Iodine deficiency status in Sri Lanka ;Then and Now | ලංකාවේ අයඩින් ඌනතා තත්ත්වය; එදා සහ අද

Since the late 1940’s, many studies have recognized goitre as an endemic in Sri Lanka. A goitre belt was established in the Southwest region that extended over the Western, Sabaragamuwa, Central, Southern Provinces and part of the Uva Province; consisting the wet zone of the country. Several preventative measures had been undertaken to overcome the goitre endemic. However in 1986, it was found the overall goitre prevalence amongst schoolchildren was 18.2%. In response to this and in line with the goals set by the world summit for children in 1990, the Sri Lankan government initiated the “Universal Salt Iodization” programme in 1995. There was also the implementation of the mandatory introduction of iodised salt and potassium iodate, under the Food Act where a minimum of 50ppm iodine at the factory level and 25ppm at the consumer level was made essential. Along with this, cyclic monitoring of the iodine content in drinking water was also initiated from 2001.

Based on previous studies of balance and excretion over a 24-hour period, it has been found that a safe intake between 50ug-100ug can be recommended as a requirement for ones daily intake. 

Past:

·The goiter prevalence in 1947 was found to be 43% in males and 28% in females

·Comparison of goitre rates :

·  1986 – 18.8% with goitre

·  2000 – 18.0% with goitre

·  2005 – 3.8% with goitre

·Cyclic monitoring of iodine content in drinking water since 2001 found:

·  <5.0 in Central, Sabaragamuwa and Uva Provinces

·  5.0-19.9 in Western and Southern Provinces

·  20.0-29.9 in South Western and Eastern provinces

·  30.0-50.0 in North Central Province

· >50.0 in Western Province

·Comparison of urinary iodine levels from 2000 shows:

·  2000 – 145.3ug

·  2005 – 154ug

·Distribution of iodine level in alt at the household level in 2005 was found to be 91.1%

Present (2010): 

·  Goitre rate in 2010 was found to be 4.4%

·  The median urinary iodine levels in 2010 had increased to 163.4ug/L from 2000

·  The median urinary iodine levels among pregnant women was 113ug/L

·  Iodine content of salt samples at the household level had a median of 21.2ppm

·  Only 68.2% were using adequately iodised salt, at the household level

For the Sinhalese version of this article Click Here | ๧මම ල๢ප๢๧ය๞ ස๢๜හල ප໱ව໮තනය සඳහ๟ ๧මත๠නට යන๞න. 

"Gout" what is it? | "ගවුට්" යනු කුමක්ද?

Image From-http://upload.wikimedia.org

Gout is another type of Arthritis, like Rheumatoid Arthritis which most people know about. It is not only an arthritis, but there are other manifestations of the disease as well as kidney disease.

This is a genetic disease which comes from your parents or ancestors, the problem lies in an enzyme which breaks down the by-products of the protein in our diet. It make excess uric acid in blood which inturn deposits in joints to cause arthritis or in kidney causing glomerular nephritis.

Some people are more prone to this disease such as those who are obese, diabetic, people taking some diuretic drugs and leakeamics. Even losing weight rapidly can aggravate this condition.

Image from- http://knol.google.com/k/gout

There is a long lasting state of the disease called "chronic gout" and an suddenly occurring state called "acute gout" which very painful and usually presents as arthritis around big toe.

This condition is more common in western world, however we see increasing number of cases appearing in Sri Lanka in the recent past.

Apart from the medical management using drugs like Allopurinol and pain killers, every patient must adhere to strict dietary guidelines; especially during an acute attack to control the disease. The limitations are very drastic specially at acute state; therefore the patient should be a highly motivated.

They should refrain from using all the meat, poultry and fish products; even pulses like dhal to reduce the protein consumption to at least to 60g per day. Instead, they can consume milk and milk products and nuts as alternative protein sources. In milder patients it is advisable to try no more than one item from this "banned" list per day if they wish, with caution.

The patient can consume a high carbohydrate diet. In contrary to the common norm of eating raw rice and whole grain, these people will benefit from using refined products.

There should be low fat intake; as for a normal healthy person.

Alcohol except for wine, some vegetables like spinach and cabbage will have to be opted from your menu, while your tea consumption can be maintained at nearly two cups per day.

We hope this guide would be a guide to people suffering from Gout, for more information contact our Deprtment's "Nutrition Information Center".

Based on an interview with Dr. Renuka Jayatissa (Consultant Medical Nutritionist)

Written by-
Dr. Wedisha Gankanda