Iodine-deficiency disorders in the Aseer region, south-western Saudi Arabia: 20 years after the national survey and universal salt iodization

Abbag, Fuad; Abu-Eshy, Saeed; Mahfouz, Ahmed A.; Al-Fifi, Suliman A; El-Wadie, Hussein; Abd-Allah, S. M.; Musa, Mustafa G; Devansan, Charles S; Patel, Ayuub

doi:10.1017/s1368980014003073

Cited by 24 publications

(20 citation statements)

References 15 publications

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“…This finding was in line with another report from Ethiopia [28] and Saudi Arabia [19]. Implementation of universal salt iodization is the most cost effective and proven intervention to eliminate IDDs [49, 50], in spite of this fact only one-third of the households utilized adequately iodized salt and majority of children were found with poor dietary intake of iodine rich food.…”

Section: Discussionsupporting

confidence: 88%

Poor dietary diversity, wealth status and use of un-iodized salt are associated with goiter among school children: a cross-sectional study in Ethiopia

2017

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BackgroundGlobally, more than two billion people are at risk of iodine deficiency disorders, 32% of which are school children. Iodine deficiency has been recognized as a severe public health concern in Ethiopia, however little is known about the problem. Therefore, this study aimed to assess the prevalence of goiter and associated factors among school children (6 to 12 years) in Dabat District, northwest Ethiopia.MethodsA school-based cross-sectional study was conducted from February 21 to March 31, 2016. A total of 735 school children were included in the study. A stratified multistage sampling followed by systematic sampling technique was employed to select the study participants. Thyroid physical examination was done and classified according to the World Health Organization recommendations as grade 0, grade 1, and grade 2. The level of salt iodine content was determined using the rapid field test kit. The value 0 parts per million (PPM), <15 PPM and ≥15 PPM with the corresponding color chart on the rapid test kit were used to classify the level of iodine in the sampled salt. A multivariable logistic regression analysis was employed to identify factors associated with goiter. Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was calculated to show the strength of association. In multivariable analysis, variables with a P-value of <0.05 were considered statistically significant.ResultsIn this community, the overall prevalence of goiter was 29.1% [95% CI: 25.9, 32.6], in which about 22.4 and 6.7% had goiter grade 1 and grade 2, respectively. The age of children (AOR = 1.13; 95% CI: 1.01, 1.26), being housewife mother (AOR = 1.49; 95% CI: 1.08, 2.15), use of unprotected well water source for drinking (AOR = 6.25; 95% CI: 2.50, 15.66), medium household wealth status (AOR = 1.78; 95% CI: 1.18, 2.92), use of inadequately iodized salt (AOR = 2.79; 95% CI: 1.86, 4.19), poor dietary diversity score of the child (AOR = 1.92;95% CI: 1.06, 3.48) and medium maternal knowledge (AOR = 0.65; 95% CI: 0.42, 0.94) were significantly associated with goiter.ConclusionsThe prevalence of goiter is higher in Dabat District, which confirmed a moderate public health problem. Therefore, regular monitoring of household salt iodine content, improving access to safe water, promoting the importance of diversified food for children is recommended to address the higher burden of iodine deficiency.

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Section: Discussionsupporting

confidence: 88%

Poor dietary diversity, wealth status and use of un-iodized salt are associated with goiter among school children: a cross-sectional study in Ethiopia

2017

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“…Others also showed an enhancement of SAC iodine status after the execution of USI in the Southwestern of KSA, a previously classified severe iodine deficient region [34]. Contrariwise, a research group has disclosed severe iodine deficiency (median UIC 17 μg/L) in 3046 SAC from the same region, and 24% of the children had goitre [25]. Moderate iodine deficiency (median UIC 84 μg/L) has also been reported in 1887 SAC from Makkah province, and 7.4% of the participants were goitrous [26].…”

Section: Discussionmentioning

confidence: 93%

“…In contrast, the pregnant group median UIC was below the WHO minimal level for iodine sufficiency despite that iodised salt and/or daily iodine supplements were used by 71.5% and 27.6% of the participants, respectively. Our findings infer that the reproductive age Saudi women were marginally iodine sufficient, while the pregnant population had mild deficiency that could denote a public health burden [25][26][27][28].…”

Section: Discussionmentioning

confidence: 99%

“…Alissa et al (2009) followed the WHO recommended median UIC cut-off values for iodine adequacy, and their results revealed severe deficiency in the enrolled hypothyroid patients as well as healthy participants from the Western region of KSA [24]. Although KSA is currently classified by the IGN (2019) as iodine sufficient based on a national survey of SAC in 2012 [5], other more recent national studies have revealed marked iodine deficiency and high prevalence of goitre in their SAC populations [25,26]. According to another recent national survey, KSA has also adopted the USI policies since 1995 and most of the locally available salt is adequately iodised (15-40 ppm) [27].…”

Section: Introductionmentioning

confidence: 99%

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Iodine adequacy in reproductive age and pregnant women living in the Western region of Saudi Arabia

