Upload
arshad-mahmood-uppal
View
233
Download
0
Embed Size (px)
Citation preview
8/7/2019 Synopsis Nadir Shah Final
1/25
8/7/2019 Synopsis Nadir Shah Final
2/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
SUPERVISOR S CERTIFICATE FOR SUBMISSION OF SYNOPSIS
It is certified that Dr. Nadir Shah; MBBS (Peshawar), ROLL No. Y-571869;Registration No. 07-KGT-0535 has worked under my close supervision for development of synopsis for thesis entitled STUDY OF EFFECT OF IODINE
SUPPLEMENTATION ON IDD AMONG ADOLESCENT GIRLS IN DISTRICT
GILGIT. I have gone through the synopsis and found it satisfactory for the conduct of Research and further discussion by the experts.
Dr Arshad Mahmood UppalMBBS (Pb), MCPS (Pak), FACP (USA),
PGD-Nutrition (Pak), MSc (Pak)
House # DK 61/20, Usman Lane, Street # 1,Bilal Colony, Rawalpindi-46300
PakistanEmail: [email protected]
Dated: September 29, 2010
2
mailto:[email protected]:[email protected]8/7/2019 Synopsis Nadir Shah Final
3/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
TITLE:
Study of effect of iodine supplementation on IDD among adolescent girls in district
Gilgit
INTRODUCTION :
Iodine deficiency disorder (IDD) is the cause of an Ancient Scourge of mankind,
which may take him in the womb. Lest we forget, it is a story of human suffering
cretinism with its tragic and brutal impact, visible goiter and its deformities, and
above all the vast invisible, silent and life-long mental and physical impairment that
are its consequences. Fighting IDD and preventing this suffering, however, is an
inspirational story of unprecedented multidisciplinary societal effort. In terms of its
impact on humanity, IDD threatens and harms more people than many of the most
feared scourges. An estimated two billion people in 130 countries are at risk. Yet,
prevention is today well understood and achievable: regular use of the right kind of
salt, an indispensable and low-cost food for everyone (Hetzel, 2004).
This is more common in the hilly trains of the globe. So Gilgit like other mountainous
areas of the world is endemic for IDD and Hussain et al, (2009) reported the incidenceup to 70% here. The reason mainly reported is washing away of Iodine by glaciation
during the last ice age, which is reflected in low iodine contents of local foods,
notably cabbage (Clements, 1954).
Deficiency during childhood reduces somatic growth and cognitive and motor
function (Zimmermann, 2009). Hence adolescents being in rapidly growing phase fall
an easy prey to it. Adolescents are classified as early 10 to 13 years, middle 14 to 16
years and late 17 to 19 years old on biological, psychological and developmental basis
(Hendee, 1991; Kurz and Welch, 1994). Iodine deficiency in them exists as the single
most common cause of preventable mental retardation, goiter, hypothyroidism,
cretinism, deaf mutism; impaired learning capacity hence impaired school
performance, dwarfism, abortions, still births, and other congenital abnormalities
(Higdon, 2003; WHO, 1995). The main reason in Eastern Mediterranean region,
including Pakistan, is inadequate iodine intake and percentage of households with
access to iodized salt is low i.e. 47.2% (WHO, UNICEF and ICCIDD, 2007).
3
8/7/2019 Synopsis Nadir Shah Final
4/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
Zimmermann, et al. (2008) is of the view that the iodine supplementation is the
mainstay in the prevention of IDDs. According to Foote, (2007) food fortification is
the better and tolerable alternative, which is worth practicing.
STATEMENT OF THE PROBLEM:
IDD is public health problem as its prevalence is more than 5% in the world (WHO,
1995; Ali, et al. 2009). Globally, it is estimated that 2 billion individuals have an
insufficient iodine intake, and South Asia and sub-Saharan Africa are particularly
affected. However, about 50% of Europe remains mildly iodine deficient, and iodine
intakes in other industrialized countries, including the United States and Australia,have fallen in recent years (Zimmermann, et al. 2009; Zimmermann, 2008). In
adolescents it peaks with goiter and is more common in girls. In one study of 348
Swiss adolescents the prevalence of goiter was 15% in the age range of 11-17 years
(Fleury, et al. 1999).
