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Introduction of iodised salt benefits infants’ mental development in a community-based cluster-randomised effectiveness trial in Ethiopia

  • Karim Bougma (a1), Frances E. Aboud (a2), Tizita M. Lemma (a3), Edward A. Frongillo (a4) and Grace S. Marquis (a1)...
Abstract

The effectiveness of salt iodisation in improving the mental development of young children has not been assessed. We implemented a community-based cluster-randomised effectiveness trial in sixty randomly selected districts in the Amhara region of Ethiopia. We randomly allocated each district to treatment and randomly selected one of its villages. In parallel to national salt iodisation efforts, iodised salt was brought early into the markets of the thirty intervention villages before it became widely available in the thirty control villages 4–6 months later. The primary outcome was children’s mental development scores on the Bayley Scales. This was an intention-to-treat analysis using mixed linear models adjusted for covariates and clusters. The trial was registered at ClinicalTrials.gov, NCT013496. We assessed 1835 infants aged 5–11 months at baseline. The same children (85 % of the sample) were re-assessed at 20–29 months when all villages had iodised salt. At endline, urinary iodine concentration was higher in children in the intervention group compared with those in the control group (median 228·0 v. 155·1 µg/l, P=0·001). The intervention group had higher scores compared with the control group on the Bayley composite score (raw scores:130·60 v. 128·51; standardised scores: 27·8 v. 26·9; d=0·13; 95 % CI 0·02, 0·23) and three of the four subscales: cognitive (53·27 v. 52·54, d=0·13; 95 % CI 0·03, 0·23), receptive language (20·71 v. 20·18, d=0·13; 95 % CI 0·03, 0·24) and fine motor (35·45 v. 34·94, d=0·15; 95 % CI 0·04, 0·25). The introduction of iodised salt contributes to children’s higher urinary iodine concentration and mental development.

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Corresponding author
* Corresponding author: K. Bougma, email karim.bougma@mail.mcgill.ca, kbougma@gmail.com
References
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1. Black, MM, Walker, SP, Fernald, LC, et al. (2017) Early childhood development coming of age: science through the life course. Lancet 389, 7790.
2. Berbel, P, Auso, E, Garcia-Velasco, JV, et al. (2001) Role of thyroid hormones in the maturation and organisation of rat barrel cortex. Neuroscience 107, 383394.
3. Zoeller, RT & Rovet, J (2004) Timing of thyroid hormone action in the developing brain: clinical observations and experimental findings. J Neuroendocrinol 16, 809818.
4. Delange, F (1994) The disorders induced by iodine deficiency. Thyroid 4, 107128.
5. Bougma, K, Aboud, F, Harding, K, et al. (2013) Iodine and mental development of children 5 years old and under: a systematic review and meta-analysis. Nutrients 5, 13841416.
6. Pretell, EA, Torres, T, Zenteno, V, et al. (1972) Prophylaxis of endemic goiter with iodized oil in rural Peru. Adv Exp Med Biol 30, 249265.
7. Thilly, CH (1981) Psychomotor development in regions with endemic goiter. In Fetal Brain Disorders: Recent Approaches to the Problem of Mental Deficiency, pp. 265282 [BS Hetzel and RM Smith, editors]. Amsterdam; New York; New York, NY: Elsevier/North-Holland Biomedical Press; Sole distributors for the USA and Canada, Elsevier North-Holland.
8. Connolly, KJ, Pharoah, PO & Hetzel, BS (1979) Fetal iodine deficiency and motor performance during childhood. Lancet ii, 11491151.
9. Untoro, J (1999) Use of oral iodized oil to control iodine deficiency in Indonesia. PhD Thesis, Wageningen Agricultural University.
10. van den Briel, T, West, CE, Bleichrodt, N, et al. (2000) Improved iodine status is associated with improved mental performance of schoolchildren in Benin. Am J Clin Nutr 72, 11791185.
11. Huda, SN, Grantham-McGregor, SM & Tomkins, A (2001) Cognitive and motor functions of iodine-deficient but euthyroid children in Bangladesh do not benefit from iodized poppy seed oil (Lipiodol). J Nutr 131, 7277.
