Peta Gondok dan Gangguan Akibat Kekurangan Iodium di Jawa Tengah

Tahun 1997 Volume 32 Nomor 1
Oleh : RRJ. Sri Djokomoeljanto

Back ground :
Scattered goiter prevalence surveys in Indonesia were done earlier in this century, however the first national goiter survey among schoolchildren were initiated in 1980 – 1982 by the Department of Health . The target was to show how big the problem was in 26 provinces at subdistrict level. The concept that prevailed was that schoolchildren total goiter rate may reflect the population goiter rate and hence the community IDD problems. The survey was conducted purposefully based on the earlier information reported by community health centers from every subdistrict. Out of 966 subdistrict covered, 68.3% subdistrict were categorized as goiter endemic areas, while 39.5% belongs to severe endemic area.

Intervention efforts using iodinated oils and iodized salt improved the TGR all provinces but Jambi, Maluku, Bali, and Central Sulawesi. as shown by the 1990 survey. In Central Java province the TGR and VGR decresased from 36.8% and 8.4% (1980 survey) to 22.4% and 3.8% (1990 survey) respectively.

The government of Indonesia has decided, that by the year 2000, no new cretin born and the TGR should be less than 10% among schoolchildren, while iodized salt should be consumed by more than 80% of Indonesian households. To attain and to guarantee this goal, periodic surveillance on TGR of schoolchildren and iodine nutritional status of pregnant persons is very important. The general objective of this survey is to know the development of IDD and its related epidemiological factors in Central Java and put it in the map form. The specific objective are : (1) to know the TGR, VGR of schoolchildren and (2) to know the TGR, VGR, UEI (urinary excretion of iodine) and TSH (thyroid stimulating hormone) of pregnant mother. (3) to collect information related to iodinated capsule and iodized salt distribution and their perception on IDD.

Results :
Schoolchildren” goiter survey. 158.421 schoolchildren (mean age 9.5 yr) consisted of 79.868 males and 77.195 females were examined. Coverage of study was 99.26%. The overall TGR was 4.5%. This consists of 3.9% grade Ia 3.9%, Ib 0.5% and II 0.1% and the VGR 0.6%. All of the known endemic areas  show drastic improvement in TGR values to less than 10%, except kabupaten Karanganyar, Pati, and Temanggung. Banjarnegara and Wonosobo must be alerted (TGR 9.3% and 9.0% respectively). However, from the 14 kabupaten and administrative cities known as non endemic in 1980 survey, only kabupaten Cilacap emerges as new endemic area with TGR of 16.6% among their schoolchildren.

Pregnant-lactating mother. The coverage was 98.62%. The TGR was 8.4% (consistend of 6.4% grade Ia, 1.5% grade Ib, 0.4% grade II and 0.1% grade III. VGR was 2.0%, with 0.4% nodulary). Considering WHO epidemiological UEI median criteria cur-off point of 100 ug/L, only 2 kabupatens (Jepara and Temanggung) are iodine deficient. However, significant numbers of pregnant women in each kabupaten have UEI less than 100 ug/L (23 out 35 kabupaten had 20% or more pregnant mother with low EUI). Following this criterion pregnant mother with low UEI were found high in kabupaten Jepara (65.3%), Temanggung (59.9%) and Sragen (42.3%). Hypothyroidism in mothers many bring consequences to their babies. Subclinical hyopothyroidism, based on their serum TSH > 5 uU/ml was found in 22.8% of mothers from administrative city Tegal, Kebumen (19.5%), Kendal (16.2%), Boyolali (15.8%), Blora (11.9%) and kabupaten Tegal (10.8%).

Other fundings. From the samples of iodized salt the market collected during the survey, it is shown that only small part of those fulfills the recommended iodine content.

Conclusions :
a. The present TGR of schoolchildren age 6 – 15 (mean 9.5 yr) is 4.5% (Ia 3.9%, Ib 0.5% II 0.1%) with VGR of 0.6%). There were 4 kabupaten with TGR > 10% : kab. Cilacap, Temanggung, Pati, and Karanganyar.

b. TGR among pregnant-lactating mothers is higher, e.g. 8.4% (6.4% grade Ia, 1.5% grade Ib, 0.4% II and 0.1% III, with0.4% nodularity), with VGR of 2.0%.

c. Based on WHO UEI median criteria, only kabupaten Jepara and Temanggung can be classified as iodine deficient, however a significant percentage of pregnant women with low UEI are present in almost all other kabupaten.

d. The same hold true for subclinical hypothyroidism among pregnant women (with sera TSH > 5 uU/dl) in many kabupaten. This present situation shows that our community is not yet free from the risk of IDD.

e. It is apparent from this study that schoolchildren TGR may not completely reflect the iodine nutrition of the community especially not for high risk pregnant women in the program of IDD elimination.