Status of iodine nutriture and universal salt iodisation at beneficiaries levels in Kerala State, India.

Iodine deficiency disorders are an important public health problem in India. It is wrongly believed that populations residing in coastal areas do not suffer from iodine deficiency as they consume sea foods which are rich in iodine. A high prevalence of iodine deficiency has been reported in 11 districts of Kerala ranging between 9.3 and 44.5%. In spite of the high prevalence of iodine deficiency, the state government of Kerala has not banned the sale of non-iodised salt in the state. Thus, the present study was conducted to assess the current status of iodine nutriture and level of salt iodisation in Kerala state. The study was conducted in all the 14 districts in the state by utilising the uniform sampling methodology. A total of 2110 salt samples were collected randomly from children. On the spot casual urine samples were collected from 689 children. The results revealed that overall 43.8% of the families in the state were consuming salt with 15ppm and more of iodine. It was found that three districts namely Kasargod, Idukki and Kottayam had median urinary iodine excretion level < 100.0 microg/l and also more than 20% of the samples had urinary iodine excretion levels less than 50 microg/l. The findings of the present study revealed continued iodine deficiency amongst the three districts identified as endemic earlier. This indicates the need of immediate ban on the sale of non-iodised salt for the edible purposes and intensive information, education and communication activities for promotion of consumption of iodised salt.

Prevalence of multiple micronutrient deficiencies amongst pregnant women in a rural area of Haryana.

Deficiencies of micronutrients (zinc, iron, folic acid and iodine) during pregnancy are known causes of Low Birth Weight (LBW). Studies have documented status of one or two micronutrients amongst pregnant women (PW). However, no attempt has been made to concurrently assess the prevalence of multiple micronutrient deficiencies and the factors associated with them amongst PW. OBJECTIVE: The present study was undertaken to assess the prevalence of multiple micronutrient deficiencies amongst PW in a rural area. METHODS: A community based cross sectional survey was conducted in six villages of a rural area of district Faridabad in Haryana state, India during November 2000 and October 2001. All PW aged 18 years or more, with pregnancy duration of more than 28 weeks were enrolled. Data were collected on socio-economic status and other demographic parameters. Serum zinc, copper and magnesium levels were estimated by utilizing the Atomic absorption spectrophotometry (AAS); serum ferritin and folate was estimated by Enzyme Linked Immuno Sorbent Assay (ELISA) method and the Radio-Immuno Assay (RIA) method, respectively and serum thyroid stimulating hormone (TSH) level was estimated by the Abbot AxSYM System. Serum zinc, copper, magnesium, ferritin, and folate levels less than 70.0 microg/dl, 80.0 microg/dl, 1.80 mg/dl, 15 ng/ml, and 3 ng/ml, respectively were considered as indicative of deficiency for respective micronutrients. The TSH levels of 4.670 and more indicated iodine deficiency status. Dietary intake of micronutrients was assessed utilizing 1-day 24-hour dietary recall methodology. Food consumption pattern was assessed utilizing the food frequency questionnaire methodology. RESULTS: Nearly 73.5, 2.7, 43.6, 73.4, 26.3, and 6.4 percent PW were deficient in zinc, copper, magnesium, iron, folic acid and iodine, respectively. The highest concurrent prevalence of two, three, four and five micronutrient deficiency was of zinc and iron (54.9%); zinc, magnesium and iron (25.6%); zinc, magnesium, iron and folic acid (9.3%) and zinc, magnesium, iron, folic acid and iodine (0.8%), respectively. No pregnant woman was found to have concomitant deficiencies of all the six micronutrients. Dietary intake data revealed an inadequate nutrient intake. Over 19% PW were consuming less than 50% of the recommended calories. Similarly, 99, 86.2, 75.4, 23.6, 3.9 percent of the PW were consuming less than 50% of the recommended folic acid, zinc, iron, copper, and magnesium. The consumption of food groups rich in micronutrients (pulses, vegetables, fruits, nuts and oil seeds, animal foods) was infrequent. Univariate and Multivariate logistic regression analysis revealed that low dietary intake of nutrients, low frequency of consumption of food groups rich in micronutrients and increased reproductive cycles with short interpregnancy intervals were important factors leading to micronutrient deficiencies. CONCLUSION: There was a high prevalence of micronutrient deficiencies amongst the PW of the area, possibly due to the poor dietary intake of food and low frequency of consumption of food groups rich in micronutrients. The concurrent prevalence of two, three, four and five micronutrient deficiencies were common.

