Objective. To quantify the prevalence of goitre and iodine deficiency.

Setting. Ndunakazi, a rural community of approximately

8 000 people in KwaZulu-Natal. Design. A cross-sectional community-based survey and a school-based survey.

Participants. The 127 mothers and 114 children aged 6-11 years, selected during the cross-sectional survey. and 304 children aged 6-14 years, from the school-based survey.

Methods. Urinary iodine levels and thyroid size were determined and categorised according to guidelines proposed jointly by the WHO, UNICEF and the ICCIDD. Z-score anthropometric indicators were calculated, and mid-year exam marks of goitrous and non-goitrous pupils for Zulu and mathematics were compared. Results. In school-aged children, both surveys demonstrated a goitre prevalence in the 20-29.9% range and a median urinary iodine level in the 2-4.9 IJg/dl range, indicating iodine deficiency of moderate severity. Goitrous subjects scored consistently worse in their Zulu exam papers than those wIThout goitre. Stunting was not more prevalent than in the rest of Kwazulu-Natal. Iodised satt was not available in any of the three community shops.

Conclusion. This level of iodine deficiency in children can adversely affect their neuropsycho-intellectual development. Factors contributing to deficient iodine intake in Ndunakazi are present in many rural areas, and South Africa cannot afford to be overty confident about the apparent absence of iodine deficiency as a public health problem.