geographic distribution pattern of congenital_2012

8/10/2019 Geographic Distribution Pattern of Congenital_2012

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Queen Sri Savarindira & Prince Mahidol Adulayadej Commemoration Conference October 31 - November 1, 2012

Mahidol University Graduate Research 2012 P a g e |282

GEOGRAPHIC DISTRIBUTION PATTERN OF CONGENITAL

HYPOTHYROIDISM AND ENVIRONMENTAL RELATED FACTORS IN

NAKHON PATHOM PROVINCE THAILAND

Ratsida Saithong*, Kitiphong Harncharoen1, Mathuros Tipayamongkholgul

1

and Sangsom Sinawat2

*Master of Science (Public Health) Programme in Infectious Diseases and Epidemiology1Department of Epidemiology

Faculty of Public Health, Mahidol University, Bangkok, Thailand2Department of Health, Ministry of Public Health, Nonthaburi, Thailand

*E-mail: [email protected]

ABSTRACT

This study was performed to analyze the distribution pattern of congenital hypothyroidism

(CH) and risk factors as display of spatial data in all subdistricts of Nakhon Pathom province.

Geographic information systems (GIS) of provincial data had been used for studying a situationof CH. CH-screening program on the newborn baby was necessary for diagnosis and treatment

of a defected case. It was usually done and obtained from community hospitals. Agriculture

areas and factory distribution data were obtained from District Agriculture Offices and

Department of Industry Works during years 2007 2011.

Over all prevalence of CH in Nakhon Pathom was 0.68 per 1,000 newborns. It varied from

0.13 per 1,000 to 0.78 per 1,000 during these 5 years peroid. Results revealed that prevalence of

CH was significantly associated with a prevalence of factories (p-value


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will loses costs around 3,360 millon baht ( 2511). So,

CH is still a major health problem in Thailand.

Thailand has newborn screening programs by Department of Medical Sciences . CH-

screening is performed by heel prick collected on special filter paper cards and measuring a

total TSH and T4 that obtained shortly after birth (U.S. Department of Health and Human

Services & Centers for Disease Control and Prevention, 2008). The prevalence of neonatal TSHlevels above 5 mU/L were 20.00 39.9 % during years 2005-2006 in Nakhon Pathom province

(Charoensiriwatana, Srijantr, Janejai, & Hasan, 2008).

Nakhon Pathom province has a geographic variation. The people in Nakhon Pathom

province have many occupations such as farming, agriculture, fishery and factory. Nakhon

Pathoms people have various of culture and behavious because they migrate to this province

for living and working. Especially, behavior of prevation is very important for healthly. For

example, in case agriculture if people use pesticide for occupation. They was disrupted

endocrine and thyroid disease. The result about morbidity rate of pesticide poisoning in Nakhon

Pathom Province during 2009 - 2011 were 1.82, 2.51 and 3.19, respectively (Center of

Epidemiological Information, Bureau of Epidemiology, & Mininstry of Public Health, 2552).

Trends in the incidence of these disease in Nakhon Pathom Province increase every year.

According to the previously study, pesticide was risk factor for thyroid disease such as

insecticides, herbicides and fungicides have been endocrine disruptors and related thyroid

disruptors through diverse mechanisms such as inhibition of thyroid iodine uptake, interference

with iodothyronine deiodinases , interference with thyroid hormone receptor, binding to

transport proteins and increased clearance of thyroid hormone (Whitney, et al., 2010). Nakhon

Pathom province have many factory, especially chemicals and plastics industries. The

compounds of chemicals and plastics industries may affect thyroid function such as Bisphenol-

A, polychlorinated biphenyls (PCBs), Styrenes. It was direct actions on the thyroid hormone

receptor and associated with low serum T4 levels (Pearce & Braverman, 2009).

GIS and epidemiological methods can use identify that locate environmental risk factorassociated disease. GIS was used in locate high prevalence areas and populations at risk through

monitor intervention and control programs in areas that affected disease (Clarke, Mclafferty, &

Tempalski, 1996). So, this study use GIS tool for study about CH. Especially, study distribution

pattern of CH and risk factors as display of spatial data.

OBJECTIVE/RESEARCH QUESTION

1.To explore distribution pattern of prevalence rate of congenital hypothyroidism in everysubdistrict of Nakhon Pathom province.

2.To determine association factors of distribution pattern of prevalence rate congenitalhypothyroidism every subdistrict in Nakhon Pathom province.

RESEARCH METHODS

Study design

The present research is design as an ecological study that explore distribution pattern of

prevalence rate of congenital hypothyroidism and factors association in every subdistrict of

Nakhon Pathom province.

Population study

The unit of study is subdistrict of Nakhon Pathom provinces.The subdistrict of Nakhon

Pathom provinces are 106 subdistricts.

