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of Gujarat have withdrawn the ban on sale of non-iodization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
- Desai VK, Kumar Pradeep. A Book on Iodine Deficiency
Disorders (IDD) in Gujarat, 1995.
- Hetzel BS, Pandav CS. S.O.S. for a Billion: The conquest of
Iodine Deficiency Disorders, 1994.
- Government of India. Draft Policy Guidelines on National Iodine
Deficiency Disorders, 1997.
- About IDD-www.who.org
- Khan QH, Singh MP – Iodine Deficiency Disorders in Amreli
district Gujarat state A report on the resurvey – 2000 -
Unpublished Report, 2000.
- 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]
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
- Desai VK, Kumar Pradeep. A Book on Iodine Deficiency Disorders (IDD) in Gujarat, 1995.
- Hetzel BS, Pandav CS. S.O.S. for a Billion: The conquest of Iodine Deficiency Disorders, 1994.
- Government of India. Draft Policy Guidelines on National Iodine Deficiency Disorders, 1997.
- About IDD-www.who.org
- Khan QH, Singh MP – Iodine Deficiency Disorders in Amreli district Gujarat state A report on the resurvey – 2000 - Unpublished Report, 2000.
- 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]
