PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Mrs. K.INDUMATHYI YEAR M. Sc. NURSING

COMMUNITY HEALTH NURSINGYEAR 2008-2010

PADMASHREE COLLEGE OF NURSING,GURUKRUPA LAYOUT, NAGARBHAVI,

BANGALORE-560 072

0

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESBANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FORDISSERTATION

1NAME OF THE CANDIDATE

AND ADDRESS

Mrs. K. INDUMATHY,I YEAR M.Sc. (NURSING),PADMASHREE COLLEGE OF NURSING,GURUKRUPA LAYOUT,NAGARBHAVI,BANGALORE – 560 072.

2 NAME OF THE INSTITUTIONPadmashree College of Nursing, Bangalore-72.

3COURSE OF THE STUDY

AND SUBJECT1st year M.Sc. (Nursing)Community Health Nursing

4DATE OF ADMISSION TO

COURSE 06/06/2008

5 TITLE OF THE STUDY

To Assess the Knowledge and

Attitude of Mothers regarding

Prevention of Iodine Deficiency

among school children in a selected

rural area, Bangalore.

1

6. BRIEF RESUME OF THE INTENDED WORK

“CHILDREN ARE THE FUTURE PILLERS OF THE COUNTRY”

6.1 INTRODUCTION:

Children constitute a large section of population in India. It is great challenge to

the nation to Provide healthy nutrition to the children below 12 years. Good health and

nutrition helps to achieve one’s full educational potential because nutrition affects

intellectual development learning ability. Piaget described school children as a period of

‘concrete operations’ meaning that logical thinking develops and the child can understand

cause and effect. Children are stimulated to become industrious and creative.1

Children with more adequate diets score higher on tests of factual knowledge that

those with less adequate nutrition. Studies show that the academic performance and

mental ability of children with good nutritional status are significantly higher than those

of children with poor nutritional status. School age population comprising of 38% of the

country who are dependent, unproductive but has great potential.2

The magnitude of iodine deficiency among school children constitute a major

public health problem in many parts of the world. School-age children are a usual target

group for iodine deficiency disorder surveillance because they are easily accessible and

are particularly vulnerable to the adverse effects caused by iodine deficiency, due to

inadequate consumption of iodized salt in their daily diet.3

Iodine is essential micronutrient important for essential hormone development in

the human body. Inadequate intake of dietary iodine can lead to and enlarged thyroid

gland (goiter) or other iodine deficiency disorders. Iodine found in food as iodide body

2

need it to make thyroid hormones, thyroid is a gland that regulates metabolic processes.

The two main thyroid hormones, thyroxin (T4) and tri-iodothyronine (T3) are synthesized

from the amino acids, tyrosine and from iodide. Iodine essential for optimal physical and

mental development, growth and development and well being of all humans.4

Iodine deficiency is a major nutritional problem in India. Iodine equated with

goiter. In recent years, it has become increasingly clear that iodine deficiency leads to a

much wider spectrum of disorders commencing with the intrauterine life and extending

through childhood to adult life serious health and social implications. The social impact

of iodine deficiency arises not so much from the effect on the central nerves system.5

Iodine deficiency disorders are the world’s single most significant cause of

preventable brain damage and mental handicap. Iodine deficiency among school children

is one of the factors which diminish his/her mental and intellectual development. Effects

on children which results in goiter, hypothyroidism, retarded physical development and

impaired mental function (? 13 IQ points). The intelligent Quotient score of children

living in an iodine deficient environment is nearly 13 IQ points less than those living in

iodine sufficient areas. Implications of loss of IQ results which results as poor scholastic

performance, frequent failures or grade repetitions, absenteeism’s/dropouts, major

implications of education for all, consequent economic and social effect, drain an human

resource development.6

The most obvious consequence of iodine deficiency is goiter but recent studies

have indicated that there is a much wider spectrum of disorders, some of them so severe

as to be disabling, include hypothyroidism, retarded physical development and impaired

mental function, increased rate of spontaneous abortions and still births among mothers,

neurological cretinism, including deaf-mutism, myxedematous, cretinism, including

