Toward an Ecosocial Epidemiological Approach to Goiter and Other Iodine Deficiency Disorders: A Case Study of India's Technocratic Program for Universal Iodization of Salt

2009 ◽  
Vol 39 (2) ◽  
pp. 343-362 ◽  
Author(s):  
Ritu Priya ◽  
Atul Kotwal ◽  
Imrana Qadeer
Keyword(s):  
Iodine Deficiency ◽  
Negative Impact ◽  
Public Health Problem ◽  
Evidence Base ◽  
World Health ◽  
Major Public Health Problem ◽  
Iodine Deficiency Disorders ◽  
Iodine Nutrition ◽  
The Government ◽  
Epidemiological Approach

The program of universal salt iodization (USI) was intensified in the 1990s. Unfortunately, a recent World Health Organization review finds that there was a global increase of 31.7 percent in total goiter rate from 1993 to 2003. However, the WHO review places only 1 country as severely, 13 as moderately, and 40 as mildly deficient in populations' iodine nutrition, and places 43 countries at optimal, 24 at high, and 5 at excessive levels of iodine nutrition. Thus, it is imperative to weigh the benefits and risks of intensifying USI further. The WHO review places India in the category of “adequate” iodine nutrition, but in 2005 the Government of India promulgated a universal ban on sale of non-iodized salt, calling iodine deficiency disorders (IDDs) a major public health problem. This article attempts to understand these contradictions and weigh the benefits and costs of USI. Based on a review of studies since the 1920s, the authors reconstruct the evolution of IDD control in India. Conceptual and methodological limitations challenge the evidence base and rationale of stricter implementation of USI now. Finding evidence for its negative impact, the authors recommend a reexamination of the USI strategy and propose a safer, people-centered, ecosocial epidemiological approach rather than a universal legal ban.

scholarly journals A community based cross sectional study on prevalence of iodine deficiency disorders among 6-12 years children of a district of North Karnataka

2017 ◽  
Vol 4 (12) ◽  
pp. 4553 ◽  
Author(s):  
Rekha S. Sonavane ◽  
Ramesh H. Mayappanavar ◽  
Ananthachari K. R. ◽  
Subarna Roy ◽  
Venkateswara Prasad U. ◽  
...  
Keyword(s):  
Iodine Deficiency ◽  
Primary Schools ◽  
Age Groups ◽  
Public Health Problem ◽  
Cross Sectional Study ◽  
Major Public Health Problem ◽  
Iodine Deficiency Disorders ◽  
Community Based ◽  
Cross Sectional ◽  
Goitre Prevalence

Background: Iodine deficiency is the major preventable cause of irreversible mental retardation in the world with nearly 2 billion people with iodine deficiency disorders (IDD).In India district level surveys conducted in 2006 in 324 districts have revealed that IDD is a major public health problem in 263 districts that is total goitre prevalence rate of more than 10% in the population. Methods: The survey was conducted from November 2016 to January 2017, after obtaining permission from Institutional Ethical Committee, using population proportionate to size (PPS) sampling method among of 6-12 years children. In the selected villages, primary schools were visited and a sample of 90 children was selected and was examined after consent from school authority. Prevalence of goitre was assessed and graded by standard palpation method. In few selected children urine and house hold salts are examined. Results: The prevalence of goitre among the 6 to 12 years children was found to be 22.78%. There was not much difference in prevalence of goitre in females compared to males in all the age groups and prevalence of goitre was observed to increase with age, which was found to be statistically significant (p=0.00001). Conclusions: Prevalence of iodine deficiency is significantly high and higher prevalence was found with increasing age. 

scholarly journals Assessing Status of Iodine Nutrition in Union Territory of Chandigarh, India

2016 ◽  
Vol 20 (1) ◽  
pp. 38-41
Author(s):  
Jasbinder Kaur ◽  
Seema Gupta ◽  
Neeraj Agarwal ◽  
Jaswinder Kaur ◽  
Shivani Jaswal ◽  
...  
Keyword(s):  
Iodine Deficiency ◽  
School Children ◽  
Urinary Iodine ◽  
Public Health Problem ◽  
Iodine Content ◽  
Urinary Iodine Excretion ◽  
Urinary Iodine Concentration ◽  
Major Public Health Problem ◽  
Iodine Nutrition ◽  
Union Territory

