Dietary pattern and its association with iodine deficiency among school children in southwest Ethiopia; A cross-sectional study

Prevalence of iodine deficiency and associated factors among school-age children in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Currently, iodine deficiency has become a significant burden globally; where 2 billion people and 29.8% of school-age children are iodine deficient. It is a leading cause of preventable brain damage among children, resulting in impaired cognitive and motor development. Even though salt iodization was started to be implemented to alleviate this burden in Ethiopia, primary studies assessing iodine deficiency in the country show highly variable findings, and no systematic review was conducted to determine the pooled prevalence of the problem which makes it difficult to assess the effect of the intervention as well as to design appropriate and timely measures. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of iodine deficiency and the common factors affecting its occurrence among school-age children in Ethiopia.

METHOD

To obtain the eligible studies, databases (EMBASE, Scopus, Hinari, and PubMed), websites (Google and Google Scholar), and references of the eligible studies were searched systematically. Data were extracted using an Excel spreadsheet and analyzed using the STATA 17 version. The I2 test was used to assess heterogeneity between the studies. A DerSimonian and Laird random-effects model was used to estimate the pooled prevalence and pooled odds ratio. A funnel plot and Egger's test were used to detect publication bias.

RESULT

A total of 15 eligible studies, representing 15,611 school-age children, were included in the systematic review and meta-analysis. The pooled prevalence of iodine deficiency among school-age children in Ethiopia was found to be 58% (95%CI 44.00-77.00), while the highest prevalence was recorded in the Oromia Region, which was 64% (95% CI 49-79). Goitrogenic food consumption (adjusted odds ratio (AOR) 2.93, 95% CI 1.60-5.35) and being female (adjusted odds ratio (AOR) 1.87, 95% CI 1.43-2.44) showed a significant association with the prevalence of iodine deficiency.

CONCLUSION

Iodine deficiency among school-age children in Ethiopia was noticeably high. Goitrogenic food consumption and the sex of the child were determinant factors for the occurrence of iodine deficiency among the children. Therefore, appropriate advice should be given to households to limit goitrogenic foods in the diet of their children by giving due attention to their female children.

Thyroid Malignancy in Patients Who Underwent Thyroidectomy for Multinodular Goiter and Solitary Thyroid Nodule

PURPOSE

Worldwide, incidence of thyroid malignancy is increasing. The purpose of this study was to evaluate the pattern and magnitude of nodule types.

METHODS

A cross-sectional retrospective study was performed at Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia, among patients who underwent thyroidectomy from May 2018 to June 2022. Data were extracted using a structured format. Descriptive statistics were performed using SPSS version 26 software. Results were presented in terms of percentages and frequencies.

RESULTS

During a 4-year period, 1,476 patients had thyroidectomies and histopathologic information of 212 malignant cases was studied. Within multinodular goiter (MNG), thyroid cancer accounted for 69.8% (n = 148) of patients, whereas in solitary nodules, it accounted for 30.2%. From the total, 160 participants (75.5%) were female, and the female:male ratio was 3.1 (mean, 41.72; ± standard deviation [SD], 16.44) years, and age range of 12-88 years versus men, who have a mean of 44.71 (±SD, 14.91) years and an age range of 21-78 years. The mean age of male cases with solitary nodule and MNG was 40.6 and 46.5 years, respectively. The most frequent cancer in both types of nodules, accounting for 59% of patients, was papillary carcinoma, which was found in 64% of solitary nodules and 57.4% of multinodular nodules. Overall, 14.1% of tumors had multiple centers (17.4% in multinodular nodules and 6.9% in solitary nodules). In 7.1% of patients, microcarcinoma (<1 cm) was found, with papillary carcinoma accounting for 91.7% of the total.

CONCLUSION

Compared with men, women with cancer typically manifested at a younger age. Males with malignancy in solitary nodules had a lower mean age than those with MNGs. The most frequent and significant cause of multicentric presentation is papillary carcinoma.

Iodine concentration level, availability of adequately iodised salt and proper utilisation, and its influencing factors among households in Eastern Ethiopia: a community-based cross-sectional study

OBJECTIVE

The availability of iodine concentration in iodised salt at the household level does not guarantee the prevention of iodine deficiency disorders, but it can be significantly assured through proper utilisation. In eastern Ethiopia, there are no data on the use of iodised salt at the household level. The purpose of this study was to determine the iodine concentration, the coverage of adequately iodised salt and the factors that influencing the proper iodised salt utilisation in households.

