The prevalence of insufficient iodine intake in pregnancy in Africa: protocol for a systematic review and meta-analysis

Prevalence of Hypothyroidism in Pregnancy and Its Associations with Adverse Pregnancy Outcomes Among Pregnant Women in A General Hospital: A Cross Sectional Study

Background

Hypothyroidism affects 3-5% of all pregnant mothers, making it the most common thyroid disorder associated with pregnancy. Furthermore, it is associated with adverse outcomes of pregnancy and newborn. Therefore, this research is aimed at determining the magnitude and pregnancy adverse outcomes associated with hypothyroidism among pregnant women having maternity services in a general hospital in Somalia.

Methods

A cross-sectional study was conducted on pregnant women who delivered in the hospital between December 2022 and May 2023. Subjects were selected through systematic sampling and data collected through an interviewer-based questionnaire. Adjusted odds ratios (AORs) of P values and 95% confidence intervals (CIs) were used to assess the correlation between variables.

Results

The prevalence of hypothyroidism was 23.6% (95% CI: [19.4-27.8]). Overt DM (AOR=9.125, CI (3.106-26.812)), History of Recurrent pregnancy loss (AOR=12.938, CI (4.958-33.763), hypertension during pregnancy (AOR=6.718, CI (2.326-19.994)) and preterm delivery (AOR=7.015, CI (3.234-13.958)) were variables associated with hypothyroidism in pregnancy.

Conclusion

The study has shown a high prevalence of hypothyroidism during pregnancy at Daruxannan Hospital compared to previous studies around the world. This finding highlights the need for national and regional surveys to identify the prevalence and associated factors that contribute to hypothyroidism in pregnancy to set up interventions and determine policy directions.

Nearly one-in-five households utilized inadequate iodized salt in Nifas Silk Sub-City, Addis Ababa, Ethiopia

BACKGROUND

There is no country in the developing world where iodine deficiency is not a public health problem including Ethiopia. Therefore, this study aimed to assess inadequate utilization of iodized salt and associated factors at household level in woreda 11 Nifas Silk Sub-city, Addis Ababa, Ethiopia.

METHODS

A community-based cross-sectional study was conducted with multistage sampling technique on 348 household respondents. The data were collected using interviewer-administered structured questionnaires and an iodine rapid test kit. The data were edited, cleaned, and entered using Epi-data version 4.6.2 and exported to SPSS version 25 for analysis. A multivariable logistic regression model was fitted to identify associated factors for inadequate utilization of iodized salt. The statistical significance was declared at a p-value of less than 0.05 with 95% confidence interval.

RESULTS

A total of 348 household respondents were participated. The amount of iodine content in salt 0 ppm, < 15ppm and > 15ppm were 11.8%, 7.2% and 81.0% respectively. Total inadequate utilization of iodized salt was 19%. Using unpacked salt [AOR; 0.50 (95%CI: 0.27, 0.93)], using a container without a lid [AOR; 0.29 (95%CI: 013, 0.63)], and having insufficient knowledge [AOR; 2.10 (95%CI: 1.14, 3.86)] were all significantly connected with using inadequate iodized salt.

CONCLUSIONS

Iodized salt utilization was inadequate. Using containers without a lid, unpacked salt, and poor knowledge were associated factors. There should be a provision of adequate knowledge about iodized salt, a proper storage and handling.

The prevalence of insufficient iodine intake in pregnancy in Africa: a systematic review and meta-analysis

BACKGROUND

Fortification of foodstuffs with iodine, mainly through iodization of salt, which commenced in several African countries after 1995 is the main method for mitigating iodine deficiency in Africa. We assessed the degree of iodine nutrition in pregnancy across Africa before and after the implementation of national iodine fortification programs (CRD42018099434).

METHODS

Electronic databases and gray literature were searched for baseline data before implementation of population-based iodine supplementation and for follow-up data up to September 2020. R-metamedian and metamean packages were used to pool country-specific median urinary iodine concentration (UIC) estimates and derived mean UIC from studies with similar features.

