[Current status and the 10 years trend in the malnutrition indexes of children under 5 years in Iran]

Malnutrition is one of the main nutritional problems among children under 5 years especially in developing countries. The effects of malnutrition in this range of age group includes; disorder of mental and physical growth and development, increase in the morbidity and mortality, decrease of the learning capacity. A detailed epidemiological picture of the prevalent malnutrition status among children under 5 years in different regions of Iran enables health policy makers to identify priorities, establish political commitment and design appropriate interventional programs to prevent and control malnutrition and improve nutritional status of children. To determine the prevalence rate of malnutrition among children under 5 years. Demographic data, weight and height of 34200 Iranian children between 0-72 months old in 28 provinces of the country in 2005 year based on a cluster sampling were gathered. The subjects' weight and height were measured by trained staff. Prevalence of underweight, stunting, and wasting indicators was determined by measuring the weight and height of subjects in urban and rural areas. EPI6 statistical software, version b6/04, was used for all statistical analyses. 4.7% of the children aged less than five years suffered from stunting [95% CI: 4.5- 4.9%] the prevalence of this type of malnutrition among urban children is significantly less than rural children [95% CI: 3.1- 3.5% and 6.5-7.1% respectively]. Meanwhile the prevalence of underweight was 5.2% in the country [95% CI: 5.1-5.4%] while the prevalence of this type of malnutrition was significantly less among urban children than those in rural ones. Moreover, the prevalence of wasting was 3.7% [95%CI: 3.5-3.9%] and there was a significant difference in this regard between the urban and rural children. Thus this indicator was significantly higher among urban children than those in rural areas [95%CI: 3.8-4.3% and 3.0-3.5% respectively]. The results of the study show that the prevalence of protein-energy malnutrition was low among Iranian children under five years old. In comparison with previous studies, it is felt that there has been a prudent decrease in all malnutrition in all levels. However, there were significant differences in the prevalence of malnutrition in different provinces, which has resulted in the differences in their developmental stages as well. It appears that subjective strategies are required to improve the nutritional and health status among children under five in all provinces

[Marked reduction in goiter prevalence and eventual normalization of urinary iodine concentrations in Iranian schoolchildren, 10 years after universal salt iodination [third national survey of iodine deficiency disorders 2000]]

Two years after legislation of salt iodization of 40 parts per million [ppm] in 1994, goiter was still endemic and urinary iodine concentration [UIC] remained elevated in many provinces of Iran. Goiter prevalence and UIC were compared two and seven years after sustained consumption of uniformly iodized salt by Iranian households. From December 2000 to June 2001, schoolchildren [7-10 yr] of all provinces were randomly selected by cluster sampling; their goiter rate, UIC, and household salt iodine levels were compared to similar data collected in 1996. Factory salt iodine produced in 2001 was also compared to that of 1996. Ultrasonographically determined thyroid volumes of 7-10 yr old children were compared in 2001 to those of 1999. Total, grade 1, and grade 2 goiters were 13.9 vs. 53.8%, 11.0% vs. 44.8%, and 2.9% vs. 9.0%, in 2001 [n=33600] vs. 1996 [n=36178], respectively [p<0.0001]. Median [range] UIC in 2001 [n=3329] was 165 [18-410] micro g/L and in 1996 [n=2917] was 205 [10-2300] micro g/L [P<0.0001]. Means for iodine salt content were 32.7 +/- 10.1 and 33.0 +/- 10.2 [P=0.79] in households and 33.2 +/- 13.4 and 33.8 +/- 13.2 [P=0.67] in factories, in 2001 and 1996, respectively. Only 7-yr-old children in 2001 [the only group with probably no history of iodine deficiency] showed significantly smaller thyroid volumes compared to those in 1999. After seven years of optimized iodized-salt supplementation in Iran, adequate UIC values and marked reduction in goiter rate have been achieved

[ prevalence of goiter and urinary iodine exertion in 7 - 10 year old school children of Qom 2001 - 2002]

Iodine deficiency was a public health problem in Iran before the start of iodine supplementation program in 1989. This study has been conducted in the framework of the national monitoring survey in 2001 to find the prevalence of goiter and urinary iodine levels in order to evaluate the effect of national supplementation program on the iodine status of school-aged children in the city of Qom. In a descriptive, cross-sectional study, 1200 schoolchildren, aged 7-10 years, were selected randomly from all regions of Qom, and the grade of goiter was determined in 600 boys and 600 girls according to WHO classification. Urinary iodine content was estimated using the digestion method in one tenth of the schoolchildren. Goiter was observed in 26% of children [24.3% of girls and 27.7% of boys]. The average urinary iodine level was 15.2 micro g/dl. Urinary iodine levels higher than 10 micro g/dl was measured in 71.7% and less than 5 micro g/dl in 8.1% of children. Urinary iodine levels less than 2 micro g/dl has not been observed in any of the cases. No significant difference was observed in prevalence of goiter and the urinary iodine level between males and females, and students in living in urban or rural areas. Comparison of these results with those of the year 1996 shows that prevalence of goiter has significantly decreased in these students. Also, it shows that in the city of Qom, the urinary iodine levels of schoolchildren fall in the standard range determined by WHO. This indicates that the iodine intake is adequate in the province of Qom. Therefore, this province can be considered as an "iodine deficiency-free" zone

[ prevalence of goiter and urinary iodine excretion in school-aged children of ChaharMahal and Bakhtyari]