DESIGN

A community-based cross-sectional study was conducted. Data were collected through face-to-face interviews and iodine concentration was determined using the WYD Checker iodine test. We used the logistic generalised estimating equation statistical analysis method to assess the factors that affect proper iodised salt utilisation at a household level.

SETTING

The study was conducted in Dire Dawa City Administration, Eastern Ethiopia.

PARTICIPANTS

A total of 473 households were selected using one-stage sampling technique.

PRIMARY MEASURES

Iodine concentration, availability of adequately iodised salt and proper utilisation were primary outcomes of this study.

RESULTS

Only 37% of households found sufficient iodine concentration in iodised salt, while only 25.2% of households used iodised salt properly. College or above education (adjusted OR=5.1, 95% CI: 1.2 to 21.6, p=0.024), good knowledge (adjusted OR=5.3, 95% CI: 4.3 to 13.4, p<0.0001), good attitude (adjusted OR=4.2, 95% CI: 2.5 to 7.0, p<0.0001) and household with family size >5 (adjusted OR=0.39, 95% CI: 0.23 to 0.7) were significantly associated with proper utilisation of iodised salt.

CONCLUSIONS

Adequate coverage and iodised salt utilisation were low. The proper use of iodised salt is associated with educational status, family size, knowledge and attitudes. Raising public awareness, health promotion and continuous regulation of iodine concentration at all levels by regulatory bodies are important strategies for addressing the public health problems of iodine deficiency and related diseases.

Mandatory Versus Voluntary Implementation of Salt Iodization Program for the Last Two Decades in Ethiopia: A Comparative Review of Existing Literatures

BACKGROUND

Ethiopian government was implementing mandatory salt iodization program for the last decade to eliminate iodine deficiency disorders, but several recent studies reported mixed findings.

OBJECTIVE

This review aimed to assess the difference in implementation of iodized salt program 10 years before and after mandatory salt iodization being implemented in Ethiopia since 2011.

METHODS

In Ethiopia, legislation that enforces salt producers to iodize all salts used for human consumption started in February 2011. All studies about iodine deficiency and iodized salt conducted in Ethiopia in the last 2 decades were searched. Searches were performed in PubMed database. Google Scholar, Iodine Global Network, and Ethiopian Public Health Institute websites were also searched.

RESULTS

A total of 235 titles and abstracts were identified. After scanning the abstracts and full papers, 43 articles were remained for final data synthesis. In this review, all studies conducted before 2011 reported a urinary iodine concentration (UIC) value of < 100 μg/L and 66.7% of them reported a goiter prevalence of > 30%. On the other hand, among studies conducted after 2011, 88.9% reported UIC value < 100 μg/L and 73.7% reported goiter prevalence of > 30%. Household availability of adequately iodized salt increased from nearly 20% in pre 2011 to more than 50% in post 2011 period.

CONCLUSION

Despite the efforts made by the Ethiopian government on mandatory salt iodization for the last decade, iodine deficiency is sustained in the country. Moreover, the goal of universal salt iodization program is offtrack and needs urgent revision.

REGISTRATION

Registered on PROSPERO register with reg. no CRD42021251124.

Prevalence of iodine deficiency among Moroccan women of reproductive age

BACKGROUND

Iodine deficiency disorders (IDD) affects nearly 1.9 million people worldwide. Iodine deficiency (ID) remains a public health concern not only for pregnant women, but for women of reproductive age (WRA) as well. This study was planned to evaluate the iodine status and the prevalence of iodine deficiency in a nationally representative sample of Moroccan WRA according to their socio-economic data and living areas.

METHODS

This study is a cross-sectional national survey conducted on 1652 WRA aged between 18 and 49 years. Iodine status was assessed by the evaluation of the urinary iodine concentration (UIC) on spot urinary samples, using the Sandell-Kolthoff reaction, and by the estimation of iodine-rich food consumption, using a food frequency questionnaire. The World Health Organization cutoff of a median UIC of < 100 μg/l was used to define ID in the population.

RESULTS

The median UIC [20th- 80th] was 71.3 μg/l [37.5-123.1] and 71% of participants had UIC < 100 μg/L, indicating insufficient iodine status and mild iodine deficiency. WRA from urban and rural areas showed an UIC median of 75.94 μg/l [41.16-129.97] and 63.40 μg/l [33.81-111.68], respectively. Furthermore, ID prevalence was significantly higher in rural areas (75.6%) as compared to urban areas (67.9%) (p < 0.05). Food frequency questionnaires analyses highlighted that dairy products are the most commonly consumed iodine-rich food, reported to be consumed daily by 43.1% of WRA. Of particular interest, 83.5% of WRA reported a weekly consumption of fish.

