Incidence and dietary risk factors of goitre in children in a rural area/ D.R.Congo
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Background: Although deficiency in dietary iodine remains the main cause of endemic and sporadic goitre, naturally occurring goitrogens in foods are additional factors that play a major role in developing goitre. In this study we focused on the relationship of different potential goitrogenous food and the development of goitre in preschool children in the rural area of Bwamanda, Democratic Republic of the Congo (DRC). Objectives: First, to do a semi-systematic literature review on the incidence of goitre and the role of dietary pattern in its genesis. Second, describe the incidence of goitre in preschool children in DRC in relation to age, sex, and season. Third, examine the effects of specific food items on occurrence of goitre in these children. Methods: For the 1st objective, we used a semi- systematic method to search for relevant published articles to the topic area. We searched four online databases, three online journals, five authors and the reference lists of the identified key articles. We did a secondary analysis of the data from an original dynamic population study which was done in the rural area of Bwamanda, DRC. That study included an open cohort of 5657 children which was followed up every 3 months throughout six survey rounds, during a period of three years from 1989- 1991. All the investigations and clinical examination were done by trained doctors and interviewers at special under five clinics in the study setting. Incidence of goitre among the children who were at risk of developing goitre was calculated for 5 survey intervals. The incidence of goitre was also assessed in relation to season, sex and age of the children. For the 3rd specific objective, seven food items were selected to be investigated for their potential goitrogenic effects. The exposed group was those children who ate these foods and the unexposed group was the children who didn’t eat these foods. Age, sex, height for age Z-score (HAZ), and weight for length Z-score (WLZ) were considered as potential confounders. All selected food items and confounders were analysed using logistic regression analysis. Results: Four studies were included in the semi-systematic literature review; the conclusion was similar in all of them with iodine deficiency being the main cause of goitre in man, and cassava consumption being an important factor in addition to that. Incidence of goitre was different in each survey interval and it was higher in rainy season. The incidence of goitre increased significantly when children got older but being a male or a female was statistically unrelated. Eating cassava leaves, cassava tubers and maize played a major role in developing goitre especially in older children, while nuts reduced the risk of developing goitre in those children. Banana, fish and papaya had non-significant contributions. iv Conclusion: This study confirms that goitre incidence in children (0-5years) in a rural area in Central Africa is significantly related with age as the older children had more risk to develop goitre than the younger children, but it had no relation to gender. The incidence of goitre increased also during rainy seasons. This is the 1st longitudinal analysis showing the relationship between consumption of specific food items and the development of goitre in children (0-5 years) in a rural area in central Africa, where cassava and maize found to be important contributory factors while nuts may have a protective role in developing goitre in those children.