IODINE AND HEAVY METAL DISTRIBUTION IN PERIPHERAL ENDEMIC
AREA OF IODINE DEFICIENCY DISORDER IN PONOROGO DISTRICT,
EAST JAVA, INDONESIA.
Muhamad Arif Musoddaq1*, Khimayah 1
Center of Health Research and Development, Magelang, NIHRD, MOH-RI
Kavling Jayan, Borobudur, Magelang
Senamata2009@yahoo.com
Submitted:
Revised:
Approved:
Bagian ini diisi oleh Jurnal Media Gizi Mikro Indonesia (MGMI)
ABSTRACT
Iodine Deficiency Disorder is a serious public health problems in Ponorogo. Ministry of Health reported
that 4,1% of 5,657 of population in Sidoharjo Village, 1,4% of 7,827 of population in Krebet Village SubDistrict of Jambon has been identified as having mental retardation due to IDD in 2011. Other factor that
could be related to IDD is the present of heavy metal as a blocking agent.The surrounding area where
endemic IDD is found most likely face similar problem including Dayakan and Watubonang Village. The
aim of study is to confirm whether those area can be regarded as an IDD or non-IDD areas. This is a
cross-sectional study conducted in Dayakan and Watubonang Village in 2011. 165 school-aged children
(age 9-11 years) was selected as sample for analysis of Urinary Iodine Excretion. 29 soil and 87 water
samples were taken from area study for iodine and heavy metal (Hg, Pb, Cd) concentration measurement.
The result shows that the median of UIE is 130ug/L (optimal). The average of iodine concentration in
soil and water are 36,74 mg/Kg and 13,6ug/L respectively. The average of Hg soil concentration is
96,466mg/kg, while it is 1ppb in water which is consider not tolerable. The average amount of Pb in soil
is 5,811mg/Kg, while there is no detectable lead in the water. Cd is not detectable both in soil and water.
In conclusion, Dayakan and Watubonang Village is not an IDD area, however malnutrition and IDD
control program should be undertaken to prevent future public health problem.
Keyword: Iodine, IDD, UIE, heavy metal
I.
Background
Iodine deficiency is one of major global
public health problem. Wide range of
negative impacts resulting from iodine
deficiency on human growth events
from the beginning of life in the womb
to adulthood called Iodine Deficiency
Disorders (IDD). In fetus, IDD might
cause abortion, birth-death, congenital
abnormalities,
increased
perinatal
mortality and child mortality. In women
of childbearing age, IDD can manifest
clinically in the form of goiter,
hypothyroidism, and impaired mental
function. While in toddlers and school
children, iodine deficiency is known to
cause hypothyroidism, impaired growth
and decreased intellectual capacity. A
number of studies comparing the
school children who lived in endemic
and non-endemic area of IDD, showed
that children who lived in endemic
areas had lower levels of cognitive
development and school achievement.
In general, the impact of iodine
deficiency is mental retardation, which
in turn have an impact on social and
economic development of the country
(Zimmermann, 2007; Djokomoeljanto,
1986). Epidemiological observations
suggest that environmental factors
have a significant effect on the
settlement and development of new
IDD cases in endemic areas (Hetzel
and Dunn, 1989).
Low iodine content of the environment
is a main cause of IDD. Iodine content
of the soil is specific for its environment.
Ecological processes has eliminated
iodine in many regions through flooding
and exacerbated by heavy rains.
Mountain areas and flood plains
generally contains low iodine. Food
produced in an iodine lack environment
would not be able to provide enough
iodine for human needs.
Similarly,
water from iodine lack environment
might contain low iodine. Theoretically,
in the mountainous areas might found
IDD case, generally. However, IDD
was also found in coastal areas and
islands,
where
the
materials
goitrogenik, blocking agents, and
genetic factors apparently played a role
in these conditions (Taha et al, 2002;
Sulchan, 2007).
II.
Method
This research is a descriptive study with
cross-sectional design.
Spot urine
samples from 165 school age children
were collected then measured of its
iodine concentration (Urinary Iodine
Excretory = UIE) of each sample by
Sandell-Kolthoff reaction. Soil samples
from 29 point samples and water
samples from 87 water sources were
collected and measured concentration
of iodine and mercury (Hg), lead (Pb),
and cadmium (Cd) of each sample.
Location and condition of soil and water
point samples were noted to get
longitude, latitude, altitude, landuse and
kind of water sources.
The presence of heavy metals in the
environment in many cases was related
to the incidence of endemic goiter.
Drinking water from a shallow water is
often contaminated by heavy metals.
Heavy metals are known to inhibit the
use of iodine in the thyroid gland
(Sulchan, 2007).
In Ponorogo, low content of iodine in
water and soils have been associated
with the emergence of mental
retardation caused by iodine deficiency,
where 4.1% of 5657 inhabitant of
Sidoharjo village 5657, and 1.4% of the
7827 inhabitant of Krebet villages had
mental retardation.
