Prof V.Ramlingaswami surveyed the Kangra district in Himachal pradesh during the period, 1956–1972, Wherein 1 lack school children were surveyed. Intervention was planned and the area was distributed in zones. Zone A was supplied with ordinary salt. Zone B received salt + potassium iodide. The results showed that the goiter rate dropped from 40% in 1956 to 19% in 1962, in zone B.
This study is well known as Kangra Valley study. Government of India realised the magnitude of the problem and launched a 100% Centrally Sponsored Programme called National Goiter Control Programme in 1962. In August 1992 this programme was renamed as National Iodine Deficiency Disorders Control Programme with a view to conver the wide spectrum of Iodine Deficiency Disorders like mental and physical retardation, Deaf – mutism, cretinism, still births, abortions.
International focus on elimination of Iodine Deficiency Disorders reflected in passing resolutions in world summit for children held at New York in September 1990, 43 rd world health assembly held at Geneva in may 1990, SAARC conference on children of South Asia held at Colombo in Sept,1992. India as a signatory to these resolutions reiterated its commitment to eliminate IDD.
Now, from 2 lacs tonnes of annual production, more than 40 lacs of annual production has been achieved. India is second largest manufacturer of Iodized Salt in the world after China. Presently 4.00 million tones of Iodized Salt in produced.
In last 50 years many countries in North America, Asia, Europe have eliminated IDD with Salt Iodization. For example, cretinism, Goiter have been eliminated in Switzerland due to salt Iodization since 1922.
As per WHO estimate about 30 % of world population is reported to have IDD.
As a Public Health Problem IDD is reported from 110 countries which account for 46% world population.
Elimination of IDD from the world is receiving highest priority from WHO, which is a reflected in the subject selected for discussion at 97 th session of the executive board and 49 th world health assembly held in may 1996. In 1995, a inter country conference was organized by international council for control of IDD, UNICEF, Canadian international Development, micronutrient agency Govt. of Bangladesh at Dhaka. The main theme of this meeting was commitment to the goal of eliminating IDD.
There are series of declarations at the following events
- International Conference on Nutrition, Rome in 1992.
- Rawalpindi resolution on children of South Asia at.
- “Third SAARC ministerial Conference on children of South Asia”.
- Surveys to assess the magniutde of the Iodine Deficiency Disorders.
- Supply of Iodated salt in place of common salt.
- Resurvey after every 5 Years to assess the extent of Iodine Deficiency Disorders and the impact of iodated salt.
- Laboratory monitoring of iodated salt in urinary iodine excretion.
- Health education.
Strategy of National Iodine Deficiency Disorders Control
Intervention strategies in prevention and control of IDD
Method for iodine supplementation and associated difficulties
- Iodized salt.
- Iodized salt by injection.
- Iodized oil by mouth.
- The highly volatile nature of iodine in all forms, potassium iodide ( ki) being the most volatile and potassium iodate ( KIO3) the least, makes production and quality assurance of iodinated salt quite difficult.
- The problem may be compounded due to fragile distribution network and faulty preservation system, e.g. salt may be left uncovered or exposed to heat. Addition of salt after cooking to reduce loss of iodine is advocated.
- The last but not the least difficult task is to ensure actual consumption of salt. Though the addition of iodine makes no differences in the taste of the salt, but the introduction of a new variety of salt, where a familiar one is already available, is likely to be resisted. Thus it is quality important to create a high demand and preference for iodized salt to be used in households.
In order to make the national programme of IDD elimination possible, it is important to take up effective steps in the following directions
- Advocacy efforts create awareness – The impact of iodine deficiency on the next generation and its potential economic impact need to be highlighted.
- Education of the masses through IEC materials will assure a demand for iodized salt.
- Formulation of legalization that only salt with specific iodine content should be produced or imported, guarantees that only iodized salt is available in the market.
- Quality assurance procedures should be opted for production, distribution and marketing of salt.
- A strategy needs top be established to verify the extent and nature of the IDD problem.
Guidance to medical officer, team at district training Centre and review in monthly meeting about spot testing of salt sample and Collection of Urine Sample.
Dy. Director of Health Services (IDD) is responsible for the implementation of National Iodine Deficiency Disorders Control Programme by CME about IDD, functional status of various district Public Health Lab and Regional Public Health Lab, Co-ordination in various sectors like Food and Drug Administration (FDA), Civil Supplies Department, Tribal Development Department, ICDS wing of Women & Child Department, Workshop in various medical collages involvement of Municipal Corporation.
Services to Common People
The anganwadi workers. MPW’s at PHC, ANM’s at Sub–centre can have Spot – testing of salt and also estimation of Iodine content salt in Public Health Laboratories can be done free of charge for a common man directly or through health workers.
Urinary Iodine estimation is done at Aurangabad, Nasik, Nagpur, Pune regional public health laboratories at no charges.
Medical Officer at PHC, Sub–district hospital, Rural Hospital, examines for the diagnosis of goitre in out patient department and treatment can be obtained free of charge.
Service Centers Available in each District ANM/MPW at sub – Centre/PHC can accept salt sample and sent to district Public Health Lab for estimation Iodine content.
In some high risk pregnancies the Urinary Iodine Estimation can be done by sending the sample to public health laboratory at Pune, Nasik, Nagpur, Aurangabad.
The medical Officers at PHC, Rural Hospital, District Hospital examine the patient for any swelling in the neck and give free treatment.