3

dwarfism and severe mental retardation. The term “endemic goiter” is now replaced by

the term Iodine Deficiency disorders .5

The symptoms of hypothyroidism are often subtle. They are not specific which

means they can mimic the symptoms of many other conditions. And children with

hypothyroidism become obvious as the condition worsens. Intolerance to cold decreased

concentration in school studies impaired mental function, excessive sleep, retarded

physical development, dry skin and loss of hair.7

The main factor responsible for iodine deficiency is a low supply of iodine. It

occurs in population living in areas where the soil has low iodine content as a result of

past glaciations or repeated leaching effects of water, and heavy rainfall. Crops grown in

this soil, therefore, do not provide adequate amounts of iodine when consumed.

Iodine is found in food as iodide such as sea food iodized salt, cereals, fresh foods.

Vegetables also contain iodine but if they are only grown in iodine-rich soils. Vegetarians

may also be at risk of iodine deficiency if they do not eat sea food. Instead they can get

their iodine from iodized table salt. A study published in sept-oct, 2003. Annual of

Nutrition and metabolism showed that 25% of vegetarians, 80% of the vegans and 9% of

those eating a mixed diet had low iodine states. Salt is the recommended the vehicle

distributing iodine and best food source consumed by every body on daily basis.8

4

Inadequate intake of iodine in the diet is the primary cause of iodine deficiency.

The World Health Organization recommendations for iodine intake by age (mg per day):

Children 0.5 yrs. 90 mcg/day

Children 6-12 yrs. 120 mcg/day

Children >12 and adults 150 mcg/day

Pregnancy 250 mcg/day

Lactation 250 mcg/day 9

Realizing magnitude of the problem National Goiter Programme launched in the

year 1962 towards end of second five year plan with objective of identification of goiter

endemic regions, to supply iodized salt in place of ordinary common salt to the goiter

endemic areas, to assess impact of goiter control measures. Later National goiter control

programme renamed to National Iodine Deficiency Disorder Control Programme to have

wider coverage.10

Goiter control mainly based on four components they are Iodized or oil,

monitoring and surveillance, manpower training and mass communication. Recently the

National Institute of Nutrition, Hyderabad has come with new product common salt

fortified with iron and iodine. Community trails launched to examine the efficacy of

“Two-in-One”.5

So, as to keep normal growth and development of children and preventing

impaired physical development and to improve intellectual capacity of the children

adequate intake of iodine is most important. Mothers are control figure in identifying

common sources of iodine to provide their children of iodine in their daily diet.

5

The knowledge of mothers regarding iodine deficiency will have influence on

maintaining iodine status among children.

Iodine deficiency can be prevented by health promotion and specific protection is

better than cure. Including early diagnosis and treatment disability limitation and

rehabilitation. “Daily consumption of adequately iodized salt is a healthy habit”. Towards

sustainable elimination of iodine deficiency disorders.6

6

6.2 NEED FOR THE STUDY

“We ourselves sometimes feel that what we do is just a drop in the ocean but the

ocean would be less because of that missing drop”

- Mother Teresa

Iodine deficiency is a major public health problem through out the world,

particularly among school children. They are a threat to the social and economic

development of countries. The most devasting out come of iodine deficiency is the

greatest cause of decreased intellectual capacity and retarded physical development of the

child.

Iodine deficiency has been identified all over the world. It is significant health

problem in 130 countries and effect 740 million people. One third of the world

population is exposed to risk of IDD. It is estimated that in India alone, more than 6.1

crore people are suffering from endemic goiter and 88 lakh people are mental/motor

handicaps. A national level survey has been carried out in 25 states and 5 union territories

in the country and found that out of 282 districts surveyed, in 241 districts it is a major

public health problem where the prevalence rate is more than 10%. It is estimated that

more than 71 million persons are suffering from goiter and other iodine deficiency

disorders like Mental Retardation, Deaf Mutism, Squint and Neuromotor defects.11

Global scenario 2 billion individuals world wide have insufficient intake of iodine

including a third of all school age children. Iodine deficiency has many adverse effects on

growth and development. These effects are due to inadequate production of thyroid

hormone and are termed as iodine deficiency disorders. Iodine deficiency remains a

public health problem in 47countries.8

7

Prevalence of iodine deficiency among school children (6-12 yrs.)

