Objective To find out the situation of household consumption of iodized salt in Hebei province so as to provide scientific basis for prevention and control of iodine deficiency disorders(IDD). Methods According to the "national iodine deficiency disorders surveillance program (Trial)", the county (city, district) was taken as a unit, township (town) and administrative villages were selected in accordance with the principle of systematic sampling, then households were chosen by random sampling to collect their edible salt in Hebei province from 2007 to 2009. Salt iodine content was detected by direct titration method. Results A total of 48 675, 48 448 and 48 756 salt samples were collected from 2007 to 2009, respectively. The consumption rate of qualified iodized salt from 2007 to 2009 was 91.16%, 91.96% and 96.17%, respectively. There were 24.6%(41/167)and 18.0%(30/167)counties with consumption rate of qualified iodized salt under 90% in 2007 and 2008, respectively. The percentage of counties with consumption rate of qualified iodized salt above 90% was 100.0%(167/167) in 2009. In general there was a significant differences in frequency distribution of consumption rates of qualified iodized salt among the three years(H = 10.778, P ＜ 0.01 ), and the difference was found significant between 2007 and 2009 as well as between 2008 and 2009(all P ＜ 0.05), but was not significant between 2007 and 2008(P ＞ 0.05). Conclusions The consumption rate of qualified iodized salt at household level increases annually from 2007 to 2009. By 2009,the consumption rate of qualified iodized salt in each county is more than 90%, which has reached the national standard stipulated in "the evaluation programs for fulfilling the goal of eliminating IDD at county level".

Objective To investigate the supply of iodized salt in non-excessive iodine counties and iodine-free salt in excessive iodine counties at household level in Hebei province so as to provide a basis for the prevention and control of iodine deficiency disorders(IDD). Methods According to the national project of IDD surveillance,the county was taken as the elementary sampling unit. The towns and villages were selected by systematic and random sampling in every county and households were chosen by random sampling to collect their edible salt in Hebei province in 2008. The salt iodine content in non-and excessive iodine regions was detected by direct titrition method and semiquantitative method respectively. Results all 48 448 salt samples were collected from 167 non-excessive iodine counties. Weighed by the population of counties,the rate of non-iodized salt was 4.73%. Iodized salt accounted for 95.27%,out of which,96.13% were qualified and the consuming rate of qualified iodized salt was 91.96%. Eighty point eighty three percent(135/167) of the counties covered by iodized salt above 95%,92.81% (155/167) passing rate of iodized salt above 90% and 82.04 (137/167) consuming rate of qualified iodized salt. All 1466 salt samples were collected in 5 counties with excessive water iodine content and the coverage rate of iodine-free salt was 93.25%(1367/1466). Conclusions In a nutshell,the national targets for preliminary elimination of IDD have been achieved in regions of non-excessive iodine of Hebei province. Nevertheless,the coverage rate of iodized salt and qualified iodize salt rate in some counties are still below the national standard. Therefore the prevention and control of IDD need to be strengthened. The supply of iodized salt in excessive iodine regions should be timely stopped.

Objective To understand the status of drinking-water-borne endemic fluorosis and the effect of preventive measure in Hebei province, so as to provide a basis to prevent and cure the disease. Methods Thirtyeight affected counties(cities, districts) with drinking-water-borne endemic fluorosis were sampled by random sampling in Hebei in 2009. All affected villages in every county were divided into mild, moderate and severe endemic fluorosis areas and a village was randomly selected from each category of the area to carry out the monitoring of endemic fluorosis. Dental fluorosis of children aged 8 - 12 were examined and 6 copies of urine samples were randomly collected in each age group in the above-mentioned villages. Clinical skeletal fluorosis was diagnosed among adults aged 16 and over and 20 copies of urine samples were tested for fluorosis in every village.Results A total of 112 affected villages were investigated, among which the drinking water quality of 66 villages were improved and 46 villages were not improved. A total of 236 copies of water samples from the 66 villages were measured and the fluoride content ranged from 0.1 to 4.3 mg/L, among which 20 copies of water samples exceeded the fluorine standard of 1.2 mg/L, accounting for 33.3%. A total of 230 copies of water samples were collected in the 46 villages and the fluoride content ranged from 0.2 to 4.6 mg/L, among which 76.1% (35/46) of the water samples exceeded the fluorine standard of 1.2 mg/L. A total of 5169 children aged 8 - 12 were examined of dental fluorosis, the dental fluorosis rate was 36.43%(1883/5169) and the dental fluorosis index was 0.81. A sum of 71 497 adults aged over 16 years were examined, and the rate of skeletal fluorosis was 4.81%(3438/71 497), moderate or severe clinical detection rate of skeletal fluorosis was 1.56%( 1114/71 497). A total of 2876 copies of children urine samples and 2021 copies of adult urine samples were tested and the geometric mean of fluoride content was 2.30,3.32 mg/L, respectively. Conclusions The prevalence of dental fluorosis of children in the areas with improved water is less than 30% and the rate of dental fluorosis and skeletal fluorosis decline gradually with time.The rate of dental fluorosis and skeletal fluorosis increases with the increase of water fluoride in the water quality not improved areas. The endemic fluorosis is still comparatively serious in Hebei. The progress of improving water quality in the areas with endemic fluorosis should be accelerated and the acceptability of improved water should be enhanced.

