Author: Kharabsheh, S.; Belbesi, A.; Qarqash, W.
UNICEF supported a study in 1993 on Iodine Deficiency Disorders (IDD), which revealed a 38% prevalence of IDD. A national programme was launched and salt iodisation became mandatory in 1995. After launching the nation-wide iodization program, no evaluation studies have been carried out in the country. The Ministry of Health, in collaboration with UNICEF & WHO, conducted this survey to evaluate the control program and monitor progress towards achieving our long-range goals. Furthermore, the survey aimed at studying the clinical & biochemical indicators.
Purpose / Objective
This study aims to assess the effects of the iodization program on the Jordanian population by:
- Determining the present prevalence of goiter among school children aged 8-10 years in Jordan
- Measuring urinary iodine concentration
- Measuring the condition of progress of implementation of the IDD control program by assuming the consumption of adequately iodized salt
A sample was taken from school children from all school types and from all clusters in the country, proportional to the size of the population in each cluster. Taking into consideration the nearly 100% school enrolment, this should be representative of all children in the nation. 2,601 school children aged 8-10 years were selected, 56% of the sample were males and 44% of them were females. Each selected student was examined by the clinician and the score for goitre was recorded using WHO criteria, and a clinical information sheet was filled. To assess iodine intake, urine was collected from each selected student.
A sample of salt from households and local retailers in each cluster area was collected and analysed for iodisation using a rapid test kit.
Key Findings and Conclusions
The results revealed that the median iodine concentration in urine was 15.40 ug/100 ml. 24.5% of the study population received insufficient iodine intake (less than 10ug/100ml); about 47% received adequate intake, while the rest of the students proved to receive either more than adequate or excessive intake (28.8%).
The overall prevalence rate of goitre was found to be 33.5% compared to 37.8% in the 1993 study. Since the sample size is too small at the governorate level to allow for the calculation of the actual prevalence rates in each governorate, the governorates rates calculated are to be used as rough indicators only.
The prevalence of goitre as related to sex was studied; it showed that it was significantly higher among males than among females (36.6%, 27.9%, respectively), contrary to the 1993 study where females were higher than males (39.2%, 36.3%, respectively).
A relatively large proportion of the study population (14.5%) are still consuming salt without iodine fortification, due to the fact that some small unknown packagers are still not complying with the standards and specifications, making the addition of iodine to salt mandatory. The proportion of households consuming effectively iodized salt was 85.4%.
In future studies or monitoring of goitre, more significance should be given to the biochemical indicator rather than the clinical indicator.
The level of iodine in salt should be reduced from a dose of 40-60 mg/kg to a dose of 30 mg/kg. This strategy becomes valid only when the monitoring system becomes mature enough and when all factories, retailers and distributors comply with the iodisation regulations.
A comprehensive monitoring plan should be implemented on all levels of the market to ensure compliance of all salt producers with the standards and specification of iodine fortification.
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Health - Micronutrients IDD
WHO, Ministry of Health