The current situation of iodised salt use and the effects of iodine deficiency on high risk populations in Vinh Phuc province in 2017

Nội dung text: The current situation of iodised salt use and the effects of iodine deficiency on high risk populations in Vinh Phuc province in 2017

1. Journal of Diabetes & Endocrinology No. 48 - 2021 THE CURRENT SITUATION OF IODISED SALT USE AND THE EFFECTS OF IODINE DEFICIENCY ON HIGH RISK POPULATIONS IN VINH PHUC PROVINCE IN 2017 Ha Minh Nguyet1, Nguyen Thanh Hai2, Nguyen Hoai Le1 1Vinh Phuc preventive medicine center 2Vinh Phuc department of health DOI: 10.47122/vjde.2021.48.6 ABSTRACT implement strict sanction the production of Background: Vietnam's salt iodine iodine products that do not meet the quality supplementation program is a Government standards to ensure the quality of products that funded activity. Since 2005, the reduction of the reach consumers. funding source has had a direct impact on the Keywords: iodine deficiency, iodized salt, effort to reduce iodine deficiency disorders high risk nationwide, including Vinh Phuc. Objectives: Main correspondence: Nguyen Hoai Le Assessing the current situation of using salt and Submission date: 20th April 2021 iodine-containing products of people in Vinh Revised date: 26th April 2021 Phuc province. Determining the impact of Acceptance date: 26th May 2021 iodine deficiency on the high risk subjects. Email: lenguyenhoai@gmail.com Methods: The study applied the Descriptive Tel: 0982513298 Epidemiology method - Cross-sectional investigation to evaluate the current situation of 1. BACKGROUND iodized salt use and the effect of iodine Iodine is an essential micronutrient for deficiency on the at-risk subjects. The study was human health. According to statistics of the conducted in 2017 on 540 households, 108 World Health Organization (WHO), there are women of reproductive age from 18-49 years old more than one hundred countries with iodine and 720 primary school students in 36 deficiency problems around the world, about communes of Vinh Phuc province. Results: The one and a half billion people live in iodine results showed that 98.1% of the households use deficient areas and are at risk of developing fish sauce, 11.9% use salt, 93.9% use used any disorders due to iodine deficiency, of which type of seasoning powder, and 72,4% used more than 11 million people suffer from mental iodized seasoning powder. 540 samples of salt slowing due to iodine deficiency [7]. and seasoning powder were taken for testing and Vietnam is a country in an iodine-deficient all samples (100%) did not contain sufficient region with 94% of the population living in iodine content to meet disease prevention iodine-deficient areas. Since 1994, Vietnam has standards. The goitre rate in primary school educated the entire population to use iodized salt students is 2.5%, mainly at level 1A (94.4%). for disease prevention and has achieved great There was no relationship between gender and successes in iodine deficiency disorders goitre rate in students (p = 0.6). In women, there prevention activities. In 2005, Vietnam was no relationship between occupational status eliminated the iodine deficiency according to and iodine salt use (p = 0.453) and use of iodized three criteria: coverage of iodized salt meeting seasoning powder (p = 0. 57). There was no disease prevention standards > 90%; the rate of correlation between literacy and iodized salt and goitre in children aged 8-12 years <5% and iodized powder use (p = 0.3 and p = 0.7). median urinary iodine level ≥ 10 mcg / dl [1]. Conclusion: Iodine supplementation in salt, fish However, after 2005, the program of adding sauce and spices is one of the effective measures iodine to salt was no longer funded by the in iodine deficiency disorders prevention. The Government. Budget shortages and changes in study proposes to strengthen inspection and management structure have resulted in a 34