Place %

America 40.8%

East Mediterranean 48.8%

Europe 52.4%

Southeast Asia 30.3%

Western pacific 22.7%

Total (World wide) 31.5%

The magnitude of the problem in India is far greater than estimated in 1960s when

it was estimated that about 9 million persons were affected by goiter, currently, no less

than 170 million people are estimated to be suffering from endemic goiter. In one

particular district (Gonda) of Utter Pradesh is highly endemic. In recent years renewed

surveys iodine deficiency and associated iodine deficiency disorders are endemic in parts

of Madhya Pradesh, Gujarath, Andhrapradesh, Kerala, Karnataka and Tamilnadu. In

short, no state in India can be said to be entirely free from goiter.5

Cross sectional study was conducted in the rural field practice area of department

of Community Medicine, Manipal, Karnataka, India to find out prevalence of goiter

among school children in the age group of 8-10 years. 722 children selected from study

population by probability proportion, children examined for goiter and graded according

to WHO guidelines. Urine & salt sample conducted from sub sample for urinary iodine

excretion & iodine content in salt Results of the study prevalence of goiter was 312% in

females & 28.8% in males.12

8

At present 17 districts have been declared endemic and supply of iodized salts is

made compulsory in these districts. Four survey teams have been sanctioned for

conducting sample surveys in various districts. Initial survey shown more than 20%

prevalence in districts and more than 10% prevalence in 19 districts. 13

“Global Iodine Deficiency day is on 21st October 2008” Ensuring the required

daily intake of iodine to maintain normal brain function is as important as the provision

of iodized salt. There should be expertise to ensure the sustained elimination of IDD from

the entire the world. An important statistics that should be borne in mind is that out of 26

million children borne in India every year, nearly 13 million are unprotected in terms of

iodine deficiency.14

Knowledge and attitude can help mother to move from a passive role in iodine

deficiency prevention. Information, Education and communication (2001-02) activities

helps mothers to promote awareness about the importance of iodated salt and its

consumption through appropriate health teaching. Future planes are states to complete

survey in the remaining districts to assess the exact magnitude of IDD, further strengthen

IEC (Information Education Communication) activities focus on rural, urban slums to

promote iodated salt, supply of good quality of iodated salt at reasonable rate, control

problem of IDD and its prevalence.9

By the prevalence of inadequate knowledge regarding iodine deficiency

among mothers by the researcher’s personal witnesses during field experience. The

investigator felt strong need to educate mother among rural community regarding

importance of iodine intake in their daily diet.

6.3 STATEMENT OF PROBLEM

9

To Assess the Knowledge and Attitude of Mothers regarding Prevention of Iodine

Deficiency among school children in a selected rural area, Bangalore.

6.4 OBJECTIVES

1. To assess the knowledge of mothers regarding prevention of iodine deficiency

among school children.

2. To assess the attitude of mothers regarding prevention of iodine deficiency among

school children.

3. To find out association of knowledge and attitude of mothers regarding prevention

of iodine deficiency with the selected demographic variables.

4. To develop the health education pamphlet on prevention of iodine deficiency

based on findings and distribute to the mothers.

10

6.5 OPERATIONAL DEFINITIONS:

1. Knowledge: Refers to the level of understanding and awareness of mothers

regarding iodine deficiency and its prevention.

2. Attitude: In this study it refers to the ideas, views and opinions of mothers on

prevention of iodine deficiency.

3. Mothers: Rural mothers having school age children between 6-12 yrs.

4. Iodine Deficiency: Is referred to a group of signs and symptoms commonly

observed among school children such as intolerance to cold decreased

concentration in school studies impaired mental function, excessive sleep, retarded

physical development, dry skin and loss of hair.

