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Osei Tutu B, Nkansah BR, Yeboah NAS, Atupra F, Daddey-Adjei RK, Darko DA. Salt production and iodization practices among artisanal salt producers in selected districts within the Greater Accra and Central Regions of Ghana. Heliyon 2024; 10:e29621. [PMID: 38681581 PMCID: PMC11053186 DOI: 10.1016/j.heliyon.2024.e29621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 05/01/2024] Open
Abstract
Background This study was conducted to assess salt production and iodization practices by artisanal salt producers located at six districts across Greater Accra and Central regions. Methods One Hundred and Sixty-Six (166) salt miners in Greater Accra and Central Regions were interviewed using a structured questionnaire and their production sites inspected for salt iodization practices. Results The study revealed that salt iodization is not practiced among majority (69.28 %) of artisanal salt producers. They were conversant with salt iodization (93.98 %) and had fair knowledge on the health effects on consumers when iodine is absent in salt. Some of the producers attributed the nonadherence to the mandatory salt iodization to the unavailability of potassium iodate/iodide on the market. All artisanal salt producers interviewed utilise the solar evaporation method for salt production. The evaporation is done on tarpaulin/polyethylene lined pans and concrete pans. The tarpaulin/polyethylene lined pans were predominantly used in Greater Accra, and concrete pans in Central region. Conclusion For Ghana to increase availability of iodized salt on the market and improve household consumption of iodized salt, regulatory authorities need to enforce the laws and regulations on salt iodization and also create the enabling environment for artisanal salt producer to have access to potassium iodate for production.
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Affiliation(s)
- Benjamin Osei Tutu
- Food Safety and Consumer Education Directorate, Food and Drugs Authority, Ghana
| | | | | | - Faustina Atupra
- Food Safety and Consumer Education Directorate, Food and Drugs Authority, Ghana
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Kareem YO, Ameyaw EK, Amoah RM, Adegboye OA, Yaya S. An assessment of Individual, community and state-level factors associated with inadequate iodised salt consumption among pregnant and lactating women in Nigeria. BMC Pregnancy Childbirth 2023; 23:524. [PMID: 37464273 DOI: 10.1186/s12884-023-05833-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Iodine deficiency is the most common cause of thyroid disease, and in its severe form can result in cretinism; the impairment of the brain development of a child. Pregnant and breastfeeding women's daily iodine requirement is elevated due to physiological changes in iodine metabolism, requiring up to double the iodine intake of other women. Although Nigeria was the first African country to be declared iodine sufficient in 2007, recent evidence has shown that only about seven in ten households consume salt with adequate iodine content (≥ 15 ppm), with variation across states. The study aimed to assess the Individual- and household-, community- and state-level factors associated with inadequate iodised salt consumption among pregnant women and breastfeeding mothers in Nigeria. METHODS This study utilised the Multiple Indicator Cluster Survey to assess factors associated with inadequate iodised salt consumption among 4911 pregnant women and breastfeeding mothers in Nigeria. The descriptive analysis was presented using frequencies and percentages. The prevalence of adequate and inadequate iodised salt consumption with their 95% confidence interval were computed. Several multi-level mixed effect log-binomial logistic regressions were used to explore the factors associated with inadequate iodised salt consumption. The Loglikelihood, Akaike Information Criterion and Bayesian Information Criterion were used to assess the goodness of fit of the models. All analyses were adjusted for the complex survey design and analysed using Stata 15.0 at p < 0.05. RESULTS The prevalence of inadequate iodised salt consumption among pregnant and breastfeeding mothers was 35.2% (95% CI: 33.1-37.5). Inadequate consumption of iodised salt was highest among pregnant and breastfeeding women aged 45-49 years (48.2%; 95%CI: 37.8-58.8), as well as those with non-formal education (52.7%; 95%CI: 47.7-57.6) and no education (34.6%; 95%CI: 31.3-38.1). Our findings revealed that pregnant and breastfeeding women living in the poorer, middle, richer and richest quintiles were 32%, 47%, 35% and 62% less likely to consume salt with inadequate iodine compared to those in the poorest households. Those with non-formal education were 1.8 times (95%CI: 1.36-2.42) more likely to consume salt with deficient iodine than those without education. Pregnant and breastfeeding mothers residing in moderately and most deprived communities were 3.5 (95%CI: 2.57-4.73) and 4.7 times (95%CI: 3.38-6.55) more likely to consume salt with inadequate iodine than those from least deprived communities. Women in the Northwestern region and those from the Southwestern region were 4.0 and 3.5 times, respectively, more likely to consume salt with inadequate iodine compared to pregnant and breastfeeding women residing in the North-Central region. CONCLUSIONS The study has shown that inadequate consumption of iodised salt dominates among older pregnant and breastfeeding women. Also, women with non-formal education have higher prospects of consuming salt with lesser iodine. There is a need to enhance women's economic opportunities and empowerment as well as sensitisation on their nutritional requirements during pregnancy and breastfeeding. Both formal and non-formal educational initiatives on nutrition are extremely important and should be prioritised by the Nigerian government in its efforts to encourage the consumption of iodised salt among pregnant and lactating mothers. Additionally, health promotion interventions that seek to advocate iodised salt intake must be prioritised by the actors in the health sector.
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Affiliation(s)
| | - Edward Kwabena Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Lingnan, Hong Kong
| | - Roberta Mensima Amoah
- Maternal and Child Health Unit, Directorate of University Health Services, University for Development Studies, Tamale, Ghana
| | - Oyelola A Adegboye
- Menzies School of Public Health, Charles Darwin University, Darwin, NT, 0811, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada.
- The George Institute for Global Health, Imperial College London, London, United Kingdom.
