Iodine deficiency disorder

IODINE DEFICIENCY DISORDER (IDD)

Presented withArati Kunwar

Prepared BySAgun PAudel

INTRODUCTIONIodine is essential for human health as it is a constituent of thyroid hormones, which play an important role in physical and mental development.

Iodine is one of the leading causes of preventable mental retardation and brain damage in the world. Iodine deficiency not only leads to goiter and cretinism but also to a much broad spectrum of disorders.

Iodine deficiency is the single most common cause of preventable mental retardation and brain damage in the world. The deficiency has an immediate effect on child learning capacity, women's health, the qualities of life in communities and economic productivity.

The normal requirement of iodine for human beings averages 150 μg per person per day.

When people consume diet lacking sufficient iodine several important health consequences known as iodine deficiency disorder (IDD) will result.

Iodine deficiency is a major public health problem for populations throughout the world, particularly for the pregnant women and young children.

DefinitionIodine Deficiency Disorders refer to a spectrum of health consequences resulting from inadequate intake of iodine. The adverse consequences of iodine deficiency lead to a wide spectrum of problems ranging from abortion and still birth to mental and physical retardation and deafness, which collectively known as Iodine Deficiency Disorders (IDDs).

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Spectrum of IDD

Most important consequences of the spectrum of IDD are:• Goiter• Mental retardation• Hypothyroidism• Cretinism• Increased morbidity and mortality of infants and neonates


Risk factorsFollowing is a list of potential risk factors that may lead to iodine deficiency:• Low dietary iodine• Selenium deficiency• Pregnancy• Exposure to radiation• Increased intake/plasma levels of goitrogens,

such as calcium


• Sex (higher occurrence in women)• Smoking tobacco• Alcohol (reduced prevalence in users)• Oral contraceptives (reduced prevalence in

users)• Perchlorates• Thiocyanates• Age (for different types of iodine deficiency at

different ages)


Epidemiology

• Iodine deficiency is the single most important cause of preventable mental retardation. Globally more than two billion (or over 38% of the population living in 130 countries) are estimated to be at risk of IDD and 260 million people in Africa are at risk and 150,000 are affected by goiter.

Source: 2007


Distribution of Iodine Deficiency in Developing Countries

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According to WHO a goitre rate above 5% constitutes a public health problem. A profile analysis from different studies in different countries showed that from all babies born to iodine deficient mothers, 3% will have sever mental and physical damage, 10% show moderate mental retardation and the remaining 87% show some form of mild intellectual disability.


Iodine deficiency world wide

WHO, UNICEF & International Council for the Control of Iodine Deficiency Disorders

WHO Regions

Proportion of population with UI < 100 g/L (%)

Population with UI < 100 g/L (in millions)

Africa 47.6 48.342

The Americas 14.1 9.995

Eastern Medierranen 55.4 40.224

Europe 59.9 42.206

South East Asia 39.9 95.628

Western Pacific 19.7 36.082

Total 36.9 272.438

ESTIMATED POPULATIONS AT RISK AND PREVALENCE OF ENDEMIC GOITRE IN EIGHT COUNTRIES OF THE WHO SOUTHEAST ASIAN REGION (numbers in 1000)

Country Total POP. Population at risk (TGR > 10%) Endemic goitre prevalence

Number % Number %

Bangladesh 97 438 37 150 38.1 10 225 10.5

Bhutan 1 446 1 466 100. 946 65.4

Burma 39 920 14 545 36.5 5 694 14.3

India 746 010 149 588 20.0 7.3

Indonesia 161 003 29 773 18.5 9 759 6.1

Nepal 16 386 15 099 92.0 7 555 46.1

Sri Lanka 16 099 10 565 65.6 3 112 19.3

Thailand 52 709 20 439 38.8 7 740 14.7

TOTAL 1 131 011 278 605 24.6 99 349 8.8

14TGR = Total Goitre Rate (prevalence)Percentages shown are percentages of total populationSource: Clugston and Bagchi (1985, p. 14) and for total population data UN Demographic Yearbook 1981/1982

• It is estimated that approximately 516 million people in Asia are at risk due to environmental iodine deficiency, with about 176 million actually goitrous. In Nepal, about 14 million people are at risk of which 8 million are goitrous.

