Determination of Urinary Iodine Excretion (UIE) to Assess Iodine
Deficiency Disorder (IDD) among Pregnant Women in District
Hospital of Sindhupalchowk, Nepal

Submitted toSociety for Eliminating Nepalese Iodine Deficiency (SENID), Osaka, Japan

Submitted by

Public Health and Infectious Disease Research Center (PHIDReC)
Kathmandu, Nepal

August, 2016

Study Team

Investigators
Prof. Dr. Anand Ballabh Joshi, PhD
Prof. Chitra Kumar Gurung, M.Sc., MPH
Dr. Megha Raj Banjara, PhD
Dr. Akhil Tamrakar, MD (Paediatrics)
Mr Krishna Raj Pant, MBS
Advisors
Prof. Chikayoshi Atsuta
Dr Jiro Okawa, MD
Mr. Rajan Malla
Ms. Noriko Malla

2

Acknowledgements

We would like to express sincere gratitude to Prof. Chikayoshi Atsuta, Chairman,
Society for Eliminating Nepalese Iodine Deficiency (SENID) Osaka, Japan, for providing
technical and financial support to the study. We would like to express sincere thanks to
Mr. Rajan Malla and Ms. Noriko Malla, for their co-operation in the study. We would
like to thank Dr Sagar Rajbhandari DHO, Mrs. Tara Sunuwar, Public Health Nurse, andGeeta Shrestha ANM Chautara Hospital, Sindhupalchowk for her support for sample
and data collection.
We would like to express sincere thanks to pregnant women who provided us
information and allowed us for collection of urine samples.
The financial support for this survey was provided Prof. Chikayoshi Atsuta and SENID,
Osaka, Japan.
PHIDReC Team
June, 2016
Kathmandu

3Summary
Pregnant women and infants are risk populations of iodine deficiency disorders (IDD).
Our previous studies also revealed that pregnant women are at risk of non-visible IDD.
Therefore, this study has been designed to explore the status of Iodine Deficiency
Disorders (IDD) among pregnant women through analysis of urinary iodine excretion(UIE). A total of 97 pregnant women from Chautara Hospital Sindhupalchowk was
included to analyze UIE. Although the general clinical status of women was satisfactory,
the urinary iodine excretion revealed that still 25.2 percent of pregnant women and 20
percent children below one year of age in Sindhupalchowk had insufficient iodine
intake. About 80% mothers had heard of iodized salt. Most of the households except
one were using iodized salt with two children logo during the survey. About 13%
mothers had knowledge of benefits of iodized salt, 41.9% had knowledge of iodine
deficiency diseases, 38.4% had knowledge on iodine source. Although awareness of
iodine and use of iodized salt was satisfactory, pregnant women are still at risk ofiodine deficiency disorder and they should be in priority population for the IDD
prevention program.

4

1. Introduction
Iodine Deficiency Disorder (IDD) is the world’s single most significant cause of
preventable brain damage and mental retardation. Twenty nine percent of the
population (1570 million people) is at risk of iodine deficiency today in the world. The
immense danger to health due to IDD arises from the fact that these disorders canbegan even before the child is born. Although iodine is needed in small amount on anaverage of 150 mcg (100 to 300) per person per day, 1, 2 lack of iodine is associated withwide range of clinical and sub-clinical conditions. The most obvious sign of IDD is goiter,
which is a gross enlargement of the thyroid gland in the neck, with a global prevalenceof 12%. In addition to goiter, IDD leads to infant mortality, stillbirths, birthcomplications, mental retardation and depressed psychomotor functions. Moderate
IDD in early childhood has been estimated to lower the intelligence quotient by about
10-15 points, while in adults it causes lethargy. 3
IDD is an important major micronutrient deficiency problem in Nepal. In some isolated
mountainous area of Nepal, most of the adult woman had goiter and up to 10% of
population were cretins, the severest form of IDD. 4
In areas with severe iodine deficiency (<50 mcg intake/day), goitrogenesis as well as
hypothyroidism were frequently observed in mother and newborn as a result of theinability of the thyroid gland to adjust to changes in thyroid economy associated withpregnancy. Hence, the pregnant woman and the newborn have been consideredprimary targets for iodine supplementation in such areas.5 Ministry of Health andPopulation has prioritized Iodine Deficiency Disorders as a high level activity in its
Nutrition Policy and Strategy 2004. By the year 2017 iodine deficiency disorders will beeliminated virtually from Nepal. 7
We implemented iodine supplementation among pregnant mothers in Antenatal Care
(ANC) Clinic of Chautara Hospital Sindhupalchowk. We found significant positive
outcome in mothers and children born from iodine supplemented mothers.
All these findings associated with pregnant women justify the burning issue for the
research on iodine deficiency disorders among pregnant mother and newborn. With
these motivations, this study was designed to screen among pregnant women andnewborn in Sindhupalchowk district hospital in 2015 and 2016 analyzing urinary iodine.