In India this problem was first observed in Sub-Himalayan belt and since has been
found throughout the country. Over the last 20-30 years several district level goiter
prevalence surveys in 236 districts of 29 states/UTs (of the total of 32), goiter was
endemic in 194. These surveys unearthed 2.2 million cretins. The effected were
mainly deficient in urinary iodine (Kofi Annan, 2002).
Akhtar & Ullah, (2003) observed high goiter rate of 52% and 45% in boys and girls
students of age 8-10 years in Swat; Khyber Pakhtoon Khawa province of Pakistan.
The study concludes that the area is still highly endemic to IDD and needs urgent
correction. Ali, at al. (2009) reported total goiter rate (TGR) of 22.2% in Gilgit-
Baltistan province of Pakistan, whereas in Gilgit it was 10.2%. This is sufficient to
alarm it as a public health problem.
RATIONALE OF THE STUDY:
This public health problem needs an urgent attention at all levels of healthcare. In
most countries, the best strategy to control IDD in populations is carefully monitoreduniversal salt iodization, one of the most cost-effective ways to contribute to
4
8/7/2019 Synopsis Nadir Shah Final
5/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
economic and social development. Achieving optimal iodine intakes may minimize
the amount of thyroid dysfunction in populations (Zimmermann, 2009). Iodine (as
iodide) is widely but unevenly distributed in the earths environment. Mountainous
areas are especially deficient in it; hence the crops grown here are iodine deficient
(WHO/ICCIDD/UNICEF, 2007). Previous studies have tapped only the prevalence of
goiter in different areas of the country and mainly addressed the salt iodization as a
remedy. Though it is successful but other areas need to be effectively addressed as the
dietary habits and food fortification. For these we need to have a fresh look at the
problem and address the other facets of IDDs apart from goiter. This study will home
us on the overall improvement in the situation as a result of previous efforts and paint
a fresh picture. This study also intends to have a review of the effect of goitrogenic
foods.
SIGNIFICANCE OF STUDY:
This study will enable us to have a latest review of the situation and iodine profile of the affected population. This will also show the effects of iodization and diet
modification on the affected population.
REVIEW OF THE LITERATURE:
Gray Lussac, in 1813 discovered this essential trace element and gave it the name iode
from the Greek iodes meaning violet colored (Abraham, 2006) and the first iodized
salt was introduced in Switzerland in the province of Appenzell in 1922
(Zimmermann, 2009).
Lv, et al. (2009) conducted a study to evaluate the effectiveness of universal salt
iodization (USI) for the control of IDD in Hebei province of China since it was
implemented in 1995 and identify the problems currently encountered in the
implementation of USI and provide practical proposals for addressing these problems.
5
8/7/2019 Synopsis Nadir Shah Final
6/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
He determined the iodine content of salt with titration method and urinary iodine by
the method of ammonium per sulfate oxidation. They found that the use of iodized salt
increased from 65.0% in 1995 to 98.0% in 1999, then decreased to 88.1% in 2005
which was below the national standard of 90%. The median urinary iodine of children
aged 8-10 years varied between 160.1g/L and 307.4g/L, which were above the
national standard. The proportion of urinary samples with iodine content above
300g/L was over 30% in 2005, implying exorbitant iodine nutrition among the
children. The goiter rate (TGR) among children aged 8-10 years dropped from 11.8%
in 1995 to 2.7% in 2005, indicating that the spread of endemic goiter was under
control. They concluded that to effectively address the problem, management and
supervision of salt market needs to be strengthened to prevent non-iodized salt from
reaching households; updating equipment and modifying techniques are also
necessary to ensure the quality of iodized salt; to clarify the causes of excessive
urinary iodine content, the various sources of iodine from the diet need to be
investigated in the future.