RESULTS

Of 54 African countries, 23 had data on iodine nutrition in pregnancy mostly from subnational samples. Data before 1995 showed that severe iodine deficiency was prevalent in pregnancy with a pooled pregnancy median UIC of 28.6 μg/L (95% CI 7.6-49.5). By 2005, five studies revealed a trend towards improvement in iodine nutrition state in pregnancy with a pooled pregnancy median UIC of 174.1 μg/L (95% CI 90.4-257.7). Between 2005 and 2020 increased numbers of national and subnational studies revealed that few African countries had sufficient, while most had mildly inadequate, and some severely inadequate iodine nutrition in pregnancy. The pooled pregnancy median UIC was 145 μg/L (95% CI 126-172).

CONCLUSION

Improvement in iodine nutrition status in pregnancy following the introduction of fortification of foodstuffs with iodine in Africa is sub-optimal, exposing a large proportion of pregnant women to the risk of iodine deficiency and associated disorders.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018099434.

Prevalence of goiter and iodine deficiency in indigenous pregnant women from five nonmetropolitan areas of Colombia 2019

Objective: To assess the prevalence of goiter and iodine deficiency in indigenous pregnant women coming from five non-metropolitan areas in Colombia. Materials and methods: Descriptive cross-sectional cohort study that included pregnant women of any gestational age with no pregnancy-related conditions, seen in community health centers or in their homes. Patients with comorbidities at the time of pregnancy and those who were receiving iodine supplementation were excluded. Simple random sampling was used. The sociodemographic and obstetric characteristics, urinary iodine concentration and the presence of goiter were measured in accordance with the World Health Organization methodology. A descriptive analysis was performed. Results: Of 189 indigenous pregnant women who were candidates to enter the study, 2 declined participation, and 62 had exclusion criteria, and 125 were included in the final analysis. The mean urinary iodine concentration was 184.4 μg/L (min-max: 12.0-390.0). A total of 42 women (33.6%) had iodine deficiency (< 100 μg/L), and goiter (grade 1-2) was found in 43 (34.4%). No grade 3 or 4 goiter was identified. Conclusions: A high prevalence of goiter and iodine deficiency was found in indigenous pregnant women living in non-metropolitan areas. There is a need to assess maternal and perinatal effects and to implement nutritional interventions.

Spectrum and Prevalence of Thyroid Diseases at a Tertiary Referral Hospital in Mogadishu, Somalia: A Retrospective Study of 976 Cases

BACKGROUND

Thyroid disorder is one of the most common noncommunicable diseases worldwide and neglected public health issues in Somalia. The aim of the study thus was to investigate the thyroid disorders in patients attending to the largest tertiary referral hospital in Somalia.

METHODS

This retrospective study was conducted on patients admitted to the internal department of Somalia Mogadishu-Turkey Education and Research Hospital, Somali, between January 2017 and December 2019. Patients who were tested for thyroid function tests and had complete data were included. Patients with incomplete data and currently treated for any thyroid disorder were excluded from the study. Abstracted data including patients' sociodemographic characteristics, thyroid function tests, and histopathological findings were retrieved from the hospital database system.

RESULTS

A total of 976 patients with thyroid disorders were enrolled, of whom 66.6% (n = 650) were female and 33.4% (n = 326) were male. The mean age of the patients was 47 ± 18.5 years. The majority of the patients were reported in the 31-50 (35.9%) age range. The most reported thyroid function disorders were 58.8% euthyroid sick syndrome followed by 15.4% hypothyroidism, 12.5% subclinical hypothyroidism, 7.6% hyperthyroidism, and 5.7% subclinical hyperthyroidism. The distribution of comorbidity indicated that 13.4% had diabetes mellitus, 10.4% had HIV, 4.9% had malaria, and 4.5% had HIV and malaria coinfection. Thyroid malignancies were detached in 22 (2.2%) patients including eleven papillary thyroid cancer, nine patients had follicular thyroid cancer, and two patients had differentiated thyroid cancer.

CONCLUSIONS

Euthyroid sick syndrome was the most common type of thyroid disease in our setup. Hypothyroidism is the second most common, followed by subclinical hypothyroidism. Papillary thyroid cancer was the predominant histology among thyroid malignancies, followed by follicular thyroid cancer. This study revealed that thyroid diseases emerge as an important endocrine disorder encountered in Somali, necessitating a major public health response.