Iodine deficiency disorders in the Maldives: A public health problem

Because the Maldives is a country of islands it has been assumed, until now, that iodine deficiency disorders (IDD) are not a public health problem. However, no systematic scientific survey has been carried out to assess the status of IDD in the Maldives. This study represents the first IDD survey by the Government of the Republic of Maldives in association with UNICEF Maldives. Undertaken during June and July 1995, the survey adopted the EPI 30 Cluster sampling technique, as recommended by the Joint WHO/UNICEF/ICCIDD Consultation. Based on population proportion to size, a total of 30 clusters were chosen from sampling frames of all 200 islands. A total of 30 schools and 2834 children aged 6-12 years were surveyed. The total goitre rate was 23.6%, with grade 1 goitre contributing 22.5% of this figure. The prevalence of goitre was greater in girls (26.6%) than in boys (20.7%). The median urinary iodine level was 6.7 µg/dL and 65.5% of children had urinary iodine levels below 10 µg/dL. It is evident from this survey that IDD is a public health problem in the Maldives. Hence, efforts to control IDD should be instituted. The most common method of iodine supplementation is iodised salt. As tested in a non-representative sample of 39 salt samples, only 8% of salt had adequate iodine levels of approximately 15 p.p.m. Because all the atolls are affected there is a need to introduce universal salt iodization in the country.