The Role of Changing Diet and Altitude on Goitre Prevalence in Five Regional States in Ethiopia

Objective: Iodine Deficiency Disorders (IDD) as one of the leading nutritional problems has been increasing through time due to iodine deficiency, aggravating factors and IDD knowledge in many parts of Ethiopia. The effect of changing diet and altitude on goitre prevalence is assessed.
Methodology: Randomly selected five regional states (Amhara, Oromiya, Tigray, SNNP and Benshangul-Gumuz) were used to conduct cross-sectional study on IDD. In each region cluster sampling method was applied to select study subjects. Low land and adjacent high land were independently sampled to investigate the role of altitude on goiter prevalence. Totally 6960 children and the same number of biological mothers of the children were included in the clinical examination for goiter and household interview. Urine samples were collected from children for urinary iodine examination/analysis (UIE). Besides, in all clusters qualitative data were collected on IDD knowledge and cassava introduction, cultivation and consumption.
Results: Cassava consumption and living in high altitude were found to be risk factors for IDD. In the two regions (SNNP and Benshangul-Gumuz) among three where cassava is cultivated, those who consume cassava frequently were significantly (p<0.001) affected by goitre than those consuming rarely or not. In the last thirty years cassava consumption has been increasing with the concomitant increase in goitre rate and other associated health problems. Acute cyanide intoxication in children from cassava meal was reported. In Amhara region, goitre rate was significantly (p<0.05) higher in high altitudes than in low both for children and mothers. This was due to significantly (p<0.01) low level of iodine intake in high lands than in low as indicated by UIE. Due to stigma, parents do not send goitrous children to schools and goitrous girls are not wanted for marriage.
Conclusion: Besides low level of iodine intake, cassava consumption and living in high altitude were responsible for the observed variation and severity in goitre rates. IDD affects several dimensions of human life including school enrolment and marriage. Addressing IDD in-terms of salt iodization and training communities on cassava processing techniques to remove cyanide, awareness creation on IDD and soil conservation are highly recommended.

Keywords
Altitude and IDD, cassava consumption and IDD, IDD aggravating factors, IDD knowledge, UIE