|Year : 2000 | Volume
| Issue : 11 | Page : 475-480
Iodine prophylaxis programme in rural area of Kolhapur district of Maharashtra
PB Jagirdar1, DJ Trivedi2
1 Department of Community Medicine, D. Y. Patil Medical College, Kolhapur, India
2 Department of Biochemistry, D. Y. Patil Medical College, Kolhapur, India
P B Jagirdar
Department of Community Medicine, D. Y. Patil Medical College, Kolhapur
|How to cite this article:|
Jagirdar P B, Trivedi D J. Iodine prophylaxis programme in rural area of Kolhapur district of Maharashtra. Indian J Med Sci 2000;54:475-80
It is well established that iodine deficiency is the principal cause of goiter and widely prevalent nutritional problem in India  . Endemic goiter is an adaptive disease, which develops when the amount of iodine required for thyroidal metabolism is insufficient. A great number of subjects living in such iodine deficient conditions have appeared to develop adequate adaptive mechanism without clinical evidence of thyroid hyperplasia. Classically, endemic goiter is prevalent along the slopes, foothills and adjacent plains to the South of Himalaya, extending over 2400 km, from Kashmir in the West to the Naga Hils in the East. In addition, more and more pockets of endemic goiter are being reported from different parts of rest of India, now referred to as "extra Himalayan" foci of eddemic goiter  . Therefore Govt. of India implemented compulsory use of iodized salt all over the nation since 1985. After about 15 years of introduction of prophylactic programme by universal iodisation of all edible salt, many sections of the community living in pockets of endemic goiter area and other of non endemic have exhibited their resent with criticism through channels of publications, that the long term consumption of iodised salt has resulted in toxic effects of iodine, such as thyrotoxicosis and other thyroid, complications  .
A survey was carried out therefore to study the effects of prophylaxis programme among the rural community of Kolhapur dist. of non-endemic area and ill-effects if any, due to iodised salt was also studied.
| ¤ Material and Methods|| |
School going children between 5 & 14 years of age of rural area of Kolhapur Dist. were included for study. Goiter prevalence was assessed by physical examination of two grades  . Urine samples were collected from children having goiter and estimated for iodine excretion as per the method mentioned by WHO  . Salt samples collected randomly from 2 to 3 shops from each study village were analysed for iodine content. Salt samples were also collected from consumer's place and analysed for the same. Drinking water samples were collected systematically form 28 sources of study area to estimate iodine levels.
Ten villages of Kolhapur district were selected randomly and 5863 children aged between 5 to 14 years from primary and middle school were examined for goiter of grade I and II as per Stanburys criteria. Their ages were confirmed from date of birth certificates school authorities.
Urine samples were collected every 5th child (20%) having goiter. Children were asked to collect their urine of early morning in a polythene bag of capacity 200-ml size to its half the level approximately 50 to 100 ml. The ploythene bags were marked wily number, name and sex beforehand iodine excretion (UIE) was estimated by modified method of Sandel and Kolthoff , and expressed as micrograms (mcg) of iodine per gram of creatinine. Iodine in salt was estimated by iodometric titration method . About 153 salt samples collected from both retailers and household consumers. Water samples were collected from 28 different sources from villages within the jurisdiction of study area. 200ml water was collected from each source in sterile bottle with screw cap and iodine content of drinking water was analysed by using the method of Sandel and Kolthoff , .
| ¤ Results|| |
The observations of survey are shown in [Table 1] & [Table 2] Urinary Iodine Excretion Urine samples analysed for UIE is shown in [Table 3]. The mean UIE in 5 to 14 years of female children were in the range of 38.8 to 71.8mcg/L. 4 out of 21 (19.8%) samples in the age group of 5 to 9 yrs. have shown 71.8 mcg/L of UIE which is more than 50mcg/L as cut point, 17 out of 21 i.e. 80.2% samples had shown value 44.7 mcg/ L UIE which is less than 50 mcg/L. Among 10 to 14 years of age group 8 out of 38 (21%) sample showed normal 64.3 mcg?I UIE compared to 30 out of 38 (78.9%) samples had decreased UIE i.e. 38.8 mcg/L.
Iodine content of drinking water Water samples from 28 different sources were estimated for iodine content. The range observed was 9 to 29 mcg/L water.
