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A review of the case for neonatal thyrotropin screening in developing countries: the example of India
Vinod Bhatara1, Rajan Sankar, Jurgen Unutzer
1UCLA Health Services Research Center, Los Angeles, California, USA. vbhatara@usd.edu
Insights
Newborn screening for infantile hypothyroidism is crucial in developing nations. Implementing screening and salt iodization in India can prevent mental retardation caused by iodine-deficiency disorder and congenital hypothyroidism.
Area of Science:
- Endocrinology
- Public Health
- Pediatrics
Background:
- Infantile hypothyroidism, from iodine-deficiency disorder (IDD) or congenital hypothyroidism (CH), is a leading preventable cause of mental retardation globally.
- Developed nations have largely eradicated infantile hypothyroidism through salt iodization and newborn screening.
- Developing countries often lack essential newborn screening programs for this condition.
Purpose of the Study:
- To review the necessity and feasibility of newborn screening for infantile hypothyroidism in India.
- To highlight the public health implications of untreated hypothyroidism in the developing world.
Main Methods:
- A comprehensive literature review on infantile hypothyroidism in India.
- Consultation with three leading Indian thyroid experts regarding neonatal screening.
Main Results:
- Salt iodization in India has improved, with 49% of households using adequately iodized salt, yet IDD control remains insufficient.
- Regional studies on neonatal screening in India (n=12,407 and n=25,244) identified significant socioeconomic and organizational barriers to implementation.
- Nationally representative data on screening coverage in India are unavailable.
Conclusions:
- India should prioritize neonatal thyroid screening and mandatory salt iodization to form a comprehensive infantile hypothyroidism policy.
- Prevention is justified due to the high prevalence of infantile hypothyroidism, the effectiveness of screening for both IDD and CH, and the severe consequences of delayed diagnosis.
Background:
Infantile hypothyroidism, either caused by iodine-deficiency disorder (IDD) or congenital hypothyroidism (CH), is the world's leading cause of preventable mental retardation. Such hypothyroidism has virtually been eliminated in the developed world by salt iodization and neonatal thyroid screening. However, most developing countries do not have neonatal thyroid screening programs. Using India as an example, we review the case for newborn screening in the developing world.
Methods:
A literature review on infantile hypothyroidism in India was conducted and three Indian thyroid experts were queried about their views on neonatal screening in India.
Results:
Iodine nutrition improved markedly in India during the 1990s; 49% of the households are now using adequately iodized salt. The control of IDD is still insufficient in India. Nationally representative data on neonatal screening in India are not available, but two regional studies have been published. One study (n = 12,407) measured cord blood thyrotropin and the other (n = 25,244) measured filter paper thyroxine. These studies reported difficult socioeconomic and organizational barriers to the implementation of neonatal screening in India.
Discussion:
It is time for India to make neonatal thyroid screening and mandatory iodization of salt a priority and develop a comprehensive infantile hypothyroidism policy. Prioritization of infantile hypothyroidism prevention is justified by its high frequency, sensitivity of screening in detecting both IDD and CH, adverse consequences of missing diagnosis at birth, high effectiveness of prevention, severity of disability from hypothyroidism, cost effectiveness of prevention, and lack of a clinical method of diagnosis near birth.