12. Zimmermann, MB, Connolly, K, Bozo, M, et al. (2006) Iodine supplementation improves cognition in iodine-deficient schoolchildren in Albania: a randomized, controlled, double-blind study. Am J Clin Nutr 83, 108114.
13. Gordon, RC, Rose, MC, Skeaff, SA, et al. (2009) Iodine supplementation improves cognition in mildly iodine-deficient children. Am J Clin Nutr 90, 12641271.
14. Cao, XY, Jiang, XM, Dou, ZH, et al. (1994) Timing of vulnerability of the brain to iodine deficiency in endemic cretinism. N Engl J Med 331, 17391744.
15. Trowbridge, FL (1972) Intellectual assessment in primitive societies, with a preliminary report of a study of the effects of early iodine supplementation on intelligence. Adv Exp Med Biol 30, 137149.
16. Melse-Boonstra, A & Jaiswal, N (2010) Iodine deficiency in pregnancy, infancy and childhood and its consequences for brain development. Best Pract Res Clin Endocrinol Metab 24, 2938.
17. Andersson, M, Karumbunathan, V & Zimmermann, MB (2012) Global iodine status in 2011 and trends over the past decade. J Nutr 142, 744750.
18. Abuye, C, Berhane, Y, Akalu, G, et al. (2007) Prevalence of goiter in children 6 to 12 years of age in Ethiopia. Food Nutr Bull 28, 391398.
19. Central Statistical Agency (Ethiopia), ORC Macro (2006) Ethiopia Demographic and Health Survey 2005. Addis Ababa and Calverton, MD: Central Statistical Agency and ORC Macro.
20. World Health Organization (2007) Assessment of Iodine Deficiency Disorders and Monitoring their Elimination. A Guide for Program Managers. Geneva: WHO/UNICEF/ICCIDD.
21. Campbell, MK, Piaggio, G, Elbourne, DR, et al. (2012) Consort 2010 statement: extension to cluster randomised trials. BMJ 345, e5661.
22. Bayley, N (2006) Bayley Scales of Infant and Toddler Development. San Antonio, TX: Psychological Corporation.
23. Aboud, FE & Alemu, T (1995) Nutrition, maternal responsiveness and mental development of Ethiopian children. Soc Sci Med 41, 725732.
24. Drewett, R, Wolke, D, Asefa, M, et al. (2001) Malnutrition and mental development: is there a sensitive period? A nested case-control study. J Child Psychol Psychiatry 42, 181187.
25. Servili, C, Medhin, G, Hanlon, C, et al. (2010) Maternal common mental disorders and infant development in Ethiopia: the P-MaMiE Birth Cohort. BMC Public Health 10, 693.
26. Aboud, FE, Singla, DR, Nahil, MI, et al. (2013) Effectiveness of a parenting program in Bangladesh to address early childhood health, growth and development. Soc Sci Med 97, 250258.
27. Yousafzai, AK, Rasheed, MA, Rizvi, A, et al. (2014) Effect of integrated responsive stimulation and nutrition interventions in the Lady Health Worker programme in Pakistan on child development, growth, and health outcomes: a cluster-randomised factorial effectiveness trial. Lancet 384, 12821293.
28. Milgrom, J & Holt, C (2014) Early intervention to protect the mother-infant relationship following postnatal depression: study protocol for a randomised controlled trial. Trials 15, 385.
29. Aboud, FE & Yousafzai, AK (2015) Global health and development in early childhood. Annu Rev Psychol 66, 433457.
30. Bradley, RH & Corwyn, RF (2005) Caring for children around the world: a view from HOME. Int J Behav Dev 29, 468478.
31. Aboud, FE (2007) Evaluation of an early childhood parenting programme in rural Bangladesh. J Health Popul Nutr 25, 313.
32. Hetzel, BS (1988) The Prevention and Control of Iodine Deficiency Disorders. Discussion by F Delange, JB Stanbury and FE Viteri. Nutrition Policy Discussion Paper no. 3. Geneva: United Nations.
33. Radloff, LS (1977) The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1, 385401.
34. Beusenberg, M & Orley, J (1994) A User's Guide to Self Reporting Questionnaire (SRQ). Geneva: Division of Mental Health, WHO.