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Tadesse S, Hymete A, Lieberman M, Gebreyesus SH, Ashenef A. Iodine status, household salt iodine content, knowledge and practice assessment among pregnant women in Butajira, South Central Ethiopia. PLoS One 2022; 17:e0277208. [PMID: 36441747 PMCID: PMC9704620 DOI: 10.1371/journal.pone.0277208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 10/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Iodine is one of the crucial micronutrients needed by the human body, and is vitally important during pregnancy. This study aimed to determine the relationship between the iodine status of pregnant women and their knowledge, and practices regarding iodized salt. All participants were enrolled in the Butajira nutrition, mental health and pregnancy (BUNMAP) cohort, Butajira, Ethiopia in February-May, 2019. METHODS In this cross-sectional study, 152 pregnant women without hypertension or known thyroid disease before or during pregnancy were randomly selected from the BUNMAP mother to child cohort (n = 832). Spot urine samples were collected to estimate the level of urinary iodine concentration (UIC). Salt samples were also collected from their homes. The Sandall-Kolthoff (S-K) method was used to measure the level of iodine in the urine samples, and iodometric titration was used to measure the level of iodine in the salt. Data was entered and cleaned using Epi-info version 3.5.3 and then exported to SPSS version 20 for further analysis. Multivariate logistic regression analysis was performed to identify associations in the collected data. RESULTS The WHO recommended level of iodine for populations of pregnant women is 150-249 F06Dg/L. The median UIC among pregnant women in this study was 151.2 μg/L [interquartile range (IQR) = 85.5-236.2 F06Dg/L], at the low end of this range. About half (49.65%) of the participants were likely to be iodine deficient. There was a significant association between having a formal job (AOR = 2.56; CI = 1.11-5.96) and iodine sufficiency. Based on a cutoff of >15 ppm (mg/kg), 91.7% (95% CI: 87.2-96.2) of the salts collected from the household had adequate iodine content. The median iodine level of the collected salt samples was 34.9 mg/kg (ppm) (IQR = 24.2-44.6 mg/kg). CONCLUSIONS The UNICEF 2018 guidelines for adequate iodine nutrition in pregnant women include both a recommended median range of 150-249 μg/L, and an upper limit of 20% on the fraction of the population with UIC below 50 μg/L. Because our study population's median level is 151.2 μg/L and the percentage of pregnant women with urinary iodine concentration of less than 50 μg/L is 9.7% (14/145), the women received adequate iodine nutrition. The availability of adequately iodized salt in households is more than 90%, as recommended by WHO. In light of previous iodine deficiency in this region of Ethiopia, the salt iodization program promotes the health of babies and mothers.
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Affiliation(s)
- Senait Tadesse
- Department of Pharmaceutical Chemistry and Pharmacognosy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ariaya Hymete
- Department of Pharmaceutical Chemistry and Pharmacognosy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Marya Lieberman
- Department of Chemistry & Biochemistry, University of Notre Dame, Notre Dame, IN, United States of America
| | - Seifu Hagos Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ayenew Ashenef
- Department of Pharmaceutical Chemistry and Pharmacognosy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
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Rami A, Saeid N, El Mzibri M, El Kari K, Idrissi M, Lahmam H, Mouzouni FZ, Mounach S, El Ammari L, Benkirane H, Al Jawaldeh A, Zimmermann MB, Aguenaou H. Prevalence of iodine deficiency among Moroccan women of reproductive age. Arch Public Health 2022; 80:147. [PMID: 35624493 PMCID: PMC9137163 DOI: 10.1186/s13690-022-00901-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 05/13/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Iodine deficiency disorders (IDD) affects nearly 1.9 million people worldwide. Iodine deficiency (ID) remains a public health concern not only for pregnant women, but for women of reproductive age (WRA) as well. This study was planned to evaluate the iodine status and the prevalence of iodine deficiency in a nationally representative sample of Moroccan WRA according to their socio-economic data and living areas. METHODS This study is a cross-sectional national survey conducted on 1652 WRA aged between 18 and 49 years. Iodine status was assessed by the evaluation of the urinary iodine concentration (UIC) on spot urinary samples, using the Sandell-Kolthoff reaction, and by the estimation of iodine-rich food consumption, using a food frequency questionnaire. The World Health Organization cutoff of a median UIC of < 100 μg/l was used to define ID in the population. RESULTS The median UIC [20th- 80th] was 71.3 μg/l [37.5-123.1] and 71% of participants had UIC < 100 μg/L, indicating insufficient iodine status and mild iodine deficiency. WRA from urban and rural areas showed an UIC median of 75.94 μg/l [41.16-129.97] and 63.40 μg/l [33.81-111.68], respectively. Furthermore, ID prevalence was significantly higher in rural areas (75.6%) as compared to urban areas (67.9%) (p < 0.05). Food frequency questionnaires analyses highlighted that dairy products are the most commonly consumed iodine-rich food, reported to be consumed daily by 43.1% of WRA. Of particular interest, 83.5% of WRA reported a weekly consumption of fish. CONCLUSION ID is still a public health problem in Morocco highlighting the necessity to implement effective national program, including efficient salt iodization, effective nutritional education and awareness, to control iodine deficiency and prevent IDD development.