5. Prevention: It refers to the measures or practices followed by mothers to avoid the

occurrence of the above clinical manifestations by consuming adequate intake of

iodine content food in their daily diet pattern.

6. School children: Children between 6-12 years of age.

6.6 ASSUMPTIONS

1. The mothers may have inadequate knowledge regarding iodine deficiency and its

prevention.

2. Adequate knowledge and positive attitude of mothers regarding iodine deficiency

and its prevention leads to healthy life of school children.

11

6.7. HYPOTHESIS

H1- There is a significant difference between knowledge and attitude of mothers

regarding iodine deficiency and its prevention.

H2- There is a significant association between knowledge and attitude of mothers in

relation to selected demographic variables.

6.8 REVIEW OF LITERATURE

The review of literature is an extensive, systematic selection of potential sources

of previous work, acquainted fact findings after securitizations and location of reference

to the problem under study. It is helpful in understanding and developing in sight in to

the selected problem under study and also to develop a conceptual frame work for the

study.

A Community-based cross sectional study was conducted among 2,392 school

children, aged 8-10 years in Malda district of West Bengal, India, in January 2001 to

assess their iodine status. The children were selected through a multistage 30 cluster

sampling techniques to determine status of iodine deficiency disorder (IDD). The

prevalence of goiter assessed clinically using the standard palpation method and a total

goiter rate of 11.3% was found.15

12

A comparative study conducted, on effects of the iodine deficiency on intellectual

variables among children comparing iodine – deficient zones with non deficient zones at

jean (southern spain). 760 school children were selected to examine relationship between

moderate & mild iodine deficiency and intellectual capacity. The study results showed

that with low levels of iodine intake & with urinary iodine concentration lower then 100

microg / liter had a lower IQ and disruptive behavior that with high levels of criteria.16

A knowledge, Attitude, practice study was conducted along with prevalence study

of iodine deficiency disorders on elimination of iodine deficiency disorders by 2000 and

its bearing on people in a district of orissa, India. A total of 635 people were interviewed

by a pre tested structured questionnaire, adopting probability proportional to size cluster

sampling method. Result shown that only 37% of males & 29.3% females perceived

goiter as a disease only 16.4 used iodized salt regularly. The awareness and perception of

IDD implies poor knowledge about IDD.17

A study conducted to assess the status of iodine deficiency in school going

children of Pondicherry to find out the urinary excretion of iodine and the prevalence of

goiter among school children. 315 children between the age group of 9-13 years from 30

schools, examined for the presence of goiter and urine samples for urinary iodine levels.

The study results showed that the percentage of children who had inadequate iodine

intake showed urinary iodine levels less than 100 mcg / l was 44.4%.18

A study conducted to evaluate of efficiency of iodine prophylaxis based on

obligatory model of salt iodization. 1444 children from the rural and urban area, age of 8-

12 years. The prevalence of goiter detected in children population was 40%.19

13

A study conducted on iodine nutrition status among school children after

salt iodization at Jayatissa, Fernando. 6574 school children randomly selected in the age

group of 8-10 years urinary iodine levels measured in 2630 of children and 6181

samples of salt used in house hold study shown that 16.3% to 26.2% of prevalence rate.20

A study was conducted on iodine nutritional status of school children in a rural

area of Howrah district in the Gangetic, West Bengal. 969 school children in the age

group of 6-12 years clinically examined for goiter. On the spot 242 urine samples

collected from children and 108 edible salt samples collected from home of children to

measure iodine level, results have showed that 37.6% goiter prevalence.21

A cross sectional population survey conducted to determine the level of

knowledge regarding iodine nutrition and its relationship in South Africa population,

stratified cluster study sampling by home visits in the language of the respondents from

2164 house holds, participants are 98%. Results shown that 15.4% respondents iodized

salt as the primary dietary source of iodine, 16.2% knew thyroid gland needs iodine for

its functioning, 3.9% considered brain damage, 0.8% considered cretinism. Compared

with respondent from high socio-economic house holds, respondents from low socio-

economic house holds were considerably less informed about aspects of iodine nutrition

covered in this study.22

A comparative study conducted on evaluation of the impact of an iodine

supplementation programme on severely iodine-deficient school children with

hypothyroidism at Northern rural areas of Tehran. 571 students aged 6-14 years studied.

