|Year : 2017 | Volume
| Issue : 2 | Page : 204-207
Goiter Survey among School Children (6–12 Years) in Northern Himalayan Region
S Muhammad Salim Khan, Inaamul Haq, Sheikh Mohd Saleem, Mehak Nelofar, Rachel Bashir
Department of Community Medicine, Government Medical College, Srinagar, Jammu and Kashmir, India
|Date of Web Publication||15-Dec-2017|
Sheikh Mohd Saleem
Department of Community Medicine, Government Medical College, Srinagar, Jammu and Kashmir
Source of Support: None, Conflict of Interest: None
Background: Deficiency of iodine results in impairment of thyroid hormone synthesis and abnormalities grouped under the heading of “iodine deficiency disorders (IDDs).” Goiter surveys are conducted to estimate the region's iodine status. In view of this, we conducted this goiter survey among school-going children of district Baramulla, Kashmir division, to see the prevalence of IDD. Materials and Methods: This cross-sectional study was conducted among 6–12 years children in district Baramulla during the month of March and April 2017. The sample size of 2700 was calculated. The assessment of goiter was performed clinically by inspection and palpation of the thyroid gland. Results: In this study, we studied a total of 2700 school children in the age group of 6–12 years from district Baramulla with a mean age of 9 ± 1.86 years. 50.07% were boys. The age distribution prevalence of goiter among school children (6–12 years) in district Baramulla was observed to be 15.29%. The prevalence of Grade 1 goiter was more than twentyfold higher than Grade 2 goiter. The highest prevalence of Grade 1 and 2 goiter was seen among school children of 12 years age (25.19% and 1.81%, respectively). Females have higher prevalence of Grade 1 and Grade 2 goiter (17.58%). The relationship of goiter prevalence with gender and age was statistically significant. Conclusion: The present study showed mild goiter prevalence in school-aged children of 6–12 years in the district Baramulla of Kashmir valley. There is a dire need of periodic surveys to assess the magnitude of the IDD in the future.
Keywords: Baramulla district, goiter in children, goiter survey, iodine deficiency disorder among school children
|How to cite this article:|
Salim Khan S M, Haq I, Saleem SM, Nelofar M, Bashir R. Goiter Survey among School Children (6–12 Years) in Northern Himalayan Region. Arch Med Health Sci 2017;5:204-7
|How to cite this URL:|
Salim Khan S M, Haq I, Saleem SM, Nelofar M, Bashir R. Goiter Survey among School Children (6–12 Years) in Northern Himalayan Region. Arch Med Health Sci [serial online] 2017 [cited 2019 Sep 17];5:204-7. Available from: http://www.amhsjournal.org/text.asp?2017/5/2/204/220835
| Introduction|| |
Iodine, a trace element, present in the human body in minute amounts (15–20 mg, i.e., 0.02” ×10” 3% of body weight) is an essential substrate for synthesis of thyroid hormones. Deficiency of iodine results in impairment of thyroid hormone synthesis, which in turn leads to hypothyroidism, and a series of functional and developmental abnormalities grouped under the heading of “iodine deficiency disorders (IDDs).” Iodine deficiency is a major health problem for all populations of the globe, particularly for pregnant women and young children, which results in abortion, stillbirth, mental retardation, dwarfism, cretinism, goiter of all ages, etc. Goiter is one of the most visible manifestations of IDD that is caused due to overstimulation of thyroid as an adaptation to iodine deficiency.
Globally, the prevalence of goiter in general population is estimated to be 15.8%. In India, an estimated 350 million people are at the risk of developing IDD due to inadequate consumption of iodized salt. Various surveys conducted by the Central Directorate General of Health Services, Indian Council of Medical Research, Health Institutions, and the State Health Directorates show that no state in India is free from iodine deficiency, and the sample surveys conducted in 29 states and seven union territories across the country showed that out of 390 districts surveyed, 333 districts reported total goiter rate (TGR) >10% and are endemic (prevalence of IDD >5%). As per the Coverage Evaluation survey 2009, the accessibility of quality iodized salt has a very wide gap between coverage among rural (85.6%) and urban communities (46.4%).
