Follow up Assessment of Children Born from Iodine SupplementedMothers during Pregnancy in Sindhupalchok District

Public Health and Infectious Diseases Research Center (PHIDReC)
Kathmandu, NepalJanuary, 2010

Study Team

Principal Investigator- Prof. Anand Ballabh Joshi
Bio-statistician- Prof. Chitra Kumar Gurung
Clinicians- Dr Subash Pyakurel
Dr Pramesh Koirala

Epidemiologist- Dr Megha Raj Banjara
Administrative Officer- Mr Krishna Raj Pant
Data entry supporters- Mr Prakash Chandra Joshi
Mr Naba Raj Bista
Ms. Shova GurungAdvisorProf. Chikayoshi Atsuta, Japan1Acknowledgements

We would like to express our sincere thanks to Professor Prof. Chikayoshi Atsuta, Japanfor his encouragement and financial support to the study. Thanks go to Dr Rajendra
Prasad Pant, District Health Officer, Chautara Hospital and his entire team for valuable
co-operation during the study period.
We would like to thank to children, mothers and involved community people in our study
for providing data and information.

2SummaryThis follow up study was conducted to assess the anthropometric and general clinicalstatus of children born from mothers supplemented with COMB (iodine supplemented)
during pregnancy. A total of 32 children among 60 were clinically assessed to observe
the growth and development, developmental milestones, and anthropometric parameters.
Most of the children had normal growth, normal in clinical assessment and nutritional
status. Therefore, it can be suggested that iodine supplementation during pregnancy could
be an effective strategy for the normal growth and development of the children.

3

Introduction

Iodized salt and oil are considered as the most appropriate measure for iodinesupplementation. The daily requirement of iodine is 150 µg per person for adults. It isconsidered that iodine deficiency has been eliminated from one particular country when
the access to iodized salt at household level is at least 90%, together with a medianurinary iodine of at least 100 µg/l and with less than 20% of the samples below 50 µg/l.
USI is the long-term strategy for the control of IDD in Nepal. Study reflected that 17% ofsalt samples were found to contain no iodine at all, while approximately 55% of the salt
samples contained at least 15ppm iodine and other study also revealed that most of thepopulations are using powder salt but was iodine deficient. Nepal Demographic Health
Survey (NDHS, 2006) revealed that for age-group 12-23 months, malnourished (<- 2SD)by height for age - 47.5%, by weight for height- 18.0%, weight for age- 39.0% (numberof children surveyed 981).

The first phase study where the iodine supplementation was done to mothers during
pregnancy revealed that there is significant difference of newborn baby from mothers
supplemented with iodine in weight, length, and result of thyroid function test. Therefore,
this follow up study was conducted to assess the anthropometric and general clinicalstatus of children born from mothers supplemented with COMB (iodine supplemented)
during pregnancy after one year.

Objectives:
1. To describe the characteristics of children born from iodine supplemented
mothers during pregnancy
2. To assess the physical and clinical characteristics of the children
3. To assess nutritional status of the children through anthropometric measurements

4Materials and Methods

Research design
This was a follow up study to assess the effects of iodine supplementation in children
born from mothers supplemented with iodine during pregnancy.

Study site and population
The site of this study was Sindhupalchok district. The first phase study conducted in
Chautara Hospital included 60 pregnant women of first and second trimester and those
who were registered in Chautara Hospital and district ANC centre in 2007. We conductedfollow up study after one year among children born from the same group of mothers. We
selected five adjacent VDCs of Chautara VDC to include children born from mothersupplemented with iodine during pregnancy in the study.

Sample size
Among 60 children born from mothers supplemented with iodine, 32 children wereincluded in the study.

Training of clinicians and field workers
Medical doctors were trained regarding the study objectives, methodology, so as to havebetter outcome of the information. One day training to familiarize tools, method ofanthropometric measurement, clinical assessment tools was performed in the Institute ofMedicine, Tribhuvan University, Kathmandu to assure validity and reliability of the study.
Field workers were selected among female community health volunteers (FCHVs) fromconcerned VDCs. They were trained for community facilitation and implementation ofdata collection tools.

Data collection

5Data and information related to clinical conditions of the children were collected by theinvolved medical doctors. Other demographic, antenatal, natal and post natal history werecollected by FCHVs.

