Objectives: To compare thyroid-stimulating hormone (TSH) levels in neonatal cord blood between study sites in Bangladesh, Guatemala and the United States. Also, to compare neonatal TSH results with indicators of iodine deficiency in school children. Design: Consecutive births and, in school children, cross-sectional surveys. Setting: Savar, Bangladesh; San Pedro Sacatepequez, Guatemala; and Atlanta, United States. Subjects: In each study site, cord blood was spotted on to filter paper and TSH levels determined using a sensitive monoclonal assay. In the USA, heel stick blood specimens from newborns spotted on to filter paper were also obtained as well as exposure to iodine-containing antiseptics during the birthing process. Urine specimens were collected from mothers of newborns and tested for iodine concentration. School children in the same areas were surveyed for thyroid size by palpation and ultrasonography, and urine specimens collected for iodine concentration. Results: Between 141 and 243 cord blood specimens were collected from each study site. The prevalence of elevated cord blood TSH levels (. 5 mU l 21
with the collaboration of Sandy May and Glen Maberly Editorial comment During the 13 years after iodized salt was introduced into Guatemala in 1952, the prevalence of goitre fell from 39% to 5%, and for many years thereafter it was difficult to find examples of endemic goitre to demonstrate to students on field visits. However, with the political turmoil of the 1980s, the iodization of salt in Guatemala lapsed and goitre returned. An effort is being made to restore an effective iodization programme. The results are still highly unsatisfactory, as the following article reports. If the problem were specific to Guatemala, this article would not have been accepted for publication. Unfortunately, it serves as a reminder of a situation that prevails in many developing countries today even when their salt or part of it is stated to be iodized. Government regulatory authorities and United Nations institutions should be alerted by this article to carry out similar evaluations in their own countries on a continuing basis.
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