Indian Pediatrics 1998; 35:831-836 

Current Status of Iodine Deficiency Disorders Controls Program

Iodine deficiency is the most common preventable cause of mental. deficiency in the world today. Iodine Deficiency Disorders (100) constitute a major public health problem for India too. Out of 457 districts in the country, 275 districts have been surveyed for 100 and-235 districts have been found to be endemic. These districts cover all the states and Union Territories of India(1).

Iodine is an essential nutrient. If a pregnant woman is starved of iodine, the fetus cannot produce enough thyroxine with consequent retardation of physical and mental growth. Hypothyroid .fetuses often perish in the womb and many affected infants die within a week of birth. Hypothyroid children are intellectually subnormal and may also suffer physical impairment. Studies have documented that in areas with an incidence of mild to moderate 100, IQs of school children are, on an average, 13 points below those of children living in areas where there is no iodine deficiency(2).

Following the successful trial of iodized salt in the Kangra valley, Himachal Pradesh, a National Goiter Control Program was launched by the Government of India in 1962. The objectives of the program were: (i) to survey the problem of iodine deficiency in the country; (ii) produce and supply iodized salt; and then (iii) resurvey the area after five years to assess the impact of the iodized salt program. The objective of universal iodization of salt for human and animal consumption was added to the national program in 1983.

There has been a steady progress in the production of iodized salt over the past few years in India. The annual production has gone up from 0.5 million tonnes in 1985 to 4.5 million tonnes in the year 1996-97. There are over 600 iodization plants installed for the commercial production of iodized salt with an annual installed capacity of nearly 6 million tonnes(3).

During recent years, research surveys have been conducted to evaluate the success of National Iodine Deficiency Disorder Control Program (NIDDCP). As per recommendations, children in the age group 6-12 years were evaluated for the assessment of IDD because of their high vulnerability to disease, representativeness of their age group in the community and easy accessibility. Table I depicts the status of iodine deficiency in the selected states(4- 15). The goitre prevalence was documented to be as high as 20.5% in district Bikaner, Rajasthan to as low as 0.8% in district Pauri, Uttar Pradesh. However, when the median urinary iodine excretion cut off of ≥10 mcg/dl was used as a criterion for assessing iodine deficiency in a population no state included in the study was deficient. It was found that 68 to 100% population in the study area was consuming iodized salt.

Research surveys conducted to assess the impact of increased production of iodized salt on its availability at the beneficiary and traders level during 1996 to 1998 have also revealed successful implementation of NIDDCP program. These surveys were undertaken in identified districts of 10 States and 2 Union Territories (UTs) of the country. Table II presents the documented iodine content of salt at the beneficiary level(16-22). A total of 17,654 samples were collected. More than 90% of the salt samples were iodized with the exception of Goa and Rajasthan.

The number of salt samples which had a nil iodine content in the states/UTs studied ranged from 0 to 6% with the exception of Rajasthan (3.19%) and Goa (48.9%). In the states of Bihar, Punjab, Himachal Pradesh, and UT of Andaman and Nicobar more than 80% of the salt samples had an iodine content of 15 ppm and more.

The profile of iodine content of salt at traders level in different states of India was also assessed (Table III)(23-29). A total of 525 salt samples were collected at the traders level of which 99% were iodized. In all the states more than 70% of the salt samples had an iodine content of 15 ppm and more, with the exception of UT of Pondicherry.

Authors of a recent publication(30) conclude that iodized oil is safe, and decry the hesitation in India to administer iodized oil to areas in need while awaiting effective penetration of iodized salt. However, objective data collected recently argues strongly against introduction of this alternative technology. Dr. Gopalan has aptly concluded the "inexpensive technology, a time honored and time tested one for control of goiter is the iodization of common salt". Programs for goiter control must rest squarely and socially on this technology. It is difficult to imagine any areas in South Asia which are' now 'inaccessible' to common salt but readily 'accessible' to disposable syringes and to an army of 'injectors'(31).
 

In conclusion, recent data indicates that with continuation of the present policy of salt iodization, India can achieve the goal of universal access to. iodized salt and eliminate one of the biggest cause of preventable brain damage and many other ill effects which have a direct bearing on human resource development. We in India should only concentrate on the policy of universal salt iodization and should not venture for alternative methods of iodine supplementation like iodized oil.

Umesh Kapil,
Additional Professor,
Department of Human Nutrition,
All India Institute of Medical Sciences,
New Delhi 110 029,
India.

 

1. Elimination of Iodine Deficiency Disorders in South East Asia, World Health Organization, Regional Office for South East Asia, SEA/NUT /138,1997; pp 1-8.

2. Bleochrodt N, Born MP. A meta-analysis of research on iodine and its relationship to cognitive development. In: The Dam- aged Brain of Iodine Deficiency: Neuromotor, Cognitive, Behavioral, and Educative Aspects. Ed. Stanbury J. Report of the Franklin Institute Symposium, Publ Cognizant Communication Corporation, 1994.

3. Sunderesan S. Progress achieved in universal salt iodization program in India. In: Proceeding of Symposium on Elimination of IDD through Universal Access to Iodized, Salt. Eds. Prakash R, Sunderesan S, Kapil U. New Delhi, Shivansh Computers and Publications. 1998; pp 28-42.

4. Kapil U. Assessment of iodine deficiency in Andaman district of Union Territory of Andaman and Nicobar. Indian J Mat Chid Hlth 1998; 9: 19-20.

