Rajiv Gandhi University of Health Sciences s49

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA,

PROFORMA FOR REGISTRATION OF

SUBJECTS FOR DISSERTATION

NAVEEN KUMAR G. S.

1ST YEAR M.SC NURSING,

CHILD HEALTH NURSING,

YEAR 2011-2013

CAUVERY COLLEGE OF NURSING,

TERISIAN COLLEGE CIRCLE,

SIDHARTHANAGAR,

MYSORE.

6. BRIEF RESUME OF THE INTENTED STUDY

6.1 INTRODUCTION:-

India the second most popular country in the world has a major public with iodine deficiency. Goiter has said to be endemic, it is an enlargement of thyroid gland that is commonly visible as a swelling of the anterior part of the neck, it is commonly associated with iodine deficiency disorders.1 The thyroid gland is a small gland located in the neck, the thyroid can be enlarged due to generalized enlargement of the thyroid or nodules (tissues growth) with in the thyroid. The thyroid gland produces the hormones thyroxin (also called T4) and small amount of triiodothyronine (also called T3) most of the T4 is converted to T3 out side of the thyroid. These thyroid hormones influence such bodily functions as a person’s body temperature, mood and excitability, pulse rate, digestive function, and other process necessary for life. it is important to understand that goiter is not cancer and that most goiter are, in fact, benign.2

Endemic goiter associated with cretinism, deaf-mutesim and various other grades of physical & mental deterioration, continuous to be prevalent in certain reason of India. While the disease has been almost completely eradicated in many western countries, Its prevention in India & other underdeveloped countries is best with many technical problems. Its etiology & pathogenesis have still to be clarified, usually it is caused by Iodine deficiency, over active thyroid gland, under active thyroid gland, smoking etc., In this communication the prevalence of endemic goiter in India is described first, followed by a brief recapitulation of its etiology from the point of view of prevention: finally, attention is drawn to some of the problems connected with the use of mass methods of prophylaxis such as the iodization of salt.3

The southern slopes of the Hindu kush & the Himalayas, covering a distance of over 1,500 miles (2.400km) and comprising the northern parts of the Kashmir, Punjab, Utter Pradesh, Bihar, Bengal & Assam are probably the world’s most classical areas of endemic goiter. Poineer work, both in the field and in the Laboratory, on the Etiology of this type of goiter was done by Sir. Robert Mccarrison. In 1917 Mccarrison estimated that there were probably some 5 million persons affected with goiter in India. He recorded the fact that in some village it was hard to find a man, women Or child not suffering from goiter. In some Himalayan villages Mccorrision found that 60% of infants still at Breast feeding has goiter. Some years later, Stoot and his colleagues working in Uttar Pradesh found a close association between endemic goiter and congenital deaf mutism. From the census for 1911. They calculated that there were 25,000 deaf mutes in the united providences alone.3

The highest incidence of endemic goiter in most goitrous areas occurs in girls 12 to 18 years of age and in boys 9 to 13 years age. The clinical features are the presence of anterior neck mass, Difficulty in breathing and swallowing\, hyper activity, weight Loss, palpitations. Increase appetite and heat intolerance.4 In 1962 the Government of India implemented the National Goiter Control Programme. Now called National Iodine Deficiency Disorders Control Programme. This programme provides essential components for control of goiter, these are iodized salt, monitoring & surveillance, Manpower training and mass communication.5

6.2 NEED FOR THE STUDY

Goiter is an iodine deficiency disorder, It is one of the major health problem in India and also many developed country such as Bangladesh, Bhutan, Myanmar, Indonesia, Nepal, srilanka and Thailand, more children in age group of 8 to 10 years and also many people are affected and levels of severity are higher in south east Asia than anywhere else in the world.6

In India, 1960’s it was estimated that about 9 million persons were affected goitre.6 In 1995 India it was estimated that about 54.4 million people have goitre.5 On the basis of surveys conducted by the directorate general of health services, Indian council of Medical research and the state health directorates, it has been found that out of 282 Districts surveyed in 28 states 5Uts, 244 Districts are endemic that is where the prevalence of iodine deficiency disorders more then 10%. It is also estimated that more then 71 million persons are suffering from goiter and other iodine deficiency disorder.7 In 2004 India it was estimated that 150 million people in the country are affected with iodine deficiency disorders.1

Across sectional study was conducted to find out the prevalence of goiter amount school children in the age group of 8 to 10 years. in rural field Practice area of department of community medicine KMC, Manipal. Stratified sampling technique was used to collect the sample from government and private schools.722 children were examined by collecting their Urine and salt samples. The result revealed that prevalence of Goiter was 30%. Estimation of iodine content in the salt sample revealed that 48.3% of samples had adequate iodine content (>=15ppm).Prevalence of goiter was significantly higher among school children’s who had urinary iodine excretion level less then optimum (<10 mcg/dl). The study concluded that Prevalence of goiter among school children was high.8

Descriptive study was conducted to find out the prevalence of goiter among the students in rural & urban regions of kashan. Random sampling technique was used to collect samples. 3130 male and female students were examined from 30 schools from rural & urban regions. Clinical examinations of individuals were carried out by bimanual method according to the WHO guidelines. Based on the information recorded, the type goitre was classified. The type of goiter was extrapolated the population. The result revealed that the prevalence goiter was 45.7% & 52% in urban & rural regions. The study concluded that the prevalence of goiter among the students were high.9

