Transcript addis ababa ethiopia

An example of a goiter in a subject
http://en.wikipedia.org/wiki/Ethiopia
Dr. Richard Daly, 7/10/2014
Map #
After years of assessing UIC, IDD, TSH, and TV it is
unknown as to why goiter is still endemic in all regions of
Ethiopia and why USI programs are not successful 1,2,4,7,8.
Study findings indicate considerable differences in goiter
prevalence among geographical regions of Ethiopia1,2,4.
http://en.wikipedia.org/wiki/Goitre
However, there are no know studies that explore
geographical location and population density of regions,
with association to goiter prevalence for Ethiopia as a
whole.
If goiter prevalence is
association to population
density, then population
density maps could be
utilized to focus USI and
education programs in
those regions most in
need.
5
Addis Ababa, Ethiopia’s capital
city, located at 9°1′48″N
38°44′24″E at the base Mount
Entoto, altitude 2,300 meters.
1
Divided into ten districts, total
area 527 km2, pop. 3,384,569.
Districts were categorized as
urban, suburban or rural based
on their mean population
density.
2
3
7
6
4
9
8
>10,000
5,000 to 10,000
10
< 5,000
Addis Ababa
Urban
http://www.atozmapsdata.com/
(n = 400)
Living Word Community Church of Red Lion, PA
sponsored a medical mission trip in Ethiopia from
7/7/2014 to 7/11/2014.
)
Suburban
(n = 400)
Rural
(n = 400)
Community Based Self-Assessment Health Survey & Medical History
(n = 1200)
Exclusion
Criteria9
For patients who presented with goiter; age, gender,
place of residence, and goiter grade were recorded.
Physical Examination9
(pregnancy &
contraindicated
medications)
(vitals & thyroid status)
Results indicate that goiter prevalence might be
negatively correlated to population density.
No Goiter Presentation
0.25
Goiter Presentation
Goiter Assessment9
(Grading & Classification)
Goiter Frequency
0.2
0.15
0.1
Urinary Iodine
Concentration Assay7
0.05
In Ethiopia, IDD has been recognized as a major public
health problem for the last 60 years9.
Despite the introduction of Universal Salt Iodization (USI)
programs in 1990, Ethiopia is still the top iodine deficient
country in the world based on a national UIC <100 ug/L8.
Girma et al (2014) determined that in Northwest Ethiopia
the total goiter prevalence was 39.5%, with UIC ranging
from 20.54 - 62.3 ug/L. Further more, only 15 – 20% of
households in this region had and used iodized salt4.
In Southeastern Ethiopia, goiter
prevalence was determined to be
27.4 - 42.0%1.
In Southwestern Ethiopia, it was
63.3% in villages, and 93.4% in
schools1,2.
Quality
Assurance
(1/5 of Goitrous)
0
25
100
250
1000
Population Density Range (Individuals/Km2)
(Km2)
Addis Ketema
Arada
Lideta
Kirkos
Gullele
Yeka
Kolfe Keranio
Nifas Silk-Lafto
Bole
Akaky Kaliti
7.41
9.91
9.18
14.62
30.18
98.25
61.25
68.30
122.08
118.08
Population
Density
271,644
225,999
214,769
235,441
284,865
745,719
546,219
335,740
328,900
195,273
36,659
23,000
23,000
16,104
9,439
7,590
7,449
4,916
2,694
1,654
• TSH and UIC are expected to have a negative
correlation to thyroid volume and goiter grade. As
thyroid volume and goiter grade increase, TSH and
UIC levels should decrease.
• Females are expected to have a greater total
agoiter
Mean rate (TGR) than males, with no difference in
classification of nodules.
Variable
Inclusion Criteria
Sendafa, Aleltu, Beke, and Sheno were the sites
where physical examination and treatment occurred.
Area
• Goiter prevalence is expected to increase as
population density decreases.