52. Objectives
To determine the status of Iodine Deficiency Disorders (IDD) in pregnant women in
Chautara Hospital Sindhupalchowk.
Specific objectives
1. To assess physical health including blood pressure measurement of women.
2. To determine the status of IDD among pregnant women and children below one
year of age analyzing urinary iodine excretion.
3. To assess physical health of the newborn.

3. Methodology
3.1 Research design
This cross-sectional study was conducted to determine the status of IDD among
pregnant mothers in Chautara Hospital Sindhupalchowk during September, 2015 toFebruary 2016. In addition, health education on iodized salt and iodine deficiency
disorder were provided to women. This was a follow up study with adding somevariables for assessing IDD among pregnant women.
3.2 Study site
The site of this study was Chautara Hospital Sindhupalchowk. Sindupalchowk district issituated in hilly ecological region of Central Region of Nepal. Women were followed up
in their household to assess their physical health as well as their newborn.
3.3 Sample size and sampling
We enrolled 97 pregnant mothers seeking ANC in Chautara Hospital. Urine samples
from those women and children below one year of age were collected for
determination of urinary iodine excretion. We also provided health education for those
women.
3.4 Physical examination of pregnant women
6

Women visiting Chautara District Hospital for antenatal check up were examined forblood pressure. The attending nurse/ANM measured the blood pressure of examined
mothers.
Thirty one mothers and their newborn were followed up in the household in May 2016
and their physical examination was performed. Urine samples were collected from 25
children for urine iodine estimation during recent follow up visit in August 2016.
Pregnant women with high blood pressure were counseled in the hospital during her
follow up ANC visit not to take too much salt.
3.5 Collection of urine samples
Urine samples were collected from 97 pregnant women in the hospital and 25 children
below one year of age from communities for the analysis of Urinary Iodine Excretion(UIE) to screen IDD status. The urine samples were collected in clean leak proof
container. The collected urine samples were kept in refrigerator at -200C until analysis.
The UIE analysis was conducted at BP Koirala Institute of Health Sciences (BPKIHS),
Dharan.
3.6 Data collection
Knowledge on iodine and IDD, perceptions of mothers on iodized salt were collectedusing questionnaire from mothers. The UIE test data were collected after sample
analysis. The descriptive qualitative information regarding the mother’s perceptions on
iodized salt were collected through interview.
3.7 Data management and analysis
Collected data were entered in SPSS version 21 and analyzed. Descriptive analyses were
performed. Qualitative data were triangulated with quantitative data. The followingclassification of urinary iodine excretion (UIE) for pregnant women and children below
two years of age was used.
Table 1: WHO classification of iodine deficiency disorders (IDD) on the basis of urinary iodine excretionfor pregnant womenMedian Urinary Iodine (µg/L)

Iodine intake

7

Iodine status

<150 μg/L

Insufficient

Severe iodine deficiency

150-249μg/L

Adequate

Adequate iodine nutrition

250–499 μg/L

Above requirements

Risk of iodine induced hyperthyroidism≥500 μg/L

Excessive

Risk of adverse health consequences

Children aged less than two years<100

Insufficient≥ 100

Adequate8

4. Findings
Characteristics of women involved in the study
The age range of women included for UIE was 17-35 years. The mean age of thewomen was 23.2 years (SD-3.8 years). Majority of women (83.9 percent) were of age
21-35 years.
Table 2: Characteristics of the womenCharacteristics

Number (n=97)

Percent

Less than or equal to 20

16

16.1

21-35

81

83.9

More than 35

00.0

Mean age (S.D.)

