DR.MAHESWARI JAIKUMAR

NATIONAL GOITER CONTROL

PROGRAMME IN INDIA

DR. MAHESWARI JAIKUMAR

IODINE DEFICIENCY DISORDER

• Iodine is required for the synthesis of the thyroid hormones, thyroxine (T4) and triiodothyronine (T3) and essential for the normal growth and development and well being of all humans.

• It is a micronutrient and normally required around 100-150 microgram for normal growth and development. Deficiency of iodine may cause following disoders:

• Goiter• Subnormal intelligence• Neuromuscular weakness• Endemic cretinism• Still birth

• Hypothyroidism• Defect in vision, hearing, and

speech• Spasticity • Intrauterine death• Mental retardation

SIGNS AND SYMPTOMS• Nervousness• Anxiety• Increased perspiration• Heat intolerance• Hyperactivity• Palpitations

BURDEN OF DISEASE• It is estimated that more than 71

million persons are suffering from goiter and other iodine deficiency disorders like mental retardation, deaf mutism, squint, and neuromotor defects.

• 200 million people at risk of IDD

• That not even a single State/UT is free from the problem of Iodine Deficiency Disorders.

NATIONAL GOITER CONTROL PROGRAMME.

• India has launched 100% centrally sponsored the National Goiter Control Programme.

OBJECTIVES1.Initial survey to identify

magnitude of problem in the country

2.Production and supply of iodized salt to the endemic regions

3. Health Education & Publicity

4. To undertake monitoring of the quality of iodized salt assessing urinary iodine excretion pattern and monitoring of Iodine Deficiency disorder

5. Re-survey in goiter endemic regions after five years continuous supply of iodized salt to assess the impact of the control programme.

The result of re-survey in some areas has revealed that the prevalence of goiter has not been controlled as desired.

NATIONAL GOITRE CONTROL PROGRAMME(NGCP) 1962 .

• OBJECTIVES:• conduction of surveys to assess the

magnitude of Iodine Deficiency Disorders • the provision of iodated salt in place

of common salt.

GOITRE CONTROL PROGRAMME IN 1980

• assess reasons for failure of control programmes so far

• identify newly emerging dimensions of this problem and

• set out practical recommendations for future action, based on detailed

• consideration of causes of earlier failures.

• opening up iodization of salt to private sector to ensure adequate • production to meet national needs

• ensuring quality control at production site • packing salt in poly packs to reduce

iodine loss during transport and

• storage • testing iodine content of salt at

consumer level • improving awareness about the

need to consume only iodised salt

RESULTS1. Universal iodization of salt has not

been achieved even after a decade has passed away when the target was set to be achieved

2. More strengthening of transportation of iodized salt by Railways and roads is needed. Monitoring during transportation is usually not done regularly.

3. Boosting up of political and bureaucratic commitment is required as the problem of visible goiter has been reduced.

4. There is a difference in guidelines for assessment of IDD issued by Indian Government and international organisations

• In 1992, the National Goiter Control Programme (NGCP) was renamed as National Iodine Deficiency Disorder Control Programme(NIDDCP).

THE NATIONAL IODINE DEFICIENCY DISORDER CONTROL

PROGRAMME(NIDDCP) 1992

• AIM:

• To reduce the incidence of IDD

• To less than 10 % among adults

• To less than 5 % among children 10 to 14 yrs

• To zero % of cretins among the newborns by the year 2000

OBJECTIVES• To assess the magnitude of the IDD

problem in the country

• To assess the impact of control measures after every 5 years

• To monitor the quality of iodised salt available to consumers and estimate their urinary iodine excretion pattern

• To conduct IEC campaigns for promoting community participation in the implementation of the program

POLICY • Central Council of Health

decided to iodize the entire edible salt in 1992.