ABSTRACT Iodine deficiency disorders (IDDs) constitute a major public health problem in India. Goiter occurring in a large fraction of population (> 10%) is said to be due to iodine deficiency rather than any other cause. A community-based cross-sectional study was undertaken in the Union Territory of Chandigarh with the aim to track the elimination of IDD to determine the iodine status of school children unexamined for goiter status and excretion median urinary iodine concentration. Goiter was assessed by standard palpation technique in 6,517 school children, aged 6 to 12 years, selected through 30 cluster sampling methods. Spot urine samples of 823 children were collected for estimation of urinary iodine using modified method of Sandell and Kolthoff. Household salt samples of the 548 selected children from schools were analyzed for its iodine content by standard iodometric titration method. The overall prevalence of goiter was found to be 14.2% among the children examined. The median urinary iodine excretion (UIE) was 199 g/L. About 71.2% of the salt samples were adequately iodized, having iodine content of > 15 ppm. Since UIE reflects recent iodine nutrition at the time of measurement and thyroid size shows iodine nutrition over months or years, it can be said that this region is in transition phase from iodine-deficient to iodine-sufficient territory. How to cite this article Agarwal N, Kaur J, Kaur J, Gupta S, Jaswal S, Kaur H, Swami HM. Assessing Status of Iodine Nutrition in Union Territory of Chandigarh, India. Indian J Med Biochem 2016;20(1):38-41.

scholarly journals Prevalence of iodine deficiency disorders and its determinants among school children aged 6 to 12 years in rural areas of Koppal district, Karnataka

2020 ◽  
Vol 7 (2) ◽  
pp. 573
Author(s):  
Vijaykumar P. Mane ◽  
Yuvaraj Banot Yenkanaik ◽  
Smita M. Nimbannavar ◽  
Anilkumar L. ◽  
Sharankumar Holyachi ◽  
...  
Keyword(s):  
Public Health ◽  
Iodine Deficiency ◽  
School Children ◽  
Health Problem ◽  
Rural Areas ◽  
Public Health Problem ◽  
Iodine Content ◽  
Urine Samples ◽  
Major Public Health Problem ◽  
Iodine Deficiency Disorders

Background: Iodine deficiency disorders are recognized as major public health problem in India and the simplest, most effective and inexpensive preventive method is the consumption of Iodized salt. The objective of this study is to estimate the prevalence of goitre among children aged 6 to 12 years in rural areas of Koppal district, to determine various factors associated with goiter among children, to estimate the level of urinary iodine excretion among urine samples collected from children and to estimate the level of iodine content among salt samples collected in the study setting.Methods: A cross sectional study was conducted for a duration of 6 months from June 2018 to November 2018 in rural areas of Koppal district among 3047 school children aged 6 to 12 years selected by cluster sampling technique. Goiter was detected and graded using standard techniques and the collected salt and urine samples were sent to MRHRU, Sirwar, Raichur for analysis. Data was collected using pretested and semistructured questionnaire and was analyzed using WHO Epi info software version 3.5.4.Results: The prevalence of goitre among school children in Koppal district was 442 (14.5%) and it was found to be significantly associated with age and source of drinking water. Majority i.e., 65.96% of urine samples had iodine content less than 100 µg/l and majority i.e., 79.15% of salt samples had iodine content less than 15 PPM.Conclusions: Goiter is mild public health problem in Koppal district with majority of urine samples excreting iodine below optimum levels and majority of salt samples being inadequately iodized.