Data management and analysis
Data entry and analysis was done in SPSS version 11.5. Descriptive analysis was done inmean, SD, 95% CI and percentages.

60 children born from mothers
supplemented with iodine during
pregnancyChildren from 5 adjacent VDCs ofChautara VDC
32 Children

Clinical assessment,
Anthropometric measurement

Antenatal, natal and post natal
history

Figure 1: Study design

6Results
A. Descriptive characteristics of the children

We followed 32 children born from mothers supplemented with iodine during pregnancy.
Among them, 15 (46.9%) were 12-18 months old whereas 17 (53.1%) were 19-24 months
old. Those children were born from mothers supplemented with iodine for 1-4 months(65.6%), 5-8 months (31.3%), and more than 8 months (3.1%). Most of the mothers were
supplemented with more than 120 iodine capsules during pregnancy.
Table 1: Descriptive characteristics of the children
Characteristics

Number (n = 32)

Percent

12-181546.9

19-24

1753.1

Male

1340.6

Female1959.4First

2268.8

Second928.1

Fourth13.1

1- 42165.65-81031.3More than 81

3.1

30

2

6.3

60

2

6.3

90

3

9.4

120

1650.0Age of the children (in months)

Sex

Order of the child

Duration of iodine supplementation (in months)

Dose of the supplementation (capsules)

7

150

825.0

180

1

3.1

B. Physical and clinical assessment of the children

Regarding physical and clinical characteristics of the children, growth was assessedclinically. Eighty seven percent children had normal growth as compared to otherchildren of same age with normal growth. Majority of children started erection of head
within 3 months of age. More than 90% children started sitting without support withinseven months. Few children (2, 6.3%) had history of hair fall.

Table 2: Physical and clinical characteristics of the children
Variables

NumberPercent

Normal28

87.5

Forward1

3.1

Delayed3

9.4

Within 3 months

1753.1

4-6 months

1031.3More than 6 months

515.6

730

93.8

81

3.1

91

3.1

71

3.1

931

96.9

26.3

Growth of child as compared to other children of same age

Months of starting erection of headMonths of starting sitting with support

Months of starting sitting without support

History of hair fallYes

8

No30

93.7

C. Nutritional status of the children by anthropometric measurements

The mean (±SD) of age, height, weight, head circumference and chest circumference
were 18.34 months (2.13), 73.94 cm (6.50), 9.25 kg (1.83), 45.66 cm (2.69) and 47.09 cm(4.76) respectively.
Table 3: Nutritional status measurements of children
Variables

MeanSDAge (months)

18.342.13

Height (cm)

73.94

6.50

Weight (kg)

9.25

1.83

Head circumference (cm)

45.66

2.69

Chest circumference (cm)

47.09

4.76

Normal distribution curve of anthropometric measurements of children
Weight in gm
20Frequency

10Std. Dev = 1.83
Mean = 9.3
N = 32.00

0
4.0

6.0

8.0

10.0

12.0

Weight in gm

9Head circumference in cm
3020

Frequency

10Std. Dev = 2.70
Mean = 45.7
N = 32.00

0
35.0

37.5

40.0

42.5

45.0

47.5

50.0

52.5

Head circumference in cm

Chest circumference in cm
1412108

6Frequency

4Std. Dev = 4.76

2

Mean = 47.1
N = 32.00

035.0

37.5

40.0 42.5

45.0

47.5 50.0

52.5

55.0

Chest circumference in cm

10MUAC
3020Frequency

10Std. Dev = .57
Mean = 1.25
N = 32.00

01.00

1.50

2.00

2.50

3.00

MUAC

In case of nutritional status of children, 81.3, 75.0, 71.9, 93.7, 90.6% of the children had
normal mid-upper arm circumference (MUAC), nutritional status by weight for age,height for age, weight for height, and chest head ratio respectively. In reference to Nepal
Demographic Health Survey, 2006, the proportion of malnourished children born frommothers supplemented with iodine during pregnancy was considerably low (Table 4).