To identify areas of IDD, goiter surveys are conducted to estimate the region's iodine status. Goiter surveys are also a sensitive long-term indicator for the evaluation of an iodine program. As iodine deficiency has an immediate effect on child's school performance, that is why they are usually taken into account for goiter surveys.,
Literature search reveals that many studies have been conducted in different parts of India and Kashmir division to estimate the burden of IDD; no such study has been conducted in district Baramulla of Kashmir division which lies on either banks of river Jhelum, 1593 m above sea level and about 55 km away from the capital city of Srinagar. In view of this, we conducted this goiter survey among school-going children of district Baramulla, Kashmir division, to see the prevalence of IDD.
| Materials and Methods|| |
This cross-sectional study was conducted in district Baramulla of Kashmir valley from March 2017 to April 2017 among school-aged children of 6–12 years. Sample size calculation was based on a goiter prevalence of 30% and 95% confidence interval (CI). To select the study sample, cluster sampling was done. In the first stage cluster sampling, 30 clusters (i.e., villages) were selected by the probability proportionate to the size method. A sample of 90 children which consisted of 45 boys and 45 girls aged 6–12 years was selected randomly from each cluster. A total of 2700 children were examined. Prior permission to conduct the survey was obtained from the Institutional Ethical Committee and Director of the Education Department and informed consent from the Zonal Education Officer and school heads before the start of the study. All selected children were clinically examined by trained medical professionals, which included faculty members and postgraduate scholars from the Department of Community Medicine. Standard techniques were used to inspect and palpate the neck for the presence of any goiter, and the findings were recorded in a pro forma. Goiter was classified as per the World Health Organization (WHO) guide grading system as per the revised guidelines on the National Iodine Deficiency Disorder Control Programme (NIDDCP). Sum of Grade 1 and Grade 2 was taken as TGR.
Data were entered in Microsoft Excel 2007 and analyzed using SPSS Statistics v20.0 (IBM, Chicago, 104 and IL, USA). Outcome variables such as age, sex, and goiter grade were expressed as percentage. Chi-square test was used to see the statistical difference in age and sex with goiter grade. P < 0.05 was considered statistically significant.
| Results|| |
In this study, we studied a total of 2700 school children in the age group of 6–12 years from district Baramulla with a mean age of 9 ± 1.86 years. 50.07% were boys. The age distribution prevalence of goiter among school children (6–12 years) in district Baramulla is shown in [Table 1], which was observed to be 15.29% with the highest prevalence seen among school children of age 10–12 years (61.7%). The prevalence of Grade 1 goiter was more than twentyfold higher than Grade 2 goiter. The highest prevalence of Grade 1 and 2 goiter was seen among school children of 12 years age (25.19% and 1.81%, respectively). [Table 2] shows age and sex comparison of goiter grades in district Baramulla, and it is clearly evident that females have a higher prevalence of Grade 1 and Grade 2 goiter (17.58%). The relationship of goiter prevalence with gender and age was statistically significant (P value for age: <0.05 and P value for gender: <0.05).
|Table 2: Age and gender comparison of goiter grades in district Baramulla|
Click here to view
| Discussion|| |
Universal salt iodization, which means that all the salt used for human and animal consumption is iodized, is the most common widely used strategy to control iodine deficiency. In June 1992, the National Goiter Control Programme in India was redesigned as “NIDDCP,” in recognition of the spectrum of disorders due to iodine deficiency. Until the 1990s, total goiter prevalence was used as the primary indicator for the assessment of population iodine deficiency. The population group most often assessed to reflect iodine deficiency in a population is school-aged children, because they are the most efficient and practical group to survey and usually reflect the status of the general population.