Sen, et al. (2010) found in a community based cross sectional descriptive study that
iodine deficiency was endemic in West Bengal, which had already been reflected in previous studies. Twenty four Northern Parganas were studied during August-
November 2005 to assess the consumption of adequately-iodized salt and to ascertain
the various factors that influence access to iodized salt. In total, 506 households
selected using the multi-stage cluster-sampling technique and all 79 retail shops from
where the study households buy salt were surveyed. The iodine content of salt was
tested by spot iodine-testing kits. Seventy-three percent of the households consumed
salt with adequate iodine content (> or = 15 ppm). Consumption of adequately-iodized
salt was lower among rural residents [prevalence ratio (PR): 0.8, 95% confidence
interval (CI) 0.7-0.9], Muslims (PR: 0.8, 95% CI 0.7-0.9), and households with
monthly per-capita income of < or = US$ 10 (PR: 0.7, 95% CI 0.6-0.8). Those who
heard and were aware of the risk of iodine-deficiency disorders and of the benefit of
iodized salt were more likely to use appropriate salt (PR: 1.2, 95% CI 1.1-1.3). Those
who were aware of the ban on non-iodized salt were more likely to consume
adequately-iodized salt (PR: 1.1, 95% CI 1.01-1.3). The iodine content was higher in
salt sold in sealed packets (PR: 2.9, 95% CI 1.8-4.8) and stored on shelves (PR: 1.6,
6
8/7/2019 Synopsis Nadir Shah Final
7/25
8/7/2019 Synopsis Nadir Shah Final
8/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
OBJECTIVES OF THE STUDY:
1. To find out the prevalence of IDDs before and after six months of iodine
supplementation.
2. To estimate urinary iodine level before and after six months of iodine
supplementation.
3. To find out iodized salt consumption proportion.
HYPOTHESIS:
There is no association of iodine supplementation with prevalence of IDDs in
adolescent girls of Gilgit district.
8
8/7/2019 Synopsis Nadir Shah Final
9/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
METHODOLOGY:
Research design: This will be a cross sectional, interventional study. The selected
population will be studied twice i.e. before and after iodine supplementation.
Study locale: District Gilgit will be the location of study and it is located at an
altitude of approximately 1500 Meters (4800 Feet) above sea level, in the North east
of Pakistan. The city had been a central point of trade and political activity as early as
1st century AD. Since then it has always been a very strategic point for the neighboring
countries. Surrounded by the massive mountains of Karakorums Gilgit is a small
valley with a ground just enough to form a small city of 500000 persons. Gilgit is thecapital of Gilgit-Baltistan province of Pakistan. Mountains of the region are known to
be the highest and greatest in number around the world. Stretch of Gilgit comes in the
rain shadow of Nanga Parbat Mountain i.e. the moon soon winds are blocked by it,
which cannot reach Gilgit, thus leaving it dry & rugged but the labor of the strong and
willing local population has even claimed the hard mountains for cultivation's. Due to
this there are beautiful green orchids of many fruits in the valley. This makes a
spectacular contrast in the green fields and ruggedness on the mountains topped withwhite snow scenery only found in the northern areas of Pakistan. Its ancient name was
Sargin, later to be known as Gilit, and it is still called Gilit or Sargin-Gilit by local
people. It was an important city on the Silk Road , along which Buddhism was spread
from South Asia to the rest of Asia . The Dards and Chinas appear in many of the old
Pauranic lists of peoples who lived in the region, then came the Hindus , but for the
last five centuries and a half they have been Muslims . They established Trakhan
dynasty and are ruling till date (Imperial Gazetteer of India; Clements, 1954; Dani,
1989).
Study Population: All the adolescent girls (age 10-19 years) will constitute the study
population.