A cross sectional National study was conducted To find out the prevalence of Iodine deficiency disorders among school children’s in the age of 8 to 12 years in Bahrain. Multistage cluster sampling technique was used to collect the sample from government schools. 1600 children were examined for goiter by a surgeon and 50% of them were chosen at random for urinary iodine level assessment. The results revealed that out of 1600 children only 26 (1.7%) were found to have goiter. On the other hand 121 out of 749 (16.5%) children tested had low urinary iodine levels. The study concluded that Iodine Deficiency Disorders does not seem to constitute a Public Health Problem in Bahrain. Yet Iodine Deficiency Disorders is affected some children’s. Health Educations can help in increasing public awareness about the Nutritional value of Iodized slats in the prevention of this disorders.10

The purpose of this study is to bring awareness regarding goiter and its prevention. This is very dangerous that need to be solved. Goiter is an major public health problem. This problem is increasing trend that is affecting the children’s in the age group of 8-18 years due to lack of knowledge. If it is not treated in early means which is very dangerous effect to the future.

I the researcher had an experience that when I was in the community area. I had come acrossed so many childrens have suffering from goiter. They were at the age of 8-18 years. While communicating the family members of the community. This incident motivated the researcher to take this study to improve the knowledge of high school students regarding goiter and its prevention. For this purpose the researcher selected high school students.

High school students are younger generation future in life. In this reason I selected video assisted teaching programme to give information attractively and adequately to the high school students to reduce goiter future problem and use of iodized salt in routinely in their life.

.6.3 REVIEW OF LITERATURE

1.  A cross-sectional community based survey for the purpose of elimination of iodine deficiency disorders among children in the age group of 6-12 years in Tamil nadu. cluster sampling technique was used to collect the sample. The total of 1230 children’s were examined for prevalence of goiter, urinary iodine excretion & iodine content in salt at the house hold levels. The result revealed that the total goiter rate was 13.5%. The median urinary iodine excretion was found to be 89.5ug/L. The proportion of house holds consuming adequately iodized salt was 18.2%. The study concluded that the total goitre rate was 13.5%. The median urinary iodine excretion was found to be 89.5ug/L.11

2.  A community based survey was conducted for determination of iodine nutrition & community knowledge regarding iodine deficiency disorders in selected tribal blocks in Orissa. For study school age children’s (6-12years) and their mothers had taken. The result revealed that total goiter was 23.6% of which visible goiter was 6.9%. Prevalence of goiter increased with age in female tribal children’s, Study result also shows modern iodine deficiency with poor community knowledge of iodine nutrition. The study concluded that there is need to strengthen the monitoring of salt iodization and intensive education activities in the tribal areas.12

3.  A cross-sectional study to assess the goiter prevalence and iodine status in school children (6-12yrs), endocrine and metabolism research centre, Isfahan. Multistage random sampling technique was used to collect the samples from 2331children. The result revealed that out of 2331 students 32.1% of the student had goiter. The median urinary iodine concentration was 195.5ug/l (range=10-580ug/l). The study concluded that there is no biochemical iodine deficiency and iodine intake of the total population is adequate. Goiter prevalence has decreased significantly after new legislation; nevertheless it is still a public health in this region.13

4.  A study to assess the prevalence of iodine deficiency among primary school children was conducted in Cairo. Stratified random sampling technique was used to collect the samples of 1648 school children from selected 9 Schools. The result revealed that the goitre was 13.5%; Being 10.8% among males and 16.2% among females. Prevalence among females was higher than that of the males in all categories. The study concluded that iodine deficiency constitutes a mild public health problem in cairo primary school children and a salt iodization program is highly recommended.14

5.  A cross-sectional study to determine the prevalence of goiter in 6-12 years school going children was conducted by department of preventive and social medicine panchmahal district in Gujarat. Cluster sampling technique was used to collect the sample of 15900 school going children in age group of 6-12yrs.The result revealed that prevalence of goiter was 20.5% among the children. The median iodine concentration was 70mg/l indicating mild iodine deficiency: Also 61% of the urine samples examined shows iodine insufficiency. The iodine was found to be adequate in 54.3% of salt samples. The study concluded that goiter is still an important public health problem in the district. This call for identification of factors to strengthen National iodine deficiency disorder control program and the need to re impose ban on sale of non iodized salt in Gujarat.15

6.  A study to determine the iodine deficiency in adolescents was conducted by department of postgraduate studies & research in home science, Bombay. Samples of 866 adolescents From Bombay slums (416 girls & 450 boys) were examined. The result revealed that the prevalence of goiter was 56% in both boys & girls. The visible goiter was also similar in boys (9.8%) and girls (10.6).T3 & T4 levels while the thyroid stimulating hormone level increased. The study concluded that goiter has a higher prevalence among adolescents in the slums of Bombay. Mild iodine deficiency can be easily controlled by encouraging the use of iodized salt in adolescents.16

7.  A cross-sectional observational study to evaluate iodine deficiency status in children (6-12yrs) was conducted in the west coast of Turkey. 2300 children were selected by multistage randomization from 91 primary schools of 76 zones (91 clusters). The result revealed that iodized salt consumption was 51.7%. the prevalence of goiter determined by palpation was 21.1% and by ultrasound based on body surface area (BSA) age were 9.8% and 5.5% respectively. median urinary iodine was 53ug/l. The study concluded that mild to severe degree of iodine deficiency was detected in the west coast of Turkey.17