Table 4: Anthropometric measurements of the children
Variables

Number

Percent

Percentage ofmalnourishedchildren(NDHS, 2006)

Mid-upper arm circumference (MUAC)
Normal (green)

2681.3Moderate (yellow)

4

12.5

Low (red)

26.3

Malnourished

825.0

Normal2475.0

Nutritional status by weight for age
39.0

Nutritional status by height for age

11Malnourished928.1

Normal2371.9Malnourished

26.3

Normal30

93.7

Malnourished

39.4

Normal

29

90.6

47.5

Nutritional status by weight for height
18.0

Chest head ratio

12Bibliography
1. Joshi AB, Banjara MR, Rikimaru T and Pandey S. Assessment of Current Statusof IDD for the Development of Future Control program JICA Nepal. 2004.
2. Ministry of Health, Nepal. Endemic Goitre in Nepal. Paper presented at the seminar onEndemic Goitre, WHO Regional Office for Southeast Asia. WHO/SEA/26, October,1967.
3. Ministry of Health, Nepal (Ad hoc Surveys, 1979-82) in Clugston GA and K Bagchi.
Iodine Deficiency Disorders in South-east Asia. WHO/SEARO Regional Health Papers
No. 10, New Delhi, 1985.
4. GCEP-HMG/Nepal. Situation Analysis of Iodine Deficiency Disorder in Nepal.
December, 1992.
5. WHO/UNICEF/ICCIDD. Consultation on indicators for assessing iodine deficiency
disorders and their control through salt iodization. Geneva, 1994.
6. WHO, UNICEF, ICCIDD. "Indicators for Assessing Iodine Deficiency Disorders andtheir Elimination." Report on a consultation held in Geneva, Switzerland, 4-6 May 1999.
Draft version 15 February 2000.
7. Pardede LVH, Hardjowasito W, Gross R, Dillon DHS et al. Urinary iodine excretion is
the most appropriate outcome indicator for iodine deficiency at field conditions at districtlevel. American Society for Nutritional Sciences 1998; 1122-1126.
8. MoH/UNICEF/WHO/MI/New ERA Ltd. "Nepal Micro Nutrient Status Survey, 1998".
9. Baral N, Ramaprasad C, Lamsal M, Koner B.C., Koirala S. Assay of Iodine Deficiency
Status in Three Ecological Regions of Nepal by a Micro-digestion Method. South East
Asian Journal of Tropical Medicine and Public Health, 1999; 30 (3): 527-531.
10. Nutrition Section, MoH/JICA. "Nepal Abstracts of Nutrition Papers, 1985-2002" January2003.

13Annex A
Questionnaire

Questionnaires and data collection tool to test anthropometric status of children ofIodine supplemented mothers in Sindhupalchok district
Interviewer' name: Date:Individual information
Name of the Mother …………………………….
District:
Village\Municipality:
Ward No.
Name of the child………………age (in months)…….sex……
Order of the child:
Was Iodine supplementation done to the mother during pregnancy? Yes ( )No ( )
Duration of the supplementation……………Dose of the supplementation……….
Growth and development of the child
What is the pattern of the growth of the child as compared with other children of thesame age?
Normal ( )Forward ( ) Delayed ( )What is the tone of the muscle? Normal ( ) flaccid ( ) spastic ( )Developmental milestone (age wise)
Smiled at mother……
erected head……… could sit with support……….
Could sit without support…… started crawling……could stand without support….
Started walking……….. First word………First sentence…………….
Anthropometric parameters
Weight in gm………. Height in cm……..
Head circumference in cm…….
Chest circumference in cm……….MUAC: Green ( ) Yellow ( )Red ( )
Relevant general questions
Is Immunization up to date as per EPI schedule: yes ( )No ( )
Nutritional history:
Breast feeding: done ( ) not done ( )Weaning started at………………………..
Special supplementation other than age appropriate normal diet ……
Please mention if any history of disease/surgery/hospitalization so far………………..
Relevant clinical questions
Skin condition
texture……….. Sweating status………
Edema + ( ) - ( )Bowel habit normal ( ) constipation ( )Hyper defecation ( )History of hair-fall yes ( ) No ( )Neurological abnormality: Oculomotor ( ) Limbs ( ) Speech ( ) Hearing ( )14Comment/ suggestions for further improvement /feedback from the motherregarding this study/program……………………..…………………………………….…………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
..

15