Goiter graded according to the serum concentration of thyroid hormones. Results

showed that goiter rate reduced by 42 % in 1999 compared that in 1989.23

14

A study conducted to determine the prevalence of iodine deficiency in primary

school children in an Australian urban population. A cross sectional study of survey of

school children aged 5-13 years selected. Thyroid volume values estimated through

iodine status based on urinary iodine concentration. The median UIC (Urinary Iodine

Concentration) for school children was 82% microg/L and 14% of children Urinary

Iodine Concentrations below 50 microg/L.24

A study was conducted on prevalence and risk factors of iodine deficiency among

school children. 1573 school children were chosen from 14 schools in seven different

regions in Istanbul iodine contents of urine samples were determined Sandell Kolthoff

reaction. The study results shown that prevalence of iodine deficiency was significantly

higher in younger (< 10 years) children, in children with less educated mothers &

fathers.25

A study was conducted on linear growth retardation and iodine deficiency disorder

among primary school children. A cross-sectional study conducted of 1600 children

chosen randomly from all government schools. Selected children examined for goiter by

surgeon & 505 chosen for urine iodine level assessment. The study results shown that

out of 1600 examined 26 (1.7%) were found to have goiter & 121 out of 749 (16.5%)

has low urinary iodine levels. The prevalence estimates of goiter & IDD was slightly

lower for boys (15.8%) compared to girls (16.5%).26

Study was conducted to assess knowledge, beliefs and practices regarding iodine

deficiency disorders among the tribals in Car Nicobar and Nicobar Islands. The

population of the study all village heads of the sixteen villages and parents of 10% of the

school children examined for goiter was interviewed. Focus group discussions were

conducted as no prior knowledge about local names for goiter. Results have shown that

44% felt that it only affected females. About half of the respondents believed that these

15

swellings caused problems 63% respondents believed that there was treatment, 18

respondents said traditional treatment by “LAM-EEN”. No one had correct knowledge of

the cause of goiter. The awareness of Iodine Deficiency Disorder needs reinforcement.27

A community based survey was performed for determination of iodine nutrition

and community knowledge regarding iodine deficiency disorders in selected tribal blocks

of Orissa, India by adopting 30-cluster sampling and surveillance methodology on

school-age children (6-12yrs.) and their mothers for assessment of iodine deficiency

disorder. Results shown that total goiter rate was 23.6% of which visible goiter was 6.9%

prevalence of goiter increased with age in female and tribal children. 80% of respondents

did not have knowledge of iodine deficiency disorder and were not aware of salt

iodization.28

16

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA:

Mothers of school children between the age group of 6-12 years, residing in

selected rural area, Bangalore.

7.2 METHOD OF COLLECTION OF DATA

i. Research design

The research design in this study is non experimental, descriptive design.

ii. Research variables

1. Study Variables: Knowledge and attitude of mothers regarding

prevention of iodine deficiency among school children.

2. Extraneous Variables: It contains demographic variables of mothers of school

children such as age, education, occupation, income, type of family, source of

information, nature of salt and its preservation.

iii. Setting

The study will be conducted at selected rural area, Bangalore.

iv. Population

Mothers of school children residing at selected rural area, Bangalore.

17

v. Sample

Sample size of 100 mothers who fulfill inclusion criteria.

vi. Criteria for sample selection

Inclusion Criteria: The study includes mothers who are:

1. Residing at selected rural area, Bangalore.

2. Able to speak in local language.

3. Having children in the age group of 6-12 years.

Exclusion Criteria; The study will exclude the mothers of children who are:

1. Not available at the time of data collection.

2. Having children less than 6 years and more than 12 years.

3. Not able to communicate in kannada.

vii. Sampling technique

Sampling technique adopted for selection of sample is probability randomized

sampling.