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Affiliation(s)
- Anass Rami
- grid.412150.30000 0004 0648 5985Laboratory of Biology, Health and Environment, Ibn Tofail University, Kenitra, Morocco ,grid.450269.cNutrition and Alimentation Unit, CNESTEN, Rabat, Morocco
| | - Naima Saeid
- grid.450269.cNutrition and Alimentation Unit, CNESTEN, Rabat, Morocco
| | | | - Khalid El Kari
- grid.450269.cNutrition and Alimentation Unit, CNESTEN, Rabat, Morocco
| | - Mohamed Idrissi
- grid.450269.cNutrition and Alimentation Unit, CNESTEN, Rabat, Morocco
| | - Houria Lahmam
- grid.412150.30000 0004 0648 5985Laboratory of Biology, Health and Environment, Ibn Tofail University, Kenitra, Morocco
| | | | - Samir Mounach
- grid.434766.40000 0004 0391 3171Ministry of Health, Rabat, Morocco
| | - Laila El Ammari
- grid.434766.40000 0004 0391 3171Ministry of Health, Rabat, Morocco
| | - Hasnae Benkirane
- grid.412150.30000 0004 0648 5985Laboratory of Biology, Health and Environment, Ibn Tofail University, Kenitra, Morocco
| | - Ayoub Al Jawaldeh
- grid.483405.e0000 0001 1942 4602World Health Organization – Regional Office for Eastern Mediterranean, P.O. Box 7608, Nasr City, Cairo Egypt
| | - Micheal Bruce Zimmermann
- grid.5801.c0000 0001 2156 2780ETH Zürich, Laboratory of Human Nutrition, Institute of Food Nutrition and Health, Department of Health Science and Technology, ETH Zürich, Zürich, Switzerland
| | - Hassan Aguenaou
- grid.412150.30000 0004 0648 5985Laboratory of Biology, Health and Environment, Ibn Tofail University, Kenitra, Morocco
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Prevalence of insufficient iodine intake in pregnancy worldwide: a systematic review and meta-analysis. Eur J Clin Nutr 2022; 76:703-715. [PMID: 34545212 DOI: 10.1038/s41430-021-01006-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 08/04/2021] [Accepted: 09/03/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES Iodine deficiency in pregnant women is related to impaired foetal growth and development. The objective of this study was to estimate the prevalence of insufficient iodine intake in pregnant women from different regions of the world. SUBJECTS/METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, five electronic databases and Google Scholar grey literature were searched until 10 April 2021. Two reviewers independently conducted article selection, data extraction, and assessment of the risk of bias. Meta-analyses with random effects, subgroup analyses, and meta-regressions were performed. RESULTS In total, 4639 observational articles were found, with 61 eligible for inclusion. The population consisted of 163,021 pregnant women adults and adolescents, and the overall prevalence of insufficient iodine intake was 53% (95% confidence interval [CI]: 47-60; I2 = 99.8%). Pregnant women who live in insufficient iodine status country had a higher prevalence (86%; 95% CI: 78-93; I² =97.0%) of inadequate iodine nutritional status than to those living in country considered sufficient (51%; 95% IC: 45-57; I² = 99.8%). CONCLUSION Despite the progress in iodine fortification policies and periodic monitoring of the iodine nutritional status of the population worldwide, salt iodination alone may not be sufficient to provide adequate iodine status to pregnant women. Thus, other actions may be necessary to improve the nutritional clinical care of pregnant group.
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Low Iodine Intake May Decrease Women's Fecundity: A Population-Based Cross-Sectional Study. Nutrients 2021; 13:nu13093056. [PMID: 34578933 PMCID: PMC8467427 DOI: 10.3390/nu13093056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/20/2021] [Accepted: 08/26/2021] [Indexed: 12/27/2022] Open
Abstract
Salt iodization is one of the most cost-effective strategies to eliminate iodine deficiency disorders (IDD). However, China’s dismantling of salt monopoly has reduced the availability of iodized salt in the susceptible population in pregnancy, which might cause IDD and have adverse health effects on both themselves and their offspring. The aim of our study was therefore to explore the association between IDD and women’s reproductive health. This is a population-based cross-sectional study conducted in 2018 in Zhejiang Province, China. A total of 1653 pregnant women participated in this study. Median urinary iodine concentration (UIC) in the population was used to assess iodine intake. Cox regression analyses were used to estimate the association between iodine intake and time to pregnancy, which was indicated with fecundability ratio (FR) and 95% confidence interval (CI). The percentage of participants with iodine deficiency who had been waiting longer than 13 months to get pregnant (20%; median UIC 119.6 μg/L) was significantly higher than those with iodine sufficiency (14%; median UIC 147.1 μg/L). A significant decrease in fecundity was observed in participants with iodine deficiency (FR, 0.820; 95% CI, 0.725−0.929) than those with iodine sufficiency. These findings indicate the importance of ongoing monitoring of iodine nutrition in women of reproductive age. Keeping a safe and optimal level of iodine nutrition during pregnancy should be emphasized.
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Impact of Dietary Habit, Iodine Supplementation and Smoking Habit on Urinary Iodine Concentration During Pregnancy in a Catalonia Population. Nutrients 2020; 12:nu12092656. [PMID: 32878172 PMCID: PMC7551663 DOI: 10.3390/nu12092656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/19/2020] [Accepted: 08/27/2020] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The nutritional status of women during pregnancy can have a considerable effect on maternal and fetal health, and on the perinatal outcome. Aim: to assess the changes occurring in dietary iodine intake, potassium iodide supplementation, and smoking habit, and the impact of these changes on the urinary iodine concentration (UIC) during pregnancy in a population of women in Catalonia (Spain). (2) Methods: Between 2009–2011, an observational study included a cohort of women whose pregnancies were monitored in the public health system in the Central and North Metropolitan areas of Catalonia. Women received individual educational counseling, a dietary questionnaire was completed, and a urine sample was collected for iodine determination at each trimester visit. (3) Results: 633 (67.9%) women answered the questionnaire at all 3 visits. The percentage of women with a desirable UIC (≥150 μg/L) increased from the first to the second trimester and remained stable in the third (57.3%, 68.9%, 68%; p < 0.001). Analysis of the relationship between UIC ≥ 150 μg/L and the women’s dietary habits showed that the percentage with UIC ≥ 150 μg/L increased with greater consumption of milk in the first trimester, and the same was true for iodized salt use in all three trimesters and iodine supplementation in all three. (4) Conclusion: During pregnancy, increased intake of milk, iodized salt, and iodine supplements were associated with an increase in the UIC.