Goiter is still a big public health problem in developing countries. In this study, TGR was found to be 15.29% (95% CI ± 1.35). 14.70% (95% CI ± 1.33) children had Grade 1 goiter with figures higher in girls (16.83%) (95% CI ± 1.41) than in boys (12.57%) (95% CI ± 1.23). Grade 2 goiter was present in 0.59% of surveyed children with figures slightly higher in girls (0.74%) than boys (0.44%). Similar findings were observed by Rafiq et al. in a study conducted in Srinagar district of Kashmir valley, where TGR in the study population was found to be 15.27%, and the overall prevalence of Grade 1 goiter was 14.69% (girls 16.35%; boys 13.38%) and that of Grade 2 goiter was 0.59%. A study conducted by Gupta et al. in Lucknow showed a TGR of 12.7%. Bhat et al. also have reported the TGR of 11.9% in Jammu region. The prevalence of goiter in another study by Chaudhary et al. in Ambala was 12.6%. Another study conducted by Singh et al. among children in 6–12 years in rural Northwest India found the prevalence of goiter was 12.1%. An earlier study conducted by Zargar et al. had found the TGR to be 52.08% with Grade 1 goiter in 41.95% and Grade 2 goiter in 10.1% in children of Baramulla district of Kashmir valley. The prevalence was higher in boys (52.08%) than in girls (49.23%), which are not in accordance with the results of this study. Another study conducted by Zargar et al. in the same area in 1995 showed a TGR of 45.2% with 43.9% among boys and 46.2% in girls. Overall prevalence of goiter in the Kashmir valley has seen a decline in the past decade as shown by the findings of a study conducted by Khan et al. among school-going children of 6–12 age group conducted in district Kulgam of Kashmir valley where TGR was found to be 18.9% with Grade 1 goiter at 18.5% and Grade 2 goiter at 0.4%. Furthermore, in our study, we found a decline of TGR, Grade 1 and Grade 2 goiters among school-going children from the previous studies which were conducted in the valley,,,,, which clearly indicates that the prevalence of goiter has declined in the Kashmir valley which can be attributed to better awareness and sustained IEC activities by the government about the use of iodized salt.
The prevalence of goiter was higher in girls (17.58%) than in boys (13.01%). This was consistent with the findings of a study by Rafiq et al. conducted in Srinagar district of Kashmir valley which showed that the rate was higher in girls (17%) as compared to boys (13.67%). The prevalence of goiter was found to be higher in females (16.12%) than in males (10.10%) as reported by another study by Bhat et al. Another study by Zama et al. in school children of district Chamarajanagar, Karnataka, India, found the TGR was higher in females (54.63%) as compared to males (45.37%). The study by Sahu et al. conducted in Orissa showed a similar pattern with the prevalence more in girls (23.1%) than boys (17.3%). Gupta et al. in a study conducted in Lucknow, India, also reported a higher prevalence of goiter among females (19.9%) than in males (6.8%). A study conducted by Biradar et al. in district Ramanagara, Karnataka, India, showed females had a higher prevalence of 35.3% as compared to males with the prevalence of 31.4%. All the above-mentioned studies are in accordance with the results of our study where there is female predominance in the prevalence of goiter. This may be attributed to the higher demand of iodine in the females and consumption of foods deficient in iodine. Females usually prefer to eat oily and junk food which is iodine deficient. Furthermore, it is evident from the results that with the increasing age, the prevalence of goiter also increased. Maximum goiter cases were found in the age group of 12 years which may be attributed to high basal metabolic rate and increased demand at the time of puberty both in boys and girls, respectively. The present study shows that the national program has had much impact in lowering down the prevalence of goiter in district Baramulla, Kashmir division.
| Conclusion and Recommendations|| |
According to the WHO/UNICEF/ICCIDD, a TGR of 5% or more in primary school children (6–12 years) signals to the presence of a public health problem. The present study showed mild goiter prevalence in school-aged children of 6–12 years in the district Baramulla of Kashmir valley. There is a dire need of periodic surveys to assess the magnitude of the IDD in context to the impact of the iodized salt intervention, providing iodized salt to the public, strengthening, monitoring, and evaluating the IDD program, which are essential to achieving sustainable elimination of IDD in India.