23.2±3.2 (Min.-17; Max.-35)

Mean weight (Kg)51.1±7.6 (Min.-38; Max.-74)

Age distribution (in years)

One mother had hypertension.
Table 3: Blood pressure category of women
Blood pressure

Number

Percent

Normal96

99.0

Hypertension

1

1.0

Ninety percent of women had normal clinical status whereas two percent had
abnormal clinical status.
Table 4: General clinical status of women
Clinical status

Number

Percent

Normal97

100.0

Abnormal00.0

Urinary iodine level among pregnant women
Urinary iodine excretion (UIE) level indicates that 27 percent of women had insufficient9iodine intake. Similarly, 31 percent of women had excessive UIE greater than 500 μg/l.
Table 4: Urinary iodine excretion level and iodine intake status
UIE level (μg/l)

Number

Percent (n=91)

Insufficient (<150)

23

25.2

Adequate (150-249)

29

31.9

Above requirements (250-499)

39

42.9

Excessive (≥500)--

Urinary iodine excretion (UIE) level indicates that 20 percent of children had insufficient
iodine intake. Similarly, 52 percent of children had sufficient UIE between 150-249 and
24 percent children had UIE greater than 550 μg/l which is above requirement.
Table 4: Urinary iodine excretion level and iodine intake status of children below one year
UIE level (μg/l) *Number

Percent (n=25)

Insufficient (<100)

5

20.0

Adequate (150-249)

13

52.0

Above requirements (250-499)

6

24.0

Excessive (≥500)--

Note: One sample was contaminated with stool and urine iodine estimation was not done.
*Epidemiological criteria for assessing iodine nutrition based on median urinary iodine
concentration for children aged less than one year.

Follow up results of women
We followed 31 mothers and their newborn in May 2016. Most of the followed up
mothers were from Chautara and surrounding VDCs of Chautara.
Table 5: VDC wise distribution of number of mother and newborn followed up
VDC

NumberBatase3

9.7

Chautara

11

35.5

Irkhu

3

9.7

Kunchowk

3

9.7

Pipaldanda

8

25.8

Sanosiruwari

3

9.7

10

Percent

The average height, weight and BMI of mothers were normal. However, some mothers
had height less than 145 cm, low weight upto 37Kg and BMI less than 18Kg/m2.
Table 6: Physical parameters of followed up mother
Parameters

Mean (±S.D.)

Range (min.-max.)

Height (cm)150.23±4.63

141-161

Weight (Kg)

52.65±7.25

37-69

2

23.25±2.83

17-28

BMI (Kg/m )Most of the mothers had normal BMI whereas one mother had BMI less than 18 Kg/m2
and 22.6% had BMI greater than 25 Kg/m2.

Table 7: BMI categories of followed up mother
BMI categories (Kg/m2)

Number

Percent

<18

1

3.2

18-25

23

74.2

>25

7

22.6

11

Photograph 1: Physical examination of follow up mother

None of the mothers had pallor sign, jaundice and oedema during physicalexamination. Similarly, they did not have swelling of thyroid. According to mother'sreport, they did not have goiter during pregnancy. Followed up mothers mentionedthat 77.4% of them had still birth in the past but none of them had still birth in lastdelivery.

12Figure 1: Still birth in the past from followed up mother

About 80% mothers had heard of iodized salt. Most of the households except one wereusing iodized salt with two children logo during the survey. About 13% mothers had
knowledge of benefits of iodized salt, 41.9% had knowledge of iodine deficiency
diseases, 38.4% had knowledge on iodine source.
Table 8: Iodine awareness and use of iodized salt among mothers
Variables

NumberHeard of iodized salt

25

80.6

Use iodized salt with two children logo

30

96.8

Knowledge on benefits of iodized salt (multiple response)

4

12.9

Mental development

3

9.6

Physical growth2

6.4

Disability prevention1

3.2

Knowledge on iodine deficiency diseases (multiple response)

13

41.9

Goitre5

16.0

Disability

4

12.8

Memory loss

1

3.2

Lethargy1

3.2

Knowledge on iodine source (multiple response)

12

38.4

Beans

3

9.6

Vegetables

5

16.0

Meat

2

6.4

Fruits3

9.6

13Percent (n=31)

Majority of mothers (93.5%) took iron tablets during their last pregnancy.