IDD study in
Ponorogo has not been yet covering a
wider area of research. Likewise, the
iodine content of the environment and
the presence of other factors in the
environment potentially associated with
the case of IDD.
The aims of this was to determine
iodine intake status of school age
children, and the distribution of iodine
and heavy metals contents in water and
soil in the surrounding area that had
IDD problems.
Data analysis was conducted both
descriptive and bivariate analysis.
Descriptive analysis was done to
describe
characteristic
of
data.
Bivariate analysis was conducted to
gain association between iodine,
mercury,
lead,
and
cadmium
concentration in soil and water with
environmental
factors
(altitude,
landuse, and kind of water souce).
III.
Result
3.1. UIE (Urinary Iodine Excretory)
Concentration
Iodine intake of iodine can be described
through the excretion of iodine in urine
(UIE).
Median UIE of school age
children was 130 ug/L in which EIU less
than 50 ug/L at 33.1% of population.
Based on success catagory indicators
due to IDD (WHO,2001), the EIU
primary school age children indicated
no deficiency of iodine intake in study
area.
Table 1. UIE of School Age Children
Category of UIE
(ug/L)
3.2.
Frequencies
%
<50
2
1,57
50 - 99
40
31,50
100 - 199
60
47,24
>200
25
19,69
Total
127
100,00
Environment Iodine Content
Soil Iodine Concentration
It was detected in wide range
concentration of iodine in soil, from
6,640 – 108,809 mg/kg. There is a
significant difference of soil iodine
concentration between altitude less
than 250 masl. and altitude of 250-500
masl. (p=0,021) and altitude more than
500 masl. (p=0,007), where soil iodine
Explanation
Median UIE
130 (14–1187 ug/L)
concentration in altitude less than 250
masl. was the highest. There was no
significant difference between the
concentration of soil iodine in altitude of
250-500 masl. and altitude lower than
500 masl. (p=0,843). No significant
difference was found between soil
iodine levels of land use in the study
sites (Table 2, 3, and 4).
Table 2. Iodine Soil Concentration in Study Area (mg/kg)
N
Mean
Median
29
36,740 + 27,539
33,777 (6,640 - 108,809)
< 250 masl
9
54,035 +19,338
51,965 (36,778 - 100,209)
250 - 500 masl
13
30,522 + 32,813
15,702 (7,010 - 108,809)
> 500 masl
7
26,049 + 14,875
26,509 (6.640 - 44,617)
Build Up Area
5
50,409 + 9,325
51,965 (39,961 - 60,988)
Irrigated Rice Field
2
48,643 + 9,488
48,643 (41,934 - 55,352)
Iodine Concentration
Altitude
Landuse
Dry Land
11
19,596 + 15,971
9,876 (6,604 - 58,676)
Bush
5
43,988 + 39,336
41,159 (9,653 - 108,809)
Forest
6
46,771 + 36,714
35,278 (7,604 - 108,809)
Table 3. Mann-Whitney Test of Soil Iodine Concentration
between Altitudes in Study Area
p
<250 masl
250 – 500 masl
<250 masl
250 – 500 masl
0,021
>500 masl
0,007
0,843
Table 4. Mann-Whitney Test Soil Iodine Concentration between Landuse in Study Area
p
Build-Up Area
Rice Field
Irrigated
Dry Land
Bush
Build-Up Area
Rice Field Irrigated
1.00
Dry Land
0.08
0.076
Bush
0.347
0.439
0.100
Forest
0.361
0.505
0.07
Water Iodine Concentration
Iodine concentration in water of study
site area ranged from 0 ug/L
(undetectable) to 49 ug/L, where there
were concentration differences between
type of water source, and also between
altitude and landuse of study site.
There were significant different of
iodine concentration between spring
water and dug wells water (p=0,000)
and also borehole water (p=0,000),
where spring water have the lowest
concentration. While the water is
sourced from dug wells did not differ
significantly with water sourced from
wells drilled (p=0.429). There were
significantly difference of water iodine
concentration of altitude less than 250
0.855
masl with altitude of 250-500 masl
(p=0.000) and also altitude higher than
500
masl
(p=0.000),
where
concentration of iodine water at altitude
less than 250 masl was the highest.
There was no significant difference
between water iodine concentration at
altitude of 250-500 masl and at altitude
higher than 500 masl (p=0,366).
Difference landuse at study site
produced water with significantly
different iodine concentration (p<0,05)
with exception between the dry land
and bush.
Highest water iodine
concentration found at buid up area
(settlement) followed by water derived
from rainfed (Table 5, 6, 7 and 8).