Data collection- Congenital hypothyroidism screening program on the newborns was necessary for

diagnosis of a defected case begins with serum TSH level as or above 25 mU/L, leading to


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serum thyroid function tests (typically TSH and free T4) to confirm the diagnosis that were

obtained from community hospital in Nakhon Pathom province that data during the years 2007

2011.

- Environmental factors such as factories and industrial type of chemical and plasticsproduction were obtained from Department of Industry Works. Agriculture areas were obtained

from department of District Agricultural Office.- Health service factors such as antenatal care ( at last four times with iodine

supplementing) were obtained from community hospitals in Nakhon Pathom province.

Data analysis

Data were obtained from:

1. Descriptive statistic : General characteristic such as factory, industrial type of chemicaland plastics production, agriculture land and anternal care, show in the form of percentage.

2. Inferential statistic : Studied results were presented association between environmentalfactors, health servince and congenital hypothyroidism by poisson regression.

3. Map data analysis by STATA version 8.0.

Ethical

This project have been reviewed and approved according to the Standard Operating

Procedures of Ethical Review Committee for Human Research, Faculty of Public Health,

Mahidol University during May 18, 2012.

RESULTS

This research aimed for study distribution pattern of prevalence rate of congenital

hypothyroidism and determine association factors of distribution pattern of prevalence rate this

disease in every subdistrict of Nakhon Pathom province. The studied results were presented as

follows:

General characteristics

Units of analysis are 106 subdistricts in Nakhon Pathom province and variable factors are

factory, industrial type of chemical and plastics production, agriculture area, antenatal care. The

percentage of factories that located in each subdistrict are varies from place to place then

quartiles of factories distribution were used in categorized this factor in four levels (31 factories). The percentage of industrial type of chemical and plastics production in

four levels (4 factories), agriculture area in four levels (12,035 rai) , and antenatal care in four levels(24 person) were

categorized by the same manner (Table 1).

Prevalence rate of congenital hypothyroidism

Prevalence rate of congenital hypothyroidism in Nakhon Pathom province during years 2007

2011 are, also, varies from 0.13 to 1.05:1,000 newborns. For subdistrict scale, probability to

find CH baby was 0.05 (95%CI, 0.032-0.068).

The number of CH cases that presented in subdistrict level are minimum 1 and maximum 4

cases, it located in for study showed prevalence rate of subdistrict with congenital

hypothyroidism (1 persons) during years 2007 2011 were 0.94%, 4.72%, 7.55%, 5.66% and

5.66%, respectively. The area reported to have congenital hypothyroidism repeatedly was

1.89% during five years (Table2).

The association among environmental factors, health service factors and congenitalhypothyroidism

The results from univariate analysis of poisson regression was used to examine congenital


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hypothyroidism and factories (>17-31, >31 factories, compared with less than 10 factories)

were significant in year 2010 (p-value4 factories, compared with less than 1 factories) were significant with

disease during years 2009 (p-value < 0.01, 95%CI: 26.29-29.57, 26.26-29.12) and during years

2010 (p-value < 0.01, 95%CI: 25.25-29.78, 25.61-29.19). Agricultural area and antenatal care

was not significant with disease (Table3).The result from adjusted by multivariate technique of poisson regression was used to

examine congenital hypothyroidism and chemical and plastics industry (3-4, >4 factories,

compared with less than 1 factories) was significant with disease during years 2009 (p-

value12,035 rai, compared with less

than 2,443 rai) was adjust associated with congenital hypothyroidism during year 2009 (p-value

< 0.001, 95%CI: 24.50-29.91, 24.43-30.20) Table4).

Geographical distribution of congenital hypothyroidism and environmental factors , health

service factors

The number of subdistrict with prevalence rate of congenital hypothyroidism (1 persons)during year 2007 2011 were 1, 5, 8, 6, 6, respectively (Figure 1).

The number of subdistrict with factory (31 factorys) during year 2007

were 29, 28, 25, 24 during year 2008 were 30, 29, 25, 22 during year 2009 were29, 31, 23, 23

during year 2010 were 29, 28, 26, 23 and during year 2011 were 25, 31, 24, 26 (Figure 2).

The number of subdistrict with prevalence of chemical and plastics industry (19 factorys) during year 2007 were 35, 21, 30, 20 during year 2008 were 35, 28, 25, 18

during year 2009 were 34, 23, 24, 25 during year 2010 were 24, 30, 29, 23 and during year

2011 were 26, 28, 26, 26 (Figure 3).

The number of subdistrict with agriculture area (12,035

rai) during year 2007 were 26, 31, 23, 26 during year 2008-2010 were 24, 29, 27, 26 during

year 2011 were 26, 27, 27, 26 (Figure 4).

The number of subdistrict with prevalence of antenatal care (35 persons)

during year 2007 were 29,7,11,19 during year 2008 were 37,22,7,15 during year 2009 were 26,

28, 7, 20 during year 2010 were 36, 21, 6, 18 and during year 2011 were 21, 23, 17, 20 (Figure

5).


