Report on

Knowledge, Attitude and Practice of Women and Screening of
Iodine Deficiency Disorder (IDD) among Pregnant Women inDistrict Hospital of Myagdi, Nepal

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

Submitted by

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

April, 20131

Study Team
Investigators
Prof. Chitra Kumar Gurung, M.Sc., MPH
Dr. Suresh Prasad Bastola, MBBS, MPH
Dr. Megha Raj Banjara, PhD
Mr Krishna Raj Pant, MBS
Mr Naba Raj Bista, MA
Advisors
Prof. Chikayoshi Atsuta
Dr Jiro Okawa, MD
Mr. Rajan Malla
Ms. Noriko Malla

2

Summary

This study was designed to determine the status of Iodine Deficiency Disorders (IDD) among
pregnant women who are at risk of IDD. A total of 80 pregnant women from Myagdi District
Hospital, Beni were included in the study. Urine samples were collected from pregnant
women. The urine samples were analyzed for urine iodine estimation. In addition, focus
group discussion was conducted among women and inhabitants of three village development
committees of Myagdi district to assess the knowledge, and practices on iodine and IDD, andto provide nutrition education on iodine and iodized salt. Although the knowledge andpractices of women on iodized salt was satisfactory, the urinary iodine excretion revealed thatstill one fifth of pregnant women had insufficient iodine intake. This indicates that theidentified at risk population of IDD are still significant proportion in the population and theseissues should be addressed by concerned government agencies and other stakeholders.

3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 andfinancial support to the study. We would like to express sincere thanks to Mr. Rajan Mallaand Ms. Noriko Malla, for their co-operation in the study. We would like to thank Mr. Bimal
Poudel, Myagdi District Hospital, Beni for her support for sample and data collection.

We would like to express sincere thanks to pregnant women who provided us information andallowed us for collection of urine samples.

The financial support for this survey was provided Prof. Chikayoshi Atsuta and SENID,
Osaka, Japan.
PHIDReC Team
May, 2013
Kathmandu

4

Contents
Chapter-I: Introduction… ..........................................................................................................6
1.1 Background ......................................................................................................................6
1.2 Objectives .........................................................................................................................7
Chapter-II: Methodology ...........................................................................................................8
2.1 Research design ................................................................................................................8
2.2 Study site ..........................................................................................................................8
2.3 Sample size and sampling ................................................................................................8
2.4 Selection of pregnant women ...........................................................................................8
2.5 Collection of urine samples..............................................................................................9
2.6 Health education on iodine to pregnant mothers, women and Female Community
Health Volunteers ...................................................................................................................9
2.7 Data collection................................................................................................................10
2.8 Validity and reliability ....................................................................................................10
2.9 Data management and analysis ......................................................................................10
Chapter-III: Findings ............................................................................................................... 11
3.1 Findings from qualitative methods................................................................................. 11
3.2 Findings from quantitative study....................................................................................14
Chapter-IV: Conclusion ...........................................................................................................18
References................................................................................................................................19
Appendix-I: Focus Group Discussion (FGD) with Women.....................................................20
Appendix-II: Performa for collection of urine samples from baby .........................................22
Appendix-III: Information Sheet for Pregnant Women and Parents of Children ....................24

5

Chapter-I

Introduction

1.1 Background
Iodine Deficiency Disorder (IDD) is the world’s single most significant cause of preventablebrain 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 can began even before the child is born.
Although iodine is needed in small amount on an average of 150 mcg (100 to 300) per person
per day, 1, 2 lack of iodine is associated with wide 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 prevalence of 12%. In addition to goiter, IDD leads to infant mortality,
stillbirths, birth complications, 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 IDD status assessment conducted in 2004 in Nepal
noted that 16.3 percent household salt samples were found to have less than 15 ppm iodine,
35.33 percent samples found to have 15 to 30 ppm, 40 percent samples were found to have30-50 ppm and 12.64 percent salt samples had iodine greater than 50 ppm.

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 inability6

of the thyroid gland to adjust to changes in thyroid economy associated with pregnancy.
Hence, the pregnant woman and the newborn have been considered primary targets for iodine
supplementation in such areas.5 Ministry of Health and Population has prioritized Iodine
Deficiency Disorders as a high level activity in its Nutrition Policy and Strategy 2004. By theyear 2017 iodine deficiency disorders will be eliminated 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 inmothers and children born from iodine supplemented mothers.