CONCLUSION

ID is still a public health problem in Morocco highlighting the necessity to implement effective national program, including efficient salt iodization, effective nutritional education and awareness, to control iodine deficiency and prevent IDD development.

Prevalence of urinary iodine concentration among school children: in Dessie City, Ethiopia

Background

Urinary iodine is recommended by the world health organization as the main indicator to assess iodine status in a population. Despite this recommendation little is known about urinary iodine concentration in the study area. Therefore, this study aimed to determine the level of urinary iodine concentration among school-aged children.

Methods

An institution-based cross-sectional study design was used to assess the level of urinary iodine from April to June 2019 and a systematic random sampling technique was applied to select study participants. Socio-demographic characteristics were assessed using a pretested structured questionnaire and the laboratory method by Sandell–Kolthoff reaction method was used. Data were cleaned, coded, and entered into Epi data version 3.1 and then exported to SPSS version 21 software for analysis.

Result

A total of 634 study participants were enrolled in the study with a median age of 12 years (±SD = 2.0). The majority of the children were females (55.4%) and more than half of respondents report the use of iodized salt always. Median urinary iodine concentration was 158.5 μg/L (±SD = 104.1) with minimum and maximum values of 5.1 μg/L and 528.8 μg/L, respectively. The overall iodine deficiency in this study was 18.6% and severe deficiency constituted 7.4%.

Conclusions

The iodine deficiency of the school children aged 6 to 14 in the present study was 18.6% indicating high prevalence. A high proportion of iodine deficiency was observed among females and it increases as age increases. This indicates the need for an additional strategy to control iodine deficiency.

Factors influencing the iodine status of children aged 12 to 59 months from Jaffna District, Sri Lanka in the post-iodization era; a descriptive, cross-sectional study

BACKGROUND

Iodine status, including Iodine Deficiency (ID) of the children aged 12-59 months of Jaffna District, Sri Lanka, have never been studied. This study thus aimed to assess ID among children aged 12-59 months by monitoring the Urinary Iodine Concentrations (UIC), the prevalence of goitre, and the factors causing ID.

METHOD

A cross-sectional study was conducted among 846 children aged 12-59 months in Jaffna District, Sri Lanka. Sociodemographic characteristics and other factors were collected using an interviewer-administered questionnaire. Dietary pattern of children was obtained using semi-quantitative food frequency questionnaire. We performed urinary iodine estimation and physical examinations to detect the goitre, according to the World Health Organization criteria. A multivariate logistic linear regression model was used to identify the factors that causing ID.

RESULT

The median UIC was 146.4 μg/L (interquartile range = 112.6-185.3 μg/L). Based on the UIC (<100 μg/L), 17.8% had ID, of which 15.7% and 2.1% had mild and moderate ID. The mean consumption of iodine from food was 128.7 (±20.2) μg/day. Gender variation had no influence on ID (p>0.05). Median UIC was significantly associated with living area, wealth status, type of drinking water, and method of iodized salt usage. A higher percentage of ID was significantly associated with younger age [AOR 2.32 (95% CI: 1.31-4.10)], urban area [AOR 1.94 (95% CI 1.27-2.96)], inland regions [AOR 3.20 (95% CI 1.85-5.55)], improper method of iodized salt usage [AOR 3.63 (95% CI: 1.38-9.56)], and low consumption of iodine-containing foods. The neck palpation revealed that only three children had goitre (0.4%).

CONCLUSION

This study revealed that high ID among the children in Jaffna children was due to improper usage of iodized salt, even though the iodized salt is freely available in the region, living area, and age, while the prevalence of goitre was not significantly identified as a public health problem.

Excessive intake of iodine and low prevalence of goiter in school age children five years after implementation of national salt iodization in Shebedino woreda, southern Ethiopia

Background

Iodine is a trace element required for the synthesis of thyroid hormones. The multiple effects of iodine deficiency on human health are called iodine deficiency disorders (IDDs). IDDs have been common nutritional problems in Ethiopia. In 2012, Ethiopia launched a national salt iodization program to address IDDs. The objective of this study was to assess the effects of this program after 5 years by measuring urinary iodine concentration (UIC) and prevalence of goiter in school age children as well as household salt iodine concentration (SIC).

Methods

A school-based cross-sectional design was employed. After ethical approval, 408 children from eight randomly selected primary schools provided urine samples. UIC was analyzed by inductively coupled plasma mass spectrophotometry (ICP-MS). A 10 g salt sample was collected from each household of a sampled child. SIC was analyzed with a digital electronic iodine checker (WYD, UNICEF) and goiter was assessed by palpation.

