Assessing the iodine status of children, availability and awareness of iodised salt, use of salty condiments and flavoring in households in Zia community, Huon District, Morobe Province Papua New Guinea

@#The strategy of fortifying food grade salt with iodine has been globally successful in increasing iodine intake and significantly reducing the prevalence of iodine deficiency. In addition, the consumption of salt through processed foods is increasing in many countries. The major objectives of the current study were to assess the iodine nutritional status among school children, the availability and awareness of iodized salt, the use of salty condiments and flavorings in households in a remote Zia community. This was a school and community based prospective cross-sectional study carried out in February 2020. The study population included 6 to 12 years old school children in five schools in Zia. Simple random sampling was used to select the children. Salt samples were collected from randomly selected households in the community. Discretionary salt intake was also assessed in a sub-set of households. The size of the thyroid gland of the children was assessed by a single specialist endocrinologist using the standardized procedure for palpation and grading, after which a single urine sample was collected from the children after obtaining informed consent from their parents. A pre-tested questionnaire was used to assess the awareness and use of iodized salt in the households. The iodine content in salt samples was measured using the single wavelength semi-automated WYD Iodine Checker Photometer. The urinary iodine concentration (UIC) was measured by isotopic dilution, using 129I as a spike. The 127I/129I ratio was measured by Inductively Coupled Plasma Mass Spectrometry (ICPMS) (quadrupole ICP-MS iCap). The volume of urine required per run was 0.3ml. The mean iodine content of the salt samples from the Households was 31.7 ± 5.9mg/kg. The daily per capita discretionary intake of salt was 5.7 ± 2.2g. The calculated per capita discretionary intake of iodine was 126.5 ± 48.8μg per day. The Median UIC among the children was 147.5μg/L, which indicates normal iodine status at the time of this study. A total of 44.5% of all the children had palpable goiter (grade 1). This may indicate long-standing prevalence of mild status of iodine deficiency. Majority of the households (93.9%) used Maggi Kakaruk stock cubes to make their food salty compared to 90.9% that used salt. Instant noodles/2-minute noodles are the best wheat based alternative processed foods that should be fortified with iodine. Salt and Maggi Kakaruk stock cubes are the two optimal food vehicles for fortification with iodine in this remote community.

Thiamine levels in malnourished children in Port Moresby General Hospital

@#Thiamine deficiency may be associated with severe acute malnutrition (SAM) and contribute to its clinical signs and complications. This hospital-based prospective study aimed to determine if thiamine deficiency is present in children with SAM in Port Moresby General Hospital (PMGH). Convenient sampling was used to select 208 children aged between 2 months and 13 years (median age 15 and IQR 11-32 months) presenting to the Children’s Emergency Department requiring venipuncture for routine testing who had additional blood taken for assay of thiamine levels. Nutritional status was determined using the WHO weight for height (WFH) z-scores. Details of socioeconomic background and diet were recorded. Thiamine levels were determined using enzyme-linked immunosorbent assay (ELISA) test kits. A total of 158 (76%) of the 208 samples were satisfactory for analysis; 86 (54%) from children with normal WFH, 26 (17%) from those with moderate malnutrition and 46 (29%) from those with severe malnutrition. Thiamine levels were normally distributed overall. The mean was 34.18  5.8 ng/ml. This was within the reference level of 16-48ng/ml. There was no statistically significant difference in levels between the normal, moderately and severely malnourished children (33.6  5.6, 35.3  5.7 and 34.4  5.7 ng/ml). The assay of thiamine levels in serum using ELISA is not the best method for determining thiamine deficiency and further studies using whole blood and high-performance liquid chromatography are needed

Assessment of anaemia and iron status among pregnant women in the National Capital District, Papua New Guinea

