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Indian Journal of Community Medicine

Prevalence of Goiter in 6-12 Year Children of Kandhamal District in Orissa

Author(s): T. Sahu, N.C. Sahani, D. M. Satapathy, T.R. Behera

Vol. 30, No. 2 (2005-04 - 2005-06)

Abstract

Research questions: What is the prevalence of goiter among 6-12 year children in a tribal district of Orissa? Objectives: To unfold the goiter problem and its severity as public health problem at district and sub district (block) level. Study design: Cross-sectional Setting: Randomly selected 30 cluster villages and schools in 3 randomly selected blocks of Kandhmal district of Orissa. This district of Kandhmal is predominantly inhabited by Tribals, having difficult areas of hills and forests in most parts. Participants: 1,448 children in 6-12 year age group in community and school. Study variables: Goiter rate, severity of goiter as public health problem, sex of children, grade of goiter. Statistical analysis: Qualitative and quantitative method, proportions, chi square test. Results: Goiter as severe public health problem with overall prevalence of 30.18% in Kandhamal district without significant difference in the blocks. The prevalence was significantly more in girls than boys. School survey was found more suitable over community survey in detection of goiter in this age group in the tribal region.

Conclusion: Prevalence study shows goiter as an important public health problem in the district of Kandhamal and calls for further epidemiological evaluation in tribal context to identify the factors to strenghten NIDDCP.

Key Words: Prevalence of goiter, Iodine Deficiency Disorders (IDD), Goiter survey

Introduction

Role of Iodine as an essential micronutrient in both physical and mental growth as well as development has been established by the biomedical scientists, nutritionists and clinicians. But it is difficult to appraise the community regarding the consequences of the deficiency of iodine as the associated morbidity conditions are insidious in onset and rarely result in fatalities.

The term "IDD" as proposed in 1983 referes to all effects of iodine deficiency on growth and development in human and animal population, which can be prevented by correcting the deficiency1. But the effects are ill appreciated and never attributed to iodine deficiency due to lack of awareness among the people except the visible physical swelling of thyroid (goiter) which raises the concern from cosmetic point of view. Many studies conducted in all over India have shown high prevalence of goiters2-9.

Paucity of clinical, laboratory and epidemiological data in Orissa makes it difficult to understand the magnitude of the problem. Therefore an attempt was made to find out the goiter problem in the Kandhamal district of Orissa, a tribal district with hills and forests covering 58% area of the district and more than 45% tribal population (Census 2001).

Material and Methods

According to 2001 Census 647, 912 populations live in 3,759 villages and hamlets of 12 blocks in Kandhamal district. Geographically the district area was divided into three zones according to the distance from seacoast (Bay of Bengal). One block in each zone was randomly selected. 10 cluster villages were selected randomly in each block so as to get 30 cluster villages in the district for goiter survey.

The result of National Family Health Survey (NFHS-2) 1998­99 suggests consumption of iodized salt by 70.4% households in Orissa10. The sample size was calculated basing on this information and a minimum of 686 households with 6-12 years age group children were to be verified in the 30 cluster villages. In each cluster village, 23 households with one 6-12 years age group child were examined for thyroid gland enlargement. In villages where 23 such households were not found, all available households with 6-12 year children were taken in to consideratin. One child was selected at random when there was more than one in the age group of 6-12 years present in single houshold. The age of the child was verified from the memory of the parents referring the important events (fairs/ festivals/other memorable dates).

The Upper Primary Schools were randomly selected to have proportionate sample in three blocks. Number of schools in each block was decided basing on their school registration to cover double the calculated sample size considering 50% absentees in tribal schools. The students from class II to VII were examined after verification of their age from school register. The diagnosis of goiter was based entirely on inspection and palpation of the neck as per the techniques of examination laid out in the Policy guidelines on NIDDCP8 and the goiter grade was done as per WHO/UNICEF/ICCIDD guideline5.

Appropriate modifications were made to select the target households and individuals for examination considering the local tribal settlements at different places in the district. The study was conducted from October 2003 to March 2004.

Results and Discussion

In total 1,448 children were clinically examined for presence or absence of goiter out of which 843 children were examined during community survey and 605 during school survey. Out of 1,448 children examined 437 (30.18%) had goiter.The district is endemic for goiter according to criteria laid by WHO11. Iodine Deficiency Disorders (IDDs) pose a severe public health problem in the district (PR>30%). All three blocks were found endemic for goiter (PR>5%) of which the severity of goiter problem is moderate in one block (PR 20.0-29.9%) and severe in other two blocks (>30%). The difference in prevalence of goiter in different blocks was not significant (X2 =3.53, df=2, p>0.05). (Table-I)

Table I - Goiter Prevalence in Children in Kandhamal District

Name of the block Children
Examined
(6-12 yrs.)
Goiter Prevalence
rate
Severity as
Public health
problem
n %

Khajuripada

577

176

30.5

Severe

Raikia 415 137 33.0 Severe

Daringbadi

456

124

27.2

Moderate

Total 1448 437 30.18 Severe

Prevalence of goiter in boys was 27.38% and in girls 33.14% in the same age group. The sex wise difference was found significant (X2 =5.67, df=1, p<0.02). In Khajuripada block where male and female children were equally affected, goiter was found proportionately more in female children in other two blocks. The higher prevalence of goiter in girls may be due to puberty related iodine metabolism in this age.

