Has iodized salt reduced iodine-deficiency disorders among school-aged children in north-west Iran? A 9-year prospective study

Objective: Low iodine intakes are associated with goitre and other iodine-deficiency disorders (IDD) that have affected billions of people worldwide. We aimed to assess total goitre rate (TGR) and urinary iodine concentration (UIC) in schoolchildren between 2007 and 2015, percentage of iodized salt consumption by households, and salt iodine content at production, distribution and household levels in north-west Iran. Design/Setting/Subjects: UIC assessed among schoolchildren in nine consecutive years; 240 schoolchildren aged 8-10 years selected by systematic random sampling each year in the West Azerbaijan Province. Results: Median UIC was > mu 100 g/l in all years. More than 50% of children had iodine deficiency (UIC < 99 mu g/l)in 2010 and 2011, while this rate was approximately 15-35% in other years. Proportion with UIC below 50 mu g/l was <20% in all years except. 2010 and 2011. Excessive UIC (>= 300 mu g/l) rate was between 5.4 and 27.5%. TGR decreased from 44% in 1996 to 7.6% and 0.4% in 2001 and 2007, respectively. Regular surveys from 2002 to 2015 showed that 98% or more if households consumed iodized salt. Iodine level >= 20 ppm was observed in 87.5, 83 and 73% of salt at production, distribution and household level, respectively (data from national study in 2007). The last national study in 2014 showed that median iodine level in household salt was 27 ppm. Conclusions: Our focused data suggest that the universal salt iodization programme is improving the iodine status of schoolchildren in the West Azerbaijan Province of Iran. Reduction of TGR to less than 5% in schoolchildren indicates successful elimination of IDD as a major public health problem.