Role of trace elements zinc, copper and magnesium during pregnancy and its outcome.

Trace element deficiencies have been documented to play an important role in determination of the fetal outcome. Pregnant women in developing countries have been reported to consume diets with a lower density of minerals and vitamins. Deficiencies of trace elements like zinc, copper and magnesium have been implicated in various reproductive events like infertility, pregnancy wastage, congenital anomalies, pregnancy induced hypertension, placental abruption, premature rupture of membranes, still births and low birth weight. The present review article highlights the important of role played by zinc, copper and magnesium during pregnancy and its outcome. The role of individual trace elements and in combination with other trace elements has not been completely documented. There is a need to undertake further studies in this field.

Profile of iodine content of salt and urinary iodine excretion levels in selected districts of Tamil Nadu.

OBJECTIVE: Iodine deficiency disorders (IDD) is the most common cause of preventable mental retardation in world today. Out of 29 districts in Tamil Nadu, 24 have been surveyed and all have been found to be endemic to IDD. There is a complete ban on the sale of non iodised salt in the state since 1995. The present study was conducted to assess the iodine content of salt and urinary iodine excretion levels amongst the beneficiaries in the state to help the government to strengthen the existing Universal salt iodisation (USI) programme activities. METHODS: The study was undertaken in 24 districts of Tamil Nadu during the year 2001. The guidelines recommended by WHO/UNICEF/ICCIDD for a rapid assessment of salt iodisation in a district was adopted. A minimum of 150 salt samples were collected from each district by utilising the uniform sampling methodology. The iodine content of salt samples was analysed using the standard iodometric titration method. At least 60 children from each school were randomly selected and were requested to provide "on the spot" casual urine samples. The urinary iodine excretion (UIE) levels were analysed using the wet digestion method. RESULTS: It was observed that 62.3% of the families were consuming iodised salt with more than 5 ppm of iodine. It was found that district Perambalour had deficient iodine nutriture as revealed by the median UIE levels less than 100 micro g/l. CONCLUSION: The findings of the present study reveals the success of USI programme and highlights need for continued monitoring of the quality of salt provided to the population in order to achieve the goal of IDD elimination.

Status of serum ferritin and folate levels amongst young women in a rural community of Haryana, India.

A community based cross sectional study was conducted amongst young married non-pregnant women aged 18 years or more from six randomly selected villages in Ballabhgarh block, district Faridabad, Haryana state. Data was collected on socio-demographic profile and obstetric parameters utilizing a pre-tested semi-structured questionnaire. The non-pregnancy status of the women was confirmed by inquiring about the last menstrual period. Serum ferritin and folate levels were assessed utilizing the ELISA and the RIA method, respectively Serum ferritin and folate levels less than 15.0 and 3 ng/ml were considered as indicator of poor iron and folic acid stores, respectively. The dietary intake of iron, folic acid and calories was assessed utilizing the 24-hour dietary recall methodology. Almost 63.8 and 27.7 % of the women had poor serum ferritin and folate levels. The mean dietary intake of iron, folic acid and calories was 14.8+/-7.7 mg, 49.2+/-20.1 microg, and 1564+/-411 kcal, respectively. There was an inadequate intake of food as revealed by their calorie intake that was 83.4% of the recommended dietary allowances. Only 6.9 and 7.8 % of the women were consuming iron and folic acid more than 75.0 % of the recommeded dietary allowances (RDA) Women with dietary intake of calories less than 50.0 % of the RDA had a lower serum ferritin level compared to the women who had a higher calorie intake. It was also revealed that there was a decreasing trend in serum folate levels with poor socio-economic status. Young rural women had poor serum ferritin and folate levels in the community studied, possibly due to poor dietary intake of food and thereby iron and folic acid. Distribution of iron and folic acid tablets may be recommended to young women of reproductive age group.

Elimination of iodine deficiency disorders in Delhi.

