandibular premolar teeth were used. Access cavities were prepared and the teeth were mounted in glass vials. Root canals were then contaminated with a pure culture of Enterococcus faecalis (ATCC 29212) and incubated at 37°C for 24 h. The contaminated roots were divided into four experimental groups of 15 teeth each and one control group of 10 teeth. Group 1: ProTaper; Group 2: K3XF; Group 3: Twisted file; Group 4: Hand K‑file; Group 5: Control group. Bacteria extruded from the apical foramen during instrumentation were collected into vials. The microbiological samples were incubated in culture media for 24 h. Colonies of bacteria were counted and the results were given as number of colony‑forming units (CFU)/ml. Statistical Analysis Used: The obtained data were analyzed using the Kruskal–Wallis one‑way analysis of variance and Mann–Whitney U‑tests. Results: There was a significant difference between the rotary and hand instrumentation system related to the apically extruded intracanal bacteria. Conclusions: Both the rotary and hand instrumentation systems extruded intracanal bacteria through the apical foramen. K3XF file system showed least bacterial extrusion amongst all instrumentation groups.

An Outbreak of Rubella in Chandigarh, India.

Objective: To investigate an outbreak of fever with rash in an urbanized village in Chandigarh, India. Methods: Active case search was performed by house-to-house survey. The etiological agent of the outbreak was confirmed by serology. Spot map was done using Geographical Information System (GIS) technology. Results: Out of 7742 persons screened, 12 were serologically confirmed rubella cases and 83 were epidemiologically linked cases. Overall attack rate was 1.1, more among the age group 1-4 years (4.9). Conclusion: An outbreak mimicking measles was investigated only to be confirmed as rubella.

Evaluating the role of low-speed centrifugation towards transfecting human peripheral blood mononuclear cell culture.

The conventional method of transfection of suspension cells by chemical has proven to be very difficult. We present a new transfection protocol, wherein, low‑speed centrifugation of cell culture plates immediately after adding the lipid: DNA complex significantly enhances the transfection efficiency. Peripheral blood mononuclear cells (PBMCs) were transfected with BLOCK‑iT™ Fluorescent Oligo (scrambled siRNA) and lipofectamine complex using conventional and low‑speed centrifugation modified transfection protocols. The efficiency of transfection was determined using flowcytometer and cell viability was checked using MTT assay. Incorporation of low‑speed centrifugation significantly enhances the transfection efficiency of BLOCK‑iT™ in the suspension culture of PBMCs as compared to conventional transfection method (99.8% vs 28.3%; P < 0.0001), even at a low concentration of 40 picomoles without affecting the cell viability. Centrifugation enhanced transfection (CET) technique is simple, time‑saving and novel application without compromising the cell viability in the context of recently popular RNA interference in suspension cultures of PBMCs. This undemanding modification might be applicable to a wide variety of cell lines and solve crucial problem of researchers working with RNA interference in suspension cultures.

Evaluation of pre test and post test knowledge after intensive ICTC team training among health care workers in Bhavnagar District.

Background & Objectives: HIV counselling and testing services are a key entry point to prevention of HIV infection, and to treatment and care of people who are infected with HIV. In Gujarat at present 308 ICTC are functioning out of them 19 are functioning in Bhavnagar District. ICTC team training produce skilled personnel who can identify their client problems, are well informed and can provide high quality HIV related services so the objective of this study is to study knowledge regarding HIV/AIDS & Counselling amongst staff of ICTC running in Bhavnagar District. Methods: This was a cross sectional study conducted among participant of ICTC team Training during April 2011-May 2011. Results: The knowledge of participant regarding HIV/AIDS and Counselling aspects improved significantly after intervention. Interpretation & Conclusion: The informative & educable intervention definitely has a positive effect on awareness levels which would eventually encourage expansion of knowledge & help in improve the skill of counselling and positive attitude towards the client coming at different ICTC centre and increase the service utilization by client so this type of inductive training for newly appointed health care workers and refresher training for health workers, who employed longer than one year should be organized on regular basis for effectively utilization of ICTC.

Unmet needs for family planning in UHTC area of Government Medical College Bhavnagar.

