Academic journal article Bulletin of the World Health Organization

Endemic Goitre in the Sudan despite Long-Standing Programmes for the Control of Iodine Deficiency disorders/Goitre Endemique Au Soudan Malgre Les Programmes Permanents De Controle Des Troubles Dus a la Carence En iode/Persistencia del Bocio Endemico En Sudan Pese a la Aplicacion Desde Hace Tiempo De Programas Para Controlar Los Trastornos Por Deficiencia De Yodo

Academic journal article Bulletin of the World Health Organization

Endemic Goitre in the Sudan despite Long-Standing Programmes for the Control of Iodine Deficiency disorders/Goitre Endemique Au Soudan Malgre Les Programmes Permanents De Controle Des Troubles Dus a la Carence En iode/Persistencia del Bocio Endemico En Sudan Pese a la Aplicacion Desde Hace Tiempo De Programas Para Controlar Los Trastornos Por Deficiencia De Yodo

Article excerpt

Introduction

In the Sudan, the period from the early 1980s to the mid 1990s witnessed substantial activity in connection with iodine deficiency disorders (IDDs) in the form of epidemiological and etiological studies and assessments of the effects of different interventions. (1-7) The total prevalence of goitre reported in those studies ranged from 13% in the eastern city of Port Sudan and 17% in Khartoum state, to 78% in the central region and 87% in Darfur, in the west. According to a national study conducted in 1997, the overall prevalence of all types of goitre was 22% (8) and prevalence figures ranged from 5% in the city of Khartoum to 42% in the Upper Nile region. It has been estimated that every year more than 200 000 children born in the Sudan are at risk of iodine deficiency (9) and that 3% of those children may develop cretinism, while 10% may experience severe intellectual impairment and 87% less severe intellectual disability.

Various etiological factors in addition to iodine deficiency contribute to goitre endemicity in the Sudan. (1-3,5,7) They include vitamin A deficiency and protein-energy malnutrition, both of which can affect thyroid function, and the very high consumption of pearl millet, which contains thiocyanate, a goitrogenic substance.

Although IDD control programmes in the form of distribution of iodized oil capsules and iodized sugar and the universal salt iodization strategy, were launched in the Sudan as early as the mid 1970s, (5,10,1l) in 2006, when this study was conducted, no progress in implementation had been made. (9) Indeed, most iodine supplementation programmes, if not all, had ceased to exist, and only 1% of all Sudanese households had access to iodized salt, according to estimates by the United Nations Children's Fund (UNICEF). (12) A more recent situational analysis has shown that IDDs still affect children and women throughout the Sudan and that no policy supporting universal salt iodization is in place. (13) Thus, the aim of this study is to evaluate the current status of IDDs in the Sudan and to provide baseline impact indicators for future IDD control programmes. The study also seeks to respond to the 2005 World Health Assembly resolution (WHA58.24) mandating countries to report on their IDD situation every three years.

Methods

We performed a descriptive cross-sectional study to investigate the burden of IDDs using three indicators recommended by the World Health Organization (WHO): goitre prevalence, median urinary iodine concentration (UIC) (determined from casual urine samples) and mean serum thyroglobulin (Tg) levels. Mean serum levels of thyroxine (T4), triiodothyronine (T3) and thyroid-stimulating hormone (TSH) were also measured, along with urinary thiocyanate (USCN) excretion. (1-3,9,10) Our study, which was conducted from June to November 2006, covered ethnically and socioeconomically heterogeneous populations of schoolchildren aged 6 to 12 years residing in the capital cities of nine states located in different parts of the Sudan. The cities were Nyala (west), Elfasir (west), Wau (south), Atbra and Dongla (north), Kosti (centre), Dmazine (south-east), Port Sudan (east) and Khartoum (centre). The sampled populations varied considerably with respect to their sources of drinking water and their staple foods. The locations from which population samples were drawn are shown on the map of the Sudan in Fig. 1.

[FIGURE 1 OMITTED]

A multistage sampling technique was used. (14) Each city was first divided into three sectors and one school from each sector was then randomly selected, regardless of the gender of the school's attendees. Subsequently 150 to 250 children were randomly selected from each school and a total of 6083 children between the ages of 6 and 12 years were examined for goitre by a single investigator through palpation of the thyroid gland. Goitre size was graded according to the criteria recommended by WHO, UNICEF and the International Council for the Control of Iodine Deficiency Disorders (grade 0, no goitre; grade 1, thyroid palpable but not visible; and grade 2, thyroid visible with neck in normal position). …

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