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Ba DM, Ssentongo P, Na M, Kjerulff KH, Liu G, Du P, Song W, Richie JP, Gao X. Factors Associated with Urinary Iodine Concentration among Women of Reproductive Age, 20-49 Years Old, in Tanzania: A Population-Based Cross-Sectional Study. Curr Dev Nutr 2020; 4:nzaa079. [PMID: 32462108 PMCID: PMC7236838 DOI: 10.1093/cdn/nzaa079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/14/2020] [Accepted: 04/25/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Universal salt iodization (USI) is the most feasible and cost-effective, and equitable, approach to prevent iodine deficiency. Severe maternal iodine deficiency during pregnancy is associated with serious adverse gestational and birth outcomes. OBJECTIVES The aim was to assess iodine status and identify independent factors associated with urinary iodine concentration (UIC) among women of reproductive age in Tanzania. METHODS This was a weighted, population-based, cross-sectional study in 2985 women of reproductive age (20-49 y) in Tanzania who participated in the Demographic and Health Surveys in 2015-2016 (DHS 2015-2016) and had measured UIC. Multivariable generalized linear regression was used to identify potential factors that were associated with UIC. RESULTS The median UICs among women consuming inadequately iodized salt (93.6 μg/L; 25th and 75th percentiles: 43.1, 197.9 μg/L) and women in the lowest socioeconomic status (92.3 μg/L; 45.6, 194.4 μg/L) were below the WHO-recommended ranges (≥150 μg/L for pregnant women and ≥100 μg/L for nonpregnant women). The results of multivariable models indicated that pregnant women had 1.21 μg/L lower UIC than nonpregnant women (β = -1.21; 95% CI: -3.42, -0.12), breastfeeding women had 1.02 μg/L lower UIC than nonbreastfeeding women (β = -1.02; 95% CI: -2.25, -0.27), and women with no education had a 1.88 μg/L lower UIC compared with those with secondary/highest education (β = -1.88; 95% CI: -4.58, -0.36). Women consuming inadequately iodized salt had 6.55 μg/L lower UIC than those consuming adequately iodized salt (β = -6.55; 95% CI: -9.24, -4.33). The median UIC varied substantially across geographic zones, ranging from 83.2 μg/L (45.9, 165.3) in the Western region to 347.8 μg/L (185.0, 479.8) in the Eastern region. CONCLUSIONS Our findings indicated a great heterogeneity in median UIC across regions of Tanzania among women of reproductive age. Poverty, consuming inadequately iodized salt, and lack of education appeared to be the driving factors for lower UIC in Tanzania.
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Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Muzi Na
- Department of Nutritional Sciences, Penn State University, State College, PA, USA
| | - Kristen H Kjerulff
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Ping Du
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Won Song
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA
| | - John P Richie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Xiang Gao
- Department of Nutritional Sciences, Penn State University, State College, PA, USA
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Dei-Tutu SA, Manful A, Heimburger DC, Malechi H, Moore DJ, Oppong SA, Russell WE, Aliyu MH. Correlating maternal iodine status with neonatal thyroid function in two hospital populations in Ghana: a multicenter cross-sectional pilot study. BMC Pediatr 2020; 20:26. [PMID: 31964362 PMCID: PMC6974977 DOI: 10.1186/s12887-020-1932-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 01/16/2020] [Indexed: 11/10/2022] Open
Abstract
Background Congenital hypothyroidism is a common, yet easily treatable cause of poor growth and intellectual disability. Newborn screening programs play an important role in the early detection and treatment of congenital hypothyroidism. However, an estimated 71% of children are born in countries such as Ghana, which does not have a screening program. Iodine deficiency, a common cause of congenital hypothyroidism, is present in the Ghanaian population. Mild to moderate maternal iodine deficiency may negatively impact cognitive function in children. A structured approach to examine the association between maternal iodine levels and infant thyroid function may have important ramifications on our understanding of congenital hypothyroidism in Ghana. We investigated the hypothesis that maternal iodine deficiency impacts infant thyroid function, using Thyroid Stimulating Hormone (TSH) as a marker of thyroid function. We also explored potential opportunities and barriers to newborn screening for congenital hypothyroidism in Ghana. Methods This was a cross-sectional, multicenter pilot study of 250 women and their neonates recruited from post-natal clinics in Accra and Tamale, Ghana. We compared maternal urine iodine concentration and infant TSH, as well as maternal sociodemographic and nutrition information. Regression models were used to model the relationship between variables. Results Median infant TSH was 4.7 μIU/ml (95% CI: 3.9–5.5) in Accra. In Tamale, the median infant TSH was 3.5 μIU/ml (95%CI: 3.3 to 3.6) (Δ: 1.3 μIU/ml, 95% CI: 0.5–2.1, p = 0.002). Median maternal urine iodine concentrations were 141.0 μg/L (95% CI: 115.7 to 166.3) and 142.5 μg/L (95% CI: 125.1 to 160.0) in Accra and Tamale, respectively (Δ: − 1.5 μIU/ml, 95% CI: − 32.2 – 29.2, p = 0.925). There was a weakly positive correlation between maternal urine iodine and infant TSH (rho 0.1, p = 0.02). Almost one-third (30%) of women in both locations had biochemical evidence of iodine deficiency. Mothers with any formal education were more likely to have higher iodine levels than their counterparts who had no formal education (coefficient 0.31, p = 0.006). Conclusions Maternal iodine deficiency is prevalent in Ghana and is correlated to infant thyroid function. We recommend studies with larger sample sizes to assess the true scope of this relationship.