Sampling: Multistage sampling with cluster technique will be applied, which will
include schools, colleges and general population. The total sample size in this study
will be calculated keeping in view following facts: -
9
http://en.wikipedia.org/wiki/Silk_Roadhttp://en.wikipedia.org/wiki/Buddhismhttp://en.wikipedia.org/wiki/Asiahttp://en.wikipedia.org/wiki/Dard_peoplehttp://en.wikipedia.org/wiki/Chinashttp://en.wikipedia.org/wiki/Chinashttp://en.wikipedia.org/wiki/Puranashttp://en.wikipedia.org/wiki/Hinduhttp://en.wikipedia.org/wiki/Mohammedanshttp://en.wikipedia.org/wiki/Mohammedanshttp://en.wikipedia.org/wiki/Silk_Roadhttp://en.wikipedia.org/wiki/Buddhismhttp://en.wikipedia.org/wiki/Asiahttp://en.wikipedia.org/wiki/Dard_peoplehttp://en.wikipedia.org/wiki/Chinashttp://en.wikipedia.org/wiki/Puranashttp://en.wikipedia.org/wiki/Hinduhttp://en.wikipedia.org/wiki/Mohammedans8/7/2019 Synopsis Nadir Shah Final
10/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
a. Significance level or power of the study will be 5%.
b. Confidence/probability level will be 95%.
c. The incidence of the disease will be taken as 10.2% (Ali, et al. 2009).
d. The formula for such cross sectional studies as described by Hanif & Ahmad,
(2005) is n= [{Z (1-/2)} 2 p (1-P)]/d 2.
e. In this study p will be 0.102.
f. And d=5 percentage points=0.05.
g. Probability level or confidence level (1-) =95%.
h. At this level Z (1-/2) =1.96.
i. So the sample size will be = {(1.96) 2 (0.102) (0.898)}/ (0.05) 2 = 140.75; to
make the figure round it will be taken as 141girls.
Exclusion criteria:
1. Non willing subjects
2. Sick girls
Inclusion criteria:
1. Adolescent girls from schools, college and general population of the Gilgit
district
Limitations:
1. Time and financial constrains for lab tests & logistics may affect the study.
2. Ill be a single person and have no sponsorships.
3. Sample units may be missing in second survey.
Delimitations:
1. Experienced & cooperative supervisor.
2. Primary data collection.
10
8/7/2019 Synopsis Nadir Shah Final
11/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
3. First interventional study in the region
Research instruments:
1. Questionnaire for assessment of iodine salt intake
2. Clinical examination for goiter grading
3. Biochemical evaluation of iodine in urine ( standard methods as recommended
by the WHO will be used).
Ethical issues: Written approval will be taken from the concerned principal of the
school/college and from the municipal/health authorities. Subjects and their parentswill be briefed on the study, their queries will be addressed through personal
communications, teachers and public reps. Consent will be taken from the subjects
after explaining the purpose of study for the collection of urine, blood and salt
consumed in the household for iodine estimation.
Pilot study: 10 adolescent girls from school, colleges & general population will be
selected randomly and given questionnaire for filling as per instruction. They would
be examined for goiter and sample of urine would be collected in the given container
by researcher, colleague lady doctor and a staff nurse trained for the same one week
before conducting the actual survey.
Data collection: Data will be collected on the questionnaire. The process will be
repeated after the iodine supplementation.
Data analysis: Analysis will be done using SPSS latest version after consultation with
a statistician. The study deals with samples, I may find the significant differences
between the outcomes or dependent variables before and after study, which are goiter
and UI levels. Results will be compared with WHO standards for computing outcome
variables. Here paired T test (before and after iodine supplementation) will be
performed. Status of Impact indicators i.e. for UI level e.g. frequency tables,
histogram to show distribution of UI values, levels of median, percentile ranges, TGR,
age proportion for various samples and iodine supplement intake among sample
ranges will be calculated. Sample results will be subjected to chi square test to find out
11
8/7/2019 Synopsis Nadir Shah Final
12/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
whether these results are applicable to the population or not. The p value will be
calculated and significant a value < 0.050 will be considered significant.
Expected outcomes
This study will help me assess whether lipoidal iodine supplementation given to
adolescents under study significantly reduces the TGR and enhances the UI excretion
pre and post exposure for reducing IDD in the region.
