3.3 AFRICAN REGION

An extensive report (WHO, 1984) provides a valuable survey (see Table 6). The situation is summarized as follows (see also Table 9).

1. Goitre. Practically all countries of the region have significant goitrous areas and in some of them the problem is severe, e.g. 85 percent of female children aged 11-15 years in East Cameroon had palpable goitres of grades 1 to 3 (see Table 9).

2. Control is relatively easy from the technological viewpoint, by

a) iodized salt;
b) injecting iodized oil (every five years).

The strategy proposed by the WHO Africa Regional Office is to iodate salt where feasible within the country, preferably at national or provincial level, and (simultaneously or afterwards) deal with the remaining pockets by injections of iodized oil.

For most countries what is lacking is the political will, backing, and financial resources for the necessary intersectoral action, since the Implementation of such a programme necessitates at least the cooperation of the Ministries of Health, Trade and Commerce, Finance and sometimes other specialized bodies (laboratories for quality control of iodated salt, etc.).

More detailed data from Algeria, Zaire and Senegal have recently been published (Benmiloud and Ermans, 1986). The roles of retinol deficiency in Senegal and cassava consumption in Zaire have been identified as exacerbating the effects of iodine-deficiency. The fragmentary nature of the data from east, central and southern Africa has been pointed out (Volde-Gebriel, 1986).

Difficulties in Tanzania mentioned by Kavishe et al. (1981) include defining the magnitude of the problem, lack of laboratory facilities, the technology and organization of salt iodization at sector level, manpower and staff training. Recent data are given by Ekpechi (1987).

It seems likely that there is a high prevalence of goitre throughout the extensive southern Africa plateau which includes large areas of Zimbabwe, Zambia, Botswana and Mozambique, all of which have substantial IDD problems. In Zimbabwe, cretinism has been seen only in the more remote eastern highlands, justifying overall classification of the IDD problem as moderate.

TABLE 9

PREVALENCE OF ENDEMIC GOITRE IN SELECTED AREAS OF AFRICA

Country		Palpable goitres grades 1-3 (%)(1)		Visible goitres grades 2-3 (%)(1)
Cameroon
East Cameroon:
Adults:		M 48	F 70.7	-
Children:	11-15 yrs.	M 61.5	F 85.1	(grade 3) 1.3-12
	5-17 yrs.	M 51-85	F 59-92
West Cameroon:
Children:	5-17 yrs.	M 40-58	F 37-70
Ethiopia
ICNND 1959 (2)
Molineaux -	Gondar	M 10-14	F 30-39	4-12
				47
				90
Hofvander	Ijaji			27
	Bako			53
Ethiopia Nutrition
Institute (1978)
	Bora		53	28
	Ankober		71	48
	Ebantu		28	5
	Bure		67	37
Cote d'lvoire
9 subprefectures
	0-7 yrs.	M 66	F 7.1	-
	8-15 yrs.	M 11.9	F 12.9	-
	16-25 yrs.	M 4.2	F 15.9	-
	25	M 9.3(32)	F 32.1	-

(1) See Section 7 for definition of grades
(2) ICNND - Interdepartmental Committee on Nutrition
M = Male
F = Female for National Defence (USA)

Country	Palpable goitres grades 1-3 (%)		Visible goitres grades 2-3 (%)
Kenya
Eburu Naivasha
(Rift Valley)	M 41	F 60	M 18		F 39
Roret (Kericho)	M 40	F 58	M 16		F 32
Lesotho (1957-58)
	M 30-50
	(41)
(1-12 years)			M 7		F 9
(13-18 years)			M 14		F 22
(above 18 years)			M 23		P 15
Mali
Pales 1948	10.2%
Hellegouarch 1968:
Boubouni	F 24-41	M 13.25
Bandiagara	F 43-69	M 30-63
Ag Rhaly
1974 Icati, Dio, Neguela	42-97
1975 quartier Samakebougou (Kati)	F 53	M 48
1976 Neguela	F 67	M 53
1978 Neguela-Koulikoro (Ile Region)	48-72
Nigeria
1966 Nwokolo, Ekpeche & Nvokolo Nsukka	F 14-59	M 15-20
Ogoja	P 10-81	M 26-58
1965 Nutrition Survey,
Nigeria
Lagos (children)	F 11
Savannah (5-15 yrs.)	F 15
Plateau (5-15 yrs.)	F 10
Jos/Pankshin (5-llyrs)	F 16	M 14
Asaba (5-11 years)	F 42
Olurin 1970-74
Oyo	12-32
Ashoun	15-50
Ijesha	18-32
Ekiti	20-37
Afemai	16-20
Senegal
Children
6-12 years:	M 32	F 41
13-18 years:	M 26	F 36	Casamance
			F 11 - 48
			Eastern Senegal
			F 23 - 51
Adults	M 18	F 50
Sierra Leone
South-Eastern Province
Kono	56
Koinadugu-Koranko	M 43	F 71	-
Kenema, Kalhun	M 19	F 25	-
Lowlands	0		-
Burkina Faso (all ages)	7.7 (0-18% Didougou)		-
Zambia	M 42	F 59	M 8	F 19

Source: Goitre Control in the African Region. WHO, 1984

Conclusion

In general, only fragmentary data are available for Africa and technical resources are severely limited. More attention to the IDD problem in Africa is urgently required. In southern Africa salt iodization could be an effective solution. In more severe endemias such as Zaire iodized oil has been used and will probably need to be continued. Many other countries fall between these extremes.