IODINE AND NUTRITIONAL STATUS OF PRIMARY SCHOOL CHILDREN IN OKPUJE, NSUKKA LGA, ENUGU STATE, NIGERIA

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ABSTRACT

This study was designed to assess iodine and nutritional status of primary school children in a rural community, Okpuje, using recommended quantifiable indicators. A total of 395 school children, 6-12 years (204 males and 191 females) were selected through a multi-stage sampling procedure. Structured questionnaire was used to obtain information on socioeconomic status (name, age, class, sex, parents occupation and household size). Dietary information was obtained using 24hour dietary recall and food frequency questionnaire. Heights and weights of the children were measured using approved methods. Age was assessed using school records. The WHO Z score system was used to classify stunting, wasting and underweight among the children. Goiter was assessed clinically by a trained nurse using the standard palpation method. Salt samples were collected from Okpuje market and the children were asked to bring salts (10g) from their mother’s kitchen to test for iodine content. Urinary iodine excretion (UIE) levels of 20% sub-sample study subjects, selected through simple random sampling by balloting without replacement, were analyzed using the Sandell-Koltholf reaction to determine the urinary levels of iodine. Data obtained were analyzed using descriptive statistics and chi-square analysis. Results showed that children were from predominantly farming communities and consumed monotonous diets. Twenty four hour dietary recall revealed that majority of the children ate 3 times a day and consumed cereals and cassava based diets for breakfast, lunch and supper. No child was found with goiter. The prevalence of stunting, wasting and underweight were 19.5%, 8.9% and 8.5%, respectively. Wasting was more in male children than in female children. Underweight and stunting were more in females than males. Stunting and wasting was more in older children (10-12 years) while underweight was more in younger children (6-9years). The mean UIE was 124.7mcg/l. About 96% of the children had UIE value consistent with adequate intake (UIE > 100mcg/l). A total of 3.8% of the children had UIE less than 100mcg/l. Iodine content of 395 salt samples from home, tested with spot testing kit revealed that 94.2% had iodine greater than 15ppm and 5.8% had iodine less than 15ppm. No salt sample was found without iodine. The entire salt sample collected from the market had iodine greater than 15ppm. The mean urinary excretion of 124.7mcg/l obtained in this study suggests no biochemical iodine deficiency in majority of the respondents and indicates that Okpuje in Nsukka LGA is in the transition phase of iodine deficiency to iodine sufficiency.

TABLE OF CONTENT

TITLE PAGE
LIST OF TABLES
LIST OF FIGURES
ABSTRACT

CHAPTER ONE: INTRODUCTION
1.1       Background to the study
1.1       Statement of problem
1.2       Objectives of study
1.3       significance of study

CHAPTER TWO: LITERATURE REVIEW
2.1       Iodine
2.2       Absorption and Metabolism of Iodine
2.3       Actions of Thyroid Hormones
2.4       Interaction of Iodine with Goitrogens
2.5       Dietary Requirement of Iodine
2.6       Food Sources of Iodine
2.7       Assessment of Iodine Nutrition
2.7.1 Urinary Excretion of Iodine
            2.7.2 Thyroid Size
2.7.3  Serum Thyroglobulin (Tg) Level
2.8       Iodine Deficiency disorders
2.8.1    Iodine Deficiency during Postnatal Period
2.9       Epidemiology of Iodine Deficiency
2.9.1    Iodine Deficiency in Worldwide
2.9.2    Iodine Deficiency in Nigeria
2.10  Selenium and its Importance in the Reduction of the Risk of ID
2.11     Control of IDD
2.11.1  Iodization of Salt
2.11.2  Iodized Oil
2.11.3  Iodine Fortification
2.11.4  Iodine Supplementation
2.12     Nutritional Status
2.12.1  Anthropometry
2.13.2  Clinical Assessment

CHAPTER THREE: MATERIALS AND METHODS
3.1       Research Design
3.2       Study Area
3.3       Study Population
3.3.1    Sample Size Calculation
3.3.2    Sampling Procedure
3.4       Method of Data Collection and Analysis
3.4.1    Approach to the Community
3.4.2    Training of Research Assistants
3.4.3    Questionnaire
3.4.4. Anthropometry
3.4.4.1 Height
3.4.4.2 Weight
3.4.4.3 Determination of z Scores
3.4.5    Estimation of Iodine in Salt
3.4.6    Urinary Iodine Excretion
3.4.7. Clinical Assessment
3.4.8. Statistical Analysis

4.0 CHAPTER FOUR: RESULTS

5.0 CHAPTER FIVE: DISCUSSION, CONCLUSION & RECOMMENDATIONS
5.1 Discussion
5.2. Conclusion
5.3. Recommendations
REFERENCES
APPENDIX


CHAPTER ONE

1.0                                                          INTRODUCTION

1.1     Background to the Study
Iodine is an essential mineral required by the body to synthesize thyroid hormones (thyroxine and triiodothyronine). The most important of which is thyroxine, a metabolism regulating substance (Kennedy, Nantel & Shetty, 2003). The trace element (iodine) is an essential nutrient for human growth and development.