We would like to acknowledge the services and assistance of the Directorate of Education, Chief education officers, principals/head of institutions, teachers, and students who took part in the survey.
Financial support and sponsorship
This study was supported by the NIDDCP.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Delange F. The disorders induced by iodine deficiency. Thyroid 1994;4:107-28.
Dumont JE, Ermans AM, Maenhaut C, Coppée F, Stanbury JB. Large goitre as a maladaptation to iodine deficiency. Clin Endocrinol (Oxf) 1995;43:1-0.
De Benoist B, Andersson M, Egli I, Takkouche B, Allen H. Iodine status worldwide. WHO Global Database Iodine Deficiency. Geneca, World Health Organzation; 2004. p. 1-12.
Pandav CS, Yadav K, Srivastava R, Pandav R, Karmarkar MG. Iodine deficiency disorders (IDD) control in India. Indian J Med Res 2013;138:418-33.
] [Full text]
World Health Organisation. The World Health Report: Reducing Risks, Promoting Healthy Life. Geneva: World Health Organisation; 2002.
Hetzel BS, Dunn JT, Stanbury JB, editors. The Prevention and Control of Iodine Deficiency Disorders. Amsterdam: Elsevier Science Publishers BV; 1987.
Hetzel BS. The Story of Iodine Deficiency: An International Challenge in Nutrition. Oxford and New Delhi: Oxford University Press; 1989.
DeMaeyer EM, Lowenstein FW, Thilly CH. The control of Endemic Goitre. World Heal Organ. 1979;1–86.
World Health Organisation. Assessment of the Iodine Deficiency Disorders and Monitoring their Elimination. Geneva: WHO; 2007. p. 1-107.
Rafiq M, Jan R, Ashfaq Ahamad Y. Goitre prevalence survey in school going children (6-12 years) of Srinagar district of J&K. J Evol Med Dent Sci 2013;2:4630-7.
Gupta P, Srivastava JP, Zaidi ZH, Srivastava MR. A study to assess the iodine deficiency disorder and salt consumption pattern in Lucknow. Int J Community Med Public Health 2015;2(1):29–32.
Bhat IA, Pandit IM, Mudassar S. Study on prevalence of iodine deficiency disorder and salt consumption patterns in Jammu region. Indian J Community Med 2008;33:11-4.
] [Full text]
Chaudhary C, Pathak R, Ahluwalia SK, Goel RK, Devgan S. Iodine deficiency disorder in children aged 6-12 years of Ambala, Haryana. Indian Pediatr 2013;50:587-9.
Singh G, Kaur G, Vijay Mengi SK. Difference in prevalence of goitre among school children (6-12 years) in rural North-West, India. Public Health Res 2013;3:79-84.
Zargar AH, Shah JA, Masoodi SR, Laway BA, Shah NA, Mir MM, et al.
Prevalence of goitre in school children in Baramulla (Kashmir valley). Indian J Pediatr 1997;64:225-30.
Zargar AH, Shah JA, Mir MM, Laway BA, Masoodi SR, Shah NA, et al.
Prevalence of goiter in schoolchildren in Kashmir Valley, India. Am J Clin Nutr 1995;62:1020-1.
Khan SM, Mahjabeen R, Masoodi MA, Kauser J, Nabi S. Prevalence of goitre among primary school children of Kulgam District, Jammu & Kashmir, India. Acad Med J India 2014;2:18-21.
Zama SY, Ahmed M, N
V. Prevalence of goitre in school children of Chamarajanagar district, Karnataka, India. J Clin Diagn Res 2013;7:2807-9.
Sahu T, Sarani NC, Satpathy DM, Behera TR. Prevalence of Goiter in 6-12 Year Children of Kandhamal District in Orissa. Indian J Community Med 2005;30:12-3.
Biradar MK, Manjunath M, Harish BR, Goud NB. Prevalence of iodine deficiency disorders among 6 to 12 years school children of Ramanagara district, Karnataka, India. Int J Community Med Public Health 2016;3:166-9.
[Table 1], [Table 2]