Urinary iodine excretion as a predictor of the iodine content of breast milk.

Endemic goitre has re-emerged in Thailand. This is particularly dangerous for children since iodine deficiency disorders (IDDs) might negatively influence their intellectual and mental development. In order to assess the situation, the iodine content of breast milk was determined and a method is proposed on how to monitor IDDs in lactating mothers later on. Seventy-five lactating women aged from 15 to 45 years, from 12 villages of 3 districts, namely Chumpae. Srichompu and Pupaman within the mountainous areas of Khon Kaen province, Northeast of Thailand were investigated. The breast milk from 46.7 per cent of mothers was found to be below recommended standards. In addition, 52.0 per cent of the women investigated had low urinary iodine excretion. The risk of women with low iodine excretion was 15 fold higher in comparison to women with sufficient iodine excretion to provide breast milk for their babies with insufficient iodine content. It is concluded that urinary iodine excretion can be used to monitor the IDDs in lactating mothers.

Evaluation and monitoring of iodine deficiency disorders in school children in north-east Thailand.

The possibility of improving iodine deficiency disorder (IDD) in school children in Khon Kaen province was investigated during the period of 1 year, using an operational research approach. Four schools in Pupaman and Srichompu districts, namely Ban Khoa Wong, Na Fai Witaya, Ban Pa Num Tieng and Ban Non Khom, were selected for this study. Ban Non Khom served as the control school. Different methods were used for iodine fortification. Iodized salt was used for the children of the Ban Khoa Wong school, iodized water was used for Na Fai Witaya school and iodized fish sauce was used for Ban Pa Num Tieng school. The iodized salt, water and fish sauce were provided with the help of the school teachers under the supervision and advice of the team of investigators. Urine iodine excretion as well as palpation of the thyroid gland and the thyroid hormones T4, T3 and TSH were selected for monitoring and evaluation. The proportion of children with low urine iodine excretion, indicated by a cut-off point suggested by the WHO/ICCIDD/UNICEF working group, decreased during the course of the project in all schools receiving iodine supplementation as well as in the control school. However, the decrease was less in the control school in comparison with the implementation schools. Furthermore, the goitre rate decreased in all schools under investigation. The decrease of the goitre rate for the children of the control school might have been due to the activities of a village health volunteer from a nearby village who was using iodized salt for IDD control according to the ongoing national programme initiated by the Ministry of Public Health. No significant difference in the level of thyroid hormones was detected before or at the end of the supplementation for either the experimental schools or the control school. The results from the determination of thyroid hormone serum levels could not be used for assessing the outcome of the project. The measuring of urinary iodine excretion might be helpful in monitoring the iodine intake during the intervention phase. Long-term effects of iodine fortification could be seen best by the declining proportion of children with goitre. However, an observation of 1 year might not have been enough to clearly see the outcome of the project. The other possible contributing error to this study is intra-observer variation of the palpation technique when the sample size was not big enough. Goitrogens in this area might be another risk factor for the high prevalence rate of goitre. Further study in this field should be encouraged. The results of the study indicate that iodine fortification of salt and fish sauce is more effective than iodine fortification of drinking water. Due to the local preference of adding fish sauce (nam pla) instead of salt to almost all dishes, fish sauce proved to be the best vehicle for iodine fortification. The success of the project depended heavily on the understanding and cooperation of the school teachers and the school children. Major constraints in conducting this project were the insufficient distribution of iodized salt and potassium iodide solution for the fortification of drinking water, and the inconsistency of iodide concentration in the salt after fortification.

Vitamin B12, folic acid, ferritin and haemoglobin status of rural women in child-bearing age in northeast Thailand.

Serum vitamin B12, folic acid, ferritin and haematological variables were investigated in six hundred and seven women from 12 villages of 3 districts namely Chumpae, Srichumpu and Pupaman of Khon Kaen province, Northeast Thailand within the age range of 15-45 years. The cut-off point of haemoglobin concentration < 12 g/dl was applied for defining the normal and anaemic group (17.3%). The result showed that the concentration of ferritin, folic acid and vitamin B12 in the anaemic group were less than that of the normal group. Forty six out of 607 women or 7.6 per cent were found to be undernourished and 27.2 per cent of females were overnourished. The prevalence of deficiencies of vitamin B12, folic acid and ferritin were 6.3 per cent, 4.3 per cent and 12.5 per cent respectively.

Compliance of population groups of iodine fortification in an endemic area of goiter in northeast Thailand.

Methods of iodine fortification were tested among women of child bearing ages in four villages of Khon Kaen province, an endemic area of goiter in northeast Thailand, Ban Wang Pa Dum, Ban Pa Klauy and Ban Non Chart received iodine fortified in fish sauce, salt and drinking water respectively, whereas, Ban Non Sa-aad served as a control village. Urine iodine concentrations were investigated before supplement and after three and six months of the experimental period. Three months after supplement, urine iodine levels of villagers from Ban Non Chart and Ban Non Sa-aad were higher than those of Ban Wang Pa Dum and Ban Pa Klauy. Six months later, subjects from Ban Wang Pa Dum and Ban Pa Klauy who had received fortified fish sauce and iodinated salt respectively had significantly higher urine iodine concentrations than those of the other two villages. The result implied that fortified fish sauce and iodinated salt were well accepted by the villagers. However, fortified fish sauce might be the best and most feasible method because villagers use fish sauce more constantly in cooking and salting dishes.