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Iodine Deficiency, Worldwide Health Problem

by Pravakar Sahoo

Iodine deficiency is a major public health problem worldwide. The available information indicates that there are nearly two billion people with iodine deficiency worldwide. Though there has been substantial progress in the last decade, there remain challenges in achieving a sustainable elimination of IDD.

In India , IDD has been identified as a public health problem. Recognising the importance of elimination of IDD as a health and developmental goal, the Government of India launched the National Goiter Control Programme

in 1962; which was renamed as National Iodine deficiency Disorders Control Programme (NIDDCP) in 1992.

A total of 263 districts out of 324 were found to be endemic for IDD (i.e. prevalence of IDD is greater than 10 percent). It is estimated that more than 71 million individuals are suffering from goiter and other IDDs, while 200 million people are at risk for IDD.

For the elimination of IDD in India , the main strategy adopted under NIDDCP is iodisation of salt. In November 2005, the Union Ministry of Health and Family Welfare issued a notification banning the sale of non-iodised salt for direct human consumption throughout the country under the Prevention of Food Adulteration (PFA) Act to be effective from May 17, 2006

Iodine deficiency is the single most common cause of preventable mental retardation and brain damage in the world.

It also decreases child survival, causes goiters, and impairs growth and development. Iodine deficiency in pregnant women causes miscarriages, stillbirths, and other complications. Children with IDD can grow up stunted, apathetic, mentally retarded, and incapable of normal movements, speech, or hearing. Globally, 2.2 billion people (38 percent of the world's population) live in areas with iodine deficiency and risk its complications.

Iodine deficiency was once considered a minor problem, causing goiter, an unsightly but seemingly benign cosmetic blemish. However, it is now known that the effects on the developing brain are much more deadly, and constitute a threat to the social and economic development of many countries.

The effects of IDDs: On individuals – goiter, hypothyroidism, and loss of energy; in pregnant mothers – miscarriages, stillbirths and mentally retarded children; and in children – impaired mental and physical development, mental retardation, physical deformities and cretinism.

Effective and affordable technology exists to prevent iodine deficiency and the problems it causes. The most important are iodised salt and effective monitoring of iodine nutrition.

The solution is relatively simple. A teaspoon of iodine is all a person requires in a lifetime, but because iodine cannot be stored for long periods by the body, tiny amounts are needed regularly.

In order to deal with the situation, the National Iodine Deficiency Disorders Control Programme (NIDDCP) was started in Odisha in December 1989. It is a 100 percent Central Plan Scheme.

Among other things, the aim of the programme is to prevent IDDs by monitoring progress towards achieving long-range goals to create awareness among the people through IEC activities regarding use and benefits of iodised Salt.

Further, the programme in Odisha aims to conduct IDD/Goiter survey in remaining un-surveyed 20 districts in a phased manner taking help of the three medical colleges of the State.

Efforts are already on to achieve the goals. But robust and continuous government commitment and industry motivation were still essential.

Partnerships between governments and donors, between governments and salt producers, and among all those supporting elimination efforts need to be strengthened at all levels.

The salt industry must recognise iodisation as a fundamental responsibility. The government must work with salt producers to improve their capacity and producers must maintain and improve this capacity.

A continuous and effective monitoring system is also essential. Three types of monitoring are needed – covering the salt iodisation process from the factory to the household, the impact on a population's iodine levels, and the overall sustainability of the programme.

The tracking progress using all the three indicators (total goiter rate, urinary iodine excretion and salt iodine content) should be undertaken to sustain the efforts toward the elimination of IDD as a public health problem.

There is need to focus on behavior change communication to increase the consumption of inadequately iodised salt and sustain it thereafter.

Periodic monitoring with the focus on the iodine content of salt measured on a sample basis regularly is important to ensure that the consumption of adequately iodised salt exists at the household level.

Urgent monitoring of the availability and access of iodised salt to the public, and strengthening the information, education and communication programme for awareness building should be accorded top priority.

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