ENDEMIC GOITER IN A RURAL-COMMUNITY OF KWAZULU-NATAL

Objective. To quantify the prevalence of goitre and iodine deficiency. Setting. Ndunakazi, a rural community of approximately 8 000 people i n KwaZulu-Natal. Design. A cross-sectional community-based survey and a school-based survey. Participants. The 127 mothers and 114 children aged 6 - 11 years, selected during the cross-sectional survey, and 304 children aged 6 - 14 years, from the school-based survey. Methods. Ur inary iodine levels and thyroid size were determined and categorised a ccording to guidelines proposed jointly by the WHO, UNICEF and the ICC IDD. Z-score anthropometric indicators were calculated, and mid-year e xam marks of goitrous and non-goitrous pupils for Zulu and mathematics were compared. Results. In school-aged children, both surveys demonst rated a goitre prevalence in the 20 - 29.9% range and a median urinary iodine level in the 2 - 4.9 mu g/dl range, indicating iodine deficien cy of moderate severity. Goitrous subjects scored consistently worse i n their Zulu exam papers than those without goitre. Stunting was not m ore prevalent than in the rest of KwaZulu-Natal. iodised salt was not available in any of the three community shops. Conclusion. This level of iodine deficiency in children can adversely affect their neuropsych o-intellectual development. Factors contributing to deficient iodine i ntake in Ndunakazi are present in many rural areas, and South Africa c annot afford to be overly confident about the apparent absence of iodi ne deficiency as a public health problem.