COLLEGE OF MEDICINE AND HEALTH SCIENCES:
DEPARTMENT OF GENERAL PUBLIC HEALTH
ASSIGNMENT ON PUBLIC HEALTH NUTRITIONAL PROBLEMS
PREPARED BY: MERON GIRMA
SUBMITTED TO: ALEMSELAM ZEBDEWOS (PhD)
Date: March
21, 2023
PUBLIC HEALTH NUTRITIONAL PROBLEM:
IODINE DEFICIENCY AMONG PREGNANT
WOMEN
Contents
• Introduction
• Prevalence of Iodine Deficiency
• Factors associated with Iodine Deficiency
• Conclusion
• Recommendations
• References
Introduction
• Iodine is one of the crucial micronutrients required for the normal
growth of humans from the fetal stage to adulthood.
• It is required for the synthesis of thyroxin (T3) & triiodothyronine
(T4) hormones in the thyroid gland.
• These hormones regulate metabolism and protein synthesis as well
as neuronal function and brain development.
Introduction contd…
• Without enough iodine, these thyroid hormones do not work
properly and can lead to an under-active or overactive thyroid
gland.
• This under/over activity of the thyroid gland causes a medical
condition of hypothyroidism and hyperthyroidism with various
negative side effects in the body.
Clinical Features (Signs and Symptoms)
Clinical features of IDD in general have a wide spectrum according to the
age of the individual. This spectrum of IDD is as follows:
Fetus
• Abortion - Congenital
anomalies
• Stillbirth - Increased
perinatal mortality
• Endemic cretinism
Neonate
• Neonatal goiter
• Neonatal hypothyroidism
• Endemic mental
retardation
Child and
adolescent
Adult
• Hypothyroidism
• Goiter
• Impaired mental function
• Impaired mental
development and
function
Most important consequences of
the spectrum of IDD are:
• Hypothyroidism
• Mental retardation
• Retarded physical
development
• Hypothyroidism
• Goiter
• Cretinism
• Increased morbidity and
mortality of infants and
neonates
Introduction contd…
• Production of thyroid hormones increases during pregnancy,
requiring higher intakes of iodine.
• Both the fetus and infant require enough iodine for normal
physical growth and brain development.
• Breast milk contains iodine, though the amount will depend on
the mother’s diet, and many infant formulas contain iodine.
Introduction Contd…
• A deficiency of iodine can inhibit a normal growth and development.
This is especially dangerous in pregnant women and infants, in which
miscarriage, stillbirth, stunted growth, and cognitive impairments can
occur.
• Iodine is the main cause of potentially preventable mental retardation
in childhood. It causes permanent mental impairment during infancy as
well as a spectrum of morbidities referred to as iodine deficiency
disorders (IDD).
Introduction contd…
• In adults, an iodine deficiency of less than 10-20 mcg a day can lead
to inadequate thyroid hormone production, called hypothyroidism,
which disrupts normal metabolic functions like regulating heart rate,
body temperature, and body weight.
• RDA: The Recommended Dietary Allowance for iodine is 150
micrograms (mcg) daily for adult men and women 19+ years, and
220 and 290 mcg daily for pregnant and lactating women,
respectively.
• UL: A Tolerable Upper Intake Level (UL) is the maximum daily dose
unlikely to cause adverse side effects in the general population. The
UL for iodine for adults 19+ years and pregnant and lactating women
is 1,100 mcg daily.
Introduction contd…
Sources of Iodine
• Iodine is found in soil and the ocean, which
varies in amount and will affect how much
of the mineral is contained in a food.
• Iodine is found mainly in animal protein
foods and sea vegetables, and to a lesser
extent in fortified foods like breads, cereals,
and milk.
• Seaweed (plants that grow in seas)
• Fish, shellfish (cod, canned tuna, oysters,
shrimp)
• Table salts labeled “iodized”
• Dairy (milk, cheese, yogurt), Eggs,
• Beef liver, Chicken, Fortified infant formula
Prevalence of Iodine Deficiency among Pregnant Women
• The meta-analysis of seven studies that included 2190 pregnant
women showed a pooled prevalence of iodine deficiency during
pregnancy in Ethiopia to be 68.76% (95% CI: 55.21–82.31).
• In a subgroup analysis, the prevalence in Oromia region was
71.93% (95% CI: 54.87–88.99), and in Amhara region 60.93%
(95% CI: 57.39–64.48). Iodized salt use (AOR = 0.18; 95% CI:
0.08–0.44) and 1st-trimester pregnancy (AOR = 0.68; 95% CI:
0.47–0.99) were found to have a significant association with iodine
deficiency. (Kabthymer et al, 2021)
Prevalence of Iodine Deficiency in Pregnant Women
• According to a study in Ada district, Oromia region, Ethiopia, by
Fereja et al, 2018, the Prevalence of goiter was significantly higher
among pregnant women aged 30–44 years (AOR = 2.32 (95% CI: 1.05–
5.14) than among younger women and among illiterate women (AOR =
2.71 (95% CI: 1.54–4.79).
