Prevalence and factors associated with multinodular goitre in patients attending Mulago hospital surgical outpatient department Thyroid clinic.
Kabirigo, Ibrahim Phillipo
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Introduction: Thyroid disease is estimated to affect 5% of the general population worldwide. Multinodular Goiter (MNG) is the commonest cause of Thyroid disease accounting for 15% of these patients. The burden of the disease in patients referred to Mulago Thyroid clinic has not yet been documented. Although the causes of MNG are not known, a number of factors have been associated with the disease including low Iodine intake, goitrogenic diet and environmental substances, genetic predisposition and hormonal factors. These factors have been studied in other countries and no study has been done to find out the likely factors associated with MNG in patients who report to the Surgical Outpatient in our setting. Objective: This study aimed at estimating the Prevalence and Factors associated with MNG in patients who report for surgical management at Mulago Surgical out Patient Department (SOPD). Methodology: This was a Cross-sectional study among patients attending the Thyroid clinic at Mulago Surgical Outpatient Department for the period running from 1st March 2018 to 31st of May 2018. A total of 196 patients attending the Thyroid clinic met the inclusion criteria and were enrolled into the study. A Semi-structured Questionnaire was administered to all enrolled participants. Results: Of the 196 participants who met the inclusion criteria, 69 of them were found to have Multinodular Goitre giving us a Clinic Prevalence of 35% (95% CI 28.9-42.1). Patients with MNG were predominantly female 98% as male patients were sporadic. Most patients with MNG presented with anterior neck swelling as the chief complaint (78%).Frequent Cassava diet consumption at least every week showed higher likelihood of having MNG (OR= 4.33 at 95% CI 1.97-9.50) and so was Cabbage consumption (OR=1.95 at 95% CI 0.95-3.15). History of using Non-iodized Salt in food for considerable amount of time in the patient’s life showed a higher likelihood of having MNG (OR=1.32 at 95% CI 0.68-2.56) in the participants we evaluated. Patients with parity >4 showed significant likelihood of having MNG (OR=4.05 at 95% CI 1.23-13. 27). Conclusions: Multinodular Goitre is a common diagnosis in patients attending Mulago Hospital Surgical Outpatient Department Thyroid Clinic accounting for more than a third of the presenting cases. It predominantly affects women between 30yrs to 60yrs of age. Dietary factors including Cassava, Cabbage and Non iodised salt consumption were associated with increasing odds of MNG while reproductive factors including low parity and contraceptive use were found have reduced odds of MNG. All these factors can easily be influenced through Community Health Education as a pillar for reducing the Prevalence of the disease in our setting. Recommendations: Public Health awareness is needed to sensitize our communities on possible association between MNG and excessive consumption of certain food stuffs like Cassava and Cabbage. Improved access and use of iodised salt are recommended as consumption of non-iodized salt for a significant period in the patient’s life showed higher likelihood of having MNG. Use of Modern Family Panning Methods should continue to be advocated for in our setting since higher parity was found to increase the odds of MNG and females intending to carry four or more pregnancies and those already carrying such pregnancies need to be encouraged to take iodine supplementation to reduce the likelihood of developing MNG.