All these findings associated with pregnant women justify the burning issue for the researchon iodine deficiency disorders among pregnant mother and newborn. With these motivations,this study has been designed to screen among pregnant women and newborn in Beni Hospital
Myagdi in 2012 and 2013 analyzing urinary iodine. This study also provides health education
to the women of rural community regarding the use of two children logo containing iodized
salt.

1.2 Objectives
To determine the status of Iodine Deficiency Disorders (IDD) in pregnant women in Beni
Hospital Myagdi.
Specific objectives
1. To determine the status of IDD among pregnant women analyzing urinary iodine
excretion.
2. To assess knowledge, attitude and practice of women on iodine and iodine deficiency
disorders.
3. To provide health education to pregnant mothers and mother’s group in the ruralcommunity regarding iodized salt and IDD.
7

Chapter-II

Methodology

2.1 Research design
This cross-sectional study is being conducted to determine the status of IDD among pregnant
mothers in Beni Hospital Myagdi from March 2013. In addition, knowledge, attitude andpractices of women were assessed through qualitative study.

2.2 Study site
The site of this study is Beni Hospital Myagdi. Myagdi district is situated in hilly ecologicalregion of Western Region of Nepal. For qualitative study, three VDCs namely Arthunge,
Pulachaur and Singa were included.

2.3 Sample size and sampling
We are planning to enroll 100 pregnant mothers in Myagdi district hospital who will attend
for antenatal care from March 2013 to May 2013.
For qualitative study, a total of 48 women in three groups were included for focus group
discussion and health education classes on iodine and IDD. The community people including
teachers, social leaders and female community health volunteers (FCHVs) also participated in
the discussion and health education class.

2.4 Selection of pregnant women
Eighty pregnant women who attend Beni Hospital Myagdi for antenatal care were included in8the study.

2.5 Collection of urine samples
Auxiliary Nurse Midwife (ANM) and health assistant (HA) of Myagdi district hospital weretrained on collection of urine samples and required data in the questionnaire. Urine samples
were collected from 80 pregnant women in the hospital 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 performed at BP Koirala Institute of Health Sciences (BPKIHS), Dharan.

2.6 Health education on iodine to pregnant mothers, women and Female
Community Health Volunteers
Pregnant women were counseled and health education was provided regarding importance of
iodine during pregnancy. We also assessed mother’s knowledge on IDD. Health education
was provided to pregnant mothers in the hospital.

In addition, we assessed the knowledge, attitude and practices of women in the community
regarding iodine, iodized salt and iodine deficiencies. Health education was provided to
women along with Female Community Health Volunteers (FCHVs) in the rural community of
Myagdi. The health education was provided to 3 mothers group in the district. The mothers
group of the dalit, janajati and disadvantaged community were included for health education
package. In the meeting in the community, iodized salt packet with two children logo wasdistributed to motivate them to use iodized salt.

92.7 Data collection
Knowledge on iodine and IDD, perceptions of mothers on iodized salt was collected using
questionnaire from mothers.
The descriptive qualitative information regarding the mother’s perceptions on iodized salt
were collected through interview and focus group discussion. Focus group discussion was
conducted with women in the meeting.

2.8 Validity and reliability

Validity and reliability of the study was considered with high priority to minimize therespective errors. Standard techniques are being used for urine sample collection. Training
and orientation for health workers were conducted as per need and sample are being collectedunder strict supervision of researcher.

2.9 Data management and analysis
Collected data were entered into SPSS version 13 and analyzed. Descriptive analysis was
conducted. The following classification of urinary iodine excretion (UIE) for pregnant
women was used.
Table 1: WHO classification of iodine deficiency disorders (IDD) on the basis of urinary
iodine excretion for pregnant womenMedian Urinary Iodine (µg/L)

Iodine intake

Iodine status<150 µg/L
150-249µg/L
250–499 µg/L

Insufficient
AdequateAboverequirements
Excessive

Severe iodine deficiency
Adequate iodine nutrition
Riskof
iodineinducedhyperthyroidism
Risk of adverse health consequences≥500 µg/L

10Chapter-III

Findings
Data were collected using both qualitative and quantitative methods in Myagdi district.
Qualitative data were collected from the community through focus group discussion.
Quantitative data including urine samples were collected from pregnant women attending
antenatal care check up clinic at Myagdi District Hospital, Beni.

