title: Iodine nutritional status and risk factors for goitre among schoolchildren in South Tajikistan.
abstract: BACKGROUND
  Iodine deficiency affects nearly 1.9 billion people worldwide, but it can be prevented by salt iodization. This cross-sectional survey assessed current iodine status, iodized salt coverage and risk factors for goitre among schoolchildren in South Tajikistan.
  
  
  METHODS
  Ten primary schools in four districts in South Tajikistan were randomly selected. In schoolchildren aged 7 to 11 years, a spot urine sample was collected for measurement of urinary iodine, dried blood spots were collected for measurement of thyroglobulin, and goitre was assessed by palpation. Iodine content of salt samples and local selling points was determined by coloration using rapid test kits and titration method.
  
  
  RESULTS
  Of 623 schoolchildren enrolled, complete data was obtained from 589. The overall median urinary iodine concentration (UIC) was 51.2 μg/L indicating mild-to-moderate iodine deficiency. Among all children, 46.6% (95% Confidence Interval (CI) = 42.4%-50.6%) of children were found to be goitrous (grade 1 goitre: 30.6%, 95% CI = 26.9%-34.5%; grade 2 goitre: 16.0%, 95% CI = 13.1%-19.2%). The risk factor for goitre remaining significant in the multivariable logistic regression model was 'buying salt once a month' (OR = 2.89, 95% CI = 1.01-8.22) and 'buying salt once every six months' (OR = 2.26, 95% CI = 1.01-5.04) compared to 'buying salt every one or two weeks'. The overall median thyroglobulin concentration was elevated at 13.9 μg/L. Of the salt samples from households and selling points, one third were adequately iodised, one third insufficiently and one third were not iodised.
  
  
  CONCLUSIONS
  Iodine deficiency remains a serious health issue among children in southern Tajikistan. There is a persisting high prevalence of goitre, elevated thyroglobulin and low UIC despite interventions implemented by Tajikistan and international partners. Quality control of salt iodine content needs to be improved. Continued efforts to raise awareness of the health effects of iodine deficiency are needed to increase consumer demand for iodised salt.
authors.affiliation: Swiss Tropical and Public Health Institute, Swiss Centre for International Health, P,O, Box, CH-4002, Basel, Switzerland. barbara.matthys@unibas.ch.
authors.forename: Barbara
authors.initials: B
authors.lastname: Matthys
authors.forename: Mohbegim
authors.initials: M
authors.lastname: Davlatmamadova
authors.forename: Gulzira
authors.initials: G
authors.lastname: Karimova
authors.forename: Vreni
authors.initials: V
authors.lastname: Jean-Richard
authors.forename: Michael B
authors.initials: MB
authors.lastname: Zimmermann
authors.forename: Kaspar
authors.initials: K
authors.lastname: Wyss