Iodine status of children from the Red Sea, and the Nile Valley regions of the Sudan: implications for health and development

Hussein, Izzeldin S. (2010) Iodine status of children from the Red Sea, and the Nile Valley regions of the Sudan: implications for health and development. Doctoral thesis, London Metropolitan University.


Iodine deficiency leads to multitude disorders often refereed as "iodine deficiency disorders" that are preventable by supplementation. Iodine deficiency is the leading cause of brain damage and mental disability. Moreover, it is the most common cause of decreased fertility rate, miscarriages, stillbirths and foetal and infant mortality in the developing countries. Contrary to the widely held popular perception, iodine deficiency is not restricted to the developing countries. Investigations of urine of children and adults, and maternal milk reveal a high prevalence of iodine deficiency in many European countries as well as the. United States. It is estimated; about 1.5 billion people in 118 countries are at risk of developing one or more of the disorders induced by iodine deficiency. Sudan is the largest country in Africa with diverse geographical and ecological regions. These diversities have had a major influence on nutrition and health of the various ethnic groups who live in the different regions. There is a scarcity of reliable published data on micronutrients, particularly iodine, status of Sudanese children.
This thesis reports findings of investigations of iodine status of Sudanese school children who live in two contrasting regions of the country, Red Sea (Port Sudan) and Nile Valley (Jabal Awliya) states. The implications of the findings to health and development of the children, and nutrition and health policy have been assessed.
Two hundred two (n = 282) male and female children aged 6 to 12 years were enrolled from schools in the Port Sudan and Jabal Awliya using a multistage random sampling survey procedure. At recruitment, the children were assessed for urinary iodine and thyroid enlargement (visible goitre). Salt samples brought by the children from their home were tested for iodine content. In addition, information on the frequency of fish consumption by the children and family was obtained.
In Port Sudan, the median urinary concentration, prevalence of visible goitre, the percentage of children who consumed fish at least once a week and ix iodine content of the collected salt samples were 555.2 ~g IL, 17 %, 1.7 % and 150 - 360 mg/kg, respectively. The corresponding values in Jabal Awliya were 159.6 ~g/L, 1.4 %, 77 % and 0 % (below the detection limit), respectively.
According to the World Health Organisation criteria of assessment of iodine level,' the children from Jabal Awliya, in spite of consuming salt devoid of iodine, had optimal iodine status. This finding is borne out by the low prevalence of visible goitre, and optimal urinary iodine level. It appears; the Nile fish and the wheat, sorghum, beans and green vegetables, which grow in the alluvial soil of the river and are extensively consumed by families in the area, is rich in iodine.
Assuming children living in Port Sudan were consuming the recommended 5 g of salt per day, their intake of iodine was between 750 and 1800 ~g/day. These high intakes were reflected in the elevated level of urinary iodine. The Recommended Dietary Allowance of iodine for adult men and women (non-pregnant and non-breast feeding), and children is 150 and 90 -150 ~g/daYi respectively. 'Moreover, median urinary iodine concentrations of 100--200 ~g/L indicate adequate iodine intake and optimal iodine nutrition. In contrast to the children from Jabal Awliya with adequate intake and status of iodine, those from Port Sudan are at higher risk of iodine-induced hypothyroidism resulting from consumption of excessively iodised salt.
The findings of this study clearly demonstrate a major problem with iodine nutrition and quality control and monitoring of salt iodisation programme in Sudan. There is a very urgent need for critical evaluation of the: (a) Health impact of excessive consumption of iodine in the whole country; (b) Guidelines and regulatory environment of iodisation of salt.

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