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Affiliation(s)
- Selorm A Dei-Tutu
- Ian Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN, USA. .,Baylor College of Medicine, Section of Pediatric Diabetes and Endocrinology, Houston, TX, USA.
| | - Adoma Manful
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Hawa Malechi
- Department of Obstetrics and Gynecology, Tamale Teaching Hospital, Tamale, Ghana
| | - Daniel J Moore
- Ian Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Samuel A Oppong
- Department of Obstetrics and Gynecology, Korle-Bu Teaching Hospital, Accra, Ghana
| | - William E Russell
- Ian Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Nashville, TN, USA
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Toloza FJK, Motahari H, Maraka S. Consequences of Severe Iodine Deficiency in Pregnancy: Evidence in Humans. Front Endocrinol (Lausanne) 2020; 11:409. [PMID: 32636808 PMCID: PMC7318882 DOI: 10.3389/fendo.2020.00409] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/21/2020] [Indexed: 11/13/2022] Open
Abstract
Iodine is a necessary micronutrient for the production of thyroid hormones and normal human development. Despite the significant worldwide strategies for the prevention and control of iodine deficiency, it is still a prevalent public health issue, especially in pregnant women. Severe iodine deficiency during pregnancy and neonatal period is associated with many major and irreversible adverse effects, including an increased risk of pregnancy loss and infant mortality, neonatal hypothyroidism, cretinism, and neuropsychomotor retardation. We will review the impact of severe iodine deficiency on maternofetal, neonatal, and offspring outcomes. We will also discuss its epidemiology, classification of iodine deficiency severity, and current recommendations to prevent iodine deficiency in childbearing age and pregnant women.
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Affiliation(s)
- Freddy J. K. Toloza
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Knowledge and Evaluation Research Unit in Endocrinology (KER-Endo), Rochester, MN, United States
| | - Hooman Motahari
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Spyridoula Maraka
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Knowledge and Evaluation Research Unit in Endocrinology (KER-Endo), Rochester, MN, United States
- Central Arkansas Veterans Healthcare System, Little Rock, AR, United States
- *Correspondence: Spyridoula Maraka
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Kubuga CK, Abizari AR, Song WO. Iodine status of reproductive age women and their toddlers in northern Ghana improved through household supply of iodized salt and weekly indigenous meal consumption. PLoS One 2019; 14:e0216931. [PMID: 31150410 PMCID: PMC6544231 DOI: 10.1371/journal.pone.0216931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/20/2019] [Indexed: 11/19/2022] Open
Abstract
Iodine deficiency (ID) during pregnancy results in pregnancy losses, intrauterine growth retardation, and lower IQ in the offspring. Even after two decades of universal salt iodization (USI) implementation, the efficacy of USI has not been reported in high risk groups in vulnerable regions in Ghana. We aimed to assess and improve ID status in childbearing age women (all lactating women) and their toddlers in northern Ghana, a geographically and socioeconomically vulnerable region. We provided weekly supply of household iodized salt and community-based feeding of native Hibiscus Sabdariffaa leaves meal (HSM) prepared with iodized salt to women and their toddlers in intervention (n = 60) vs. control group (n = 60). At baseline, ID was prevalent in women (36%) and their toddlers (29%). For women, both median UIC values for intervention (57.4 ug/l) and control group (65.1 ug/l) were below the recommended UIC value of 100 ug/l with no significant differences between the two groups (p = 0.2778). At the endpoint, median UIC for the intervention group (123.6 ug/l) was significantly higher (p = 0.008) than the control group (59.7 ug/l). Our results suggest that weekly supply of iodized salt along with the feeding HSM is an effective channel for improving iodine status of economically disadvantaged groups in communities remote from coastal lands. Furthermore, our results suggest that decreased median UIC among lactating mothers does not necessarily imply lower iodine status for their breastfed toddlers. And finally, the observed median UIC<100 ug/l may point to a non-improvement in iodine status for the past decade for Ghana. There is a need to revisit, assess, and ascertain the challenges in preventing populations from attaining the intended benefits of the USI policy in Ghana.
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Affiliation(s)
| | - Abdul-Razak Abizari
- Nutritional Sciences Department, University for Development Studies, Tamale, Ghana
| | - Won O. Song
- Food Science and Human Nutrition Department, Michigan State University, East Lansing, MI, United States of America
- * E-mail:
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Abu BAZ, Oldewage-Theron W, Aryeetey RNO. Risks of excess iodine intake in Ghana: current situation, challenges, and lessons for the future. Ann N Y Acad Sci 2018; 1446:117-138. [PMID: 30489642 PMCID: PMC6618322 DOI: 10.1111/nyas.13988] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/05/2018] [Accepted: 10/19/2018] [Indexed: 12/21/2022]
Abstract
In Ghana, iodine deficiency was first reported in 1994 among 33% of the population. A nationwide Universal Salt Iodization (USI) program plus other complementary interventions were subsequently implemented as a response. Our paper reviews the current risks of excess iodine status in Ghana and identifies policy and research gaps. A mixed methods review of 12 policies and institutional reports and 13 peer‐reviewed articles was complemented with consultations with 23 key informants (salt producers and distributors, food processors, regulatory agency officials, and healthcare providers) purposively sampled between May and August 2017. The findings show a strong policy environment indicated by regulations on food and salt fortification (Act 851), including the USI regulation. However, currently, only a third of Ghanaian households use adequately iodized salt. Recent evidence shows that voluntarily fortified processed foods (including condiments) supply a considerable amount of iodine to the food system. Limited biological impact data suggest possible household exposure to excessive dietary iodine (>15 parts per million). Currently, there is no systematic tracking of iodine content from fortified foods and other sources. Cross‐sectoral actions are needed to understand this situation better. Key research gap is the lack of comprehensive data on iodine content and intake from other sources in Ghana.