Eliminating Hepatitis B from Bangladesh by the Year 2030

2020 ◽  
Vol 38 (3) ◽  
pp. 145-149
Author(s):  
Md Golam Mustafa ◽  
Md Shahinul Alam ◽  
Md Golam Azam ◽  
Md Mahabubul Alam ◽  
Md Saiful Islam ◽  
...  
Keyword(s):  
Hepatitis B ◽  
Health Workers ◽  
Health Sector ◽  
Public Health Problem ◽  
Integrated System ◽  
Hbv Infection ◽  
Diagnosis And Treatment ◽  
Major Public Health Problem ◽  
Medical Institutions ◽  
The Government

Worldwide, hepatitis B virus (HBV) infection is still a major public health problem. Bangladesh having a large burden of HBV infection, should be a major contributor towards it’s elimination by 2030. The country has been making progress in reducing incidence of HBV infection during the past decades. The progresses are mainly due to large vaccination coverage among children and large coverage of timely birthdose vaccine for prevention of mother-to-child transmission of HBV. However, Bangladesh still faces challenges in achieving target of reduction in mortality from HBV. On the basis of targets of the WHO’s Global health sector strategy on viral hepatitis 2016–2021, we highlight priorities for action towards HBV elimination. To attain the target of reduced mortality we propose that, the service coverage targets of diagnosis and treatment should be prioritized along with vaccination. Firstly, improvements are needed in the diagnostic and treatment abilities of medical institutions and health workers. Secondly, the government needs to reduce the costs of health care. Thirdly, better coordination is needed across existing national program and resources to establish an integrated system for prevention, screening, diagnosis and treatment of HBV infection. In this way, we can make progress towards achieving the target of eliminating HBV from Bangladesh by 2030 J Bangladesh Coll Phys Surg 2020; 38(3): 145-149

scholarly journals Prevalence of anemia among pregnant women in rural Koppal: a study from teaching hospital, Koppal, India

2017 ◽  
Vol 6 (9) ◽  
pp. 3792 ◽  
Author(s):  
Seema B. N.
Keyword(s):  
Pregnant Women ◽  
Public Health Problem ◽  
Peripheral Blood Smear ◽  
Poverty Line ◽  
World Health ◽  
Major Public Health Problem ◽  
Severe Anemia ◽  
Mild Anemia ◽  
High Prevalence ◽  
Prevalence Of Anemia

Background: Anemia is the nutritional deficiency disorder and 56% of all women living in developing countries are anaemic according to World Health Organization. India has the highest prevalence of anaemia and 20% of total maternal deaths are due to anemia. To determine the prevalence of anemia and factors influencing its causation among pregnant women.           Methods: This is the study of 1769 pregnant women which was conducted in a rural population of Koppal district, Karnataka, India, from June 2016 to November 2016 i.e. a period of 6 months. This longitudinal prospective observational study was conducted in the district hospital of Koppal. Anemia was classified as per the Indian Council of Medical Research (ICMR) criteria. The diagnosis of anemia was undertaken by peripheral blood smear examination and standard hemoglobin estimation by shale’s method.Results: The average age of pregnant women was 23.5 years, ranging between 18 and 40 years. Most of the women belonged to below poverty line (BPL) families (84.6%) and Hindu religion (98%). Regarding education, 28.9% were illiterates. The mean haemoglobin level was found to be 8.95. Prevalence of anemia was 96.5% among the pregnant females in this region of rural Koppal. Out of these 22.47% had mild anemia, 56.30% had moderate anemia, 14.98% had severe anemia and 2.73% very severe anemia according to ICMR classification of anemia.Conclusions: High prevalence of anemia among pregnant women indicates anemia to be a major public health problem in the rural community and indicates strict implementation of National Nutrition Anemia prophylaxis programme. Factors such as socioeconomic status, education, birth interval, and gravida contribute to this high prevalence.

Severity and costs associated with hospitalization for dengue in public and private hospitals of Surat city, Gujarat, India, 2017–2018

2019 ◽  
Vol 113 (11) ◽  
pp. 661-669 ◽  
Author(s):  
Viral R Bajwala ◽  
Denny John ◽  
T Daniel Rajasekar ◽  
Manoj V Murhekar
Keyword(s):  
Urban Areas ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Warning Signs ◽  
World Health ◽  
Severe Dengue ◽  
Major Public Health Problem ◽  
Private Hospitals ◽  
Government Hospitals ◽  
The Cost