@#Assessing the prevalence of anaemia, iron deficiency and iron deficiency anaemia among non-pregnant and pregnant women is essential for evidence-based intervention programs. The purpose of this prospective outpatient and community-based cross-sectional study was to assess the prevalence of those conditions among pregnant women resident in the National Capital District (NCD) and attending the Outpatient Antenatal Clinic in Port Moresby General Hospital. Blood samples were collected from 50 non-pregnant and 157 pregnant women who gave consent. HemoCue was used to measure haemoglobin; the serum ferritin, soluble transferrin receptor (sTfR) and C-reactive protein were measured by specialized 96-well enzyme-linked immuno-sorbent assay (ELISA) kits. The ‘sTfR-F index’ was calculated. Mild to moderate anaemia, low serum ferritin and elevated serum sTfR were found in 28% of the non-pregnant women; the sTfR-F index showed that 16% of them had iron deficiency anaemia. Among the pregnant women, 60% had mild to severe anaemia indicating severe public health significance; 48% had low serum ferritin and 38% had elevated serum sTfR; the sTfR-F index showed that 38% of them had iron deficiency anaemia. Mild to severe anaemia was present in 47%, 71% and 62% of the pregnant women in the first, second and third trimesters respectively, while iron deficiency anaemia was present in 20%, 53% and 48% of the pregnant women in the first, second and third trimesters respectively. The sTfR-F index showed that iron deficiency anaemia was present in 36% of primigravida and 40% of multigravida. Social mobilization, intensive and focused education, aggressive awareness campaigns, including all relevant target groups and policy makers, are required to effectively address this major public health issue.

Status of Iodine nutrition among school-age children in Karimui-Nomane and Sina-Sina Yonggomugl Districts in Simbu Province Papua New Guinea

@#Iodine deficiency is regarded as the single most common cause of preventable mental impairment in communities with suboptimal intake of iodine. Universal Salt Iodization is the most effective and sustainable intervention strategy for prevention, control and elimination of iodine deficiency. Urinary iodine concentration is the biochemical indicator for assessing the iodine status of a population. This study was prompted by reports showing evidence of cretinism in Karimui-Nomane district in Simbu province. The major objectives were therefore to assess the availability of adequately iodized salt in households, the per capita discretionary intake of salt per day and the iodine status of school children (age 6–12 years) in Karimui-Nomane, the district of concern, and Sina Sina Yonggomugl, a comparison district in Simbu province. Iodine level was assessed in salt samples collected from randomly selected households in both districts. The head of each household completed a questionnaire on knowledge, attitudes and practices related to salt iodization. Urinary iodine concentrations were measured in spot urine samples collected from randomly selected 6 to 12 years old children from selected primary schools in the two districts. 82.4% and 63.8% of salt samples from Karimui-Nomane and Sina Sina Yonggomugl respectively were adequately iodized above the national standard of 30ppm. The mean per capita discretionary intake of salt in households in Karimui-Nomane district was 4.62 ± 0.42 g/day, and in Sina Sina Yonggomugl district was 6.0 ± 2.61g/day. At measured levels of iodization (mean iodine content 34.7ppm and 32.7ppm respectively), this amount of salt would provide the recommended intake of iodine (150ug/day). However, for children in Karimui-Nomane the median UIC was 17.5μg/L and the interquartile range (IQR) was 15.0 – 43.0μg/L. and in Sina Sina Yonggomugl, the median UIC was 57.5μg/L and the IQR was 26.3–103.0μg/L, indicating severe and mild iodine deficiency respectively. These apparently conflicting findings may be explained by the fact that only 34% of households in Karimui-Nomane and 72% of households in Sina Sina Yonggomugl had salt on the day of the survey. The results indicate that iodine deficiency is a significant public health problem in Karimui-Nomane and Sina Sina Yonggomugl districts in Simbu province, potentially because of lack of access to salt, rather than inadequate implementation of salt iodization. Further studies are needed to quantify access to salt for communities in areas that are not easily accessible like Karimui-Nomane district in Papua New Guinea and, if inadequate salt access is confirmed, to develop alternative or complementary strategies to salt iodization

Assessment of aflatoxin M1 in breast milk of lactating mothers in Papua New Guinea