Background & Objectives: India, with 1.22 billion populations, is the second most populous country in the world. India contributes 17.31% population in the world. Demographers expect India's population to surpass the population of China by 2030. Recent data of NFHS III revealed that 13% of married women have unmet need for family planning in India so this study was planned to estimate the prevalence of unmet need for Family Planning among married women of reproductive age residing at UHTC area Government Medical College Bhavnagar and to find out the determinants of unmet need for Family Planning in the study population. Methods: This was a cross sectional descriptive study conducted in UHTC catchment area of Government Medical College; Bhavnagar from August 2011 to October 2011. The calculated sample size was 140 (P=9.76, L=5%). A total 150 married women of reproductive age group (15-49 years) were interviewed for the same with their informed consent. The data were entered and analysed in software epi.info.3.5.1. Results: The prevalence of unmet need for Family Planning in UHTC catchment area was found to 18.7%. The unmet need was higher for temporary methods of Family Planning (10.0%), in the women age group of 20-29 years (71.5%), Illiterate (42.8%), Muslim women(42.8%), poor knowledge of contraception(82.1%), no advice on Family Planning (57.1%) and no male participation (75.0%). These entire variable were found to be associated with high unmet need for Family Planning (P<0.05). Interpretation & Conclusion: The present study concluded that the percentage of unmet need years, low education and also in Muslim religious women. To decrease unmet need family planning measures should be specifically directed toward this group of women. Health education and strategic behaviour change communication for appropriate target audience is requiring cope up unmet need.

Evaluation of antigenicity and cell mediated immunity of Hepatitis E virus patients: Using non radioactive MTT assay.

Hepatitis E virus (HEV) is an important cause of hepatitis in developing nations. Disease spans from asymptomatic infection to acute viral hepatitis (AVH) and acute liver failure (ALF). Cell-mediated immunity (CMI) is less studied. Studies document CMI in HEV patients using [ 3 H]-thymidine incorporation (radioactive in nature). The aim of this study was to evaluate the antigenicity of recombinant HEV ORF 2 peptide (452-617 a.a) (pORF2) by non-radioactive MTT assay and detecting the proliferation indices of primary PBMC culture. A total of 27 laboratory confirmed HEV patients (16 AVH and 11 ALF) and 20 apparently healthy individuals (HC) were included. PBMCs were isolated, plated and stimulated with pORF2. After an incubation of 4 days, cells were looked for blastogenic transformation and subjected to MTT assay. PI of AVH, ALF and healthy controls were found to be 3.249 ± 0.219, 1.748 ± 0.076 and 0.226 ± 0.017, respectively. PI of AVH Vs HC, ALF Vs HC and AVH Vs ALF were found to be significantly higher ( P < 0.0001). This study demonstrates MTT to be an adaptable technique to evaluate CMI in HEV patients. Recombinant pORF2 was found to be antigenic in nature and PBMCs from AVH patients were immunologically more reactive than ALF patients.

Rapid assessment of IMNCI programme in Bhavnagar District, Gujarat.

Background & Objectives: The desired impact of IMNCI is the reduction of mortality, morbidity and suffering, through assuring children’s access to quality health care in health facilities and improved case management at home. Maintaining the performance of health and village workers is essential to achieve this impact. So objective of this study is to assess IMNCI implementation in Bhavnagar district of Gujarat to strategize for accelerating effective implementation. Methods: A cross sectional study was carried out in March 2012 in Bhavnagar district. Four blocks of Bhavnagar district were purposefully selected out of seven blocks on the basis of immunization coverage of previous year. From each block one best PHC and from selected PHC one best sub-centre and one best Anganwadi were selected purposefully by solely on basis of perception of Medical Officer in charge PHC and BHO for implementation of IMNCI in their area in last one year. The purpose of adopting such method was to evaluate the performance of IMNCI implementation in centres (PHC, SC, AW) that was judged best by their supervisors. After selection, PHC, SC and Anganwadi centre were visited to assess the practice of IMNCI by ANM and Anganwadi Worker. Medical Officer, Health Supervisors and ICDS officers were interviewed to understand overall implementation process. For collecting data pre-tested and predesigned questionnaire was utilized. Results: Basic IMNCI training in Bhavnagar was completed in 90% of health and ICDS workers. More than 87.5% workers said that their knowledge, skill, confidence and credibility among community were increased after IMNCI training. Logistic and drugs supply were insufficient at sub centre and Anganwadi centre. Out of the total 80 filled IMNCI case sheets by the health and ICDS workers, 32(40%) were found accurately complete as the correctly filling of all the column (assessment and classification and treatment) in form considered as complete form. Accurate classification, management and advice of cases according to IMNCI guidelines were 62 (77.5%), 42 (52.5%) and 38 (47.5%) respectively as the accurate classification (assessment, classification and treatment) of the entire column in form correctly. Combination of one correct and other incorrect assessment or classification or treatment considered as partial accurate and inaccurate if all the column were not assessed or not classified or not given the treatment correctly. While observing actual practice of IMNCI, accuracy among health and ICDS workers was found in assessment 5(31.3%), Classification 8(50%) and treatment 7(43.8%). Supportive supervision and feedback mechanism were lacking at all level. Interpretation & Conclusion: Supportive supervision and feedback mechanism are key concern and must address. Proper logistic and drugs planning and management also main concern for IMNCI programme.

