Indian Pediatrics 2001; 38: 654-657
Assessment of Current Status of Salt Iodization at the Beneficiary Level in Selected Districts of Uttar Pradesh, India
Department of Human Nutrition, All India Institute of Medical Sciences,
New Delhi 110 029, India.
Manuscript received: July 31, 2000; Initial review completed: September 4, 2000; Revision accepted: November 23, 2000.
Iodine Deficiency Disorders (IDD) are a major public health problem in India. Goiter surveys conducted in 275 districts of 25 states and 4 Union Territories in the country have identified 235 districts as endemic for IDD(1). Earlier surveys conducted by a National Goiter Team reported a high goiter prevalence rate in many districts of Uttar Pradesh State(1).
The Government of Uttar Pradesh, under the National Iodine Deficiency Disorder Control Programme (NIDDCP), has adopted a policy of Universal Salt Iodization (USI) under which the entire population of the state is to receive edible salt with a minimum of 15 ppm of iodine(2) facilitated through Salt Department, Government of India. The present study was conducted to assess the current status of salt idodization at beneficiary level in districts of three regions of the UP State.
The study was undertaken in 17 districts of UP from June 1998 to December 1998. The districts were selected by purposive sampling on the basis of geographical location, distance from salt unloading railway station and mode of procurement of salt (road/railway or both). According to WHO/UNICEF/ICCIDD guide-lines for a rapid assessment of salt iodization status in a district, 100 salt samples should be collected from 10 remote villages in order to assess the availability of iodized salt(3). In the present study 200 salt samples were collected utilizing this approach.
Household base surveys provide true picture as they are representative of all house-holds in specified geographical area. However, they are more time consuming. School based surveys are rapid, although there is a potential of bias if proportion of children who attend school is low. In the present study, in all the selected districts the school enrollment was more than 80% and hence, school based survey was conducted that provided rapid and adequate data on salt iodization.
In each district, one block at least 30 km away from the distrtict headquarters was selected. In the block selected, one high school was further selected. The children of the eighth and ninth standards belonging to different villages were identified and included in the study. These school children were briefed about the study objectives and were given autoseal polyethylene pouches with an identification slip. They were asked to bring about 20 g of salt being used in their family kitchen. The iodine content of all the salt samples collected was analyzed by using the standard (iodometric titration) method(4).
A total of 4576 salt samples were collected from 17 districts in the state (Table I). It was observed that out of a total 4576 samples, 2.7% had nil iodine content and about 43.0% salt samples had adequate iodine (³15 ppm). Districts Meerut, Agra, Bareilly, and Lakhimpur procured salt by road transport and had higher percentage of samples with nil iodine content (Table I).
Out of 3112 powdered salt samples collected, only 3.4% had nil iodine content and 56.5% iodine content of 15 ppm or more. Of the 1464 crystalline salt samples collected, 1.4% had nil iodine content and 84.1% had iodine content of less than 15 ppm. Districts (Agra, Meerut, and Bareilly) which procured iodized salt from Rajasthan (the salt producing state) by road transport had more salt samples with nil iodine content. The movement of iodized salt by road transport is not monitored for its quality by the Government of India.
The Government of UP has banned the sale of non-iodized edible salt since 1984(5). However, in the present study, 2.7 and 57% of total families surveyed were consuming salt with nil and <15 ppm of iodine, respectively. These findings revealed that the salt was being iodized. However, either an inadequate quantity of iodine was added to it at the production level or there were losses of iodine during the different points of distribution network. Evaluation studies conducted earlier have also yielded similar conclusions in Madhya Pradesh, Himachal Pradesh and Punjab.
Crystalline salts are also iodized at the level of production. A higher percentage of crystalline salt samples (85.0%) as compared to the powdered salt samples (43.0%) had iodine content of less than 15 ppm. The possible reasons for this observation could be storage of crystalline salt outside the shops where it is exposed directly to sunlight and rain. These factors are known to cause loss of iodine. Similar findings have been reported earlier(6,7).
It was found that the districts receiving iodized salt by road had a higher number of salt samples with nil iodine content as compared to the districts receiving iodized salt by rail transport. The quality of salt transported by railways is vigilantly monitored by the inspectors of the salt department before it is loaded to the train. However, no monitoring of quality salt is done for transportation of salt by roadways.
The findings of the present study revealed that there is a need of strengthening the system of monitoring the quality of salt by the State Government to ensure the availability and consumption of salt with 15 ppm of iodine by the population as envisaged under National Iodine Deficiency Disorders Control Program.
We would like to thank Dr. Shiela Vir for her kind support and guidance during the different stages of the research study. We are grateful to Mr. R. Prakash, the Salt Commissioner for the help and encouragement extended during the survey. School principals, teachers and students are duly acknowledged for their kind cooperation in the data collection.
Contributors: UK co-ordinated the study and collected the data; he will act as the guarantor for the manuscript. MT, PP and RP analyzed the salt samples and also helped in drafting of the paper.
Department, Government of India, Jaipur.
Table I - Iodine Content of "Total Salt Samples" collected at Beneficiary Level in Uttar Pradesh
( Figures in parentheses denote percentages.)