Assessment of goiter and iodine deficiency among school children in North Kashmir: A cross-sectional study.

Background: Iodine deficiency disorders (IDDs) remain a significant public health challenge in developing countries, including India, where they contribute to goiter and other health impairments. Despite efforts to fortify salt with iodine, IDDs persist in regions like Kupwara, Kashmir, characterized by unique topography and socio-demographic diversity.

Objectives: To assess the prevalence of iodine deficiency disorders among school-aged children in Kupwara district, Kashmir. To evaluate iodine content in household salt samples and urinary iodine concentration as markers of iodine deficiency.

Methods: A community-based, cross-sectional study was conducted from March 22 to March 31, 2022, involving 2,700 children aged 6-12 years selected using population proportionate to size (PPS) sampling from 30 clusters in Kupwara. Clinical examination for goiter was performed following WHO guidelines. Household salt iodine content was assessed through iodometric titration, and urinary iodine concentration was analyzed using the Sandell-Kolthoff reaction. Ethical approval and informed consent were obtained.

Results: Out of 2,700 children, 255 (9.44%) had Grade 1 goiter, and 17 (0.63%) had Grade 2 goiter, yielding a Total Goiter Rate (TGR) of 10.1%. Goiter prevalence was higher in females (11.2%) than males (9%). The highest TGR was observed in children aged 10 years (14.4%). Salt iodine content: 75% of samples contained 6.3 ppm iodine. Urinary iodine concentration: (1) 10.4% had mild-to-moderate iodine deficiency. (2) 12.3% exhibited adequate iodine intake. (3) 31.4% showed excess iodine levels.

Conclusion: The study highlights a moderate prevalence of goiter in Kupwara, with iodine deficiency remaining a significant concern despite fortified salt usage. The findings underscore the need for strengthened monitoring and public health interventions targeting iodine deficiency, especially among school-aged children.