The daily recommended intake of iodine for school children (6-12yrs) is 120mcg/day (WHO/UNICEF/International Council for Control of Iodine Deficiency Disorders (ICCIDD), 2007). Iodine deficiency disorders are primarily the result of inadequate amounts of iodine in the soil, water and food as well as consumption of foods rich in goitrogenic substances (Ene-Obong, 2001). Apart from intake of goitrogenic and inadequate amounts of iodine, other factors are known to interfere with adequate iodine nutrition and these include protein energy malnutrition (Brahmbhatt et al., 2007), and vitamin A deficiency (ACC/SCN, 1994). The world’s natural supply of iodine is mostly from the ocean in the form of iodide. The adequacy of dietary iodine is usually determined by the measurement of urinary excretion of iodine (Lee, Bradley & Dwyer, 1999). The commonest manifestation of iodine deficiency is goiter. It occurs when the iodine level of the blood is low; the cells of the thyroid gland enlarge in an attempt to trap as many particles of iodine as possible. Sometimes the gland enlarges until it is visible as a swelling in the anterior part of the neck (Chatterjea & Rana, 2004).
Inadequate dietary iodine leads to reduced synthesis of thyroid hormones (Thyroxine (T4) and Triiodothyronine (T3)). A lower level of T4 stimulates the pituitary gland to stimulate thyroid stimulating hormone (TSH) to fulfill the production of thyroid gland hormones. It is important not to over consume iodine as it has a relatively narrow range of intakes that reliably support good thyroid function. Consumption of an excessive amount of iodized salt or seaweeds could readily result to complex disruptive effect on the thyroid gland and may cause hyperthyroidism in susceptible individuals, as well as increasing the risk of thyroid cancer (Chatterjea & Rana, 2004).

The supply of adequate iodine in the diet and the elimination of goitrogens are ways to prevent endemic goitre. However, there is increasing evidence that endemic goitre could be provoked by genetic as well as environmental factors including emotional stress, smoking and infections (Abuye, Omwega & Imungi, 1999).


Iodine is an important micronutrient required for proper brain development. One of the millennium development goals (MDG) of the United Nations is to reduce child mortality by 2015 (Andy & Andrew, 2004). Severe iodine deficiency in the mother has been associated with miscarriages, still births, preterm delivery and congenital abnormalities in their babies (Benoist, McLean, Anderson & Rogers, 2008). Iodine deficiency in its most extreme form, results in cretinism. Of much greater public health importance, are more subtle degrees of brain damage and reduced cognitive capacity, which could affect the whole population (World Health Organization (WHO), 2001). Iodine is the world’s leading cause of mental retardation. More than two billion children suffer from lowered intelligent quotient (IQ) and retardation due to iodine deficiency (United Nations Children’s Fund (UNICEF), 2002). Iodine deficiency disorder can be corrected by re-supplying iodine in the diet (Delange, 2000). The impact of IDD is enormous and it affects all the stages of life (ICCIDD/UNICEF/WHO, 2001).

As part of the strategies to reduce the prevalence of IDD in Nigeria, the universal salt iodization (USI) program was introduced in 1995. In most countries of the world, universal salt iodization has been employed as a means of eliminating disorders secondary to iodine deficiency. WHO, UNICEF and ICCIDD has brought iodine sufficiency within reach of about 1.5 billion people of the world who were deficient decades ago; and now rely on the urinary iodine concentration as the primary indicator of effectiveness (WHO, ICCIDD, 1999). In Africa and indeed Nigeria, great progress has been made towards the elimination of iodine deficiency saving millions of children from its adverse effects, largely due to the increased household availability of iodized salt (ICCIDD, 2003; WHO, 2007; Lantum, 2009).

Most iodine absorbed in the body eventually appears in the urine; therefore, urinary iodine concentration is a good marker for very recent dietary iodine intake. Urine iodine excretion is a good biomarker of dietary intake of iodine over days and is the measure of choice for assessment of iodine status (WHO/UNICEF/ICCIDD, 2007). For epidemiological studies, a population distribution of urinary iodine is required and, because the frequency distribution is typically skewed towards high values, the median rather than the mean is judged the best indicator of iodine status. WHO, ICCIDD, and UNICEF (2007) recommend that for national surveys of iodine nutrition, the median urinary iodine from representative samples of spot urine collections from children aged 6—12 years can be used to define a population's iodine status. School-age children 6-12 years old form a useful study group for assessing iodine deficiency because of their physiological vulnerability to disease, their accessibility through school and a representation of iodine deficiency disorders (Joshi et al, 2006). In Nigeria, the National Agency.....

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