Performance – District Wise
Survey is done in various districts the results are as follows
|Sr.No||District||Survey year||Goiter cases in surveyed % population|
Re–Survey is done in various districts the results are as follows
|Sr.No.||District||Year of Re–Survey||Goiter cases in surveyed % population|
Field staff working under District Health Officer & Civil Surgeon collects salt sample
Urinary Iodine Estimation is done at Pune & Nagpur Public Health Lab, Results are as follows
|Year||Total Sample||50–99 micrograms||20–50 micrograms||Below 20 micrograms|
Special Features of Programme
The role of micronutrients is increasingly getting appreciated. Iodine is one of the important micronutrient. It is required to the extent of 150 microgram per day.
0–5 yrs: 10 Micrograms
6–12 yrs: 120 Micrograms
above 12 yrs: 150 Micrograms
pregnancy: 200 Micrograms
Normally, to the source of iodine is the plants Vegetables, animal products.
About 4 lack tones of Iodine is evaporated from Sea and by rains it is available in upper layer of soil.
The plants absorb iodine from the soil. But due to industrialization, tree felling etc, there is erosion of soil. Due to erosion the upper layer of sail is lost and so, also the iodine content is lowered.
Due to deficiency of Iodine there is wide spectrum Disorders called Iodine Deficiency Disorders.
Spectrum of Iodine Deficiency Disorders
|Increased Prenatal Mortality|
|Neurological Cretinism||Mental deficiency|
|Child and Adolescent||Goiter|
|Impaired mental function|
|Retarded physical developement|
|Adult||Goiter with this complications|
|Impaired mental function|
Due to loss of IQ by 10–15 points and decrease in the activity of all members of society due to deficiency of iodine results in adverse effect on economy. The IDD is a problem of all the states in the country. Sample survey conducted in 28 states and 6 UT has revealed that IDD endemic 254 district out 0f 312 districts.
So, this major public Health problem needs to addressed urgently by adopting various strategies like universal consumption of iodized salt, increased awareness at all levels, Surveillance etc.
Achievements of National Iodine Deficiency Disorders Control
Due to sustained support of GOI, UNICEF the iodized salt production has increased from 2 lacks tones in 1984 to 40 lacks tonnes currently. Initially only Government was the sole manufacturer of iodized salt. But with efforts of UNICEF & GOI, the private sector has taken a lead in this area.
The quality of iodized salt is also monitored and following table shows the betterment in this aspect.
Urinary Iodine is good objective indicator of status of iodine. Till to 2003 only 2 laboratories were with the facility of estimation of Urinary iodine. But now this facility is available at 4 divisional place Aurangabad, Nashik Nagpur, Pune. Results of the investigations as follows:
This issue was discussed in state level meeting of Civil Surgeon, District Health Office, Dy. Director of Health Services. Every district level officer was given a CD about IDD.
At DGHS level meeting were held for sectoral co–ordination of FDA, Food & Civil Supplies, Women & Child health department, UNICEF, Dy. Salt commissioner etc.
Survey of the cases of Goiter is conducted in about five districts every year. The health worker visits houses and notes the cases of goiter. Cluster survey is uner taken in each taluka. One percent of the villages and 5% of school childern are surveyed.
During 2006–07 the state has proposed 23 districts goiter endemic district and tribal district. Painting of Slogans on 1500 S. T. Buses inside front panels for Iodine Deficiency.
Expected Community Participation
IDD is a sort of hidden problem, affecting almost all the members of society. IDD affects the economy of the state. Hence, the community participation is more important. The use of iodized salt by every person, will solve the problem to a large extent. The price difference between Crystal Salt and iodized salt will be less if large section of society uses iodized salt.
Every person takes about 10 gm Salt per day, so a family of 5 persons will need about 1.5 kg of salt per month. The expenses of Rs. 5 per month is too small and any family can bear it.
Quality of salt is also important 15 ppm is desired content. Members of society can have salt tested in district Public Health Laboratories free of charge.
Salt is a food item, if iodine is below 15 ppm, FDA can be contacted and the shopkeeper can be prosecuted for adulteration. The member of society can impress upon their representative for better policy like PDS & iodized salt.
Role of Other Sectors
IDD is a multi-sector involving problem. Food & Civil Supplies Department in 6 states in the country have taken up iodized salt in PDS. This can be followed by our state.
IDD affects the women & Children by lowering IQ, retardation of physical and mental growth, increased abortions, increase in congenital, abnormalities, the department may lead for PDS in iodized salt and health education by anganwadi workers & other means.
The prevalence of goitre is more in tribal regions. Therefor it is essential that at least in IDD prone areas iodised salt should be distributed by PDS.
The role of Food & Drugs Administration for preventing adulteration of salt is very important and the prosecutions may be launched against tthe culprits responsible for sub-standard quality of iodized salt.
Planning department can take initiative for the iodized salt in PDS as per GOI policy.
Department of Education can take active part by health education for the school children.
The rural development department and Social Welfare department can direct for only iodized salt in their hostels etc.
The deficiency of iodine results in loss of 10-15 points of Intelligence Quotient (IQ) in a school children. This is seen in the studies done in 22 countries.
so, also activity of all the members of society is affected. This all causes adversity foe economy. IDD also include decrease of birth weight, increase of infant mortality rate etc. Preventation of mental retardation, will help to reduce burden on society.
So, for smart, bright, healthy feature generation iodized salt consumption is so much required.