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Affiliation(s)
- Brenda A Z Abu
- Rochester Institute of Technology, College of Health Sciences and Technology, Wegmans School of Health and Nutrition, Rochester, New York.,Department of Nutritional Sciences, Texas Tech University, College of Human Sciences, Lubbock, Texas
| | - Wilna Oldewage-Theron
- Department of Nutritional Sciences, Texas Tech University, College of Human Sciences, Lubbock, Texas
| | - Richmond N O Aryeetey
- Department of Population, Family and Reproductive Health, University of Ghana, School of Public Health, Legon, Accra, Ghana
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Takele WW, Alemayehu M, Derso T, Tariku A. Two-thirds of pregnant women attending antenatal care clinic at the University of Gondar Hospital are found with subclinical iodine deficiency, 2017. BMC Res Notes 2018; 11:738. [PMID: 30333053 PMCID: PMC6192361 DOI: 10.1186/s13104-018-3829-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/09/2018] [Indexed: 11/21/2022] Open
Abstract
Objective This study was aimed at determining the magnitude of prenatal iodine deficiency and its determinants among women attending antenatal care clinic at the University of Gondar Specialized Referral Hospital, Northwest Ethiopia. A cross-sectional study was conducted from March 13 to April 25/2017. Precisely, 378 pregnant women were included in the study selected via systematic random sampling technique. Urinary Iodine concentration was determined through spectrophotometer using Sandell-Kolthoff reaction. Iodine deficiency was defined as women having urinary iodine concentration of < 150 µg/L. Moreover, stool examination was done. Results Subclinical iodine deficiency among pregnant women was 60.5% (95% CI 55%, 65.5%). The Median iodine concentration was 137 μg/L (IQR 80 μg/L). Being governmental employee [AOR = 0.42 (95% CI 0.1 = 20, 0.87)], cabbage consumption of twice or more times per week [AOR = 2.35 (95% CI 1.44, 3.82)], not consuming maize in the last 1 week [AOR = 0.29 (95% CI 0.18, 0.48)], poor household wealth status [AOR = 2.7 (95% CI 1.24, 5.89)], and second trimester of pregnancy [AOR = 2.43 (95% CI 1.37, 4.32)] were significantly associated with iodine deficiency. Prenatal iodine deficiency was high, which deemed a mild public Health problem. Therefore, improving household income, and nutrition education to minimize maize and cabbage consumption are recommended.
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Affiliation(s)
- Wubet Worku Takele
- Department of Community Health Nursing, School of Nursing College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Mekuriaw Alemayehu
- Department of Environmental Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Terefe Derso
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Tariku
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Wang Z, Liu P, Su X, Zou S, Song J, Liu S. A Comparison of Iodine Status in Children and Pregnant Women After a Policy Change in the Iodized Salt Standard in Shanghai, China. Biol Trace Elem Res 2018. [PMID: 29541993 DOI: 10.1007/s12011-018-1257-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In Shanghai, a new iodized salt standard was implemented in 2012. To provide evidence to the government, we compared iodine status before (35 mg/kg) and after (30 mg/kg) adjustment in vulnerable populations living in Shanghai. The probability-proportional-to-size sampling technique was used to select at least 360 pregnant women for urine iodine test and at least 1200 students for thyroid measurement and the household salt test. Of these students, at least 360 performed urine iodine test. The median thyroid volume and the median household salt iodine concentration of children aged 8-10 years were 1.80 ml and 24.8 mg/kg in 2015, and 0.97 ml and 28.3 mg/kg in 2011. The median urine iodine concentration (UIC) of pregnant women was 126.52 and 139.77 μg/L in 2015 and 2011. All differences were statistically significant (P < 0.05). The median UIC of students was 171.40 and 181.63 μg/L in 2015 and 2011, the difference was not statistically significant. Multivariate linear regression analysis showed that thyroid volume in children was associated with sex, age, region, and household salt iodized concentration. The current iodized salt concentration meets the basic needs of the population's iodine requirements except for pregnant women. Periodic monitoring is necessary particularly in vulnerable groups.
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Affiliation(s)
- Zhengyuan Wang
- Institute of Iodine Deficiency Disorders Prevention and Control, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang, China
| | - Peng Liu
- Institute of Iodine Deficiency Disorders Prevention and Control, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang, China
| | - Xiaohui Su
- Institute of Iodine Deficiency Disorders Prevention and Control, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang, China
| | - Shurong Zou
- Department of Nutrition Hygiene, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jun Song
- Department of Nutrition Hygiene, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Shoujun Liu
- Institute of Iodine Deficiency Disorders Prevention and Control, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang, China.
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Mao G, Zhu W, Mo Z, Wang Y, Wang X, Lou X, Wang Z. Iodine deficiency in pregnant women after the adoption of the new provincial standard for salt iodization in Zhejiang Province, China. BMC Pregnancy Childbirth 2018; 18:313. [PMID: 30075759 PMCID: PMC6091046 DOI: 10.1186/s12884-018-1952-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 07/27/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Zhejiang has achieved the goal of elimination of iodine deficiency disorders (IDD) via the implementation of universal salt iodization (USI) since 2011. Iodine content in household table salt decreased from the national standard (35 ppm) to the Zhejiang provincial standard (25 ppm) in 2012. It is crucial to periodically monitor iodine status in pregnant women because IDD in pregnancy have adverse effects on fetal neurodevelopment. METHODS We carried out a cross-sectional study between April 2014 and September 2015 in the eight sentinel surveillance counties across Zhejiang Province, where IDD was previously known to be endemic. A total of 1304 pregnant women participated and provided a random spot urine sample and a household table salt sample. Urinary iodine concentration (UIC) was determined using arsenic-cerium catalytic spectrophotometry. Iodine content in salt was measured using a titration method with sodium thiosulphate. RESULTS Overall, the median UIC of the total study population of pregnant women was 129.3 μg/L, with a higher UIC in inland (152.54 μg/L) and a lower UIC in coastal counties (107.54 μg/L). Household coverage of iodized salt was 94.6% and the rate of adequately iodized salt was 89.9%. CONCLUSIONS Our results indicate deficient iodine status in the pregnant population of Zhejiang, according to the lower cut-off value of optimal iodine nutrition (150 μg/L) recommended by the World Health Organization. In addition to sustaining USI, more efforts are urgently needed to improve iodine intake in women during pregnancy, especially those residing in the coastal counties.