Results

The mean (±SD) age of the children was 9 ± 2 years. The prevalence of goiter was 4.2% and no child had grade 2 goiter. The median (IQR) UIC was 518 (327, 704) μg/L and UIC ranged from 3.1 to 2530 μg/L. Of the salt samples, 15.6% were not adequately iodized (< 15 ppm), 39.3% were adequately iodized (≥15 to ≤40 ppm), and 45.1% were > 40 ppm. SIC ranged from 4.2 to 195 ppm. Of the mothers, 92% said iodized salt prevents goiter and 8% mentioned prevents mental retardation.

Conclusions

In 2017 iodine deficiency was no longer a public health problem in the study area. However, the high variability in UIC and SIC and excessive iodine intake are of great concern. It is vital to ensure that salt is homogenously iodized at the production site before being distributed to consumers.

Assessing Adequacy of Iodine Intake among Children from 6 Months to 15 Years of Age from Hilly Terrains of North India

BACKGROUND

Routine outcome-based monitoring is required to assess the status of consumption of iodized salt as USI strategy.

OBJECTIVE

To assess the extent of recent iodine intake among children from 6 to 15 years of age in the hilly terrain of northern states of India.

METHODS

A school-based cross-sectional observational study among 227 children attending school was done for assessment of socio-demographic, dietary, salt consumption and urinary iodine concentration (UIC).

RESULTS

Mean age of children was about 6 years and 87.7% were consuming salt of >30 and none with <15 ppm iodine content. Median UIC was 138.0 μg/L. Among those assessed, 37.9% had adequate level of UIC, whereas about 20% and 40% participants had less (<99.0 μg/L) and more than adequate to excessive (≥200 μg/L) levels of UIC. Insignificant difference (p = 0.07) was observed for mean log UIC between cabbage eaters (2.3) and non-eaters (1.9) consuming salt >5 grams/day.

CONCLUSION

Recent iodine intake among children observed to be inadequate and effect of cruciferous food items on UIC needs to be studied despite high coverage of iodized salt among children.

National incidence, prevalence and disability-adjusted life years (DALYs) of common micronutrient deficiencies in Ethiopia from 1990 to 2017: estimates from the global burden of diseases study

BACKGROUND

Understanding the national burden and trend of micronutrient deficiencies helps to guide effective intervention strategies under various circumstances. There is, however, a lack of evidence on trends, age- and sex-specific variations in Ethiopia.

OBJECTIVE

This study aimed to provide evidence on the trends of common micronutrient deficiencies including, dietary iron, iodine, vitamin A and other nutritional deficiencies in Ethiopia, from 1990 to 2017, using findings from the Global Burden of Disease study.

METHOD

We used estimates from the GBD 2017 study to report the incidence, prevalence and disability-adjusted life years of micronutrient deficiencies in Ethiopia from 1990 to 2017. All estimates, both crude counts, as well as all-age and age-standardized rates per 100,000 population, are accompanied by 95% uncertainty intervals (UIs). We summarized the age- and sex-specific patterns and we compared the burden with the sub-Saharan Africa and global estimate.

RESULTS

From 1990 to 2017, the age-standardized prevalence rate of dietary iron, vitamin A and iodine deficiency decreased by 20.1%, 16.7%, and 91.6%, respectively. However, MNDs still account for a large number of DALYs in the country. In 2017, the all-age total DALYs due to dietary iron deficiency were estimated to be 448.4 thousand [95% UI: 298.9-640.7], accounting for 1.18% of the total DALYs. Similarly, the all-age total DALYs due to vitamin A deficiency were 397.8 thousand [256.1-589.2]. The total DALYs due to iodine deficiency were estimated to be 89.6 thousand [48.3-155.4].

CONCLUSIONS

Micronutrient deficiencies and associated morbidity and mortality are still high in Ethiopia compared with the sub-Saharan and global estimate. Adolescent and early adult females and children aged under-five are disproportionately affected segments of the population. Therefore, in collaboration with other sectors, the National Nutrition Program needs to place greater emphasis upon improving accessibility and utilization of nutrient-rich foods and supplementation, particularly for vulnerable groups of the population.

