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赞比亚南部省格温贝区和锡纳宗韦区孕妇碘缺乏症患病率:一项横断面研究。

Prevalence of iodine deficiency among pregnant women in Gwembe and Sinazongwe districts of Southern Province, Zambia: a cross-sectional study.

作者信息

Kaile Trevor, Sikateyo Bornwell, Phiri Masauso M, Michelo Charles

机构信息

Department of Pathology and Microbiology, The University of Zambia, Ridgeway Campus, Lusaka, Zambia.

Department of Medical Education Development, The University of Zambia, School of Medicine, Ridgeway Campus, Lusaka, Zambia.

出版信息

BMC Nutr. 2020 Dec 9;6(1):71. doi: 10.1186/s40795-020-00397-w.

Abstract

BACKGROUND

Maternal iodine deficiency is one of the common causes of morbidity and mortality during pregnancy. Maternal iodine deficiency during pregnancy is associated with a number of adverse outcomes such as abortion, stillbirth, congenital anomalies, perinatal mortality and irreversible mental retardation. A study conducted in Zambia among pregnant women in 2013 on the prevalence of iodine deficiency showed that iodine deficiency was not a public health concern. The previous study used Urine Iodine concentration (UIC) as a marker of iodine deficiency among the pregnant women. Our study was conducted to assess the prevalence of iodine deficiency among pregnant women in Gwembe and Sinazongwe districts of Southern Province, Zambia, using urine iodine concentration and goitre presence by manual palpation.

METHODS

We carried out a community based, cross sectional study in rural areas of Gwembe and Sinazongwe districts between April 2016 to March 2018. Data were collected from 412 pregnant women by a multistage cluster sampling technique. The presence of a goitre was examined by manual palpation and urinary iodine concentration was determined by the Ultra Violet Method using PerkinElmer Labda UV Spectrometer equipment made in Jena Germany (Model 107,745). As part of the existing baseline data, we used results of a 2013 countrywide study (n = 489) for household salt iodine content which showed a greater than 40 ppm at 76.2%, between 15 and 40 ppm at 19.21% and less than 15 ppm at 4.59%. Statistical analysis was done using Stata version 14.0. The outputs of analysis are presented as median and Interquartile range (IQR) as the urine data were not normally distributed. Further, the categorical and independent variables were presented as proportions (percentages) to describe the distribution and trends in the target sample population.

RESULTS

The median Urine Iodine concentration (UIC) of the pregnant women was 150 μg/L (Interquartile Range (IQR): 100-200 μg/L). Based on the UIC, There were 49% pregnant women who had inadequate iodine intake with urine iodine concentration of less than 150 μg/L, 34.0% had UIC of 150-249 μg/L indicating adequate iodine intake, 13.0% with UIC of 250-499 μg/L indicating more than adequate iodine intake, and 5.0% with UIC of above 500 μg/L indicating excessive iodine intake. To determine whether the women had access to iodized salt, we used baseline data from 2013 Zambia national survey for iodine concentration in household salt samples as being an average of 40 ppm, which also showed that 95.41% households consumed adequately iodized salt (≥15 ppm). The prevalence of goitre in our study was very low at 0.02% among the pregnant women of all ages who participated in the study (18-49 years).

CONCLUSION

Iodine deficiency was still not a public health concern among the pregnant women of Gwembe and Sinazongwe districts of Southern Province in Zambia. Goitre prevalence has remained very low in this study area. The UIC and goitre observations were consistent with the Zambia National Food and Nutrition Commission findings in 2013 report. However, our study showed more pregnant women with insufficient than adequate iodine status indicating the risk of developing IDD is still high in this region. It also reinforces the argument that strengthening of the existing salt iodization program is needed in order to make a homogenous iodated salt available to the communities. The National Food and Nutrition Commission of Zambia needs to find innovative ways of sensitizing people about the adverse effects of IDDs and how these could be prevented. It is recommended that iodine supplementation be introduced as part of the package of Antenatal clinic care for all pregnant women.

摘要

背景

孕期母亲碘缺乏是孕期发病和死亡的常见原因之一。孕期母亲碘缺乏与多种不良后果相关,如流产、死产、先天性异常、围产期死亡和不可逆的智力发育迟缓。2013年在赞比亚对孕妇进行的一项关于碘缺乏患病率的研究表明,碘缺乏并非公共卫生问题。先前的研究使用尿碘浓度(UIC)作为孕妇碘缺乏的指标。我们开展本研究旨在通过尿碘浓度和手动触诊甲状腺肿大情况,评估赞比亚南部省格温贝区和锡纳宗韦区孕妇碘缺乏的患病率。

方法

2016年4月至2018年3月,我们在格温贝区和锡纳宗韦区的农村地区开展了一项基于社区的横断面研究。通过多阶段整群抽样技术从412名孕妇中收集数据。通过手动触诊检查甲状腺肿大情况,使用德国耶拿制造的珀金埃尔默Lambda紫外光谱仪设备(型号107,745)采用紫外法测定尿碘浓度。作为现有基线数据的一部分,我们使用了2013年全国性研究(n = 489)中家庭盐碘含量的结果,该结果显示碘含量大于40 ppm的占76.2%,15至40 ppm的占19.21%,小于15 ppm的占4.59%。使用Stata 14.0进行统计分析。由于尿碘数据呈非正态分布,分析结果以中位数和四分位数间距(IQR)表示。此外,分类变量和独立变量以比例(百分比)呈现,以描述目标样本人群的分布和趋势。

结果

孕妇的尿碘浓度中位数(UIC)为150μg/L(四分位数间距(IQR):100 - 200μg/L)。根据UIC,49%的孕妇碘摄入不足,尿碘浓度低于150μg/L;34.0%的孕妇UIC为150 - 249μg/L,表明碘摄入充足;13.0%的孕妇UIC为250 - 499μg/L,表明碘摄入过量;5.0%的孕妇UIC高于500μg/L,表明碘摄入过多。为确定这些妇女是否能获得加碘盐,我们使用了2013年赞比亚全国家庭盐碘浓度调查的基线数据,平均碘含量为40 ppm,该数据还显示95.41%的家庭食用了碘含量充足的盐(≥15 ppm)。在参与研究的所有年龄段(18 - 49岁)孕妇中,本研究中甲状腺肿大的患病率非常低,为0.02%。

结论

在赞比亚南部省格温贝区和锡纳宗韦区的孕妇中,碘缺乏仍然不是公共卫生问题。在该研究区域,甲状腺肿大患病率一直很低。UIC和甲状腺肿大观察结果与赞比亚国家食品和营养委员会2013年报告中的发现一致。然而,我们的研究表明碘摄入不足的孕妇多于碘摄入充足的孕妇,这表明该地区发生碘缺乏病的风险仍然很高。这也强化了这样一种观点,即需要加强现有的食盐加碘计划,以便为社区提供均匀的加碘盐。赞比亚国家食品和营养委员会需要找到创新方法,提高人们对碘缺乏病不良影响以及如何预防这些影响的认识。建议将碘补充剂作为所有孕妇产前门诊护理套餐的一部分引入。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/20f2/7725116/eef07e62ff2e/40795_2020_397_Fig1_HTML.jpg

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