Table 5. Water Iodine Concentration in Study Area (ug/L)
N
Mean
Median
87
13,56 + 13,814
8,00 (0-49)
Spring
15
0,59 + 1,450
0 (0-5)
Dugg Wells
65
17,02 + 17,020
12 (0-49)
Borehole
7
9,29 + 4,270
9 (2-16)
<250 mdpl
67
17,60 + 13,300
12 (0-49)
250 - 500 mdpl
11
0,08 + 0,270
0 (0-0,9)
> 500 mdpl
9
0,00 + 0,000
0
Buid Up Area
60
18,17 + 13,375
13 (0-49)
Rainfed Rice Field
9
9,89 + 12,129
5 (0-40)
Dry Land
15
0,06 + 0,232
0 (0-0,9)
Bush
3
0,00 + 0,000
0
Iodine Concentration
Type of Water Sources
Altitude
Landuse
Table 6. Mann-Whitney Test of Water Iodine Concentration
between Types of Water Source in Study Area
Spring
Dugg Wells
Spring
Dugg Wells
0,000
Borehole
0,000
0,429
Table 7. Mann-Whitney Test of Water Iodine Concentration
between Altitude in Study Area
<250 masl
250 – 500 masl
0 – 250 masl
250 – 500 masl
0,000
>500 masl
0,000
0,366
Table 8. Mann-Whitney Test of Water Iodine Concentration between Landuse at
Study Area
Build Up Area
Rainfed Rice Field
Dry Land
Build Up Area
Rainfed Rice Field
0,043
Dry Land
0,000
0,000
Bush
0,007
0,023
3.3. Heavy Metal: Mercury (Hg)
Soil Mercury Concentration
Soil mercury concentration in study
area ranged from 7,43 to 562,05 ppb.
There were no significant differences of
0,655
soil iodine concentration within altitude
and landuse in study area.in the levels
of mercury in the soil in between the
range of heights and between land use
(Tables 9, 10 and 11).
Table 9. Soil Mercury Concentration in Study Area (ppb)
N
Mean
Mercury Concentration
29
96,466 + 110,118
Altitude
<250 masl
9
128,797 + 165,551
250 - 500 masl
13
78,118 + 62,850
> 500 masl
7
88,971 + 98,904
Guna Lahan
Build Up Area
5
184,538 + 213,005
Irrigated Rice Field
2
58,560 + 4,031
Dry Land
11
99,718 + 92,119
Bush
5
55,058 + 44,979
Forest
6
64,252 + 41,242
Median
68,64 (7,43 - 562,05)
73,66 (22,25 - 562,05)
63,32 (10,42 - 255,16)
76,45 (7,43 - 296,04)
99,70 (55,22 - 562,05)
58,560 (55,71 - 61,41)
74940 (7,43 - 296,04)
36,41 (10,42 - 123,00)
59,80 (21,15 - 125,40)
Table 10. Mann-Whitney Test of Soil Mercury Concentration
between Altitude in Study Area
<250 masl
250 – 500 masl
<250 masl
250 – 500 masl
0,483
>500 masl
0,56
0,968
Table 11. Mann-Whitney Test of Soil Mercury Concentration between Landuse in Study Area
Build Up Area
Irrigated Rice Field
Dry Land
Bush
Buid Up Area
Irrigated Rice Field
0,245
Dry Land
0,336
0,43
Bush
0,117
0,699
0,462
Forest
0,144
0,739
0,615
0,715
water (p=0,174).
There was not
significant
difference
between
borehole water and dug well water
(p=0,064). Significant differences of
water mercury concentration was only
found at altitude of less than 250 masl
with altitude of 250-500 masl
(p=0,048). There are no significant
different
of
water
mercury
concentration within landuse (Table
12, 13, 14, and 15).
Water Mercury Concentration
Water mercury concentration in study
area ranged from 0.00 to 23.24 ppb.
There were significant differences of
water mercury concentration within
type of water source and altitude,
while there were no significant
difference within landuse.