Figure 2: Mothers taking iron tablets during last pregnancy

None of the family members of followed up mothers had goiter.
Assessment of newborn babies born from mothers included in the study
We followed 31 newborn of age less than six months. Among followed up children,
29% were first child of the mother, 51.6% were second child and 19.4% were third andfourth child of the mother.

14

Photograph 2: Doctor examining newborn baby

Table 9: Characteristics of followed up children
Characteristics

Number

Percent (n=31)

<1

7

22.6

1-3

14

45.1

4-6

10

32.3

Male

18

58.1

Female

13

41.9

1

9

29.0

2

16

51.6

3

4

12.9

4

2

6.5

Age of child (months)

Sex

Birth order15

Among 31 followed up newborn, one had congenital anomalies, 7 had history ofjaundice within 24 hours of birth, 2 had sluggish feeding and suckling ability, one hadno smile at mother.

Photograph 3: Physical examination of child at Sindhupalchowk hospital

Table 10: Status of newborn babies
Characteristics

Number

Percent (n=31)

Congenital anomalies

1

3.2

History of jaundice within 24 hours of birth

7

22.6

Normal29

93.5

Sluggish

2

6.5

Yes

15

48.4

No

1

3.2

Feeding and suckling ability of baby

Smile at mother16

Not at applicable to this age

15

48.4

All children had immunization applicable within six months of age. All of the children
had normal weight according to age.

Photograph 4: Weighing of the baby

Regarding status of health and diseases among newborn, 22.6% had history of
disease/surgery/hospitalization, 41.9% had fused fontanel, 6.5% had swollen eyelid.
None of the newborn had puffiness in face, open mouth with protuberant tongue, andneck swelling goiter. One child had wheeze and crepitations, and two had wheeze
during the survey.
Table 11: Status of diseases and healthCharacteristics

Number

Percent (n=31)

7

22.6

Open

12

38.7

Wide

6

19.4

Fused

13

41.9

History of disease/surgery/hospitalization
Status of fontanel

Eyelid17

Normal29

93.5

Swollen2

6.5

Pallor2

6.5

Puffiness in face0

0.0Open mouth with protuberant tongue0

0.0

Neck swelling goiter

00.0

Clinically clear

28

90.3

Wheeze and crepitations

1

3.2

Wheezy2

6.5

Cardiovascular system

Photograph 5: Physical examination of child18

5. Conclusions
Although the general clinical status of women was satisfactory, the urinary iodine
excretion revealed that still 25.2 percent of pregnant women and 20 percent of thechildren below one year of age in Sindhupalchowk had insufficient iodine intake. This
indicates that pregnant women and children are still at risk of iodine deficiency
disorder and they should be in priority population for the IDD prevention program. The
follow up results indicate that iodine related awareness and use of iodized salt weresatisfactory. There was some health disorders in newborn related to factors other than
iodine. Therefore, mothers and newborn health and their nutrition should be inpriority to achieve desirable results of reducing maternal and neonatal/infant morbidity
and mortality.