Table II - Goiter Detected By School and Community Survey*

Name of block School survey Community survey
Examined
n
Goiter
n
Prevalence
rate (%)
Examined
n
Goiter
n
Prevalence
rate (%)
Khajuripada 261 105 40.22 316 71 22.46
Raikia 167 52 31.13 248 85 34.27
Daringbadi 177 55 31.07 279 69 24.73
Total 605 212 35.04 843 225 26.69
* X2 = 11.66, d.f. = 1, P <0.01

In the present study school survey could detect more cases of goiter as compared to community survey. Hence school survey approach seems to be more suitable to catch the goiter cases in community and may be adapted in all situations. The difference in prevalence estimated in community and school settings was found highly significant (X2 =11.66, df = 1, p<0.001). (Table II)

The prevalence was found as low as 1% in Emakulum district of Kerala, 2.6% in the state of Pondicherry and 9.5% in Portblair among 6-12 years school children and the authors attributed it to the possible adequacy of dietary intake of iodine in the state.12,13,14

Conclusion and Recommendation

Goiter in 6-12 years children in of Kandhamal district of Orissa with overall prevalence 30.18% amounts to severe public health problem. Iodine deficiency, being multi factorial, needs further epidemiological evaluation in tribal settings. The problem of iodine deficiency should be unfolded in other districts as it is no more limited to goiter belt, as it was thought, School survey should preferably be adopted to assess the goiter problem in the community.

Acknowledgements

The authors thank IDD Cell, Directorate of Health Services, Government of Orissa and district school health authority of Kandhamal for their cooperation and support to carry out the study in Kandhamal district.

References

  1. Hetzel B.S. Iodine deficiency disorders (IDD) and their eradicatiion. The Lancet, 1983; 2:1126-9.
  2. WHO/UNICEF/ICCIDD. Progress towards the elimination of Iodine deficiency disorders (IDD). Geneva: WHO, 1999. Unpublished document WHO/NHD/99, 4.2.
  3. IDD and Nutrition Cell, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India. New Delhi, 2000.
  4. ICMR Task Force Study. Epidemiological survey of endemic goiter and endemic cretinism. Indian Council of Medical Research, New Delhi, 1989.
  5. Report of a Joint WHO/UNICEF/ICCIDD Consultation on Indicators for Assessing Iodine Deficiency Disorders and their Control Programmes. Geneva : World Health Organization, 1992; 22-29.
  6. ICMR Bulletin. Control of Iodine deficiency through safe use of iodised salt 1996; 26 (6): 41-46.
  7. Srinivasa Rao, P. Iodine deficiency Disorders - Goitrogens and Brain Development Nutrition News, 1995;16, 3.
  8. IDD and Nutrition Cell, DGHS, Ministry of HandFW, GOI, Policy Guidelines on National Iodine Deficiency Disorders Control Programme (NIDDCP). New Delhi. 2003; pp10.
  9. Mohapatra SSS, Bulliyya G, Kerketta AS, Acharya AS: Thyroxine and Thyrotropin Profine in Neonates and School Children in an Iodine Deficiency Disorders Endemic Area of Orissa. The Ind. J. Nutr. Dietet. 2001;38:98-101.
  10. Towards Sustaining Elimination Iodine Deficiency Disorders in Kerala. Govt. of Kerala/ICCIDD/UNICEF. 2001; pp127.
  11. Registrar General and Census Commissioner India. Census of India 1991. Final population tables, Coimbatore, Government of India Press. 1993.
  12. Kapil U, Ramchandran S, Tandon M. Assessment of Iodine Deficiency in Pondicherry. Indian Pediatrics 1998 ; 35 : 357­359.
  13. Kapil U, Tandon M, Pathak P. Assessment of Iodine Deficiency in Emakulam District, Kerala State. Indian Pediatrics 1999 ; 36:178-180.
  14. Kapil U, Ramchandran S, Tandon M. Assessment of Iodine Deficiency in Andaman District of Union Territory of Andaman and Nicobar. Indian J Mat Chld. Hlth. 1998; 9:19-20.
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