Utilization of antenatal services by pregnant women attending mamta divas in rural areas of Bhavnagar District of Gujarat.

Background: Mamta divas is an important health program implemented in India to reduce maternal and infant mortality rate. According to WHO, most maternal deaths are preventable if women have access to basic medical care during pregnancy, delivery and post partum period. Objectives: To assess utilization of Antenatal services by pregnant women attending Mamta Divas in rural areas of Bhavnagar district, Gujarat. Methods: A community based, cross-sectional study was carried out in 22 sessions (Mamta divas) selected by simple random sampling from 11 Talukas of Bhavnagar district & 210 pregnant women interviewed by pre tested questionnaires. Results: Most of the pregnant women were registered in first trimester (61.4%). Only 63% and 65.3% of them received two doses of tetanus toxoid & Iron folic acid supplemetaion respectively. During their visit, 23.8% of pregnant women were counselled for nutrition, 25.2% for danger sign of pregnancy and 20.5% for institutional deliveries. Conclusion: Health education of all pregnant women should be done at individual level by female health worker. All pregnant women should be counselled for institutional deliveries & all components of Antenatal care. More emphasis should be put on identifying the danger signs, examining the abdomen, & Hb and urine examination during visit at Mamta divas.

Determinants of hypertension in faculties of various colleges in Bhavnagar city.

Objective: To study various determinants of hypertension in faculties of various colleges in Bhavnagar city. Method: The present study was conducted among faculties of various colleges in Bhavnagar city. Total 407 faculties were enrolled in the study. Diagnosis of hypertension was done according to JNC VII criteria. Result: We found 27.5% prevalence of hypertension among the faculties. Non modifiable determinants of hypertension like age, gender and family history of hypertension were significantly associated with hypertension. Modifiable determinants of hypertension like smoking, extra salt intake, sedentary life style, co existence of diabetes mellitus and Obesity (BMI ≥25 kg/m2) were significantly associated with hypertension. Conclusion: Hypertension is a major health problem and both non modifiable and modifiable determinants affect hypertension.

A study of menstrual problems & practices among girls of mahila college.

Background: Menstruation is a normal physiological phenomenon for females still it is associated with some degree of sufferings & embarrassment. In spite of relative openness in the society, the menstrual hygienic practices have not changed much. Objectives: To study the menstrual pattern, disorders & hygiene practices among Adolescent girls of Mahila College in Bhavnagar City. Materials & Method: Present cross-sectional study was conducted among 68 adolescents from Mrs. N.C.Gandhi & Mrs. B.V.Gandhi Mahila Arts & Commerce College, Bhavnagar city. Information was obtained in a self administered questionnaire in a local language related to menstruation after verbal consent. Once the girls have finished filling up the Performa, open discussion & health education was given to the adolescents regarding menstruation & myths related to it. Results: The mean age of menarche was 14.5. Most of the girls (85.3%) had the prior information about menstruation & the most common source of information was from family members (mother & sister) & least common was school teacher. The most common menstrual pattern was >30/3-5 days. Dysmenorrhea was the main menstrual problem reported by them (66.2 %). 66.2 % girls used old plain cloth as menstrual absorbent. Conclusion: Menstrual problems particularly dysmenorrhea is common among adolescent girls. In most of the girls’ menstrual hygiene practices found to be poor. So the teachers, family members, health educators & media play very important role in improving menstrual hygiene in adolescence, so there won’t be any misconception to adolescent girls regarding menstrual hygiene.

Assessment of knowledge about tuberculosis among newly diagnosed patients registered in District Tuberculosis Center, Bhavnagar, Gujarat.

OBJECTIVE: Objective of this study was to determine the level of knowledge about tuberculosis among patients registered in district tuberculosis center, Bhavnagar. METHODS: A community based cross-sectional study was carried out among New Pulmonary Tuberculosis patients registered in District Tuberculosis Centre, Bhavnagar during 1st January, 2009 to 30th April, 2009. Data collection was carried out between 1/05/2009 to 30/06/09 at 144 patients’ house with help of pre-tested structured questionnaire which comprised of socio-demographic variables and variables to assess the knowledge about tuberculosis. RESULTS: In our study, majority of the patients were male (70.1%) with the most commonly involved age group of 21 to 30 years (30.6%). Nearly one-third (31.9%) of the respondents were illiterate and 44% had received primary education. Only 6.9% of study subjects had correct knowledge about the cause of the disease. Knowledge regarding major symptoms was found in only 47% & knowledge about mode of transmission was found in only 30.6% of respondents. Majority of the respondents (97.2%) have a correct knowledge about the duration of treatment of Tuberculosis. CONCLUSION: In this study, majority of study subjects had poor knowledge about cause of tuberculosis, its mode of transmission & major symptoms while knowledge regarding the duration of treatment was found better among most of the respondents. Proper knowledge and education about tuberculosis is vital to cope the challenge of this devastating disease. DTC, being the main center providing treatment, can play a critical role to raise knowledge among the patients about tuberculosis & its prevention.