3.1 Findings from qualitative methods
Altogether, 48 women were included in the focus group discussion and health education class.
Among three FDGs, one group was from dalit community, one from upper caste and one
from janajati. The finding of FGD is given below:

Heard of iodine deficiency disorder
Regarding the awareness about iodine deficiency disorder among the women involved in thefocus group discussion and health education classes on iodine deficiency disorder, majorityof the women were found aware of the iodine deficiency disorder. The mothers of Pipalbot
ward no. 6 of Arthunge VDC (Brahman community) were found to be more aware about
iodine deficiency as compared to women of ward no. 1 and 2 of Pulachaur VDC(Dalit
community) and the women of Singa VDC ward no. 5 (Janajati community).

Symptoms or disease caused by iodine deficiency
Majority of the women were aware about the iodine deficiency disorder and they mentioned
iodine deficiency disorders as heart disease, dizziness, handicap of hands and arms anddeformities in hands and arms. Goiter, disability and mental retardation are the diseases of11iodine deficiency. The women of Singa mentioned that the use of iodized salt decreasing therate of goiter in the children. Her son was found mentally retarded and she mentioned theimportance of iodine as below:“There was no iodized salt during the time I gave birth to my son, so my son became mentallyretarded and I always tell my relatives to eat iodized salt.”
Members of family suffering from goiter, stunted, disabled, mental retardation

No one was suffering from goiter, stunted, disabled and mental retardation from the family of
women involved in the FGD and health education classes. But we found one of the family
members of Singa VDC was mentally retarded and his mother (also involved in the FGD)
mentioned the cause of his son to be mentally retarded due to lack of iodized salt previously.

Heard about iodine and iodized salt

Most of the women involved in the focus group discussion and health education classes were
found aware of iodine. Regarding the sources of iodine majority of the mothers involved in
the focus group discussion and health education classes mentioned iodized salt as a source of
iodine. Majority of the women had heard of iodized salt from television, radio, FCHVs andhealth workers.

Photo 1: Conducting focus group discussion in Pulachaur VDC

Salt used for cooking

Regarding the use of salt for cooking all the women involved in the focus group discussion
and health education classes mentioned that they use iodized salt with two child logo for12cooking. The mothers of Arthunge VDC mentioned that they were encouraged to use iodized
salt from television, radio, FCHVs and health workers. All the mothers involved in the focus
group discussion and health education classes mentioned that they use crystal salt for cattle.

Advantages of using iodized salt

The advantages of iodized salt mentioned by women of Pulachaur VDC were: do not givebirth of disable and handicapped children and also gets vitamin. Similarly, the women of
Arthunge of Pipalbot mentioned that iodized salt prevents from goiter and being handicap.
The women of Singa mentioned that:“There was no iodized salt in previous years and there were more mentally retarded children
but nowadays it is decreasing due to the use of iodized salt.”

Storage of iodized salt at home
All the women involved in the focus group discussion and health education classes
mentioned that they store iodized salt in the closed air tight container.

Benefits of using iodized salt by pregnant mother
Regarding the benefits of iodized salt for pregnant mothers, women of Pulachaur VDC
mentioned that the health of pregnant mother becomes good and birth outcome of newborn
will be better and in children it prevents from being disable, handicap and mentally retarded.
Similarly, the women of Arthunge mentioned that lack of iodine during pregnancy can cause
birth of children with low birth weight and mental retardation.

Awareness programme, training and others about iodine deficiency disorders13

No one women involved in the focus group discussion and health education classes had
attended awareness, training and other programs about iodine deficiency disorders. But someof the mothers were given health education on use of iodized salt during antenatal check up(ANC) visit.

Education on nutrition during ANC/PNC visit
Very few women involved in the focus group discussion and health education classes were
provided nutrition education during ANC/PNC visit. During ANC visit they were provided
iron for consumption upto 45 days after delivery. Very few women of Arthunge VDC
mentioned that they were suggested to keep the iodized salt in the vegetable only after
cooking. Regarding the use of salt for cooking the women of Pulchaur and Singa VDC, theykeep salt while cooking, but the women of Arthunge VDC mentioned that they keep salt after
cooking.

Frequency of consuming meat, milk products, fish and egg products

Regarding the consumption of meat, fish and eggs, majority of the mothers mentioned thatthey sometimes consume those foods. But they consume milk products sufficiently time totime.

Photo 2: Providing nutrition education to women

3.2 Findings from quantitative study
Demographic characteristics of women involved in the study
Most of the women included for UIE were less than 35 years old. The mean age of thewomen was 22.6 years (SD-4.7 years). Majority of women were literate including one third
14

with higher secondary and above education level. Majority of women were housewife (67.3
percent). Similarly, the occupation of husband included agriculture, daily labour and foreign
employee. More than half of the women had first pregnancy. About 15 percent women had
still birth in previous pregnancy.
Table 2: Demographic characteristics of the womenCharacteristics

Number

Percent< or equal to 20

33

34.0

21-35

63

64.9

More than 35

1

1.0

Mean age (S.D.)