Iodine
concentration of borehole water
significantly differed with spring water
(p=0,007), but there was no
significant different with dug well
Table 12. Water Mercury Concentration in Study Area
N
Mercury Concentration
Type of Water Source
87
Mean
1,104 + 3,226
Median
0,00 (0,00-23,24)
Spring
15
0,732 + 1,260
0,29 (0,00-4,91)
Dug Wells
65
1,309 + 3,665
0,00 (0,00-23,24)
Borehole
7
-
0,00 (0,00-0,00)
Altitude
<250 masl
67
1,230 + 3,665
0,00 (0,00-23,24)
250 - 500 masl
11
0,904 + 1,425
0.56 (0,00-4,91)
> 500 masl
9
0,419 + 0,603
0,28 (0,00-1,69)
Build Up Area
60
1,315 + 3,815
0,00 (0,00-23,24)
Rainfed Rice Field
9
0,421 + 0,654
0,00 (0,00-1,61)
Dry Land
15
0,689 + 1,268
0.28 (0,00-4,91)
Bush
3
1,033 + 0,654
0,76 (0,56-1,78)
Landuse
Tabel 13. Mann-Whitney Test of Water Mercury
Concentration within Types of Water Source
Spring
Dugg Well
Spring
Dug Well
0,174
Borehole
0,007
0,064
Tabel 14. Mann-Whitney Test of Water Mercury
Concentration within Altitudeat Study Area
P
0 – 250 masl
250 – 500 masl
< 250 masl
250 – 500 masl
0,048
>500 masl
0,341
0,332
Tabel 15. Mann-Whitney Test of Water Mercury Concentration within
Landuse at Study Area
Build Up Area
Rainfed Rice Field
Dry Land
Build Up Arera
Rainfed Rice Field
0,983
Dry Land
0,129
0,464
Bush
0,045
0,139
3.4. Heavy Metal: Lead (Pb)
Soil Lead Concentration
Soil lead concentration in the study
area ranged from 0 to 25.227 mg/kg.
There were significant differences in
soil lead concentration within altitudes
and land use. Significant difference in
0,117
soil lead concentration was found
between altitude of less than 250 masl
and altitude of 250-500 masl (p=0,007).
Within landuse, there was significant
different of soil lead concentration
between build up area (shettlement)
and bush (p=0,028) (Tables 16, 17 and
18).
Table 16. Soil Lead Concentration in Study Area (mg/kg)
N
Mean
Median
29
5,811 + 6,303
68,640 (0,000-25,227)
<250 masl
9
8,813 + 5,098
8,907 (2,974-19,536)
250 - 500 masl
13
3,280 + 4,614
3,051 (0,000-16,803)
> 500 masl
7
6,650 + 8,957
2,967 (0,000-25,227)
Build Up Area
5
5,750 + 2,974
4,635 (2,974-8,956)
Irrigated Rice Field
2
11,062 + 0,175
11,062 (10,556-11,567)
Dry Land
11
6,112 + 8,223
3,182 (0,000-25,227)
Bush
5
2,222 + 1,325
2,967 (0,000-3,109)
Forest
6
6,548 + 7,363
5,423 (0,000-19,536)
Lead Concentration
Altitude
Guna Lahan
Tabel 17. Mann-Whitney Test of Soil Lead Concentration within
Altitude in Study Area
0 – 250 masl
250 – 500 masl
<250 masl
250 – 500 masl
0,007
>500 masl
0,153
0,599
Tabel 18. Mann-Whitney Test of Soil Lead Concentration within Landuse
Build Up Area
Irrigated Rice
Field
Dry Land
Bush
Build Up Area
Irrigated Rice Field
0,053
Dry Land
0,458
0,161
Bush
0,028
0,053
0,455
Forest
0,855
0,18
0,758
Water Lead Concentration
No detectable lead in water from the
study area.
3.5. Heavy Metal: Cadmium (Cd)
In the study area, there were no
detectable concentration of cadmium
both in soil and water.
IV. Discussion
Based on the success of the category
indicators due to iodine deficiency
disorders defined WHO (2001), the EIU
primary school age children do not
indicate a lack of iodine intake in the
study
area.
Generally
iodine
concentration both in soil and water
showed that the study area was not
lack of iodine environment.
The
average iodine concentration in water
that was 13,56 ug/L was higher 5 ug/L,
0,269
minimal value of iodine concentration in
non IDD area (Thaha, 2002). Iodine in
soil was the storage of iodine in the
environment that might leach slowly to
water.
Mercury
concentration
in
water
indicated that was higher than save
concentration of water (0,001 mg/L = 1
ppb) showed that there was a thread to
inhabitant to get pollution problem due
to mercury if consumed water. Due to
IDD, heavy metal is blocking agent of
iodine absorption in T4 and T3 (thyroid
hormone) production in thyroid and also
depleting seleno-enzym to convert T4
to T3 in perifer tissue. These both
mechanism might result IDD problems
in this area without lack of iodine intake.
The risk of mercury pollution not only by
water
consumption,
but
also
consumption of food that was harvested
from this environment. Mercury could
accumulate in food via food web with
bioacumulation mechanism. Lead in
soil this area had same risk with
mercury in soil.
There were no
detectable cadmium both in soil and
water..
program must be done in order to
prevent public health problems.
VI.
V. Conclusions and Suggestion
Conclusion
1. School
age
children
in
Watubonang
and
Dayakan
Villages did not suffer of a lack
of iodine intake
2. The study area was not poor
iodine environment.
3. Water mercury concentration in
study area was higher than save
concentration.
4. There was risk of pollution both
in water and food that was
produced in this area by
mercury and lead.
Suggestion
Although the village Dayakan and
Watubonang were not having iodine
deficiensi problem, but surveillance
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Jurnal
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Zimmermann, M.
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