19References
1. ICCIDD, UNICEF. Progress towards the Elimination of Iodine Deficiency Disorder(IDD).
2. WHO, the world Health Report 2002, was reducing Risks, Promoting Healthy Life
Geneva, 2002.
3. Dunn JT. Glinoer D. 1993 Specific recommendations on iodine nutrition for mothers
and infants in Europe. In: Delange F, Dunn JT, Glinoer D, eds. Iodine deficiency inEurope: a continuing concern. New York: Plenum Press; 478.
4. HMG, Ministry of Health (1967). Endemic Goiter in Nepal, WHO/SEA/26, October
1967.
5. HMG/N, New ERA, Micronutrient Initiative, UNICEF Nepal, and WHO.
6. NMSS (1998). Nepal Micronutrient Status Survey 1998. Katmandu, Nepal: Ministryof Health, Child Health Division,
7. MoHP Department of Health Services National Nutrition Policy and Strategy (NNPS),
2004.
8. Glinoer D. The regulation of thyroid function in pregnancy: pathways of endocrine
adaptation from physiology to pathology. Endocr Rev 1997; 18: 404-433.
9. Glinoer D, De Nayer P, Delange F, et al. 1995 A randomized trial for the treatment ofmild iodine deficiency during pregnancy: maternal and neonatal effects. J Clin
Endocrinal Metab. 80:258–269.
10. WHO. Iodine Status Worldwide, WHO Global Database on Iodine Deficiency, 2004.
11. Joshi AB, Banjara MR, Rikimaru T and Pandey S. Assessment of Current Status of
IDD for the Development of Future Control program JICA Nepal. 2004.
12. DOHS, UNFPA .Annual Report 2004 -2005. 2006, Nepal

20

Annex-I
Performa for collection of urine samples from pregnant women
Date:
Name of the mother:
Name of the husband:
Address: District:

VDC:

Village:

Ward No.:
Name of the Hospital:
1. Age of the mother:
2. Caste:
3. Religion:
4. Blood pressure (mmHg):
5. Weight:
6. General clinical statusa. Normalb. Not normal
7. Urine sample collected in filter papera. Yesb. No21;]lg8 / hg:jf:Yo tyf ;?jf /f]u cg';Gwfg s]Gb|, gFof jfg]Zj/, sf7df08f},g] k f nue{jtL cfdfx?df lk;fadf cfof]l8gsf] dfqf kl/If0f dfkm{t cfof]l8gsf]
sdLnfO{ lgwf{/0f sfo{qmd, @)&@
ue{jtL dlxnfx?af6 lk;fasf] gd'gf ;+sng ubf{ eg]{ kmf/d

書式変更: フランス語 (フランス)

書式変更: フランス語 (フランス)

書式変更: フランス語 (フランス)

kmf/fd g+=
ldltM
cffdfsf]
gfdM======================================================;Dks{ g+=>Ldfgsf]
gfdM=====================================================
lhNnfM==========================uf=lj=;=M=================================j8f
g+=M==============================
c:ktfnsf]]
gfdM=============================================================!= cfdfsf] pd]/M==========================-aif{df_@= hftM=======================================#= wd{M==========================================$=/Qmrfk (Blood Pressure in mm of Hg)………………….
%=tf}nM ===========================-s]hLdf_^=;fdfGo lslnlgsn cj:yf (General Clinical Status)-s_ ;fdfGo (Normal)-v_ c;fdfGo (Abnormal)&= lkmN6/ k]k/df lk;fasf] gd'gf ;+sng ul/Psf] 5÷5}g <-s_ 5-v_ 5}gtkfO{n] cGt/jftf{sf] nflu ;do lbg' eO{ d}n] ;f]w]sf k|Zgx?sf] hjfkm lbg'
ePsf]df wGojfb Û

22

Annex-II
Follow up Tool for Newborn
Questionnaire and Data collection tool to test Anthropometric Status of Children of
Urine Iodine Estimated Mothers in Sindhupalchowk District, May 2016
Interviewer' name: -…………………………….............Case No:..........

Date:-…………….

Individual information:
Name of the Mother ……………………………………………….
District : …………….

Village¥Municipality : ……………

Ward No: …….

Name of the child: ……………………………….....................
Age (in months):
Sex :Male (…………….

)

Female ()

Order of the child :…………….

Antenatal history:
Was Iodine supplementation done to the mother during pregnancy?
Duration of the supplementation……………

Yes (

)

No (

)

Dose of the supplementation…………

Urine Iodine level of the pregnant mothers _____________
Natal history:
Gestational age: ………

Birth weight of the baby:……….