@#Aflatoxin M1 (AFM1) is a secondary metabolite in the breast milk of lactating mothers who consume foodstuffs infected by the fungi Aspergillus flavus and Aspergillus Parasiticus. The concentration of AFM1 in breast milk of lactating mothers is of major public health concern, because it can negatively affect the health of their babies. The major objective of this study was to assess the AFM1 concentration in the breast milk of lactating mothers in Papua New Guinea (PNG). This was a prospective cross-sectional study carried out between 2011 and 2015 in three of the four Regions in PNG: the National Capital District (NCD) in the Southern Region; Eastern Highlands (EHP) and Western Highlands (WHP) provinces in the Highlands Region; and East New Britain (ENB) and Manus provinces in the Islands Region. The Susu Mama, Well-Baby and Paediatric clinics in the General Hospitals in each of the selected provinces in the three regions were the primary sites for this study. A solid phase competitive Enzyme-Linked Immunosorbent Assay (ELISA 96 Microwell plates) was used for the quantification of AFM1 in breast milk from consented lactating mothers. A total of 874 lactating mothers and their babies participated in this study. The mean age of the mothers was 28.0 ±5.5 years. The age range of all the babies was 2 to 6 weeks. 76.1% (665/874) of all breast milk samples analyzed had detectable levels of AFM1. The concentration of AFM1 was above 10.00ppt in 89 (10.2%) of the 874 breast milk samples (which, according to the Australia / New Zealand / Austria safe cut-off limits for AFM1, makes them unsafe for consumption by the babies). The mean AFM1 concentration in the breast milk samples from lactating mothers in EHP (7.99ppt) was higher than that in the samples from the other 4 provinces in the present study. AFM1 concentration was above 10.00ppt in 14 (4.6%) of the 300 breast milk samples from NCD, in 62 (31.0%) of the 200 samples from EHP, in 10 (4.5%) of the 220 samples from ENB and in 3 (3.0%) of the 100 samples from WHP. In order to reduce the AFM1 concentrations in breast milk of lactating mothers, basic nutrition education, aggressive advocacy, social mobilization, awareness campaigns, including communication with all relevant target groups and the relevant policy makers are urgently required.

Zinc status of children aged 12 to 59 months resident in the National Capital District, Papua New Guinea

@#Zinc deficiency is a major public health problem in some resource-limited countries. This study assesses the zinc status of 90 pre-school-age children, aged 12 to 59 months, resident in the National Capital District (NCD), Papua New Guinea. Children attending the Children's Outpatient Clinic at Port Moresby General Hospital participated in this cross-sectional study. Informed consent was obtained from parents before using blood samples from their children. Flame atomic absorption spectrometry was used to measure the serum zinc concentration. C-reactive protein (CRP) in serum was measured by enzyme immunoassay and used to interpret the serum zinc data. The median serum zinc concentration for all the children was 83.6 μg/dl and the interquartile range was 64.6-103.7 μg/dl. The prevalence of serum zinc deficiency (Zn <65.0 μg/dl) among all the children was 26%; and 42% had elevated serum CRP level. Serum zinc deficiency was present among 31% and 20% of the children in the 12 to 24 months and over 24 months age groups respectively. The prevalence of serum zinc deficiency among the male and female children was 28% and 25% respectively. The high prevalence of zinc deficiency among the children may be caused by the high rate of subclinical infection and low bioavailability of absorbable zinc in the popular foodstuffs that they are consuming. The prevalence of zinc deficiency among the children with and without elevated serum CRP strongly suggests the need for continuous monitoring of the zinc status of pre-school-age children in the NCD

Assessment of zinc status of women resident in the National Capital District, Papua New Guinea