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Affiliation(s)
- Guangming Mao
- Department of Environmental and Occupational Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou Zhejiang, Province, People’s Republic of China
| | - Wenming Zhu
- Department of Environmental and Occupational Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou Zhejiang, Province, People’s Republic of China
| | - Zhe Mo
- Department of Environmental and Occupational Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou Zhejiang, Province, People’s Republic of China
| | - Yuanyang Wang
- Department of Environmental and Occupational Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou Zhejiang, Province, People’s Republic of China
| | - Xiaofeng Wang
- Department of Environmental and Occupational Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou Zhejiang, Province, People’s Republic of China
| | - Xiaoming Lou
- Department of Environmental and Occupational Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou Zhejiang, Province, People’s Republic of China
| | - Zhifang Wang
- Department of Environmental and Occupational Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou Zhejiang, Province, People’s Republic of China
- Key subject for medical research, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou Zhejiang, Province, People’s Republic of China
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High Iodine Deficiency among Pregnant Women in Periurban Ghana: A Hospital-Based Longitudinal Study. J Nutr Metab 2018; 2018:9706805. [PMID: 29967696 PMCID: PMC6008623 DOI: 10.1155/2018/9706805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/06/2018] [Indexed: 11/17/2022] Open
Abstract
Background Iodine deficiency causes maternal hypothyroidism which can lead to growth, cognitive, and psychomotor deficit in neonates, infants, and children. This study examined the iodine status of pregnant women in a periurban setting in Ghana. Methods This longitudinal study recruited 125 pregnant women by purposeful convenience sampling from the antenatal clinic of the Sefwi Wiawso municipal hospital in Ghana. Urinary iodine concentration (UIC) was estimated by the ammonium persulfate method at an estimated gestational age (EGA) of 11, 20, and 32 weeks. Demographic information, iodized salt usage, and other clinical information were collected using a questionnaire. Results The prevalence of iodine deficiency among the pregnant women was 47.2% at EGA 11 and 60.8% at both EGA of 20 and 32, whereas only 0.8% of participants not using iodized salt had iodine sufficiency at EGA 32. 18.4%, 20%, and 24% of participants using iodized salt had iodine sufficiency at EGA 11, 20, and 32, respectively. Conclusion A high prevalence of iodine deficiency was observed among our study cohort.
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Gyamfi D, Wiafe YA, Danquah KO, Adankwah E, Amissah GA, Odame A. Urinary iodine concentration and thyroid volume of pregnant women attending antenatal care in two selected hospitals in Ashanti Region, Ghana: a comparative cross-sectional study. BMC Pregnancy Childbirth 2018; 18:166. [PMID: 29764405 PMCID: PMC5952633 DOI: 10.1186/s12884-018-1820-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 05/02/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Iodine deficiency is a major public health problem affecting people worldwide, particularly pregnant women. Iodine requirements increase substantially during pregnancy making pregnant women vulnerable to iodine deficiency and its disorders such as abortions, stillbirths and pregnancy goitre as well as congenital abnormalities, cretinism and mental retardation in their children. The primary aim of this study was to evaluate the prevalence of iodine deficiency and goitre among pregnant women attending antenatal sessions at two selected hospitals in Ashanti region, Ghana. METHODS A cross-sectional study was carried out in 239 pregnant women who attended the antenatal clinic at Kwame Nkrumah University of Science and Technology (KNUST) Hospital or Ejura District Hospital, both in Ashanti Region, Ghana. Socio-demographic data and information related to iodine were captured using a questionnaire. Urinary iodine concentration (UIC) was determined on spot urine samples using the Sandell-Kolthoff reaction with ammonium persulfate as digesting agent. Each woman's thyroid volume was also measured by ultrasonography. RESULTS The overall median UIC was 155.9 μg/L, indicating adequate iodine intake in the study population. However, goitre prevalence in the pregnant women was 11.3%, denoting mild iodine deficiency. The median UIC for pregnant women who attended KNUST Hospital was higher (163.8 μg/L) than that of Ejura District Hospital (149.0 μg/L). The proportion of women who did not consume iodised salt was significantly higher (p < 0.001) in Ejura District Hospital (71.2%) than KNUST Hospital (28.0%). In total, 47.3% of the pregnant women studied had a UIC < 150 μg/L. Only 16.3% knew about the increase in iodine requirement during pregnancy and 21.3% of them had knowledge of the effects of iodine deficiency during pregnancy with most (81.8%) knowing of pregnancy goitre. CONCLUSION There is generally adequate iodine intake among the pregnant women, however, iodine deficiency and goitre still exist among some pregnant women. Thus, assessment and continuous monitoring of iodine nutritional status in pregnant women in the country are warranted. Also, intensification of effective public health campaigns (through radio and television) with regard to iodine utilization and its benefits in pregnancy are still recommended among Ghanaian pregnant women.