Azzeh

Refaat

2020

Preprint

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Background: Despite the serious maternal and foetal complications associated with iodine deficiency during pregnancy, surveys related to pregnant women in the Kingdom of Saudi Arabia (KSA) are lacking. This study, therefore, measured urine iodine concentrations (UIC) alongside the potential socioeconomic factors contributing towards iodine inadequacy in reproductive age and pregnant Saudi women from the Western province of KSA. Methods: Spot urine samples were collected from 1222 pregnant and 400 age-matched non-pregnant/non-lactating reproductive age women. The socioeconomic characteristics were obtained through a structured questionnaire. The WHO criteria for iodine sufficiency in non-pregnant (100–199 μg/L) and pregnant (150–249 μg/L) women were applied. Results: The median UIC in the non-pregnant women (101.64 μg/L; IQR: 69.83 – 143.55) was at the lowermost WHO recommended cut-off, whereas the pregnant group were iodine deficient (112.99 μg/L; IQR: 81.01 – 185.57). Moreover, the median UIC was below adequacy across the different trimesters. Multiparity (OR = 3.091; 95%CI: 1.707–5.598) and earning below the minimum wage (2.520; 95%CI: 1.038–6.119) significantly increased the risk of iodine deficiency only in the non-pregnant women. Passive smoking, however, was an independent risk factor for iodine deficiency in the non-pregnant (OR = 1.818; 95%CI: 1.097–3.014) and pregnant (OR = 1.653; 95%CI: 1.043–2.618) groups. The use of non-iodised salt also significantly increased the risk of iodine deficiency in the non-pregnant (OR = 2.052; 95%CI: 1.118–3.766) and pregnant women (OR = 3.813; 95%CI: 1.992–7.297), whereas iodine supplements significantly lowered the risk in both groups (OR = 0.364; 95%CI: 0.172–0.771 and OR = 0.002; 95%CI: 0.001–0.005, respectively). Moreover, BMI correlated independently and significantly with median UIC in the non-pregnant in both study populations. Conclusions: This study is the first to show borderline iodine sufficiency in reproductive age Saudi women from the Western province, whereas mild iodine deficiency was observed in the pregnant population and could represent a serious public health problem. This study also advocates the necessity to establish routine iodine dietary advice services by the health authorities to foster adequate iodine intake in pregnant women to avoid the perilous maternal-foetal health consequences of iodine deficiency.

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“…Although consumer awareness is necessary for a quick improvement and demand for a better product, it could be too early to comment on the Ethiopian salt iodization program. In Saudi Arabia, 20 years after a universal salt iodization program was implemented, SIC showed variation from 0 to 112 ppm [25]. Despite a mandatory salt iodization program in Cambodia, a drastic decrease in the iodine content of salt was observed from 22 ppm in 2011 to 0 ppm in 2014.…”

Section: Variability Of Urinary Iodine Concentration (Uic) and Salt Imentioning

confidence: 99%

High variability of iodine in iodized salt and urine from rural households in Sidama zone, Southern Ethiopia: A cross-sectional study

Tafere¹,

Stoecker²

2020

AJFAND

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Iodine is essential for the synthesis of thyroid hormones which regulate the metabolic processes of most cells and play important roles in human growth and development. Iodine deficiency has long been one of the most common nutritional problems in the world. Ethiopia, particularly the study population (Sidama) has a history of severe iodine deficiency. The purpose of the study was to assess urinary iodine concentration, level of goiter in mothers and school-age children and household salt iodine concentration in households 10 months after launch of the national salt iodization program. A crosssectional study was conducted on a randomly selected sample of women and schoolchildren. Goiter was assessed by palpation. Concentrations of iodine in salt, urine and water were analyzed by inductively coupled plasma mass spectrometry (ICP-MS). The study included 193 mothers and 76 children. The median (IQR) urinary iodine concentration (UIC) was 143 (84, 202) µg/L in the mothers and 187 (102, 278) µg/L in the children. Mothers' UIC ranged from 17 to 767.2 µg/L and children's UIC ranged from 19 to 739 µg/L. Goiter prevalence was high in both mothers (76%) and children (79%). The median household salt iodine concentration (SIC) was 8.1 (4.3, 13.4) ppm (mg/kg) with a range of 0 to 42 ppm. None of the water samples contained iodine above the detection limit of 1 µg/L. Despite the launch of the salt iodization program in Ethiopia, 94% of the study participants were not aware that they used iodized salt and 88% did not know the benefits of iodized salt. The major source of iodine for this population was iodized salt; however, the salt at household level contained minimal but variable amounts of iodine. Low concentration of iodine in salt may be further compounded by storage, handling and cooking techniques. The high variability of salt iodine concentration (SIC) was also reflected in the UIC of the mothers and children.

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Iodine-deficiency disorders in the Aseer region, south-western Saudi Arabia: 20 years after the national survey and universal salt iodization

Cited by 24 publications

References 15 publications

Poor dietary diversity, wealth status and use of un-iodized salt are associated with goiter among school children: a cross-sectional study in Ethiopia

Poor dietary diversity, wealth status and use of un-iodized salt are associated with goiter among school children: a cross-sectional study in Ethiopia

Iodine adequacy in reproductive age and pregnant women living in the Western region of Saudi Arabia

High variability of iodine in iodized salt and urine from rural households in Sidama zone, Southern Ethiopia: A cross-sectional study

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