• To date annual production of iodated salt is 42 lakh tones

ACHIEVEMENTS 1.The policy of iodized salt production

has been liberalized to private sector.790 private manufacturers have been licensed by the Salt Commissioner to have annual production of 112 lakh tones for direct human consumption.

2.The annual production of iodized

salt has been raised from 7 lakh tones (1985-86) to 42 lakh tones in 1997-98. This is expected further to raise to 50 lakh tones in near future.

3. The Salt Commissioner in consultation with the Ministry of Railways arranges for the transportation of iodized salt from the production centers to the consuming states under priority category “B” a priority second to that of defense.

4.To ensure use of only iodized salt (w.e.f 27 May 1998) & the sale of non iodized salt was banned under Prevention of Food Adulteration Act, 1954 except in kerala.

• For effective monitoring & proper implementation of NIDDCP all the states & UTs have been advised to establish IDD Control Cell in the State Health Directorate & Central Govt provides cash grants for this purpose.

• A National Reference Laboratory for monitoring of IDD has been set up at the Bio chemistry division of National Institute of Communicable Diseases, Delhi for training medical & para medical personnel & monitoring the iodine content of salt & urine.

• For ensuring the quality control of iodized salt at consumption level, testing kits for on the spot qualitative testing have been developed & were distributed to all Dt Health Officers in endemic states for awareness.

• Cash grants are provided by the Central Govt for conducting surveys/ re surveys of IDD; Health Education & Publicity Campaign to promote the consumption of iodized salt

• The standards for iodized salt have been laid down under PFA Act, 1954. These stipulate that iodine content of salt at the production & consumption level should be at least 30 & 15 ppm respectively.

INFORMATION, EDUCATION AND COMMUNICATION

BLOCK LEVEL

• BEE /HE / Supervisor & NGO / Teachers

VILLAGE LEVEL• Training of ASHA/ANM/PRI/AWW/NGO

& village health & sanitation committee.

• One Monthly Health Day – IEC/ Demo.

• Village Health & Nutrition Day-1 session/month at AWC –(B compl feeding with iodized salt)

• Immunization& ANC-display of posters, distribution of leaflets, salt demo as focus area under NRHM.

• Postering & wall painting with key messages.

• Advocacy with press/mass media/ TV/ salt traders.

• School Health Activities –lecture & demo on salt to students involving them

• Goiter survey & monitoring of iodization of plants.

• IDD spot has been telecast on Doordarshan (National Network).

REVIEW• In 1997, all State Governments

banned the sale of salt other than iodated salt.

• advised to include iodated salt under Public Distribution System (PDS).

• The Salt Commissioner has advised to install iodization plant in consuming areas and to improve packaging of iodated salt to prevent iodine loss during transit.

MONITORING & EVALUATION

MONITORING IS DONE THROUGH THREE

METHODS:

1.Field Salt Testing Method

2. Laboratory.

3.Questionnairre

ADMINISTRATIVE SET UP

1. Salt commissioner, Central Office of Government of India, supervises the universal iodization and issues licenses to salt manufacturers.

2. A National Reference Laboratory for monitoring IDD

• Through 100 IDD control cells and IDD monitoring laboratories.

9th FIVE YEAR PLAN PROPOSAL

• Proposed to strengthen IDD Monitoring by setting up 90 IDD monitoring laboratories

• IDD monitoring at the district level is by regular checking of iodated salt as well as urinary iodine excretion.

• The goal is to bring down the incidence of IDD below 10 per cent in endemic districts by 2000 A.D.

OBJECTIVES1.Initial survey to identify

magnitude of problem in the country

2.Production and supply of iodized salt to the endemic regions

3. Health Education & Publicity

4. To undertake monitoring of the quality of iodized salt assessing urinary iodine excretion pattern and monitoring of Iodine Deficiency disorder

5. Re-survey in goiter endemic regions after five years continuous supply of iodized salt to assess the impact of the control programme.

The result of re-survey in some areas has revealed that the prevalence of goiter has not been controlled as desired.