The province of Charmahal and Bakhtiari was one of the first regions with endemic goiter in Iran. Following initiation of the program of control of iodine deficiency in 1989, production, distribution and consumption of iodized salt were begun. Goal This survey was conducted within the framework of the 2001 national monitoring survey to find the prevalence of goiter and urinary iodine level in order and to evaluate the iodine status of school aged children in Charmahal and Bakhtiari. 1200 schoolchildren, aged 7-10 years, were selected randomly from all regions of Charmahal and Bakhtiari, and the grade of goiter, in 600 boys and 600 girls, was determined according to WHO classification. Urinary iodine content was estimated using the digestion method in one tenth of the schoolchildren. Total goiter rate was 18.4%, 15.4% in girls and 21.4% in boys. Median urinary iodine was 17 micro g/dl. Urinary iodine was above 10 g/dl in 80.9% and less than 5 micro g/dl in 2.5%, no one had urinary iodine below 2 micro g/dl. It is concluded that the rate of goiter in Charmahal and Bakhtiari has decreased significantly since 1996 and urinary iodine levels in schoolchildren are indicative of adequate iodine intake. The charmahal and Bakhtiari province therefore can hence be considered a "iodine deficiency free" zone

[Evaluation of iodine sufficiency in school children of Markazi province, 2001]

Markazi province was one of the regions with endemic goiter in Iran. Following initiation of iodine deficiency control program in 1989, production, distribution and consumption of iodized salt begun. This survey was conducted in the frame work of national monitoring survey in 2001 to find the prevalence of goiter and urinary iodine level in order to evaluate the iodie status of school age children in Markazi province. 1200 school children [600 boys and 600 girls], aged 7-10 years, were selected randomly from all regions of Markazi province. The grade of Goiter was determined according to WHO classification and urinary iodine content was estimated uing the digestion method in one tenth of the tese children. Data was analyzed using T, Chi square and Pearson tests. Total Goiter rate was 4.4% [4.4% in girls and 4.4% in boys]. Urinary iodine median was 16.7 micro g/dl. Urinary iodine was above 10 micro g/dl in 81.2% and less than 5 micro g/dl in 9.2% of samples. No one had urinary iodine below 2 micro g/dl. It is concluded that the rate of Goiter in Markazi province has decreased significantly since 1986 and urinary iodine levels in school children are indicative of adequate iodine intake. Therefore Markazi province can be considered as an ''iodine deficiency free'' zone

[ prevalence of goiter and urinary iodine exertion in school-aged children in Sistan-Balouchestan]

Iodine deficiency and disorders resulting from it has long been recognized as a grave nutritional health concern. Sistan and Baluchestan Province, in studies conducted prior to Iodine dispensation, was among the regions with high prevalence of endemic goiter in Iran. 1200 schoolchildren, aged 7-10 years, were selected randomly from all regions of Sistan-Balouchestan, and the grade of goiter, in 600 boys and 600 girls, was determined according to WHO classification. Urinary iodine content was estimated using the digestion method in one tenth of the schoolchildren. Total goiter rate was 33.3%, 31.2% in girls and 35.3% in boys. Median urinary iodine was 19.8 micro g/dl. Urinary iodine was above 10 micro g/dl in 84.4% and less than 5 micro g/dl in 5.1%, no one had urinary iodine below 2 micro g/dl. UIC levels and goiter prevalence were not statistically different between boys and girls and also between urban and rural areas. It is concluded that the rate of goiter in Sistan-Balouchestan has decreased significantly since 1996 and urinary iodine levels in schoolchildren are indicative of adequate iodine intake based on WHO desirable level: Sistan-Balouchestan province therefore can be considered an "iodine deficiency free" zone

Managing nutritional programmes in developing countries

Improving community nutrition in developing countries requires a detailed epidemiological picture of the prevalent nutritional problems in different regions and age groups. This makes it possible to identify priorities, sensitize policy-makers, establish political commitment and design appropriate community programmes for income generation and education for the best use of food resources. Experiences acquired from community-based nutritional programmes show that ownership of a programme by the community and using a tailor-made approach are essential factors in the successful implementation of programmes. A multifaceted approach is needed, involving a range of sectors-agriculture, commerce, education and health-- and commitment at all levels from government to communities and individuals

Multidisciplinary intervention for reducing malnutrition among children in the Islamic Republic of Iran

A multidisciplinary intervention to reduce protein-energy malnutrition among children in rural areas was piloted in 3 provinces of the Islamic Republic of Iran. Based on an initial situation analysis, a range of interventions were implemented through local nongovernmental organizations, including nutrition, health and literacy education for mothers, improved growth monitoring and fostering rural cooperatives and income generation schemes. Malnutrition before and after the intervention [in 1996 and 1999] was assessed using anthropometric measurements of r and om samples of children aged 6-35 months in control and intervention areas. Three years into the intervention, all indicators of malnutrition had consistently decreased in all intervention areas and the prevalence of underweight and stunting was significantly lower. Control areas showed a mixed pattern of small increases and decreases in malnutrition indicators

Progress towards elimination of IDD in the Islamic Republic of Iran: a KAP survey of iodized salt consumption

It has been recognized for a number of years that iodine deficiency disorders constitute a health problem in the Islamic Republic of Iran. A programme for the prevention of such disorders was established in 1989 and intensive efforts have been made to overcome obstacles hindering its implementation. This study investigates the difficulties encountered, common factors behind the prevalence of iodine deficiency, the progress made in combating it and the results of a nationwide campaign to raise awareness of the need to consume iodized salt. The final part of the study presents general conclusions and recommendations which may be of use to countries facing a similar problem in the field of health and nutrition