2. Journal of Diabetes & Endocrinology No. 48 - 2021 significant decrease in iodized salt coverage and - Women 18 - 49 years old. urinary iodine concentrations, to the point that - Children 8 - 12 years old. the iodine deficiency disorders have once again 2.3. Sample size become prevalent medical problems in the * Calculating the number of women 18 - 49 community. According to the report of the years old to be surveyed: Central Endocrinology Hospital in 2011, the rate Apply the sample size formula: of iodized in Vietnam was 45.1%, the median Z 2 p(1 p) urinary iodine level dropped to mild deficiency 1 / 2 n 2 (only 8.3 mcg / dl in 2010) [ 2], by 2015, the iodized salt coverage in the Red River Delta was + p is the estimated percentage of iodized salt only 38.5% [3]. using in the whole province which is 60%; Similar to other provinces, the program on + ∆ is he desired difference between the rate prevention of iodine deficiency disorders in obtained from the sample (p) and the proportion Vinh Phuc has been significantly reduced since of the population (P), taken is 0,042. 2015, and prevention activities cannot be carried + α is statistical significance, which is 0,05 out regularly due to lack of funding. The corresponding to 95% reliable. Correspondingly, proportion of households using iodized salt has we have Z1-α / 2 equaled to 1.96. We get n = 523. been decreasing over the years. In 2005, the After rounding up the number, we choose 540 percentage of households using iodized salt in subjects for investigation. the province was 95.7%, in 2013 it dropped to * Calculating the number of students aged 8- 70%; in 2015 it was only 65.8%. The median 12 years old will survey: urinary iodine level in women of reproductive Apply the sample size formula : age decreased significantly, in 2005 was 32.51 mcg / dl, in 2010: 8.5 mcg / dl, in 2016: 6.5 mcg / dl. The rate of goitre students from 2010 to present has not been evaluated. This has the risk + Với p is the rate of goitre in the province, of seriously affecting the results of eliminating which is 3.9% according to the 2010 survey.; iodine deficiency disorders, the danger of iodine + ∆ The desired difference between the rate deficiency is imminent. obtained from the sample (p) and the proportion So we conduct research on the topic: of the population (P), taken is 0,015. “Current situation of salt use, iodine- + α: statistical significance, which is 0.05 containing preparations and effects of iodine corresponding to 95% confidence. deficiency on at-risk subjects in Vinh Phuc Correspondingly, we have Z1-α / 2 equal to 1.96. province”, aiming at: We get n = 640, and rounding up the number we 1. Assessing the current situation of using will choose 720 primary school students to salt and iodine-containing products of people in participate in the survey. Vinh Phuc province. Selecting samples: 2. Determining the impact of iodine - Deployed in the whole province. Each deficiency on the high risk subjects. district was surveyed and evaluated in 4 communes and 4 primary schools. 2. SUBJECTS AND METHODS OF THE - In each commune, we surveyed 3 STUDY administrative zones with 15 households and 2.1. Research design, location and time women aged 15 - 49 years old. Design: Descriptive Epidemiology - Cross- - At each primary school, we surveyed 20 sectional investigation. students in grades 3 and 4. Location: Vinh Phuc province - A total of 540 households surveyed, took Time: from July to October 2017 540 samples of salt / soup powder, 108 urine 2.2. Research subjects samples from women aged 15 to 49 years old 35
3. Journal of Diabetes & Endocrinology No. 48 - 2021 and examined goitre ultrasound for 720 primary 2.7. Errors and measures to reduce errors school students. - Error: 2.4. The method of data collection + There is no guarantee of randomness in - Method of interview, investigation selecting communes, households and students. combined with observation. + Subject does not understand the question, - Experimental method was used to leading to a wrong answer. investigate the content of iodine in salt + Not getting enough test samples. /seasoning powder and urine; diagnostic + Sample test is not correct. imaging (ultrasound) was used to investigate - How to fix errors: goitre. + Professional training, technical guidance 2.5. Data collection instrument for officers participating in the investigation. - Questionnaire for interview and + Investigators must remember the observation. questionnaire by heart, approach the object - The ultrasound machine has a dedicated politely, openly and sincerely. When the probe to survey the thyroid gland. investigating subject is confused, it is necessary - Urine