Abstract Background Dengue is major public health problem in India, especially in urban areas. We conducted a study to estimate the severity and costs of treatment among hospitalized dengue patients in Surat city, Gujarat, India. Methods We reviewed the medical records of dengue patients hospitalized in five tertiary care facilities (private [n=2], semi-government [n=2] and government [n=1]) between April 2017 and March 2018. We used the World Health Organization 2009 classification to classify the severity of dengue. A resource utilization approach was used to estimate the cost of illness in US dollars (US$) (inflation adjusted to 2018) from a quasi-societal perspective (excluding non-medical cost) for dengue hospitalization. Results Of the 732 hospitalized dengue patients, 44.7% had no warning symptoms, 39.5% had warning signs and 15.8% had severe dengue. The mean cost of hospitalization was US$86.9±170.7. The cost of hospitalization was 28.8 times higher in private hospitals compared with government hospitals. Consultant charges in private hospitals, laboratory investigations in semi-government hospitals and registration with admission charges in government hospitals accounted for 27.3%, 39.4% and 53% of the direct cost in these facilities, respectively. Conclusions A better triage system for hospitalization, subsidizing costs in the public sector and cost capping in the private sector can help to reduce the cost of hospitalization due to dengue so as to ensure affordability for larger portion of the society for universal health coverage.

scholarly journals Caso Clínico: Cirugía Reconstructiva de Tobillo

2018 ◽  
Vol 10 (2) ◽  
pp. 170-174
Author(s):  
Fulvio Enrique Zuñiga Cabrera ◽  
Jaime Santiago Clavijo Jaramillo ◽  
Adriana Abigail Guzmán Villa
Keyword(s):  
Diabetes Mellitus ◽  
Reverse Flow ◽  
Public Health Problem ◽  
Lower Limbs ◽  
World Health ◽  
Major Public Health Problem ◽  
Sural Flap ◽  
Advantages And Disadvantages ◽  
Left Ankle ◽  
Osteosynthesis Material

BACKGROUND: Diabetes mellitus is a major public health problem, according to the World Health Organization, 422 million adults worldwide in 2014. In 2012, it caused 1.5 million deaths worldwide. Diabetes is the leading cause of non-traumatic amputation in lower limbs and foot infections occur with high frequency in poorly controlled patients. This case shows the reconstruction of soft tissue defects in the lower third leg, heel, malleoli and foot through the description of the reverse sural flap. In this study the advantages and disadvantages of the use of this technique are discussed. CASE REPORT: A 56-year-old female patient with a poorly controlled history of Diabetes Mellitus type 2, who suffered a fracture of the left ankle treated with osteosynthesis, and who during the postoperative period attended emergency orthopedics and traumatology, due to severe pain in the left ankle, fever, dehiscence of surgical wound, accompanied by serous secretion. EVOLUTION: The patient, after several surgical cleanings and changes in closure therapy assisted by negative pressure, manages to control the infection, with persistence of the bone coverage defect and the osteosynthesis material. There were additional complications such as joint stiffness, muscle atrophy; it was decided to reconstruct the distal third of the foot using a reverse flow sural fasciocutaneous flap, which evolved satisfactorily, managing to cover the defect with biological tissue. CONCLUSIONS: The sural flap of reverse flow is a reproducible technique that allows to cover coverage defects in the distal third of the leg and ankle; shorten hospitalization times, especially when there is bone exposure or osteosynthesis material.

scholarly journals Trajectories and Determinants of Physical Activity during COVID-19 Pandemic: A Population-Based Study of Middle-Aged and Elderly Individuals in The Netherlands

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 3832
Author(s):  
Amy Hofman ◽  
Marlou A. M. Limpens ◽  
Tosca O. E. de Crom ◽  
Mohammad Arfan Ikram ◽  
Annemarie I. Luik ◽  
...  
Keyword(s):  
Physical Activity ◽  
The Netherlands ◽  
Latent Class ◽  
Multinomial Logistic Regression ◽  
Public Health Problem ◽  
Population Based ◽  
World Health ◽  
Major Public Health Problem ◽  
Middle Aged ◽  
Health Organization

