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Indian Journal of Community Medicine

Changing Prevalence of I.D.D. in Bhavnagar District

Author(s): P B Verma, M P Singh

Vol. 31, No. 3 (2006-07 - 2006-09)

P B Verma, M P Singh

Introduction

Iodine deficiency once considered a minor problem, causing goitre, an unsightly, but seemingly benign cosmetic blemish, is now known to be the most common preventable cause of mental handicap in the world. Previously it was thought that Iodine deficiency is present only in the foothill areas and some pockets in the tribal areas of the country, but now it is known that the problem of Iodine deflciency disorders is prevalent all over the country. In our country it is estimated that about 200 million people are at the risk of 1DD, while the number of persons suffering from goitre and other iodine deficiency disorder is above 70 million. The surveys conducted by the Central and State Health Directorates, ICMR and Medical Institutes have clearly demonstrated that not even a single State/Union Territory is free from the problem of IDD. Out of 275 districts surveyed so far, 1DD is endemic in 235 districts where the prevalence of 1DD is above 10 percent. Permanent brain damage, because of deficiency of iodine during pregnancy cannot be treated, but it is very simple to prevent. Government of India made it compulsory to sell only iodized salt to prevent this problem. However recently Government of India and then Government of Gujarat have withdrawn the ban on sale of non-iodization of salt. We have tried to reemphasize the importance of Universal Salt Iodization (USI) in this paper.

Material and Methods

The study was conducted in the entire 12 Talukas of Bhavnagar district by covering 1% of rural population and 5% of school children. The list of villages, primary schools and population were obtained from the Jilla Panchayat of Bhavnagar. Simple random sampling was done to identify villages and primary schools in all Talukas so as to cover 1% of the village population and 5% of the school children. Separate villages for village population survey and school survey were selected.

Information from all individuals were collected and recorded in standard proforma. After recording the preliminary information, all cases were phyically examined. Cases of goitre were identified and classified by using the latest classification given by W.H.O., which is easier in comparison of older ones. Cases of other manifestations of IDD like mental retardation, cretinism and deaf-mutism were recorded separately.

Results

A total of 20456 individuals of 12 Talukas were examined for the presence of goitre or any other manifestation of Iodine deficiency disorder. Out of them 237 were having goitre giving the prevalence of 1.59%. Out of 237 cases of goitre 225 were of grade I (94.93%) and only 12 (5.06 %) were of grade II. In the community, females had significantly higher prevalence of goitre than males (P<0.05). Prevalence of goitre has increased with the age till 19 years and then it has came down means the prevalence of goitre is maximum among teenagers.

Table I: Prevalence of Goitre in the Community of Bhavnagar District

Age Sex No. of People Gr. I Gr. II Total Percentage
0-4 M 1259 3 0 3 0.24
  F 1170 3 0 3 0.26
  T 2429 6 0 6 0.25
5-9 M 1404 13 0 13 0.93
  F 1266 16 0 16 1.26
  T 2670 29 0 29 1.09
10-14 M 1318 20 0 20 1.52
  F 1231 24 0 24 1.95
  T 2549 44 0 44 1.73
15-19 M 1221 20 0 20 1.64
  F 1119 26 2 28 2.50
  T 2340 46 2 48 2.05
20 &
above
M 5291 36 2 38 0.72
  F 5177 64 8 72 1.40
  T 10468 100 10 110 1.05
Total M 10493 92 2 94 0.90
  F 9963 133 10 143 1.44
  T 20456 225 12 237 1.16

To know the prevalence of goitre among school children, a total of 286313 children were examined; out of them 486 (3.09 %) were found to be having goitre. Out of them 477 (98.15 ) were of grade I and only 9 (1.85) were of grade Il. The prevalence of goitre was significantly higher among males than females (P<0.05).

Table II: Prevalence of Goitre Among School Children of Bhavnagar District

Age Sex Total Examined Stage of
Goitre
Total
I II No. Percentage
5-7 M 2673 78 2 80 2.99
  F 2411 45 0 45 1.90
  T 5084 123 2 125 2.46
8-10 M 2938 116 1 117 3.98
  F 2536 69 0 69 2.72
  T 5474 185 1 186 3.40
11 &
above
M 2791 92 4 96 3.44
  F 2384 77 2 79 3.31
  T 5175 169 6 175 3.38
Total M 8402 286 7 293 3.49
  F 7331 191 2 193 2.63
  T 15733 477 9 486 3.09

Table III: Prevalence of Goitre in the Community Survey of Various Talukas of Bhavnagar District, 1992 vs. 2000

Taluka 1992 Survey Rate/100 2000 Survey Rate/100
Bhavnagar 5.8 1.1
Batad 1.7 0.9
Gadhda 2.4 0.8
Gariyadhar 3.6 1.4
Ghogha 3.1 1.4
Mahuva 6.5 0.8
Palitana 4.5 1.7
Savarkundla 4.3 1.6
Sihor 2.5 0.8
Talaja 5.2 1.6
Umarala 4.0 1.0
Valbhipur 5.2 0.7
Total 4.2 1.37

When current prevalence was compared with the baseline data of 1992 survey, it was found that prevalence rate of goitre has decreased in all the Talukas (P<0.05). The prevalence rate of goitre was reduced also among the school children of the district (P<0.05)

Discussion

As per the guidelines of NIDDCP, all the districts are to be resurveyed every five years for the prevalence of IDD, which can tell us the impact of control measures, i.e., Universal Salt Iodization. The results of present study clearly indicate that USI has favorable effect on the prevalence of IDDs, though the effect of other factors can not be denied. The difference in the prevalence of goitre in the baseline survey of 1992 and re-survey of 2000 is highly significant. These results are in line of re-surveys of other districts (5, 6, & 7). The prevalence of goitre is maximum among teenagers because of physiological demand, which is evident in the present study also. Looking at these results, it is desirable that government should continue Universal Salt Iodization; else it will adversely affect the NIDDCP, which will be realized only after a decade or so.

Table IV: Prevalence of Goitre Amongst Primary School Children Survey in Various Talukas of Bhavnagar District, 1992 Vs. 2000

Taluka 1992 Survey Rate/100 2000 Survey Rate/100
Bhavnagar 9.5 7.7
Batad 4.3 4.3
Gadhda 3.2 2.3
Gariyadhar 5.6 2.7
Ghogha 4.2 3.3
Mahuva 10.2 1.5
Palitana 9.6 3.7
Savarkundla 8.7 2.5
Sihor 5.2 3.5
Talaja 7.0 2.5
Umarala 7.2 4.0
Valbhipur 5.3 1.7
Total 6.9 3.09

References

  1. Desai VK, Kumar Pradeep. A Book on Iodine Deficiency Disorders (IDD) in Gujarat, 1995.
  2. Hetzel BS, Pandav CS. S.O.S. for a Billion: The conquest of Iodine Deficiency Disorders, 1994.
  3. Government of India. Draft Policy Guidelines on National Iodine Deficiency Disorders, 1997.
  4. About IDD-www.who.org
  5. Khan QH, Singh MP – Iodine Deficiency Disorders in Amreli district Gujarat state A report on the resurvey – 2000 - Unpublished Report, 2000.
  6. Kartha GP, Verma PB, Lala MK. A Report on resurvey on the prevalence of Iodine Deficiency Disorders in Ahmedabad, Gandhinagar & Mehsana districts Gujarat State. – Unpublished Report, 1999.

Deptt. of Preventive and Social Medicine, Medical College. Bhavnagar-364 001.
E-mail: [email protected]

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