Sample Size Determination
(Sloven’s Formula
District
Urban
Suburban
Rural
Pop. density1
> 10,000
5,000 to 9,999 < 5,000
UIC2 (ug/dL)
15.2
10.91
5.42
TSH3 (uU/L)
0.350
0.292
0.245
TV4 (mL)
16.2
18.4
21.8
Grade5 0 (%)
86.50
71.75
45.25
Grade 1 (%)
9.75
20.50
35.5
Grade 2 (%)
3.50
6.75
16.25
Grade 3 (%)
0.25
1.00
3.00
TGR6 Males (%)
4.42
9.08
26.92
TGR Females (%)
8.83
18.17
53.83
TGR (%)
13.25
27.25
80.75
1Individuals/Km2, 2Urinary
Iodine Concentration, 3Thyroid Stimulating Hormone,
4Thyroid Volume, 5number of subjects in grade/total number of subjects in that
density category, 6Total Goiter Rate (sum of Grades 1 and 2).
>1000
Thyroid
1Abuye,
Volume5
Serum Collection6
(TSH)
Data Processing &
Analysis
I would like to sincerely thank Dr. Bridgette Hagerty, and Dr. Richard Daly for making this
project possible through their invaluable guidance and expertise. In addition, I would like to
thank Living Word Community Church and the civilians of Ethiopia for making my pilot study
and the foundational work associated with this project possible.
C., and Berhane, Y. 2007. The goitre rate, its association with reproductive failure, and the knowledge of iodine deficiency disorder (IDD) among women in Ethiopia: cross-sectional community based study.
BioMed Central Public Health [Online] 7:316-328.
2Berhanu, N., Michael, K., and Bezabih, M. 2004. Endemic goitre in school children in southwestern Ethiopia. Ethiopian Journal of Health and Development 18(3):175-178.
3Bolgale, A., Abebe, Y., Stoecker, B., Abuye, C., Ketema, K., and Hambidge, M. 2009. Iodine status and cognitive function of women and their five year-old children in rural Sidma, Southern Ethiopia. East Africa Journal
of Public Health 6:299-302.
4Kibatu, G., Nibret, E., and Gedefaw, M. 2014. The status of iodine nutrition and iodine deficiency disorders among school children in Metekel zone, northwest Ethiopia. Ethiopian Journal of Health Science 23:109-116.
5Lui, Y., Huang, H., Zeng, J., and Sun, C. 2013. Thyroid volume, goiter prevalence, and serum levels in iodine-sufficient area: a cross-sectional study. BioMed Central Public Health [Online] 13:1153-1165.
6Stockigt, J. 2000. Serum thyrotropin and thyroid hormone measurements and assessment of thyroid hormone transport. Pages 377-396 in Braverman LE, Utiger RD (eds.) Werner and Ingbar’s The Thyroid. Lippincott
Raven. Philadelphia, PA.
7World Health Organization. 1996. Recommended iodine levels in salt and guidelines for monitoring their adequacy and effectiveness. 1st ed. WHO micronutrient series. Geneva.
8World Health Organization & United Nations Children’s Fund & International Council for the Control of Iodine Deficiency Disorders. 2007. Assessment of iodine deficiency disorders and monitoring their elimination. 3rd
ed. Geneva. World Health Organization.
9World Health Organization & United Nations Children’s Fund & International Council for the Control of Iodine Deficiency Disorders. 1994. Indicators for assessing iodine deficiency disorders and their control through
salt iodization. 1st ed. Geneva. World Health Organization.
10Zimmermann, M., DeBenoist, B., Corigliano, S., Jooste, P., Molinari, L., Moosa, K., Pretell, E., Al-Dallal, Z., Wei, Y., Zu-pei, C., and Torresani, T. 2006. Assessment of iodine status using dried blood spot thyroglobulin:
development of reference material and establishment of an international reference range of iodine-sufficient children. Journal of Clinical Endocrinology and Metabolism 91(12):488-497.