22.6 (±4.7)

Age distribution (in years)(n=97)

Education level (n=98 )Illiterate

99.2

Primary level

19

19.4

Secondary level

35

35.7

Higher secondary and above level

35

35.7

Housewife

66

67.3

Agriculture

8

8.2

Business4

4.1

Student

16

16.3

Government employee

4

4.1

Agriculture

28

28.6

Business8

8.2

Daily labour

21

21.4

Government employee

10

10.2

Foreign employee

28

28.6

Student3

3.1

No child51

52.0

One child

34

34.7

Two or more than two children

13

13.3

Occupation of women (n=98)

Occupation of husband (n=98)

Number of child (n=98)

Still birth in previous pregnancy (n=98)

15

Yes

15

15.3

No

83

84.7

Knowledge of iodine and IDD among pregnant women
Although two third of women had heard of iodine and iodized salt; hundred percent wereusing iodized salt in their households. The use of iron folic acids tablets during pregnancy
was by 78.6 percent of women and 21.4 percent of women did not use which could be due tofirst trimester in first pregnancy.
Table 3: Iodine related information
Characteristics

Number

Percent

Hear about iodized salt
Yes

71

72.4

No

27

27.6

Yes

98

100.0

No

-

-

Yes

77

78.6

No

21

21.4

Use of iodized salt in household

Use of iron/folic acid tablets during pregnancy

Urinary iodine level among pregnant women
Urinary iodine excretion (UIE) level indicates that one fifth of women had insufficient iodine
intake. Similarly, 21.3 percent of women had UIE 150-249 µg/l.
Table 4: Urinary iodine excretion level and iodine intake status
UIE level (µg/l)

Number (n=80)

Percent

Insufficient (<150)

16

20.0

Adequate (150-249)

17

21.3

Above requirements (250-499)

47

58.8

Excessive (>500)--

The cross-tabulation of urinary iodine excretion with different characteristics of women16

revealed that age of women, education level, heard of iodized salt, use of iodized salt in thehousehold and use of iron folic acid had no particular association with iodine intake status.
Table 5: Factors related to IDD
Characters

Insufficient (<150)

AdequateAbove(150-249)

requirements(250-499)

Age (in years)
Less than or equal to 20

8 (26.7)

6 (20.0)

16 (53.3)

21-35

7 (14.6)

11(22.9)30 (62.5)

00

1 (100.0)

Illiterate

0 (0.0)1 (12.5)

7 (87.5)

Primary level (1-7 class)

5 (31.3)

4 (25.0)

7 (43.8)

Secondary level (8-10 class)

6 (20.0)

6 (20.0)

18 (60.0)

Higher secondary and above level

5 (19.2)

6 (23.1)

15 (57.7)No

5 (22.7)

5 (22.7)

12 (54.5)

Yes

11 (19.3)

12 (21.1)

35 (43.7)

No

-

-

-

Yes

16 (20.0)

More than 35 years
Education level

Heard about iodized salt

Use iodized salt

17 (21.3)

47 (58.8)

Consume iron/folic acidNo

3 (18.8)

2 (12.5)

11 (68.8)

Yes

13 (20.3)

15 (23.4)

36 (56.3)

17

Chapter-IV

Conclusion
Although the knowledge and practices of women on iodized salt was satisfactory, the urinary
iodine excretion revealed that still one fifth of pregnant women had insufficient iodine intake.
This indicates that the identified at risk population of IDD are still significant proportion in
the population and these issues should be addressed by concerned government agencies andother stakeholders.

18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 andinfants in Europe. In: Delange F, Dunn JT, Glinoer D, eds. Iodine deficiency in Europe: acontinuing 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: Ministry of
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 of mild
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

19

Appendix-I

Focus Group Discussion (FGD) with Women
Name of the facilitators:(1) Prof. Chitra Kumar Gurung(2) Dr. Megha Raj Banjara(3) Mr. Krishan Raj Pant
(4) Mr. Nav Raj Bist
VDC: Pulachaur

Ward No. : 1 and 2

Participant women from dalit community
S.N. Name of the womenAge(year)

Number ofchildren

1.

Mrs. Sunmaya Nepali

45

2

2.

Mrs. Geeta Pariyar

18

1

3.

Mrs. Shanti Pariyar

17

Pregnant

4.

Mrs. Man Kumari Pariyar

65

3

5.