References:
Abraham, G. E. (2006). The history of iodine in medicine part 1: from discovery to
essentiality. The Original Internist, 13: 29-36, Spring 2006.
Akhtar, T., Ullah, Z. (2003). Goitre in district Swat, NWFP-Pakistan: Current
situation. Pakistan J. Med. Res. Vol. 42 No.2,
Akhtar , T., Ullah , Z., Paracha , P. I., Lutfullah , G. (2004). Impact assessment of salt
iodization on the prevalence of goiter in district Swat. Pak J Med Sci Oct -
Dec; 20(4): 303-7.
Ali, H., Siddiqui, P. Q. R., Alam, J. M., Kazmi,T. H., Mehdi, G. (2009). Severe IDD
in Pregnancy in Northern Pakistan:a Sentinel Study. IDD Newsletter, Volume
32, number 2, May (2009) p. 9.
Clement, F. W. 1954. Endemic goiter in Australia, New Zealand and Melanesia. Bull.
WHO, 10, 105
Dani, A. H. (1989). History of Northern Areas of Pakistan , p163
Fleury, Y., Melle, G., Woringer, V., Temler, E., Gaillard, R. C., and Portmann, L.
(1999). Iodine nutrition and prevalence of Goiter in the Canton of Vaud.
Schweizerische Medizinische Wochenschrift, 129: 1831-1838.
Hanif, M., Ahmad, M., & Ahmad, A. M. (2005). Biostatistics for Health Students
with manual on software application. 1 st Eds. Published by Islamic Society of
Statistical Sciences; Lahore. Pakistan. ISBN: 969-8858-008. Pp 62-67
12
http://www.pakmedinet.com/author/Tasleem+Akhtarhttp://www.pakmedinet.com/author/Zahoor+Ullahhttp://www.pakmedinet.com/author/Zahoor+Ullahhttp://www.pakmedinet.com/author/Pervez+Iqbal+Parachahttp://www.pakmedinet.com/author/Pervez+Iqbal+Parachahttp://www.pakmedinet.com/author/Ghosia+Lutfullahhttp://www.pakmedinet.com/PJMShttp://www.pakmedinet.com/author/Tasleem+Akhtarhttp://www.pakmedinet.com/author/Zahoor+Ullahhttp://www.pakmedinet.com/author/Pervez+Iqbal+Parachahttp://www.pakmedinet.com/author/Ghosia+Lutfullahhttp://www.pakmedinet.com/PJMS8/7/2019 Synopsis Nadir Shah Final
13/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
Hendee, W. R. (1991). Sociodemographic trends and projections in the adolescent
population. The health of adolescents. A publication of American Medical
association. Jossey-Bass Publishers, San Francisco 94104, USA. Pp 2.
Hetzel, B. S. (2004). Towards the Global Elimination of Brain Damage Due to Iodine
Deficiency. A global program for human development with a model
applicable to a variety of health, social and environmental problems by
ICCIDD. Oxford University Press. YMCA Library Building, Jai Singh Road,
New Delhi 110001
Higdon, J. (2003). An Evidence-Based Approach to Vitamins and Minerals: Health
Benefits and Intake Recommendations . 1st
Eds. New York: ThiemeMedical Publishers.
Kofi Annan. (2002). Iodine deficiency. Special message from Secretary General of the
United Nations, Annual Meeting 2002. Special supplement, February 2002.
Kurz, K. M., and Welch, J. C. (1994). The nutrition and lives of adolescents in
developing countries. Findings from the nutrition of adolescent girls research
program. ICRW. Imperial Gazetteer of India. Provincial Series: Kashmir and
Jammu , ISBN 0543917762 , Adamant, p107
Lv, S. M ., Xie, L. J ., Zhou, R. H ., Chong, Z. S ., Jia, L. H ., Jing, M. A ., Zhao, J ., Xu,
D. (2009). Control of iodine deficiency disorders following 10-year universal
salt iodization in Hebei Province of China. Biomed Environ Sci. Dec;
22(6):472-9.