Any visible congenital anomalies:

Yes (

)

No (

)

If yes, mention………………
Postnatal history:
History of jaundice after 24 hours of birth: Yes (Feeding and sucking ability of baby: Normal (

)

No (
)

)

Sluggish ()

Growth and development of the child
What is the pattern of the growth of the child as compared with other children of the same age?
Normal ()

Forward ()

Delayed ()

If delayed/forward, mention if the mother observes: Lethargy (23)

Restlessness ()

Duration of sleep in hours per day…………
Developmental milestone (age wise)•

Smiled at mother……

••Could sit with support……….

•

Erected head………

Could sit without support……

•Started crawling……

•

Could stand without support….

•

Started walking………..

•

First word………

•First sentence……………

Dietary history:
Breast feeding:Done ()

Not done ()

No. of feeds per day………

Weaning started at….

Any Special supplementation……

Any chocking spells during feeding : Yes (

)

No (

)

Relevant general questions
Is Immunization up to date as per EPI schedule:
Bowel habit:

Normal (History of hair-fall:

Yes (

)
)

Yes (

)

Constipation (
No (

No (
)

)

Hyper defecation ())

Please mention if any history of disease/surgery/hospitalization so far………………..
Clinical Examination:
Status of Fontanel (Esp. Posterior):(

Normal ()

Wide (

Eyelid:Normal (Fused

Retracted ()

Swollen ())

Pallor:+()

Face puffiness/oedematous:+(+(

Normal (-(Large (

Skin condition……………….

Speech ())

Flaccid (Hearing ()

CVS:………..

Anthropometric parameters
Weight in gm……….

Height in cm……..

24

)

)

)

Neurological abnormality:

)

)

)
)

)

-(
-(

Normal (

Tone:

)

)

Neck: Swelling/ Goiter:
Abdomen:-(+(Open mouth with large protuberant tongue:

(

)

)

Resp:…………

)Spastic

Head circumference in cm…….

Chest circumference in cm……….

Length and head circumference of the baby at the time of the birth (if available)______

MUAC:

Green ()

Yellow (

)

Red (

25

)

Annex-III
Follow up Tool for Mothers

Hfg :jf:Yo tyf ;?jf /f]u cg';FGwfg s]Gb|
GfofF jfg]Zj/, sf7df08f} g]kfn
Ufe{jtL dlxnfx?sf nfuL cfof]l8gsf] sdL af6 x'g] ;d:of ;DaGwL k|ZgfjnL
Kfl/ro ;+VofM
cGt{jftf{sf/sf] gfdM

cGt{jftf{ ldltM

dlxnfsf] gfdM
lhNnfM
uf=lj=;=÷gu/kflnsfM
ufpMof]UotfM
k]zfM

pd]/M

j8f g+=
kmf]g g=

Vital:•BP•

Height (CM)•Weight (Kg)•

BMI

General:(Skin colour)•

Pallor•Jaundice•

OedemaNeck:(Thyroid swelling)•

Stage I•

Stage II•

Stage IIIWas goiter was formed during the pregnancy (if any goiter) Yes [Did goiter regressed after the birth of the baby?

-!_ tkfO{sf] slt hgf aRrfx? 5g <
26

Yes [

] No [

] No
]

[

]

-s_ 5}gg-v_ Pp6f aRrf
-u_ b'O{ jf b'O eGbf al9-@_ lautdf tkfO{sf] d/]sf] aRrf hGdLPsf] lyof]<-s_ lyof]-v_ lyPg-#_ tkfO{n] cfof]l8g g'gsf] af/]df ;'Gg' ePsf] 5<-s_ 5-v_ 5}g-$_ tkfO{sf] 3/df b'O{ jfnjflnsfsf] lrGx ePsf] cfof]l8go'St g'g k|of]uug'{ x'G5<-s_ u5f}{-v_ ub}{g-%_ tkfO{sf] larf/df cfof]l8go'St vfg]s'/fx? vfgfn] z/L/nfO{ s] s:tf
kmfO{bfx? x'G5g<-^_ tkfO{sf] larf/df cfof]l8g g'gsf] sdLaf6 s] s:tf :jf:Yo ;d:of tyf /f]ux?
x'G5g<
s_===============================================================================================================================v_===============================================================================================================================u_================================================================================================================================-&_ tkfO{sf] larf/df xfd|f] z/L/nfO{ rflxg] cfof]l8g s] s] df kfO{G5 <-*_ tkfOn] cfO{/g kmf]lns Pl;8 6]an]6 vfg' eof]÷vfO{/xg' ePsf] 5<s_ 5v_ 5}g-(_ tkfO{sf] kl/jf/df s;}nfO{ unufF8 cfPsf] 5 <s_ 5v_ 5}g!)_ olb unufF8 cfPsf] 5 eg],unufF8sf] cj:yf M
s_ 7"nf] cfsf/sf]
v_ b]Vbf klxrfg ug{ ;lsg]
klxrfg ug{ ;lsg]

