Endemic goitre: a preventable and yet highly prevalent disease in Sarawak.

Endemic goitre constitutes an important disease problem in many parts of the world. Kelly and Sneddon (1960), in an extensive review of the literature, estimated the number of goitrous subjects in the world to be about 200 million. Goitre has also been reported to be endemic in many areas of Southeast Asia including Sarawak in Malaysia (Fig. 1). Studies (Polunin, 1971; Alexander, 1979) indicate that the prevalence of goitres, among women 15 years and above, in most parts of Sarawak varies from 40 percent to 50 percent and that the most affected division in Sarawak is the 2nd Division with an average prevalence rate of 62 percent to 74 percent, while the Lubok Antu district of that division exhibits the very high rate of 99.5 percent (Maberly and Eastman, 1976). It is quite possible that this is one of the highest prevalence rates anywhere in the world, Kochupillai et al. (1973) having reported that the highest prevalence rate in the Himalayan region was 98 percent. Maberly and Eastman (1976) estimate the prevalence of neurological cretinism, in the highly goitrous Lubok Antu district, to be 3.6 percent.