Mozaffari , H., Dehghani , A., Afkhami , M., Galali , B. A., Ehrampush , M. H. (2005).
Goiter prevalence, urinary iodine excretion and household salt iodine after 10years of salt iodization in Yazd Province, Iran. Pak J Med Sci Jul - Sep; 21(3):298-
302.
Singh, V. Chritian, P. (2008). Trends in nutritional status of women and children in
India, Updates from the National Family Health Survey-3, Sight and Life
Magazine issue No 1/ (2008), p.19
WHO, (1995). Global prevalence of IDD. Micronutrient information system. MDIS
working paper No. 1. 1121 Geneva Switzerland.
13
http://en.wikipedia.org/wiki/Indiahttp://en.wikipedia.org/wiki/Special:BookSources/0543917762http://en.wikipedia.org/wiki/Special:BookSources/0543917762http://www.ncbi.nlm.nih.gov/pubmed?term=%22Lv%20SM%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Lv%20SM%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Xie%20LJ%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Zhou%20RH%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Chong%20ZS%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Chong%20ZS%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Jia%20LH%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Jia%20LH%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Jing%20MA%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Jing%20MA%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Zhao%20J%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Xu%20D%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Xu%20D%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/20337220http://www.ncbi.nlm.nih.gov/pubmed/20337220http://www.ncbi.nlm.nih.gov/pubmed/20337220http://www.ncbi.nlm.nih.gov/pubmed/20337220http://www.pakmedinet.com/author/Hassan+Mozaffarihttp://www.pakmedinet.com/author/Ali+Dehghanihttp://www.pakmedinet.com/author/Ali+Dehghanihttp://www.pakmedinet.com/author/Ali+Dehghanihttp://www.pakmedinet.com/author/Mohamad+Afkhamihttp://www.pakmedinet.com/author/Beman+Ali+Galalihttp://www.pakmedinet.com/author/Beman+Ali+Galalihttp://www.pakmedinet.com/author/Mohamad+Hassan+Ehrampushhttp://www.pakmedinet.com/PJMShttp://www.pakmedinet.com/PJMShttp://en.wikipedia.org/wiki/Indiahttp://en.wikipedia.org/wiki/Special:BookSources/0543917762http://www.ncbi.nlm.nih.gov/pubmed?term=%22Lv%20SM%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Xie%20LJ%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Zhou%20RH%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Chong%20ZS%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Jia%20LH%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Jing%20MA%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Zhao%20J%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Xu%20D%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Xu%20D%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/20337220http://www.ncbi.nlm.nih.gov/pubmed/20337220http://www.pakmedinet.com/author/Hassan+Mozaffarihttp://www.pakmedinet.com/author/Ali+Dehghanihttp://www.pakmedinet.com/author/Mohamad+Afkhamihttp://www.pakmedinet.com/author/Beman+Ali+Galalihttp://www.pakmedinet.com/author/Mohamad+Hassan+Ehrampushhttp://www.pakmedinet.com/PJMS8/7/2019 Synopsis Nadir Shah Final
14/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
WHO/ICCIDD/UNICEF, (2007). Assessment of the iodine deficiency disorders and
monitoring their elimination. World Health Organization. Geneva.
Zimmermann, M. B . (2009). Iodine deficiency. Endocr Rev. Jun; 30(4):376-408. EpubMay 21.
Zimmermann, M. B ., Jooste, P. L ., and Pandav, C. S . (2008). Iodine-deficiency
disorders. Lancet. Oct 4; 372(9645):1251-62.
Annexure 1:
Brochure for educating adolescents and their parents/teachers in Urdu.