5. Kapil U, Singh J, Prakash R, Sunde res an S, Ramachandran S, Tandon M. Assessment of Iodine Deficiency in selected blocks of East and West Champaran districts of Bihar-A pilot study. Indian Pediatr 1997; 34: 1087-1092.

6. Kapil U, Ramachandran S, Saxena N, Nayar D. Assessment of status of salt iodization in selected districts of different states in India. Indian Practitioner 1996; 96: 965-969.

7. Kapil U, Saxena N, Ramachandran S, Balamurgan A, Nayar D, Prakash. Assessment of iodine content of salt in NCT of Delhi utilizing 30 cluster method. Indian J Pediatr 1998 (in press).

8. Kapil U, Tandon M, Pathak P. Assessment of iodine deficiency in Ernakulam district, Kerala state: A pilot study. Indian Pediatr 1998; 35: (in press).

9. Kapil U. Status of salt iodization in Una, Kangra and Kullu Districts of Himachal Pradesh. Indian J Prevent Soc Med 1996; 28: 33-36.

10. Sohal KS, Sharma TD, Kapil U. Assessment of iodine deficiency disorders using the 30 cluster approach in the district Hamirpur. Indian Pediatr 1998; 35: (in press).

11. Kapil U, Sharma NC. Assessment of iodine deficiency in district Kitmaur, Himachal Pradesh: A pilot study. Indian J Pediatr 1998: 65: 451-453.

12. Sohal KS, Sharma TD, Kapil U, Tandon M. Assessment of impact of salt iodization programme on IDD in district Solan, HP. Natl Med J India 1998; 35: (in press).

13. Kapil U, Ramachandran S. Assessment of iodine deficiency in Union Territory of Pondicherry. Indian Pediatr 1998; 35: 357-359.

14. Bhardwaj AK, Kapil U. Assessment of iodine deficiency in district Bikaner, Rajasthan. Indian J Matern Child Hlth 1997; 8: 18-20.

15. Kapil U, Tandon M, Pradhan R. Status of Iodine deficiency in hill districts of Uttar Pradesh. Indian J Matern Child Hlth 1998: (in press).

16. Kapil U, Prakash R, Sundaresan S, Ramachandran S, Tandon M. Status of Universal Salt Iodization Program in the selected districts of Bihar. Indian J Matern Child Hlth 1997; 8: 90-91.

17. Kapil U, Singh C, Mathur A, Ramachandran S, Nayar D, Saxena N, Vashisht M. Status of Universal Iodization of Salt Program in selected districts of Madhya Pradesh state. Indian Practitioner 1998; 51: 111-114.

18. Kapil U, Nayar D, Singh C, Saxena N. Monitoring the implementation of universal iodization of salt programme through school approach in the state of Haryana, India. Indian Metern Child Hlth 1996: 7: 69-72.

19. Kapil U, Ramachandran S, Goel RKD, Singh C. Iodine content of salt at beneficiary level in the state of Punjab. Indian J Matern Child Hlth 1998; 9: 8-9.

20. Kapil U, Sohal KS. Process of implementation of National Iodine Deficiency Disorders Control Programme activities in Himachal Pradesh, India. Indian J Public Health 1995; 39: 172-175.

21. Kapil U, Saxena N, Nayar D. Iodine content of salt consumed and iodine status of school children in Delhi. Indian Pediatr 1996; 33: 585-587.

22. Kapil U, Jose D'sa, Nayar D, Ramachandran S. Assessment of Iodine deficiency in Tiswadi Block, Goa. Indian Practitioner 1996; 9: 749-750.

23. Kapil U, Sunderesan S, Prakash R, Singh J. Iodine content of salt at trader level in the selected districts of Bihar. Indian Practitioner 1998 (in press).

24. Kapil U, Singh C, Mathur A, Ramachandran S. Yadav R. Profile of Iodine Content of Salt at Trader Level in the selected Districts of India: Part 1- Madhya Pradesh. Indian J Matern Child Hlth 1997; 8: 51-52.

25. Kapil U, Singh C, Nayar D, Saxena N. Status of universal iodization of salt program in selected districts of Madhya Pradesh state. Hlth Popn Persp Issues 1996; 19: 132-136. .

26. Kapil U, Nayar D, Singh C. Profile of iodine content of salt at trader level in the selected districts of Haryana. India. Indian J Matern Child Hlth 1997; 8: 56-57.

27. Kapil U, Singh C, Goel RKD. Iodine content of salt at trader level in the state of Punjab. Indian J Matern Child Hlth 1998 (in press).

28. Kapil U, Sharma TD. Status of iodine deficiency in selected block of Kangra district, Himachal Pradesh. Indian Pediatr 1997; 34: 338-340.

29. Kapil U, Singh C, Mathur A, Ramachandran S, Yadav R. Profile of Io- dine content of salt at trader level in the selected Districts of India. Indian J Matern Child Hlth 1997; 8: 51-52.

30. Sankar R, Pandav CS, Ahmed FU, Rao P, Dwivedi MP, Desai V, Karmarkar MG, Nath LM. Review of experiences with Iodized Oil in national programmes for control of IDD. Indian J Pediatr 1996; 62: 381-393.

31. Gopalan C. Micronutrient malnutrition in SAARC-The need for a food-based approach. NFl Bull 1998; 19: 1-4.