Mrs. Sermila Pariyar

22

1

6.

Mrs. Kamala Pariyar

20

2

7.

Mrs. Dalli Pariyar

43

4

8.

Mrs. Sarswati Pariyar

60

5

9.

Mrs. Durga Pariyar

40

4

10.

Mrs. Bisnu Pariyar

30

2

11.

Mrs. Geeta Pariyar

22

1

12.

Mrs. Suntali Pariyar

35

4

13.

Mrs. Tulsi Pariyar

20

2

14.

Mrs. Shanti Pariyar

28

4

15.

Mrs. Rupi Sara Pariyar

45

5

16.

Mrs. Sarada Pariyar

40

2

17.

Mrs. Santu Pariyar

19

1

18.

Mrs. Santoshi Pariyar

19

1

19.

Mrs. Kali Pariyar

45

4

20.

Mrs. Rupa Pariyar

22

2

21.

Mrs. Shanti Pariyar

23

2

22.

Mrs. Bina Pariyar

30

2

20

23.

Mrs. Tolken Pariyar

57

8

24.

Mrs. Tirth Pariyar

60

2

25.

Mrs. Gaumati Pariyar

60

3

26.

Mrs. Raj Kumari Pariyar

36

3

VDC: Arthunge

Ward No. : 6

Participant women
S.N. Name of the womenAge(year)

Number ofchildren

1.

Mrs. Punamrupi Paudel

40

4

2.

Mrs. Rama Paudel

36

3

3.

Mrs. Shova Paudel

23

Unmarried

4.

Mrs. Manrupa Paudel

72

6

5.

Mrs. Jamuna Paudel

70

3

6.

Mrs. Parvati Paudel

33

3

7.

Mrs. Saru Paudel

24

2

8.

Mrs. Sarswati Paudel

27

2

9.

Mrs. Ganga Baniya

30

3

10.

Mrs. Pabitra Paudel

69

5

11.

Mrs. Sarswati Paudel

44

3

12.

Mrs. Sarita Paudel

27

2

13.

Mrs. Bhagwati Paudel

38

2

14.

Mrs. Santa Baniya

52

3

15.

Mrs. Santu Paudel

33

2

VDC: Singa

Ward No.: 5Participant women
S.N. Name of the womenAge(year)

Number ofchildren

1.

Mrs. Belmati Thapamagar

45

5

2.

Mrs. Shova Adhikari

30

3

3.

Mrs. Kopila Kishan

30

3

4.

Mrs. Ganga Kishan

28

3

5.

Mrs. Kamal Devi Shris

50

2

6.

Mrs. Laxmi Khatri

48

4

7.

Mrs. Manrupi KC

70

2

21

Appendix-II

Performa for collection of urine samples from baby
Date:
Newborn baby ID number:
Name of the mother:
Name of the father:
Address: District:

VDC:

Village:

Ward No.:
Name of the Hospital:
1. Age of the mother:
2. Caste:
3. Religion:
4. Weight of the baby:
5. General clinical status of the baby
a. Normalb. Not normal
6. Urine sample collecteda. Yesb. No

22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. Weight:
5. General clinical statusa. Normalb. Not normal
6. Urine sample collected in filter papera. Yesb. No

23

Appendix-III

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 research on the
Iodine Deficiency Disorder to determine its burden in risk population such as pregnant women andchildren.)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 to adjust tochanges in thyroid economy associated with pregnancy. Hence, the pregnant woman and the newborn havebeen 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, this pilot study has
been designed to screen IDD in children born from iodine supplemented mothers during pregnancy andpregnant mothers testing TSH in order to implement iodine supplementation in 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 and iodine. The
mothers will also be assessed clinically. Similarly, urine samples will also be collected from 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.
24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 you thatwill 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, and will 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 thebenefits that you would otherwise have.
You may stop participating in the research at any time that you wish to, without losing any of your rights asa 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).

25

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 toparticipate as a participant in this study and understand that I have the right to withdraw from the study at
any time without in any way affecting me and my family as a health care seeker.

Participant’s Name:
Signature:
Place:
Date:

Witness (Name):
Place:
Signature:
Date:

Certificate of Assent for Children for Collection of Urine Sample
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 asked have been answered to my satisfaction. I consent voluntarily for theparticipation of my child as a participant in this study and understand that I have the right to withdraw
from the study at any time without in any way affecting me, my child and my family as a health careseeker.
Parent’s/Guardian’s Name:
Signature of Parent/Guardian:Place:
Date:
Witness (Name):
Signature:
Place:
Date:

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