18

viii. Tool for data collection.

The tools for data collection in this study are structured interview

schedule and Five Point Likert Scale. It includes following sections.

Section-A:

Demographic data includes mother’s age education occupation, income, type of

family, source of information, nature of salt used and preservation.

Section-B:

Structured knowledge questionnaire to assess the level of knowledge regarding

iodine deficiency and its prevention.

Section-C:

Five point Likert Scale to assess the level of attitude regarding iodine deficiency

and its prevention.

ix. Method of data collection

After obtaining the official permission from concerned authorities and informed

consent from the respondents, the researcher will conduct the interview personally by

using interview schedule to assess the level of knowledge and also to assess the level of

attitude by five point likert scale.

Duration of the study will be 4-6 weeks.

19

x. Plan for data analysis

The data collected will be analyzed by means of descriptive statistics and

inferential statistics.

Descriptive Statistics: In Descriptive statistics mean, percentage, distribution and

standard deviation will be used.

Inferential statistics: In inferential statistics chi-square test will be used.

xi. Projected outcome:

After completing the study the researcher will know the level of knowledge and

attitude of mothers on prevention of iodine deficiency among school children. Based on

the findings the investigator will develop health education pamphlet to all mothers.

7.3 Does the study require any investigations or interventions to the

patients or other human beings or animals?

NO

7.4 Has ethical clearance obtained from your institution?

YES. The permission will be obtained from the concerned medical officer of PHC

and informed consent from the samples.

20

8. LIST OF REFERENCES

1. Margaret Barnes, Jennifer Rowe. Child youth and family Health Strengthening

Communities. Sydney Edinburgh Churchill Livingstone, Elsevier. London 2008:

79.

2. WHO Good nutrition improves the learning potential and well-being of children.

Available from http://www.who.int/schoolyouth health/resources/en/.

3. Souriksen, suruta sen, Ashok Mandal, Anindya Dasgupta and Indranil

Chakraborthy. Available from http://www.tm.mahidol.ac.th /seameo/sep-2005.

4. Iodine why is an adequate intake important; available from http://www.healthy

eating club.com/into/articles/minerals/ iodine, htm.

5. Park.K. Park’s Text book of Preventive and Social Medicine. 19th edn.

Jabalpur: M/S Banarsidas Bhanot Publisher; 2007 Feb; 493-510.

6. Dr. Chandrakant, S. Pandav, Dr. Anil Kumar, Dr. Denish Moorthy, Dr.K. Anand.

Ensuring freedom from Preventable brain damage; Available from

http://209.85.175.104/search?q=cache:

7. Available from http://www.emedicine.com/med/topic1187.htm#sectionautho sand

editors.

8. Good natural sources of iodine; available from http://www.babycentre,

in/pregnancy/antenatal health/iodine.

21

9. Michael B Zimmerman, Picter Jooste, Chandrakant S Pandav. Iodine Deficiency

Disorders. Available from www.thelancet.com; vol 372 2008 October; 2252.

10. Krishna Kumari Gulani. Community Health Nursing. 2nd edn. Delhi: JP

Brothers Pub; 2008; 650-651,652-653.

11. National Institute of Health and Family welfare; available from http://www.nihfw.org.

12. Rsp. Rao, R. Kamath, Acharya Das and Keshavamurthy. Prevalence of goiter

among school children in coastal Karnataka. Indian Journal of Pediatrics. 2007

June; 69; 6.

13. Health education to villages march 2008; available from

http://www.hetv.org/india/mh/healthsatus/iodinedeficiency.htm.

14. Roger Bond Moore. Iodine Deficiency life threatening; available from @import

url http://www.google.com/cse/api/branding.css.

15. Biswas AB, Chakraborty 1, Das DK, Biswas S, Nandy S. Iodine deficiency

disorders among school children of Malda. West Bengal, India. Journal of Health

Population and Nutrition. 2002 June; 20 (2): 180-183.