27

u_ 5fDbf dfq

Annex-IV
Information Sheet for Pregnant Women and Parents of Children
Name of Principle Investigator:
Name of Organization: Public Health and Infectious Disease Research Center (PHIDReC)
Name of Sponsor: Society for Eliminating Nepalese Iodine Deficiency Disorder (SENID) Japan

Information sheet for individuals participating in the research"Screening of Iodine Deficiency Disorder (IDD) and Supplementation of Iodine among Pregnant

Women in Beni Hospital, Myagdi, Nepal”(I am ..................................... and I work at the PHIDReC Kathmandu. We are doing some researchon the Iodine Deficiency Disorder to determine its burden in risk population such as pregnant
women and children.)Purpose of the research
Iodine Deficiency Disorder (IDD) is an important major micronutrient deficiency problem in Nepal.
In areas with severe iodine deficiency (<50 mcg intake/day), goitrogenesis as well as hypothyroidism
were frequently observed in mother and newborn as a result of the inability of the thyroid gland toadjust to changes in thyroid economy associated with pregnancy. Hence, the pregnant woman andthe newborn have been considered primary targets for iodine supplementation in such areas.
All these findings associated with pregnant women justify the burning issue for the research on
iodine deficiency disorders among pregnant mother and newborn. With these motivations, thispilot study has been designed to screen IDD in children born from iodine supplemented mothers
during pregnancy and pregnant mothers testing TSH in order to implement iodine supplementationin pregnant women.
Procedures
The site of this study is Beni Hospital Myagdi. We will collect urine samples from 400 pregnant
mothers when they seek ANC. We also assess knowledge and perceptions of mothers on IDD andiodine. The mothers will also be assessed clinically. Similarly, urine samples will also be collectedfrom newborns from the same hospitals during the study period. Urine samples will be analyzed for
urinary iodine excretion using standard procedure.
Risks and Discomforts
There will be no any risks during collection of urine sample. The urine sample will be collected using
sterile leak proof container in the hospital when you seek ANC.
Benefits
Your participation is likely to help us to find out more about what is the burden of Iodine Deficiency
Disorder (IDD) in high risk population in Nepal and this information will be useful to implement
iodine deficiency control programme.
28Incentives
You will not be provided any incentive to take part in the research.
Confidentiality
The information that we collect from this research will be kept confidential. Information about youthat will be collected from the study will be stored in a file which will not have your name on it, but
a number assigned to it. Which number belongs to which name will be kept under lock and key, andwill not be divulged to anyone except the researchers, and research sponsors.
Right to refuse or withdraw
You do not have to take part in this research if you do not wish to do so, and this will not affect the
future treatment of your family at the health facility at the District Hospital in any way. You will still
have all the benefits that you would otherwise have.
You may stop participating in the research at any time that you wish to, without losing any of yourrights as a patient or otherwise.
Who to contact
If you have any questions you may ask those now or later. If you wish to ask questions later, you
may contact:(Prof. Chitra Kumar Gurung, PHIDReC, Kathmandu, Phone: +977-1-4494254).

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Consent Form from Pregnant Women for Blood Sample Collection for IDD Screening

I have read/has been read to me the foregoing information. I have had the opportunity to ask
questions about it and any questions I have asked have been answered to my satisfaction. I consent
voluntarily to participate as a participant in this study and understand that I have the right towithdraw from the study at any time without in any way affecting me and my family as a healthcare seeker.

Participant’s Name:
Signature:
Place:
Date:

Witness (Name):
Place:
Signature:Date:30