tubes, PE bags with splints for to clarify the question. samples, pens. + Guiding investigators to take the necessary - Cold thermos. amount of salt and urine for testing: 30 grams of 2.6. Data processing methods salt, equivalent to 4 teaspoons. Soup powder 40 - Design and enter, analyze data using SPSS grams, equivalent to 4 teaspoons. Urine 5 ml, 16.0 software equivalent to 4cm height of the tube. - Use appropriate statistical tests to compare: c2- test, T test. 3. RESULTS OF THE STUDY 3.1. General characteristics of research subjects Table 1. Age of study subjects Age Number of women % 18 – 30 192 35.6 31 – 40 204 37.8 41 – 49 144 26.7 Total 540 100 Comment: The average age of subjects is 34.4. In which the highest age is 49 years old, the lowest age is 18 years old. Table 2. Educational level Educational level Number of women % Not graduated from primary school 8 1.5 Graduated from primary school 17 3.1 Graduated from secondary school 217 40.2 High School Graduation 210 38.9 Graduated from college, university and higher 88 16.3 Total 540 100 Comment: Most of the surveyed women aged 18 - 49 have secondary education (40.2%) or high 36
4. Journal of Diabetes & Endocrinology No. 48 - 2021 school (38.9%). The rate of primary school and lower is very low (4.6%). Table 3. Occupation of research subjects Occupation Number of women % Trading 65 12.0 Administrative Officer 49 9.1 Worker 119 22.0 Farmer 295 54.6 Other jobs 12 2.2 Total 540 100 Comment: The majority of women surveyed are farmer (54.6%), the second most numerous group of people are working as workers (22%). 3.2. Current situation of using iodized salt and iodized products Table 4. Use of salty spices Spices Number of households % Salt 64 11.9 Seasoning powder 507 93.9 Fish sauce 530 98.1 Comment: Most of the surveyed households used fish sauce (98.1%). The proportion of households using salt in food processing is very small (11.9%), most of them use seasoning powder (93.9%). Table 5. The rate of using salt / iodized seasoning powder through interviews Salt/Seasoning powder Number of households % Use iodized salt / iodized powder 385 71.3 Use regular salt / powder 155 28.7 Total 540 100 Comment: According to the interview, people are paying attention to buying and using salt / iodized seasoning powder, the number of people saying that their family is using salt / iodized soup powder is 71.3%. Table 6. Results of the quantitative iodine test in salt and broth Results Number of households % < 20 ppm 540 100 20 – 45 ppm 0 0 >45 ppm 0 0 Comment: All salt and seasoning powder samples tested did not contain sufficient iodine at preventive levels (between 20 and 45 ppm). 37
5. Journal of Diabetes & Endocrinology No. 48 - 2021 3.3. Evaluate the impact of iodine deficiency on the high risk subjects 2.5 BìnhNormal thường BướuGoitre cổ 97.5 Figure 1. Goitre prevalence among primary school students Comment: The rate of goitre in primary school students accounts for 2.5%. 5.6 Độ Level 1A 1A Độ Level 1B 1B 94.4 Figure 2. Goitre level Comment: Goitre level is mainly at level 1A, accounting for 94.4%. Table 7: Gender Sex No goitre Goitre Male 350 6 Female 352 12 P 0.6 (>0.05) Comment: There is no relationship between gender and goiter in pupils. 38
6. Journal of Diabetes & Endocrinology No. 48 - 2021 33.3% 35.0% 27.8% 30.0% 25.0% 16.7% 20.0% 15.0% 10.0% 5.6% 5.6% 5.6% 5.6% 5.0% 0% 0% 0.0% Vĩnh Yên Sông Lô Tam Lập Thạch Yên Lạc Tam Đảo Vĩnh Bình Xuyên Phúc Yên Vĩnh Yên Sông Lô TamDương Dương Lập Thạch Yên Lạc Tam Đảo VĩnhTường Tường Bình Xuyên Phúc Yên Figure 3. Goitre zoning in elementary school students Comment: The goitre rate is lowest in 2 delta accurate. districts: Vinh Tuong and Yen Lac, and highest The majority of women surveyed are farmers in the mountainous midland districts: Tam (54.6%), the next significant group are working Duong, Tam Dao, Binh Xuyen. In two as workers (22%). The majority of subjects are mountainous districts of the province: Song Lo employed women (97.8%). This characteristic is and Lap Thach, the goitre rate is only at an different from the 2016 study by Hong Huu Duc average level, while this was the main district et al. in Binh Duong province in which 34.26% suffering goitre 10 to 15 years ago. of women worked as housewife [4]. The test result of the median urinary iodine 4.2. The