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Affiliation(s)
- Daniel Gyamfi
- Department of Medical Laboratory Technology, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yaw Amo Wiafe
- Department of Sonography, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwabena Owusu Danquah
- Department of Medical Laboratory Technology, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ernest Adankwah
- Department of Medical Laboratory Technology, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Gertrude Akua Amissah
- Department of Medical Laboratory Technology, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Angela Odame
- Department of Sonography, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Significantly elevated foetal haemoglobin levels in individuals with glucose 6-phosphate dehydrogenase disease and/or sickle cell trait: a cross-sectional study in Cape Coast, Ghana. BMC HEMATOLOGY 2017; 17:16. [PMID: 29021902 PMCID: PMC5613503 DOI: 10.1186/s12878-017-0088-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/15/2017] [Indexed: 12/02/2022]
Abstract
Background Previously published data have demonstrated that sickle red blood cells produce twice as much reactive oxygen species (ROS) suggesting that co-inheritance of sickle cell disease (SCD) and glucose 6-phosphate dehydrogenase (G6PD) enzymopathy could lead to more severe anaemia during sickling crises. Elevated foetal haemoglobin (Hb F) levels have been shown to have positive modulatory effects on sickling crises and disease outcomes. This study sought to assess how inheritance of G6PD enzymopathy affects the level of Hb F and haemoglobin concentration in adults in steady state. Methods This cross-sectional study selected 100 out-patients (41 males and 59 females) visiting the University of Cape Coast hospital, between January, 2016 and May, 2016. Cellulose acetate electrophoresis (pH 8.2–8.6), methaemoglobin reductase test, modified Betke alkaline denaturation methods were used to investigate haemoglobin variants, qualitative G6PD status, and %Hb F levels in venous blood samples drawn from these participants. Data was analysed with GraphPad Prism 6 and SPSS and significance set at p < 0.05. Results Forty one percent of the participants demonstrated qualitative G6PD enzymopathy whereas only 10% demonstrated Hb AS type (Sickle cell trait, SCT). 5% of the participants co-inherited SCT and G6PD enzymopathy. %Hb F levels in G6PD deficient males was significantly higher than in G6PD deficient females [(p = 0.0003, 2.696% (males) vs 1.975% (females)], although the %Hb F levels was comparable in non-G6PD deficient individuals. %Hb F levels were significantly elevated in males with SCT only (p < 0.05), or G6PD enzymopathy only (p < 0.0001), or SCT + G6PD enzymopathy (p < 0.0001) compared to males with none of these pathologies even though their respective haemoglobin levels were comparable. Male participants with G6PD enzymopathy + SCT co-inheritance had significantly elevated %Hb F when compared to their counterparts with only G6PD enzymopathy (p < 0.001). Male gender [(p = 0.001, OR: 6.912 (2.277–20.984)] partial defective G6PD enzyme [(p = 0.00, OR: 7.567E8 (8.443E7–6.782E9)] SCT [(p = 0.026, OR: 4.625 (1.196–17.881)] were factors associated with raised %Hb F levels ≥2.5. Conclusion The inheritance of G6PD defect and/or SCT significantly elevate %Hb F levels in the steady state even though haemoglobin levels are not affected.
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Mtumwa AH, Ntwenya JE, Paul E, Huang M, Vuai S. Socio-economic and spatial correlates of subclinical iodine deficiency among pregnant women age 15-49 years in Tanzania. BMC Nutr 2017; 3:47. [PMID: 32153827 PMCID: PMC7050759 DOI: 10.1186/s40795-017-0163-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Iodine deficiency is a widespread global health problem that affects about 2 billion people each year. Pregnant women are particularly vulnerable to iodine deficiency due to increased iodine requirement leading to death, miscarriage, and stillbirth. Iodine deficiency also has significant negative effects on newborns including impaired cognitive development, impaired learning capabilities, and stunting. This study looks at the association between subclinical iodine deficiency and demographic factors including age, wealth index, education, family size, geographical zone, number of children, fish consumption, pregnancy trimester and household salt in pregnant women aged 15-49 years in Tanzania. METHODS The 2010 Tanzania Demographic and Health Survey (TDHS) data was re analysed. Subclinical iodine deficiency is classified as a urinary iodine concentration (UIC) of <150 μg/L. RESULTS Results showed that the prevalence of iodine deficiency (54%) was unacceptably high among pregnant women. The results of multiple logistic regression model found that number of children, wealth index, household salt, and geographical zone were significantly associated with iodine deficiency in these women. CONCLUSION These results indicate a need to implement interventions to increase iodine intake that targets pregnant women with the specific demographic characteristics.
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Affiliation(s)
- Abdalla H. Mtumwa
- Department of Statistics, The University of Dodoma, P.O. Box 338, Dodoma, Tanzania
| | - Julius Edward Ntwenya
- Department of Public Health, The University of Dodoma, P.O. Box 395, Dodoma, Tanzania
- Department of Public Health, University of Dodoma, P.O. BOX 259, Dodoma, Tanzania
| | - Edwin Paul
- Department of Statistics, The University of Dodoma, P.O. Box 338, Dodoma, Tanzania
| | - Megan Huang
- Department of Public Health, The University of Dodoma, P.O. Box 395, Dodoma, Tanzania
| | - Said Vuai
- Department of Chemistry, The University of Dodoma, P.O. Box 338, Dodoma, Tanzania
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An Increase in Consuming Adequately Iodized Salt May Not Be Enough to Rectify Iodine Deficiency in Pregnancy in an Iodine-Sufficient Area of China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14020206. [PMID: 28230748 PMCID: PMC5334760 DOI: 10.3390/ijerph14020206] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 12/23/2022]
Abstract
Universal salt iodization (USI) has been implemented for two decades in China. It is crucial to periodically monitor iodine status in the most vulnerable population, such as pregnant women. A cross-sectional study was carried out in an evidence-proved iodine-sufficient province to evaluate iodine intake in pregnancy. According to the WHO/UNICEF/ICCIDD recommendation criteria of adequate iodine intake in pregnancy (150-249 µg/L), the median urinary iodine concentration (UIC) of the total 8159 recruited pregnant women was 147.5 µg/L, which indicated pregnant women had iodine deficiency at the province level. Overall, 51.0% of the total study participants had iodine deficiency with a UIC < 150 µg/L and only 32.9% of them had adequate iodine. Participants living in coastal areas had iodine deficiency with a median UIC of 130.1 µg/L, while those in inland areas had marginally adequate iodine intake with a median UIC of 158.1 µg/L (p < 0.001). Among the total study participants, 450 pregnant women consuming non-iodized salt had mild-moderate iodine deficiency with a median UIC of 99.6 µg/L; 7363 pregnant women consuming adequately iodized salt had a lightly statistically higher median UIC of 151.9 µg/L, compared with the recommended adequate level by the WHO/UNICEF/ICCIDD (p < 0.001). Consuming adequately iodized salt seemed to lightly increase the median UIC level, but it may not be enough to correct iodine nutrition status to an optimum level as recommended by the WHO/UNICEF/ICCIDD. We therefore suggest that, besides strengthening USI policy, additional interventive measure may be needed to improve iodine intake in pregnancy.
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