14
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Zimmermann%20MB%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Zimmermann%20MB%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Zimmermann%20MB%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Jooste%20PL%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Jooste%20PL%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Pandav%20CS%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Zimmermann%20MB%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Zimmermann%20MB%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Jooste%20PL%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Pandav%20CS%22%5BAuthor%5D8/7/2019 Synopsis Nadir Shah Final
15/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
15
8/7/2019 Synopsis Nadir Shah Final
16/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
16
8/7/2019 Synopsis Nadir Shah Final
17/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
17
8/7/2019 Synopsis Nadir Shah Final
18/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
Annexure 2:
Consent of the adolescents under studyI am a student of Allama Iqbal Open University Islamabad. I am conducting a research
study for my MSc thesis. Your school/college/area is selected for this survey.
In this context I will be measuring your height and weight. You will be clinically
examined for assessment of micronutrient deficiency. For biochemical estimation your
urine will be required for urinary iodine estimation, may be your blood for
thyroglobulin, salt from your home for estimation of iodine in that. You will be asked
some questions about your dietary habits. I hope you are willing to participate in thisstudy. If you are willing please sign below.
Signature of the student: -
Name of the student: -
Class: -
School/college/area: -
Signature of the witness (class teacher/public rep): -
18
8/7/2019 Synopsis Nadir Shah Final
19/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
Annexure 3:
Demographic profile
1 Identification #
2 School/college/area
3 Class
Name
Age in complete years
Address
Mother education
Mother profession
Father education
Father profession
Is iodized salt used atyour home Yes No
Why iodized salt isused in your home
Good for health Dont know
Who told you aboutiodized salt
Media Friends Healthworker
Why iodized salt isgood for health
For physicalgrowth
For mentalmaturity
Dont know
When your mother putiodized salt in food
Before cooking After cooking
How the iodized salt is put in your home
Tight containers Open containers
Which food containsiodine
Vegetables Fish Cereals
Source of drinkingwater
Bottled Purification tank Tape
19
8/7/2019 Synopsis Nadir Shah Final
20/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
Annexure 4:
Dietary habits
Ser#
Food items No of times per One timeportion size
standardizedin g
Never Yr Month Days
/week
Day
1 Junk food
2 Fast food
3 Roti
4 Maize
5 Meat & itsproducts
6 Fish
7 Eggs
8 Pulses
9 Milk & itsproducts
10 DGLV
11 Fruits
13 Dry fruits
14 Iodized salt Yes No
Iodine rich foods
15 Haddock
16 Cod
20
8/7/2019 Synopsis Nadir Shah Final
21/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
17 Condensedmilk
18 Trifle19 Eggs
20 Mayonnaise
21 Jaffa cakes
22 Cheddarcheese
23 Malt bread
24 Naan Bread
25 Yorkshirepudding
26 Cheese cake
27 Sea kelp
28 Seaweed
29 Sea foods
30 Fresh fish
31 Fish oils
32 Sea salt
33 Maraschinocherries
34 Rhubarb
35 Spanish
36 Broccoli
Iodine poor foods
21
http://www.koausa.org/Cookbook/43.htmlhttp://www.koausa.org/Cookbook/43.html8/7/2019 Synopsis Nadir Shah Final
22/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
Fruits & vegetables that are fresh, frozen, canned or in the form of juices are all low in iodine.
37 Apples38 Grapes
39 Pears
40 Bananas
41 Berries
42 Pineapples
43 Peaches
44 Pears
45 Carrots
46 Celery
47 Cucumbers
48 Squash
49 Kale
50 Collardgreens
51 Sweeteners(jams, jelly,
honey, sugaretc)
52 Beverages
53 Nuts(almonds,walnuts,pistachios,hazelnuts,cashews and
22
8/7/2019 Synopsis Nadir Shah Final
23/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
peanuts)
54 Oils (all)
55 Rice
56 Pasta
57 Legumes
58 Poultry
23
8/7/2019 Synopsis Nadir Shah Final
24/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
Annexure 5:
Clinical examination
Cretinism
IQ level
Goiter grade 0 I II
24
8/7/2019 Synopsis Nadir Shah Final
25/25
Synopsis : Study of effect of iodine supplementation on IDD among adolescent girls in district Gilgit
Annexure 6:
Biochemical tests
Test Reading
Urinary iodine
Salt iodine