35. Haggerty, JJ Jr & Prange, AJ Jr (1995) Borderline hypothyroidism and depression. Annu Rev Med 46, 3746.
36. World Health Organization Multicentre Growth Reference Study Group, de Onis, M (2006) Reliability of anthropometric measurements in the WHO Multicentre Growth Reference Study. Acta Paediatr Suppl 450, 3846.
37. World Health Organization Multicentre Growth Reference Study Group (2006) WHO Child Growth Standards: Length/Height-for-Age, Weight-for-age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development. Geneva: WHO.
38. World Health Organization Multicentre Growth Reference Study Group (2007) WHO Child Growth Standards: Head Circumference-for-Age, Arm Circumference-for-Age, Triceps Skinfold-for-Age and Subscapular Skinfold-for-Age: Methods and Development. Geneva: WHO.
39. Sandell, EB & Kolthoff, IM (1937) Micro determination of iodine by a catalytic method. Microchimica Acta 1, 925.
40. Pino, S, Fang, SL & Braverman, LE (1996) Ammonium persulfate: a safe alternative oxidizing reagent for measuring urinary iodine. Clin Chem 42, 239243.
41. Vanzetti, G (1966) An azide-methemoglobin method for hemoglobin determination in blood. J Lab Clin Med 67, 116126.
42. Daelmans, B, Dewey, K & Arimond, M (2009) New and updated indicators for assessing infant and young child feeding. Food Nutr Bull 30, S256S262.
43. Ulijaszek, SJ & Kerr, DA (1999) Anthropometric measurement error and the assessment of nutritional status. Br J Nutr 82, 165177.
44. World Health Organization (2006) Reliability of anthropometric measurements in the WHO Multicentre Growth Reference Study. Acta Paediatr Suppl 450, 3846.
45. Ayele, B, Aemere, A, Gebre, T, et al. (2012) Reliability of measurements performed by community-drawn anthropometrists from rural Ethiopia. PLOS ONE 7, e30345.
46. Kramer, MS, Aboud, F, Mironova, E, et al. (2008) Breastfeeding and child cognitive development: new evidence from a large randomized trial. Arch Gen Psychiatry 65, 578584.
47. Berbel, P, Guadano-Ferraz, A, Martinez, M, et al. (1993) Organization of auditory callosal connections in hypothyroid adult rats. Eur J Neurosci 5, 14651478.
48. Berbel, P, Guadano-Ferraz, A, Angulo, A, et al. (1994) Role of thyroid hormones in the maturation of interhemispheric connections in rats. Behav Brain Res 64, 914.
49. Bernal, J (2005) Thyroid hormones and brain development. Vitam Horm 71, 95122.
50. Bleichrodt, N & Born, PM (1994) A meta-analysis of research on iodine and its relationship to cognitive development. In The Damaged Brain of Iodine Deficiency: Cognitive, Behavioral, Neuromotor and Educative Aspects, pp. 195200 [JB Stanbury, editor]. New York: Cognizant Communication Corporation.
51. Black, RE, Victora, CG, Walker, SP, et al. (2013) Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382, 427451.
52. Cleare, AJ, McGregor, A & O'Keane, V (1995) Neuroendocrine evidence for an association between hypothyroidism, reduced central 5-HT activity and depression. Clin Endocrinol (Oxf) 43, 713719.
53. Ethiopian Public Health Institute (2016) Ethiopian National Micronutrient Survey. Addis Ababa: Ethiopian Public Health Institute.
54. Untoro, J, Schultink, W, West, CE, et al. (2006) Efficacy of oral iodized peanut oil is greater than that of iodized poppy seed oil among Indonesian schoolchildren. Am J Clin Nutr 84, 12081214.
55. Aboud, FE, Bougma, K, Lemma, T, et al. (2017) Evaluation of the effects of iodized salt on the mental development of preschool-aged children: a cluster randomized trial in northern Ethiopia. Matern Child Nutr 13, e12322.
56. Bouhouch, RR, Bouhouch, S, Cherkaoui, M, et al. (2014) Direct iodine supplementation of infants versus supplementation of their breastfeeding mothers: a double-blind, randomised, placebo-controlled trial. Lancet Diabetes Endocrinol 2, 197209.
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British Journal of Nutrition
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