OBJECTIVE: The present study was conducted in year 2002 in NCT of Delhi with the objective to re-assess the prevalence of iodine deficiency disorders. METHODS: A total of 7009 children in the age group of 6-11 years were clinically examined for presence of goiter. A total of 991 salt samples were also collected randomly. On the spot casual urine samples were collected from 1395 children. RESULTS: The total goiter prevalence was found to be 6.2%. The percentage of children with urinary iodine excretion (UIE) of < 20.0, 20.0- < 50.0, 50.0-99.9 and 100.0 microg/l and above was 0.8, 1.8, 8.7 and 88.7%, respectively. The median UIE level was 200 microg/L. The assessment of iodine content of salt revealed that only 16% of the families were consuming salt with iodine content less than 5 ppm. CONCLUSION: The findings of the present study indicated that the population is in a transition phase from iodine deficient (as revealed by Total Goiter Prevalence) to iodine sufficient nutriture (as revealed by median UIE 200 microg/l). A significant progress has been achieved towards elimination of IDD from NCT of Delhi.

Current status of iodine nutriture and iodine content of salt in Andhra Pradesh.

A cross sectional survey was conducted in the year 2001, to establish the current status of iodine nutriture and level of salt iodisation in the state of Andhra Pradesh, India. All the 23 districts were included. The data was collected in each district through school approach. A total of 3706 salt samples and 1952 casual urine samples were collected. Nearly 45% of the population was found to be consuming iodised salt. All the districts had adequate iodine nutriture except Rangareddy and Cuddapah. The districts which were earlier found endemic to iodine deficiency namely Srikakulam, Vizianagaram, Visakhapatnam, Godavari, Khammam, Adilabad and Warrangal were found with adequate iodine nutriture as reflected by median UIE level of more than 100 microg/L. The study revealed success of salt iodisation program in the state.

Prevalence of iron, vitamin A, and iodine deficiencies amongst adolescent pregnant mothers.

OBJECTIVE: The present study was undertaken to assess the prevalence of iron, vitamin A and iodine deficiencies amongst rural Adolescent Pregnant Mothers (APM). METHODS: Survey was conducted amongst APM in a rural block; district Udham Singh Nagar, Uttaranchal State. In the district, all blocks were enlisted and one block was randomly selected. Further, villages in the block were listed (n = 64) and five villages were randomly selected for the detailed study. All APM residing in the selected villages were included for the detailed study. The data on socio demographic parameters was collected utilizing a pre-tested semi-structured questionnaire. Anaemia was assessed by hemoglobin estimation with the help of the HemoCue instrument. Vitamin-A deficiency (VAD) was assessed by presence of night blindness utilizing a pre-tested semi structured proforma. Iodine Deficiency was assessed by the clinical examination of the thyroid gland and estimating the Urinary Iodine Excretion (UIE) levels of each subject. Nutrient intake was assessed by the 24-hr dietary recall method. RESULTS: One hundred and fifty one APM, belonging to low socio economic group, were selected for the study. The occupation of the families was farming, but the APM were housewives. The mean age of the APM was 17.8 +/- 1.5 yr. Eighty nine percent of the APM were in the age group 16-19 yr. Sixty percent of the APM were in the gestational age of 24 weeks and more. It was found that 46.0% of the APM were anaemic (Hb < 11.0 gm/dl). Sixteen percent of the study subjects had presence of night blindness. Fifteen percent of the subjects had Goiter. Median UIE level in the subjects studied was 95.0 micrograms/l. Concomitant prevalence of the three deficiencies was amongst 2.0% of the population. The 24-hour dietary intake revealed that the mean consumption of retinol and iron was only 13 and 28% of the recommended dietary allowance, respectively. CONCLUSION: The findings of the present study indicated that Anaemia, Vitamin A, and Iodine deficiency existed as public health problems in the APM of the study area.

Assessment of iodine deficiency disorders in district Bharatpur, Rajasthan.

Iodine deficiency disorders (IDD) is a public health problem in India. A ban on the sale of uniodised salt for household consumption has been introduced in Rajasthan State since 1992. The present study was conducted in the district of Bharatpur, Rajasthan with the objective to assess the prevalence of iodine disorders in school children as no data is available on this aspect. A total of 3072 children in the age group of 6-12 years were included in the study and were clinically examined. On the spot urine samples were collected randomly from 450 children. A total of 1064 salt samples were collected randomly from the families of the children. The total goiter prevalence was found to be 7.2% in the subjects studied. It was found that the percentage of children with urinary iodine excretion <20.0; 20.0-49.9, 50.0-99.9 and 100 mcg/L and above was 1.1, 1.1, 7.8 and 90.0% respectively. The assessment of iodine content of salt revealed that 56% of the families were consuming iodised salt. The findings of the present study indicated that the population is in a transition phase from iodine deficient (as revealed by the TGR) to iodine sufficient (as revealed by the medium UIE of 200.0 mcg/L) nutriture.