situation of using iodized salt and level in urine tested by the Center for Disease iodized products Control of Thai Nguyen province is: 8.5 mg / dl, - Most of the surveyed households use fish at a mild iodine deficiency. sauce (98.1%). The proportion of households using salt in food processing is very small 4. DISCUSSION (11.9%), and most of them use seasoning 4.1. General characteristics of research powder (93.9%). Because the use of spices in subjects Vinh Phuc has a special feature (often using To ensure correct assessment of iodine use fish sauce and seasoning powder), mixing and iodine deficiency, the subjects must be iodine into seasoning powder and fish sauce representative of the community. The research should be encouraged. Scientific research has results show that the average age of the study shown that the amount of iodine lost in fish subjects is 34.4 years old, is at childbearing age sauce made from iodized salt is very small and and is usually the person responsible for iodine has no great influence on the color or housework and cooking in the family. The taste of fish sauce [6]. majority of women surveyed have secondary - Current situation of using salt / iodized (40.2%) or high school education (38.9%), powder according to labels at the time of the which is very convenient for the interview survey: the proportion of households using salt process and helps the survey results to be more or iodized powder was 71.3%. However, 39
7. Journal of Diabetes & Endocrinology No. 48 - 2021 according to the test results, all salt and median urinary iodine level of Vinh Phuc has seasoning powder samples did not contain been in the range mild iodine deficiency since enough iodine at preventive levels (from 20-45 2010, it will greatly affect the reproductive ppm). It is important to add preventive iodine to health of women of reproductive age, increases table salt, and by that many countries have the risk of miscarriage, premature birth, eliminated iodine deficiency disorders. These stillbirth. There is a need for a follow-up study countries all emphasize the need to maintain to to evaluate the impact of iodine deficiency on ensure lasting success [6]. In Vinh Phuc, the salt this very vulnerable group because the iodine and powder samples do not contain enough demand of women during pregnancy is 20-24.9 iodine at preventive levels, perhaps due to the mcg / dl, which is one and a half times higher following reasons: than normal level [5]. + Because of low salt / iodized powder The study results show that there is no quality at the production stage (counterfeit association between urinary iodine levels and goods, fake goods). the local goitre rate. We believe that the low rate + Because of reduced iodized salt / broth of goitre in students in Vinh Phuc may be due to powder quality during circulation and use: effective early detection and treatment. Goitre circulation and distribution time is long, storage examination and detection are carried out by temperature is not suitable. medical units from the commune health station 4.3. Iodine deficiency disorders assessment regularly. The Provincial Preventive Medicine on high risk subjects Center and the District Medical Center organize There was no relationship between gender and monthly examinations in remote communes goitre. This is because the study age of the with a schedule that is announced in advance. students is small (mainly 9-10 years old), so there is no gender development, the need for iodine is 5. CONCLUSION the same. The rate of goitre will be different 5.1. General features between the sexes if the survey age is increased. - Average age of study subjects is 34.4. The goitre rate in primary school students is Education level: mainly secondary school 2.5%, of which 1A level is at 94.4%. The rate of (40.2%) and high school (38.9%). goitre for students has decreased from 3.89% in - Main occupations are farmers (54.6%) and 2010 to 2.5% in 2017. This is very good because workers (22%).. although the rate of MI in the province is very low 5.2. Current situation of using salt / as above, it does not increase the goitre rate. iodized broth The prevalence of goitre is lowest in Vinh - Most of the households use fish sauce and Tuong and Yen Lac (0%), in our opinion, this is a seasoning powder for food processing, the