• Compared to nulliparous (never gave birth), women with parity of 1, 2,
and 3 or more had 2.28 (95% CI: 1.01–5.16), 2.81 (95% CI: 1.17–6.74),
and 4.41 (95% CI: 1.58–12.26) times higher risk of goiter respectively..
Prevalence of Iodine Deficiency in Pregnant Women
• According to a study done in Wolaita and Dawro Zones among
adolescent girls by Workie et al. 2017, The overall prevalence
(total goiter rate) of goiter in the study area was 48.9%.
• Students with Grade-1 goiter were 36.9% while with Grade-2
goiter was 11.9%.
• Females were by a long way vulnerable to goiter and account
for 60.9%.
EDHS 2016, Distribution of Iodized Salt Usage
Factors associated with Iodine Deficiency
• The main factor responsible for iodine deficiency is a low dietary
supply of iodine.
• It is highly prevalent among populations living in highland areas where
the soil has low iodine content as a result of erosion and repeated
leaching effects of snow, water, and heavy rainfall.
• Crops grown in this soil do not provide adequate amounts of iodine
when consumed.
• Seafood is usually a good source because the ocean contains a
considerable amount of iodine.
Factors associated with Iodine Deficiency…
• According to the studies reviewed,
Iodized salt use,
Duration of pregnancy (gestational age – 1st trimester
pregnancy)
Age of a woman
Sex – Being a female
Literacy
Number of births a woman gave
Showed a significant association with an Iodine Deficiency.
Factors associated with Iodine Deficiency…
• Other important factors, which also cause iodine deficiency,
may include goitrogenic substances, Protein Energy
Malnutrition (PEM) and vitamin A and selenium deficiencies.
• Moreover, poverty and general malnutrition may worsen the
effects of iodine deficiency.
• Dietary iodine absorbed from the small intestine follows two
main pathways within the body; approximately 30% is removed
by the thyroid gland and used for the synthesis of thyroid
hormone; the remainder is excreted.
Conclusions
• Iodine deficiency among pregnant women remains to be a major
public health problem in many parts of Ethiopia.
• Iodized salt utilization at the household level was significantly
associated with iodine deficiency among pregnant women.
• Although the iodized salt coverage in Ethiopia is reportedly high
(89.2%), the prevalence of IDD among pregnant women
remained significantly high.
• This finding implies that the prevalence of iodine deficiency
among pregnant women in Ethiopia still needs due consideration
and efforts have to be made by the government to increase
accessibility and utilization of iodized salt.
Recommendations
• The recommended strategy for IDD control is correcting the deficiency by
increasing iodine intake through supplementation or food fortification.
• There are four main components to implement this strategy:
1) Correction of iodine deficiency,
2) Surveillance including monitoring and evaluation,
3) Inter-sectorial collaboration and
4) Advocacy and communication to mobilize public health authorities and
educate the public.
• The Federal Ministry of health adopted a strategy to control and prevent
IDDs. These are universal iodization of salt for human and animal
consumption and supplementation of iodine capsules to populations in
highly endemic areas, where iodized salt is inaccessible
References
1.
Iodine Deficiency Disorders For the Ethiopian Health Center Team Anwar Yibrie (MD, MSc, MPH), Sisay
Yifru (MD+), Desalegn Tigabu (MD), Yifokir Tefera (BSc), Takele Tekelu (BSc), Taddis Birhane (BSc)
University of Gondar In collaboration with the Ethiopia Public Health Training Initiative, The Carter
Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education.
2. https://www.hsph.harvard.edu/nutritionsource/iodine/
3. Prevalence of iodine deficiency and associated factors among pregnant women in Ada district,
Oromia region, Ethiopia: a cross-sectional study:Fereja et al. BMC Pregnancy and Childbirth (2018)
18:257 https://doi.org/10.1186/s12884-018-1905-z
4. Systematic review and meta-analysis of iodine deficiency and its associated factors among pregnant women in
Ethiopia: Kabthymer et al. BMC Pregnancy and Childbirth (2021) 21:106 https://doi.org/10.1186/s12884-02103584-0
5. Magnitude of iodine deficiency disorder and associated factors in Dawro zone, Southwest Ethiopia; the hidden
hunger: a cross-sectional study:Asfaw and Belachew BMC Nutrition (2020) 6:20
https://doi.org/10.1186/s40795-020-00345-8
6. Assessing the status of iodine deficiency disorder (IDD) and associated factors in Wolaita and Dawro
Zones School Adolescents, southern Ethiopia:Workie et al. BMC Res Notes (2017) 10:156
7. EDHS 2016, 2019
THANK YOU!!