Is There Such a Thing as "Anti-Nutrients"? A Narrative Review of Perceived Problematic Plant Compounds

Plant-based diets are associated with reduced risk of lifestyle-induced chronic diseases. The thousands of phytochemicals they contain are implicated in cellular-based mechanisms to promote antioxidant defense and reduce inflammation. While recommendations encourage the intake of fruits and vegetables, most people fall short of their target daily intake. Despite the need to increase plant-food consumption, there have been some concerns raised about whether they are beneficial because of the various ‘anti-nutrient’ compounds they contain. Some of these anti-nutrients that have been called into question included lectins, oxalates, goitrogens, phytoestrogens, phytates, and tannins. As a result, there may be select individuals with specific health conditions who elect to decrease their plant food intake despite potential benefits. The purpose of this narrative review is to examine the science of these ‘anti-nutrients’ and weigh the evidence of whether these compounds pose an actual health threat.

Factors Associated with Urinary Iodine Concentration among Women of Reproductive Age, 20-49 Years Old, in Tanzania: A Population-Based Cross-Sectional Study

BACKGROUND

Universal salt iodization (USI) is the most feasible and cost-effective, and equitable, approach to prevent iodine deficiency. Severe maternal iodine deficiency during pregnancy is associated with serious adverse gestational and birth outcomes.

OBJECTIVES

The aim was to assess iodine status and identify independent factors associated with urinary iodine concentration (UIC) among women of reproductive age in Tanzania.

METHODS

This was a weighted, population-based, cross-sectional study in 2985 women of reproductive age (20-49 y) in Tanzania who participated in the Demographic and Health Surveys in 2015-2016 (DHS 2015-2016) and had measured UIC. Multivariable generalized linear regression was used to identify potential factors that were associated with UIC.

RESULTS

The median UICs among women consuming inadequately iodized salt (93.6 μg/L; 25th and 75th percentiles: 43.1, 197.9 μg/L) and women in the lowest socioeconomic status (92.3 μg/L; 45.6, 194.4 μg/L) were below the WHO-recommended ranges (≥150 μg/L for pregnant women and ≥100 μg/L for nonpregnant women). The results of multivariable models indicated that pregnant women had 1.21 μg/L lower UIC than nonpregnant women (β = -1.21; 95% CI: -3.42, -0.12), breastfeeding women had 1.02 μg/L lower UIC than nonbreastfeeding women (β = -1.02; 95% CI: -2.25, -0.27), and women with no education had a 1.88 μg/L lower UIC compared with those with secondary/highest education (β = -1.88; 95% CI: -4.58, -0.36). Women consuming inadequately iodized salt had 6.55 μg/L lower UIC than those consuming adequately iodized salt (β = -6.55; 95% CI: -9.24, -4.33). The median UIC varied substantially across geographic zones, ranging from 83.2 μg/L (45.9, 165.3) in the Western region to 347.8 μg/L (185.0, 479.8) in the Eastern region.

CONCLUSIONS

Our findings indicated a great heterogeneity in median UIC across regions of Tanzania among women of reproductive age. Poverty, consuming inadequately iodized salt, and lack of education appeared to be the driving factors for lower UIC in Tanzania.

Food-based indicators are related to iron and iodine deficiencies of mother-toddler dyads during the lean season in northern Ghana

Fe and iodine deficiencies are among the common forms of nutritional deficiencies globally and cause detrimental effects on mother and child. In developing countries, strategies to address these problems rarely use preventative dietary approaches. This cross-sectional study aims to ascertain whether dietary diversity score (DDS) and dietary patterns (DP) can predict the associated risk (AR) of Fe and iodine deficiencies in mother-toddler dyads during the dry/lean season in northern Ghana. Data were collected from women (15-49 years; n 118) and their toddlers (6-23 months, n 121). Dyads DDS and DP were calculated from their food intake recall. Multivariable logistic regression models were used to examine whether DDS, DP and socio-demographic factors predict higher odds of Fe and iodine deficiencies in dyads. DDS and DP predicted Fe and iodine deficiencies AR. Compared with DDS ≥4, women with DDS <4 have higher odds of Fe deficiency (ID) (adjusted OR (AOR) 1·82, 95 % CI 1·03, 3·21) and iodine deficiency (AOR 9·73, 95 % CI 3·19, 29·67). Two DP emerged in principal component analyses, 'rural elites diet' predicted ID risk in mothers (AOR 8·65, 95 % CI 1·76, 42·39), while 'indigenous diet' predicted iodine deficiency risk (AOR 11·41, 95 % CI 1·36, 95·97) in mothers only. The AR of Fe and iodine deficiencies in vulnerable populations may be predicted by diet-based measures in northern Ghana. We recommend further research into DDS and DP to predict Fe and iodine status of mother-toddler dyads in Ghana.