Mandatory iodization of salt virtually eradicated iodine deficiency within 1 y in South African schoolchildren, but the goiter rate in these children did not decline. Measurement of goiters by palpation may not be appropriate in short-term evaluations of mandatory iodization programs.

Objective: The study was undertaken to investigate whether endemic goitre still exists in the Northern Cape Province of South Africa more than 55 years after it was reported and, if so, whether iodine de®ciency, or uoride in the drinking water, is linked to the goitres. Design: Cross-sectional study of children in three pairs of towns. Subjects: The 6-, 12-and 15-year-old children (n 671) who had been lifetime residents in two Northern Cape towns with low levels, two towns with near optimal levels and two towns with high levels of¯uoride in the drinking water were recruited through the schools as study participants. Results: Endemic goitre was found in all the towns except one, ranging from 5% to 29%. Iodine de®ciency did not prevail in the study area because the median urinary iodine concentration, exceeding 1.58 mmolal in all but one of the towns, indicated a more than adequate iodine consumption. The drinking water and, to a lesser extent, iodised salt were important sources of iodine. No relationship was found between¯uoride in the water and the mild goitre prevalence (5% to 18%) in the four towns with either a low or near optimal¯uoride content in the water. The causal factor(s) responsible for the goitres in these four towns were not clear from our data. However, the prevalence of goitre was higher (28% and 29%) in the two towns with high levels of¯uoride in the water. Conclusion: These results indicate that either a high¯uoride level in the water or another associated goitrogen, other than iodine de®ciency, may have been responsible for these goitres. Sponsorship: This work forms part of the research programme supported by the Medical Research Council of South Africa.

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