[Table 4] shows that incidence of grade f goiter is highest 92 (31.4%) in area where water iodine level is less than 10 mcg/L as compared to other two groups. Similarly incidence of grade-II goiter was highest 30 i.e. 10.2% in area where water iodine content is 10.1 to 20 mcg/L of iodine. However the percentage prevalence of goiter of both the grades show-decreasing trend 39.2,34.5,26.3 with increasing levels of iodine contents of drinking water. A total of 153 salt samples were collected from retailers shops and consumers place. 1.5% of retailers out of 51 samples and 14% of consumers out let of 102 samples were found to contain iodine level less than 15 ppm.
| ¤ Discussion|| |
Apart from the 2400 km of sub-Himalayan goiter belt and extra Himalayan foci of endemic zone in country has resulted in the implementation of iodised salt all over the nation. This necessitated the need of survey to see the effects of prophylaxis programme started in 1985 and if there is any complications such as thyrotoxicosis and other thyroid related diseases among the rural community of the Kolhapur dist. due to consumption of iodised salt for more than 15 years was also seen. The over all goiter prevalence in the study area was 4.9%, which as per Caries Perez et al  is a non-endemic. In our study the percentage of grade I goiter was 3.8% and therefore according to Stanbury's  criteria the area is of low endemic or non endemic.
The UIE among the 19.8% of sample in 5-9 years of age group and in 10-14 age group 21% of sample show higher excretion i.e. 71.8 and 64.3 meg/L respectively. However 80.2% of samples from 5 to 9 years of age and 79% samples from 10 to 14 years had decreased i.e. 44.7 and 38.8 meg/L UIE respectively. As the difference is not very wide to 50meg/L as cut out point and iodine excretion among children were satisfactory. This can be attributed to majority of their families i.e. 96% were using iodised salt containing more than 15 ppm. This corresponds to 98.5% of the males and 96.5% females had no goiter. Similarly 1.5% shops in the different villages of study area were found selling loose salt which contain less than 15 ppm iodine and 4% of the families were consuming non iodised salt. This matches with our observations of satisfactory iodine levels of salt.
| ¤ Conclusion|| |
Our study concludes that use of iodised salt has beneficial effects towards prophylactic measures against goiter. Also prolonged consumption of iodised salt in non-endemic area has not resulted in any ill effects due to extra iodine.
However further detail epidemiological study with regard to above factors in higher age group required to be studied to see the beneficial effect of iodised salt.
| ¤ Summary|| |
It is well established that iodine deficiency is the principle cause of goiter and widely prevalent nutritional problem in India. A great number of subjects living in iodine deficient conditions have appeared to develop adequate adaptive mechanism without clinical evidence of thyroid hyperplasia. Also govt. of India has implemental compulsory use of iodized salt all over the nation since 1985 as a prophylactic measure. But the programme is criticized through various channels of publications, stating that the long term consumption of iodised salt may result in toxic effects of iodine, such as thyrotoxicosis and other thyroid related complications. A survey was carried out therefore to study the effects of prophylaxis programme among the rural community of Kolhapur district of non-endemic area and ill-effects if any, due to prolonged use of iodised salt were studied. Our study concludes that use of iodised salt has beneficial effects towards prophylactic measures against goiter. Also prolonged consumption of iodised salt in non-endemic area has not resulted in any ill-effects due to extra iodine.
| ¤ Acknowledgement|| |
We are grateful to Mr. Bagwan, Statistician, Department of FPW.T.C, CPR - Hospital, Kolhapur for providing necessary help. We also thank Dr. Jayant Watve for providing suggestions and editing the text.
| ¤ References|| |
|1.||CS Pandav, MD Nkochipillai, MD L.M. Nath MD, National policy on endemic goiter - harbinger of national policy on nutrition. Ind. J. Pediatrics, 1984:51:277-282. |
|2.||WHO/UNICEF/ICCIDD : Indicators for assessing Iodine Defiency Disorder, World Health Organisation, 1996, Geneva. |
|3.||John T Dunn, Techniques for measuring urinary iodine-An update, IDD news letters, 1993;9:40-43. |
|4.||Sooch SS, Deo M G, Karmarkar M G, Kochipillai N, Ramchandran K, Preservation of endemic goiter with iodised salt, Bull. WHO, 1973:49-307. |
|5.||Perez Caries, Scrimshaw S, Nevvin, Munez Antoni CJ, Techniques of endemic goiter surveys, Endemic goiter- WHO monograph series, 1960, no. 44, 369-383. |
|6.||Stanbury JB, Kevany JP, Iodine and thyroid diseases in Latin America, Environmental research, 1970;353-363. |
[Table 1], [Table 2], [Table 3], [Table 4]