16. Muela Martinez JA, Garcialeon A, Torres Barahona R, Santiago Fernandez P,

Soriguer Escofet F. Effects of the iodine deficiency on intellectual variables

among children of Spain. 2008 May; 20(2): 279-284.

22

17. Bulliyya G, Dwibedi B, Mallick G, Sethy PG, Kar Sk. Determination of iodine

nutrition and community knowledge regarding iodine deficiency disorders in

selected tribal blocks of Orissa, India. Journal of Pediatric Endocrinol Metabolic.

2008 Jan; 21(1): 79-87.

18. Sarkar S, Mohanty B, Basus. Iodine deficiency in school going children of

Pondicherry. Indian Journal of Pediatrics. 2007 Aug; 74(8): 731-734.

19. Baczyk M, Ruchala M, posarek M, Pietz L, Wrotkowska E, et.al. Iodine

prophylaxis in children population on the wielkopolska area from year 1992 to

2005. Endocrynol pol. 2006 Mar-April; 57(2): 110-115.

20. Jayatissa R, Gunathilaka MM, Fernando DN. Iodine nutrition status among school

children after salt iodization. Srilanka ceylonmed.J. 2005 Dec; 50(4): 144-148.

21. Chandra Ak, Tripathy S, Lahari D, Mukhopadhyay S. Iodine nutritional status of

school children in a rural area of Howrah district in the Gangetic West Bengal.

Indian Journal of Physiology and Pharmacology. 2004 Apr; 48(2): 219-224.

22. Jooste, PLI, Upson, N2; Charlton, KE 2, 3; knowledge of iodine nutrition in the

South African adult population. Public Health Nutrition. 8(4):382-386, June 2005.

23. Salarikia N, Hedayeti M, Mirmiranp, Kimiagar M. Evaluation of the impact of an

iodine supplementation programme on severely iodine deficient school children

with hypothyroidism. Public Health Nutri. 2003 Sep; 6(6): 529-533.

23

24. Guttikonda K, Travers CA, Lewis PR, Boyagess. Iodine deficiency in urban

primary school children: a cross-sectional analysis. Med Jouranal of Australia.

2003 oct 6; 179(7): 346-348.

25. GÜR Emel (1) ; ERCAN Oya (1) ; CAN Günay (1) ; AKKUS Semra (1) ;

GÜZELÖZ Sima (2) ; CIFTCILI Serdar (2) et al. Prevalence and risk factors of

iodine deficiency among schoolchildren. Journal of tropical pediatrics. 2003; 49;

168-171.

26. Stoltzfus, Rebecca J; Albonico, Marco; Tielsch, James M, et.al. Linear Growth

Retardation in Zanzibari School children. The Jrnl of Nutrition; June 1, 1997; 23.

27. Mallik AK: Anand K: Pandav CS: Achar DP: Lobo 3: karmarkar MG; Nath LM.

Knowledge beliefs and practices regarding iodine deficiency disorders among the

tribal in Car Nicobar. Indian Journal of Pediatrics. 1998 Jan-Feb; 65(1) : 115-120.

28. Bulliyya G, Dwibedi B, Mallick G, Sethy PG, Kar SK. Determination of iodine

nutrition and community knowledge regarding iodine deficiency disorders in

selected tribal blocks of Orissa, India; J Pediatrics Endocrinal metab. Jan, 2008;

21(1): 79-87.

24

9. Signature of the candidate :

10. Remarks of the guide : This study is beneficial for the future adolescents through their mothers to prevent iodine deficiency diseases and to improve the IQ among school children.

11. Name and designation of :

11.1 Guide : Dr. Rebecca Samson, Ph.D. Principal

11.2 Signature :

11.3 Co-guide (if any) :

11.4 Signature :

11.5 Head of the department :

11.6 Signature :

12.1 Remarks of the principal : This study is feasible and applicable for the Speciality choosen.

12.2 Signature :

25