الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Our study concluded that regarding sociodemographic characteristics, nearly half of the cases were females and about two thirds of cases were rural residents. Significant sociodemographic factors associated with the development of CH were: critically young maternal age, parents’ illiteracy and non-working for cases mothers. Neither residence nor birth order showed statistically significant difference between cases and controls Significant family related factors associated with CH were consanguinity among parents, family history of thyroid diseases, CH sibling/s, father’s smoking and usage of non-iodized salt. As regards perinatal factors twin pregnancy, NICU admission and associated congenital anomalies where the statistically significant factors associated with CH, whereas maternal diseases, maternal drug usage, history of having antenatal care and type of delivery showed no statistically significant difference between CH cases and controls. Our study reported that despite early diagnosis of CH and initiation of hormone replacement therapy there was a statistically significant difference between CH children and normal children in growth and developmental milestones as CH children were significantly overweight, stunted and developmentally delayed. Our study documented that regarding CH cases thyroid profile and its effect on growth and development, one fifth of our cases had subclinical hypothyroidism and 15% had overt hypothyroidism. Thyroid function test results were not significantly associated with defects in growth whereas overt hypothyroid children showed significant developmental delay. Based on our study the statistically significant independent risk factors that were associated with CH occurrence were consanguinity, family history of thyroid diseases, non-iodized salt consumption, twin pregnancy, critically young maternal age, NICU admission, and sibling with CH and associated birthdefects.
Mass media: health education campaigns should be initiated and maintained for raising awareness about CH including the risks of consuming non-iodized (un-packed) salt in preparing food and about the risk of consanguinity and early marriage. Ministry of supply and internal trading: the salt iodization program in Egypt must be properly monitored to achieve proper alleviation of iodine deficiency with its consequences as CH, un-packed salt that used for industrial purposes should be labeled and raising efforts by food safety officers for discovering it’s selling for food preparation and signing the maximum penalty for this as misdemeanor. MOH: adding TSH and free T4 testing to the routine antenatal care program once every trimester and estimation of urinary iodine for pregnant mothers as a screening and management of detected iodine deficient cases. For healthcare providers: During antenatal care: Activate health education about importance of iodine should be stressed (it’s already a part of health education curriculum). High risk pregnant women (gestational diabetic mothers, personal or family history of thyroid disease, recurrent abortion or stillbirths and past history of CH child) should be referred for testing their thyroid profile and strictly followed up. During follow up of CH child at health insurance clinic: IQ testing for all CH cases. Accurate growth monitoring for all CH cases. Thyroid ultrasound examination and thyroid scan if needed to differentiate the cases of CH either permanent or transient. Referral of the family for genetic counseling to take a detailed history and discover the familial factors of the disease. Designing and implementing a protocol for CH case examination to discover other birth defects that co-exist with CH including: Full clinical examination. Echocardiography. Abdominal ultrasound. Special careful follow up is mandatory for Down syndrome children as they show mild lab finding in the first screening and deteriorates with time. Proper medical recording system for: Follow up card with the cases to take home so medical staff can follow up their compliance. CH child family and medical history and time of starting the treatment. Follow up visits including growth monitoring and developmental milestones for early detection of any delay Follow up periodic thyroid function tests of each case. Further studies: Further studies are needed to: Detect scholastic achievement and adult IQ in CH cases Distinguish temporary from permanent CH. Address the effect on other age groups. Compliance of treatment and its effect on growth and development Discover the relationship between hearing impairment and CH in basis of new screening program implemented for hearing impairment. CH is deficiency in THs in utero, since it’s the most common preventable cause of mental retardation. It is a typical disease for screening that is why neonatal screening is a public health concern. CH is known to be associated with many risk factors, family related factors (consanguinity, non-iodized salt consumption…etc.) and perinatal factors (prematurity, twin pregnancy, associated congenital anomalies…etc.) and it has a wide range of effects including growth retardation and developmental delay, it also affects heart rate, body metabolism and respiratory rate. Our study aims to study the risk factors associated with CH in Assiut governorate and the effect of CH on growth and development using a case control study nested in a cohort implemented on 354 children (118 cases and 236 controls) implemented in Assiut governorate for one year from October 2017 to September 2018, data were collected from Sedi-Galal health insurance clinic and 3 chosen PHC centers. The risk factors were studied using semi-structured questionnaire and growth was classified by measuring weight and length/height while developmental delay was screened using Arabic translated ASQ3. Our study revealed that the significant family related factors associated with CH in Assiut governorate were consanguinity, family history of thyroid diseases, CH sibling/s, father’s smoking and usage of non-iodized salt and regarding perinatal factors; twin pregnancy, NICU admission and associated congenital anomalies where the statistically significant ones. Bi niary logestic regression revealed that the independent risk factors associated with CH were: consanguinity, family history of thyroid disease, iodized salt consumption, twin pregnancy, critically young maternal age, NICU admission, sibling/s with CH and associated birth defects. As regards growth and developmental milestones; overweight and stunting were higher among children exposed to CH (7.6% versus 2.1% and 47.5% versus 25.0% respectively). children exposed to CH showed developmental delay in the screened 5 developmental domains: communication domain (14.4% versus 2.5%), Gross motor domain (29.7% versus 5.9%), fine motor domain (13.6% versus 5.9% ), problem solving domain (10.2% versus 3.8%) and personal-social domain (11.9% versus 1.3%) for cases and controls respectively. Regarding thyroid functions of CH cases, 15% of cases had overt hypothyroidism and 23% had subclinical hypothyroidism, overt hypothyroidism cases showed statistical significant developmental delay in communication domain (64.7% versus 6.9%), gross motor domain (42.9% versus 3.6%), fine motor domain (43.5% versus 10.8%) and personal-social domain (42.9% versus 11.5%) for delayed and normal respectively, TSH level was significantly higher in cases with developmental delay in these 4 domains. The study concluded that the independent risk factors associated with CH were: consanguinity, family history of thyroid disease, iodized salt consumption, twin pregnancy, critically young maternal age, NICU admission, sibling/s with CH and associated congenital anomalies. Our study recommends: Health education campaigns about CH and its associated risk factors Adding thyroid profile testing to antenatal care program, IQ testing of all CH cases, and designing a protocol for examining CH children for associated congenital anomalies. Improving the recording system and documentation of the treatment, compliance and follow up assessment results in the health card of the child to be retrieved easily. further studies are mandatory to confirm our results, study the effect of age at onset of treatment and compliance to treatment on development in case of CH.