Prevalence of goiter in the children of 6-12 years in Porbandar district, Gujarat, India.

Research Question: What is the situation of Iodine Deficiency Disorders (IDD) and salt consumption in Porbandar district? Objectives: To assess the magnitude of IDD in Porbandar district and also assess the salt consumption patterns in the region. Design: Cross Sectional Study. Setting: Primary schools in rural areas. Study Tools: Clinical examination of study population for goiter, laboratory assessment of urine samples of study population. Participants: Study was conducted among 2700 school children in the age group of 6-12 years from 30 clusters. Urine samples were collected from 10% of selected children and salt samples from 20% of the selected children. Results: An overall goiter prevalence of 8.8% was observed in the region. Girls had a prevalence of 9.6% and boys had 8.0%. The median urinary iodine excretion in the region was 65 μg/l. 61.9% of children had biochemical iodine deficiency with 25.2%, 14.8% and 21.9% having severe, moderate and mild iodine deficiency respectively. In Porbandar district, only 72.4% households consume salt with Iodine content of more than 15 ppm. Conclusion: Iodine Deficiency is a public health problem in the Porbandar district.

Process evaluation of health and nutrition day (Mamta day) in urban slum areas of Bhavnagar municipal corporation.

Background: Health and Nutrition Day, “Mamta Day”, a concept for interdepartmental convergence having desirable health outcomes of children below five years, antenatal and postnatal women and adolescent girls is being introduced in the State of Gujarat by the Department of Health and Family Welfare. This would provide the first point of contact for essential primary health care and would work as the common platform for convergence amongst service providers of Health, ICDS and the community. Objectives: to identifying gaps in planning and organizing Mamta Day to improve quality of services. Methods: 30 from total 261 Anganwadis (AWs) were selected by Systematic Random Sampling. A structured proforma was prepared for data collection. Results and Conclusion: Anganwadi workers had not prepared/shared list of beneficiaries on the Mamta Day and there was no active tracking of drop outs/ left outs. All children were not being weighed on the day of Mamta day and growth chart and community growth chart were not prepared and updated. The professional performance by PHN/ANMs in urban areas in the provision of antenatal care was found to be unsatisfactory. There was miss opportunity in catering health education to beneficiaries. Recommendation: There is need to improve the quality of antenatal/child care through organisational review and implementation of relevant policies and on the job training to improve the skills of frontline workers. The provision of supplies and equipment and its maintenance should be a priority. There is need to strengthen supportive supervision by Health and ICDS supervisors.

Prolonged jaundice attributed to super infection of hepatitis E virus in a case of resolving leptospirosis.

India is endemic for both Leptospira and hepatitis E virus (HEV). The clinical presentations of these diseases have overlapping features. We report a case of superinfection of HEV in a patient with resolving leptospirosis with underlying Hodgkin lymphoma. The diagnosis of HEV in our case was established by HEV-RNA PCR as our patient was immunosuppressed. The present study highlights the need for molecular diagnosis in the case of HEV infection with strong clinical suspicion and negative serological results.

Changing Prevalence of Iodine Deficiency Disorders in Bhavnagar District.

Research Question: What is the situation of iodine deficiency disorder (IDD) and salt consumption in Bhavnagar district? Hypothesis: The prevalence of IDD has increased markedly as a result of medical as well as socio-economic factors. Objective: To assess the magnitude of IDD in Bhavnagar district and also assess the salt consumption patterns in the region. Design: Cross-sectional study. Setting: Primary schools in rural areas. Study Tools: Clinical examination of study population for goitre, laboratory assessment of casual urine sample for urinary iodine estimation of I2 content of salt samples collected from sub-samples of study population. Participants: Study was conducted among 2,940 School children in the age group of 6-12 years were selected for study using WHO 30-cluster methodology, urine samples were collected from 15% of selected children and salt samples from 43% of sub-sample. Ethical Concern: No ethical issues were involved. Results: An overall goitre prevalence of 34.19% was observed in the region. Females had a prevalence of 32.9% and males 35.4%. The median urinary iodine excretion in the region was 11.0 μg/l (range: 29.0-190.0 μg/l). Ninty-seven percent of subjects had biochemical iodine deficiency with 73.87% having severe deficiency, 21.38% having moderate and 4.04% mild iodine deficiency. In Bhavnagar region, only 34.27% households consume powdered salt having an Iodine content of greater than 15 ppm. Conclusion: Present study showed severe goiter prevalence in primary school children in Bhavnagar district.