@#This cross-sectional study assessed the zinc status of non-pregnant and pregnant women resident in the National Capital District (NCD), Papua New Guinea (PNG). Non-fasting morning blood samples were collected by venipuncture from consented women. Flame atomic absorption spectrometry was used to measure the serum zinc concentration in 27 non-pregnant and 100 pregnant women. C-reactive protein (CRP) in serum was measured by enzyme immunoassay and used to interpret the serum Zn data. For all the non-pregnant women, the median serum zinc concentration was 42.7 mug/dl with an interquartile range (IQR) of 27.6 to 91.2 mug/dl. Zinc deficiency was prevalent among 59% in this group of women. For those with normal CRP the median and IQR serum zinc concentrations were 48.9 mug/dl and 30.2 to 98.7 mug/dl, respectively. The median and IQR for all the pregnant women were 63.8 mug/dl and 40.9 to 93.2 mug/dl, respectively. Prevalence of zinc deficiency was 42% using the cut-off point of 56.0 mug/dl. Of the 100 pregnant women, 16 (16%) were in the first trimester, 51 (51%) in the second trimester and 33 (33%) in the third trimester. The median serum zinc concentrations of pregnant women in the first, second and third trimesters were 87.0 mug/dl, 61.6 mug/dl and 60.8 mug/dl, respectively. Using gestational period-specific cut-off points, zinc deficiency was prevalent among 31%, 39% and 36% of the pregnant women in the first, second and third trimesters, respectively. Our results clearly indicate suboptimal zinc status among non-pregnant and pregnant women in the NCD. According to the International Zinc Nutrition Consultative Group (IZiNCG) criteria, this should be considered as a public health problem among these groups of women in the NCD. To effectively address the issue, social mobilization, intensive education and awareness campaigns, with all relevant target groups and policy makers, are urgently required.

Using Thyroid Stimulating Hormone (TSH) Levels in Cord Blood to Assess the Iodine Status of Neonates

@#Neonatal Thyroid Stimulating Hormone (TSH) level in blood is one of the indicators recommended for assessing iodine deficiency control programs in a population. This study evaluates the TSH level in cord blood as a way of assessing the iodine status of neonates in the National Capital District, PNG. Assay of TSH in 150 cord sera was by enzyme immunoassay (EIA 96 Microwell plates) using the sensitive EIA kit provided by LiNEAR Chemicals, S.L. The median TSH level in the sera for all the neonates was 2.17mIU/L, the interquartile range (IQR) was 1.53 – 3.48mIU/L. The TSH level in only 2 (1.3%) cord serum samples was greater than 10.0mIU/L. The lower limit (2.5th) and upper limit (99.0th) of the TSH percentile cut-off levels in all the cord sera were 0.76mIU/L and 11.16mIU/L. The median TSH level in the cord sera of the male neonates was 1.98mIU/L and the IQR was 1.55 – 3.38mIU/L. For the female neonates the median TSH level was 2.22mIU/L and the IQR was 1.52 – 3.81mIU/L. The data indicates normal iodine and thyroid status and zero prevalence of congenital hypothyroidism among the neonates in NCD.

Zinc in human health

Malnutrition is a contributing cause of about half of the 10 million deaths annually worldwide, and contributes to a substantial proportion of the infectious disease morbidity among children in developing countries. Recent epidemiological and clinical evidence has shown that in most developing countries deficiencies of specific micronutrients are partly responsible for the severity of infectious disease morbidity and mortality in malnourished children. Efforts to improve micronutrient status have focused on iron, vitamin A and iodine. Supplementation with iron and vitamin A significantly reduces child mortality, while implementation of the universal salt iodization strategy reduces the incidence of iodine deficiency disorders. These strategies are considered to be among the most cost-effective health interventions in developing countries. A number of recent zinc supplementation studies in developing countries suggest that greater priority should also be given to the correction of mild to moderate zinc deficiency in children, pregnant women and lactating mothers. Some of these studies showed that zinc supplementation reduces the duration of malaria, and the severity of diarrhoea and respiratory infections (including pneumonia), and improves immunocompetence in susceptible children. The results of these studies indicate that zinc may be another specific micronutrient in which there is widespread deficiency in developing countries and that great benefits can be achieved by its supplementation.