Physical inactivity is a major public health problem, and there are concerns this might have increased during the COVID-19 pandemic. We aimed to identify distinct trajectories of physical activity over a 6-week period after the first restrictive measures and to explore determinants of these trajectories in a population-based cohort of middle-aged and elderly in the Netherlands (n = 5777). We observed that at least 59% of participants did not meet the World Health Organization recommendations for physical activity. Using latent class trajectory analyses over three time points, we identified five distinct trajectories, including four steady trajectories at different levels (very low, low, medium and high) and one increasing trajectory. Using multinomial logistic regression analyses, we observed that, compared to the ‘steadily high’ trajectory, participants in the ‘steadily very low’ trajectory were more often older, lower educated, reporting poorer physical health, more depressive symptoms, consuming a less healthy diet, smoking, and lower alcohol use, and were less often retired. A similar pattern of determinants was seen for those in the increasing trajectory, albeit with smaller effect sizes. Concluding, we observed low levels of physical activity that generally remained during the pandemic. The determinants we described can help identify groups that require additional preventive interventions.

Antidepressants

2012 ◽  
pp. 1185-1198
Author(s):  
Zubin Bhagwagar ◽  
George R. Heninger
Keyword(s):  
Burden Of Disease ◽  
Antidepressant Drugs ◽  
Public Health Problem ◽  
Premature Mortality ◽  
Primary Treatment ◽  
World Health ◽  
Years Of Life Lost ◽  
Major Public Health Problem ◽  
Treatment Of Depression ◽  
Health Organization

Major depressive disorder is a serious, recurrent illness which levies a crippling toll on individuals, families, and society in general. The importance of depression as a major public health problem is emphasized by findings from the World Health Organization Global Burden of Disease survey in showing that in 1990 it was the fourth largest cause of burden of disease (i.e. years of life lost due either to premature mortality or to years lived with a disability). It has been estimated that by the year 2020 it is expected to be the second largest cause of burden of disease. Depression is underdiagnosed and frequently under-treated, and depressed individuals have a much higher risk for suicide. The primary treatment for depression involves the use of antidepressant drugs, and it is therefore important that clinicians become familiar with and adept in utilizing this important group of compounds. Although primarily used for the treatment of depression, drugs within this category also have a number of other important uses. A thorough understanding of the pharmacology of antidepressants will aid the clinician in the selective use of these drugs for patients with depression as well as patients with a number of other disorders.

scholarly journals Incidence and Risk Factors for Severe Pneumonia in Children Hospitalized with Pneumonia in Ujjain, India

2020 ◽  
Vol 17 (13) ◽  
pp. 4637
Author(s):  
Sunil Kumar Kasundriya ◽  
Mamta Dhaneria ◽  
Aditya Mathur ◽  
Ashish Pathak
Keyword(s):  
Risk Factors ◽  
Public Health Problem ◽  
Severe Pneumonia ◽  
World Health ◽  
Major Public Health Problem ◽  
Open Defecation ◽  
History Of ◽  
Poor Ventilation ◽  
Acyanotic Congenital Heart Disease ◽  
Health Organization

Childhood pneumonia is a major public health problem. The aim of this prospective hospital-based study is to determine the incidence and risk factors for community-acquired severe pneumonia in children in Ujjain, India. The study includes 270 children, 161 (60%) boys and 109 (40%) girls, aged between 2 months and 5 years with World Health Organization defined and radiologically confirmed severe pneumonia. Considering the 270 children, 64% (95% confidence interval (CI) 57.9–69.4) have severe pneumonia. The following are identified as risk factors for severe pneumonia from the generalized logistic regression model: Born premature (adjusted odds ratio (AOR) 7.50; 95% CI 2.22–25.31; p = 0.001); history of measles (AOR 6.35; 95% CI 1.73–23.30; p = 0.005); incomplete vaccination (AOR 2.66; 95% CI 1.09–6.48; p = 0.031); acyanotic congenital heart disease (AOR 9.21; 95% CI 2.29–36.99; p = 0.002); home treatment tried (AOR 3.84; 95% CI 1.42–10.39; p = 0.008); living in a kuchha house (AOR 3.89; 95% CI 1.51–10.01; p = 0.027); overcrowding (AOR 4.50; 95% CI 1.75–11.51; p = 0.002);poor ventilation in living area (AOR 16.37; 95% CI 4.67–57.38; p < 0.001); and practicing open defecation (AOR 16.92; 95% CI 4.95–57.85; p < 0.001). Awareness of these risk factors can reduce mortality due to severe pneumonia.

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