The goitre prevalance and urinary iodine status of primary school children in Lesotho

English: Iodine deficiency has been called the world's most significant cause of mental retardation. Studies conducted since 1960 have indicated iodine deficiency as public health problem in Lesotho. The ICCIDD has been instrumental in focusing the world's attention on 100 and the goal of virtual elimination of 100 as a public health problem by the year 2000 was accepted by the united systems in 1990. This goal was reaffirmed by the e" World Health Assembly in 1993, which also provided a strategic guidance including emphasis on salt iodisation. The main objective of this study was to estimate the current 100 situation in Lesotho 5 years after the 1993 National Micronutrient Survey which was followed by iodised oil capsule supplementation as a short term intervention and the introduction of the legislation on universal salt iodisation as a long term intervention. This was a cross sectional study where stratified random sampling was used to select 5 schools in each of the 10 districts of Lesotho. All children aged 8 to 12 years from the selected schools participated in the study. The size of the thyroid gland was determined by palpation and graded according to the Joint criteria of the WHO/UNICEF/ICCIDD (1994). Casual urine samples were obtained from 10 children in each school in the morning during school hours and frozen until they were analysed for urinary iodine level using the Sandell-Kolthoff reaction involving alkaline ashing at the National University of Lesotho. Using a structured questionnaire, iodised oil supplementation coverage was determined. Salt samples brought by children were also analysed for the presence of iodine using the rapid (spot) test kits. The SAS package was used for statistical analysis of the results at the University of Orange Free State. 4071 primary school children were palpated and responded to the questionnaire, 4071 salt samples and 500 urine samples were analysed. The median urinary iodine concentration of 26.3IJg/l, which ranged from 22.3IJg/1to 47.91Jg/l and from 25.7IJg/1 to 27.2IJg/1 in the different districts and ecological zones respectively, indicated moderate 100. The prevalence of goitre, which increased with age and was higher in females than males, ranged from 2.2 to 8.8 percent and from 2.3 to 6.3 percent in the different districts and ecological zones respectively indicating mild to normal iodine deficiency. The adjusted prevalence of goitre for the whole country was 4.9 percent, indicating the absence of 100. 94.2 percent of salt samples were iodised. Coverage on iodised oil capsules supplementation, which was 55.1 percent, was not adequate. Lesotho was found in this study as having mild to moderate 100, which is still of public health concern according to WHO/UNICEF/ICCIOO (1994). Iodine deficiency was higher in the Mountains than in the Lowlands. However there is an improvement in controlling 100 in Lesotho as observed from the results of the present study and those of the previous studies. The use of iodised salt and iodised oil capsules has most likely contributed to a decrease in the 100 prevalence. Similar studies using ultrasonography and the titration method need to be conducted in the future. More iodised oil supplementation is recommended in the Mountains and in schools, which never received the capsules and this needs to be coupled with efficient awareness programs. An effective monitoring program needs to be initiated to ensure that the entire population use adequately iodised salt.