delta district with good economy compared to the proportion of households using salt is very small rest of the province, fertile soil and adequate diet (11.9%). for the people. enough so there is no shortage of - Through interviews, the majority of micronutrients, including iodine. The high rate of households use iodized salt and seasoning disease in Tam Duong (33.3%) and Tam Dao powder (71.3%). (27.8%) is because these are the two midland - Tests showed that 100% of salt / powder districts, the soil is washed away so the lack of samples being used by Vinh Phuc people are not iodine in the soil leads to the lack of iodine. qualified for disease prevention. The results of the median urinary iodine test 5.3. Iodine deficiency disorders assessment in the urine of women aged 18 - 49 are: 8.5 µg / on at-risk subjects dl, at a mild iodine deficiency. Data from 2015 Assessment of iodine deficiency disorders on up to now shows that this is the year with the the at-risk subjects - The goitre rate in primary highest level of urinary iodine (6.5 in 2015, 5.9 school students is 2.5%, of which 1A level is in 2016). The survey results also showed that the mainly at 94.4%. There was no relationship 40
8. Journal of Diabetes & Endocrinology No. 48 - 2021 between sex and goiter in these students. National Iodine Deficiency Disorders - The rate of goitre is lowest in Vinh Tuong Report", Report on 2005 activities and Yen Lac (0%), highest in Tam Duong implementation plan 2006, Hanoi, April (33.3%) and Tam Dao (27.8%). 2006, Central Endocrine Hospital. page 8 - - The median urinary iodine level in the urine 10. of women of reproductive age 18 - 49 years old 2. Central Endocrine Hospital (2011). "Report is: 8.5 µg / dl, at a mild iodine deficiency. on the prevention of iodine deficiency disorders in localities in the country 2010", 6. RECOMMENDATION Summary report on activities in 2010 - Raising awareness and guide people on how implementing the 2011 plan, Hanoi, April to choose food, how to find out information on 2011, Central Endocrine Hospital, March 2, packages and labels to buy food meeting quality October 12. standards. 3. Ministry of Health - Central Endocrine - Adding iodine to fish sauce is a necessary Hospital (2015). "Summary report on 2014 requirement to enhance the effectiveness of activities, 2015 plan deployment", Training iodine deficiency disorders prevention in the materials of the National Diabetes Control coming time. Project, activities to prevent disorders - The quality of salt, iodized soup powder in caused by iodine deficiency, Hanoi, April households is very low, it is necessary to 2015, Ministry of Health, 9 - 12, 49 - 55. strengthen coordination among sectors: Health, 4. Hong Huu Duc, Le Thi Ngoc Dung and Industry and Trade, and Police to manage well Tran Bich Tram (2016). "The situation of the iodized salt/powder circulating in the using iodized salt to meet disease market. Strengthening inspection and strictly prevention standards among 18 - 49 year sanctioning cases of counterfeiting or goods not old women in Binh Duong in 2016", Journal meeting quality standards to ensure high quality of Endocrinology - Diabetes. 22, 173 - 178. products can reach consumers. 5. Institute of Nutrition (2016). - The iodine deficiency status of women of "Recommended nutritional needs for reproductive age in Vinh Phuc is only mild, but Vietnamese people", Medical Publishing the situation has been going on for many years, House, Hanoi, 71 - 73. which will cause chronic iodine deficiency, In English affecting reproductive health .Therefore, it is 6. Chavasit V, Chanthilath B, Chareonkiatkul necessary to strengthen the management of S, Jud-prasong K (2009). "Iodine stability childbirth in hospitals and medical stations, raise and sensory quality of fermented fish sauce awareness and guide pregnant women and produced with the use of iodated salt", Food lactating mothers about appropriate Nutr Bull, 30(2): 183 – 188. micronutrient supplementation, including iodine 7. WHO/UNICEF/ICCIDD (1993). supplementation.. “Biochemical indicators, Outcome indicators of IDD, The selection of REFERENCES appropriate indicators", Indicators for In Vietnamese Assessing Iodine Deficiency Disorders and 1. Central Endocrine Hospital (2006). "2005 their control programmes. 16-23. 41