Objective To investigate the iodine nutrition status of the target population living in the areas with low coverage rate of iodized salt and to provide a basis to prevent and control iodine deficiency. Methods The investigation was carried out in the areas with coverage rate of iodized salt lower than 80%, including 7 counties (city, district). Three townships(sub-district office) were sampled in each county and two elementary schools in each township(sub-district office). Urinary iodine level was measured for 40 children aged from 8 to 10 years old in each elementary school. Drinking water iodine was collected and determined in their living villages. Twenty salt samples were tested for iodine in salt from 20 house which had fertile women, and urine iodine of 10 fertile women were tested in each village. Results Sixty-two water samples were determined and the water iodine was ranged from 5.8 to 272.7 μg/L, of which 3 water samples were equal and more than 150 μg/L. Eight hundred and seventy-two salt samples were collected. The coverage rate of iodized salt was 70.74%(585/827) and the coverage rates were below than 80% in 5 counties (city, district). A total of 1660 children' urine samples were collected, the content of urine iodine ranged from 10.0 to 1088.0 μg/L and the urine iodine median was 173.7 μg/L. Four hundred and thirty-seven urine samples were collected from the fertile women and the urine iodine median was 179.1 μg/L. The iodine level of children and women was the highest in Dongguang County(251.8,273.8 μg/L) while that of Hejian County (130.8,118.7 μg/L) was the lowest. Conclusions Although the iodine nutrition of children and fertile women is appropriate in areas with low coverage rate of iodized salt, we presume from the results that the possibility of iodine deficiency in pregnant and lactating women exists in Hejian and Anping.

Objective To evaluate the effectiveness of health education on iodine deficiency disorders (IDD) in Hebei, and to provide basic information for development of control strategies. Methods A total of 34 project counties were selected in Hebei province, and 3 townships were chosen in each project county. Heath educational activities were carried out in the classes of grade 5 in the central primary school of each selected township. In the meantime, 3 villages were chosen in each selected township where the health education for women of childbearing age in the community was carried out. Sureys on knowledge of IDD control were conducted in the 34 project counties before and after the health educational activities. Results The knowing rates of IDD control among pupils in all 34 project counties increased from 71.10%(7835/11 019) to 94.84%(10 840/11 430) after health education, with a average increase of 23.74%. The knowing rates of IDD control among housewives increased from 77.02%(4531/5883) to 95.32%(5902/6192), with a average increase of 18.30%. Of which, the knowing rates of IDD control among pupils in Hengshui city increased from 55.56% (750/1350) to 94.89% (1281/1350),with a average increase of 39.33%. The knowing rates of IDD control among housewives in Handan city increased from 65.68%(532/810) to 96.50%(909/942), with a average increase of 30.82%. Conclusions The knowing rates of IDD control among pupils and housewives are remarkably increased after implementing the health education projects. They have better life and health habits, and the project achieves desired effect.

OBJECTIVETo evaluate the effectiveness of universal salt iodization (USI) for the control of IDD in Hebei province since it was implemented in 1995, identify the problems currently encountered in the implementation of USI and provide practical proposals for addressing these problems.

METHODSProbability proportionate to size sampling (PPS) was employed in the surveillance of IDD, for which a total of 1200 school children aged 8-10 years were randomly selected from 30 counties around the whole province during each IDD survey. The iodine content of salt was determined quantitatively with the titration method. The iodine content of urinary samples was measured by the method of ammonium persulfate oxidation.

RESULTSThe coverage of iodized salt increased from 65.0% in 1995 to 98.0% in 1999, then decreased to 88.1% in 2005 which was below the national standard of 90%. The median urinary iodine of children aged 8-10 years varied between 160.1 microg/L and 307.4 microg/L, which was above the national standard. The proportion of urinary samples with iodine content above 300 microg/L was over 30% in 2005, implying exorbitant iodine nutrition among the children. The goiter rate (TGR) among children aged 8-10 years dropped from 11.8% in 1995 to 2.7% in 2005, indicating that the spread of endemic goiter was under control.

CONCLUSIONPreliminary elimination of IDD was achieved by USI in Hebei province. Nevertheless, some problems still existed in USI such as non-iodized salt competition, over iodization and un-standardized iodization. In order to address these problems, the management and supervision of salt market needs to be strengthened to prevent non-iodized salt from reaching households; updating equipment and modifying techniques are also necessary to ensure the quality of iodized salt; to clarify the causes of excessive urinary iodine content, the various sources of iodine from the diet need to be investigated in the future.

Child ; China ; epidemiology ; Female ; Goiter ; epidemiology ; prevention & control ; Humans ; Hypothyroidism ; epidemiology ; prevention & control ; Iodine ; deficiency ; pharmacology ; urine ; Male ; Nutrition Policy ; Nutritional Status ; Sodium Chloride, Dietary ; pharmacology ; Time Factors