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Table 1 The number and percent of general characteristics.

*The total of newborns using newborns during year 2011 and have missing data as follow; year

2007 (37.7%), 2008-2011 (23.6%)

Table 2 The prevalence rate of congenital hypothyroidism


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Table 3 Factors associated with congenital hypothyroidism

a. Hessian matrix singularity is caused by this parameter. The parameter estimate at the last

iteration is displayed.

b. Set to zero because this parameter is redundant. * statistical significance at


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Figure 1 spatial distribution of prevalence rate of subdistrict with congenital hypothyroidism in NakhonPathom province during years 2007 2011

Figure 2 spatial distribution of subdistrict with factory in Nakhon Pathom province during years 2007 2011.

Figure 3 spatial distribution of prevalence rate of subdistrict with chemical and plastics industry inNakhon Pathom province during years 2007 2011.


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Figure 4 spatial distribution of agriculture area in every subdistrict of Nakhon Pathom province duringyears 2007 2011.

Figure 5 spatial distribution of prevalence rate of subdistrict with antenatal care in Nakhon Pathomprovince during years 2007 2011.

DISCUSSION AND CONCLUSIONThe prevalence rate of CH in Nakhon Pathom province during five years study was

approximately 0.13 : 1,000 newborns and end up 0.78 : 1,000 newborns by year 2011. The

prevalence rate in Thailand affects about 1:4,000 newborns. Therefore, the prevalence rate of

CH in Nakhon Pathom province more than prevalence rate in Thailand that year 2008-2011

(Department of medical Sciences Thailand Ministry of Public Health). The prevalence rate of

subdistrict with CH during years 2007 2011 were 0.94%, 4.72%, 7.55%, 5.66% and 5.66%,

respectively. The problem was incerased in severity from year to year.

In this study, the majority of subdistricts consisted of factory were


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33.0%, 25.5%, 31.1%, 23.6%). The result has found agriculture area and factory in all

subdistrict.

The present study shows that association factory, chemical and plastics industry, agriculture

area and antenatal care with CH. This study showed industrial type of chemical and plastics

production (1-2, 3-4 factories) was adjust associated with CH during year 2010 (p-value< 0.01,

95%CI:21.53-29.16, 22.96-30.20) and during years 2011 (1-2 factories, p-value< 0.01, 95%CI:18.09-23.63). The previous study found the substances or compounds in this industry that may

affect thyroid function such as polychlorinated biphenyls (PCBs), bisphenol-A and styrenes.

The effects of PCBs and Bisphenol-A were direct actions on the thyroid hormone receptor. The

effects of styrenes was inhibit T4 and T3 (Pearce & Braverman, 2009). Therefore, the

prevalence of subdistrict with CH was may correlation with compounds in industrial type of

chemical and plastics production.

Agriculture area (2,443-6,104, 6,105-12,035 rai) was adjust associated with CH during year

2009 (p-value< 0.01, 95%CI: 25.29-31.05, 23.84-30.57). The previous study about pesticide use

and thyroid disease among women in the agricultural health study in 1993-1997 North Carolina,

and was increased odds of hypothyroidism with ever use of organochlorine insecticides

(ORadj=1.2 (95%CI: 1.9-5.1)) and fungicides (ORadj=1.4 (95%CI: 1.1-1.8) (Whitney, et al.,2010). And previous study that study association between organochlorine and thyroid hormone

levels in cord serum: A study from north Thailand that found levels of

dichlorodiphenyldichloroethylene (DDE), dichlorodiphenyl trichloroethane (DDT),

dichlorodiphenyl dichloroethane (DDD) and dierin in maternal serum were positively

associated with levels in cord serum(r=0.86, 0.77, 0.66 and 0.60, respectively; p-value 19 factories) and agriculture area (6,105-12,035,

>12,035 rai).

The result of present study Nakhon Pathom province have CH all five years and have

factorys in all subdistrict, especially chemical and plastics industry may cause some effects on

CH.

SUGGESTIONS

The study showed CH in risk area. Therefore, surveillance the risk areas of CH in Nakhon

Pathom province. Further research is needed to correlate this disease with chemical and plastics

industry and agriculture area.

ACKNOWLEDGEMENTSThe authors would like to thank the community hospital, department of district office of

agricultural and department of industry works for data collection, Grant to Support Graduate

Students in Academic Presentations in Thailand Academic Year 2012. The authours also wish

to expess thanks to Dr. Kitiphong Harncharoen (Department of Epidemiology, Mahidol

University) for editing this research.

REFERENCES

Asawasinsopon R, Prapamontol T, Prakobvitayakit O, Vaneesorn Y, Mangklabruks A, & Hock

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Beardsall, K., & Amanda L. (2004). Congenital hypothyroidism. Current Paediatrics, 14, 422429.

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