Source: Tyabji, R: The use of iodated salt in the prevention of iodine deficiency disorders – a handbook of monitoring and quality control. UNICEF, ROSCA, New Delhi. January 1985.


NEPAL

• Currently only 63% of households in Nepal are using adequately iodized salt.

• The proportion of low UIE values (<100μg/l) was 39.1% (adult women and school-aged children) .• The prevalence of low UIE is highest among

women in the Terai zone. It is still high as a public health problem in that group.


Only 35% of the respondents had heard educational messages about iodized salt and very few of the respondents (19%) knew about the importance of iodized salt for health.


Iodine deficiency in pregnancy causes more than 200,000 babies a year in Nepal to be born mentally impaired; even mildly or moderately iodine-deficient children have IQs that are 10 to 15 points lower than those not deficient.

Source: A National Development Priority THE WORLD BANK


Iodine deficiency disorders (IDD) affect an estimated 10 million Nepalese nationwide.

A Goitre prevalence of 41.5% among females and 38.4% among males among school-aged children 6-14 years.

Source: Nepal Micronutrient Status Survey -1998

The estimated percent of households consuming salt with some iodine is 91%. The estimate of households consuming adequately iodized salt (15ppm or above) is 63%.

Sourced from the Between Census Household Information, Monitoring and Evaluation System 2000- BCHIMES.


Prevention and Control of IDD

Iodine deficiency is a significant environmental problem. Iodine is essential for the synthesis of thyroid hormones and cannot be synthesized by the body. Leaching of iodine from the soil due to erosion of heavy rain, deforestation, overgrazing and clearing lead to loss of iodine from the soil and water.


Subsequently the iodine content would be low in water, animal and plant products originated from such iodine deficient soils. Hence, an iodine deficient environment requires the continued addition of iodine.


The following methods are intended as a major strategy:

1. Food fortification:• Fortification of foods with iodine is

an effective means of long-term prevention and control of many iodine deficiencies, and one that has been shown to be cost effective in many countries.


• Universal salt iodization- Iodization of salt for both human and livestock consumption is required- Use iodized salt in the food industry to the population on a continuous and self sustaining basis


2. Supplementation

In areas with lack of transportation and small salt producers are available• Administration of iodized oil capsule• Direct administration of iodine solution

such as Lugol's iodine at regular intervals

• Iodization of water supplies by addition of iodine solution


3. Health education Create awareness about the consequences of

iodine deficiency disorder, specially for high risk groups (infants, pregnant and lactating women)

Advise the people to use iodized salt for household consumption

Educate the public to eat iodine rich food items like sea fish, kelp, etc and avoid goiterogenic foods.


4. Set surveillance technique to monitor the distribution of adequately iodized saltin the community.


Severe IDD: a dwarfed cretin woman with a barefoot doctor of the same age from the Hetian district in Sinkiang

Policy and legislation in Nepal

Legislation on IDD: Currently, there is legislation concerning the status of IDD in Nepal. It was enacted in 1999 and makes the iodization of salt manditory at a level of 50 PPM of iodine at the production level. The legislation has not been significantly revised since, although there are no published government documents concerning IDD.


Government Agency to Address IDD There is legislation governing IDD in Nepal. It was passed in 1955 and has been revised since. Salt iodization is mandatory at the level of 20-60 ppm.The agency that is responsible for addressing IDD is the Nutrition Section, Child Health Division, of the Department of Health Services under the MOHP.



Government actions in IDD

• Universal salt iodization as sole strategy to address IDD.

• Distribution of iodized salt in remote districts at subsidized rates.

• Implementation of Iodized Salt Social marketing Campaign.

• Monitoring of iodized salt at the entry points, regional and national levels.


• Evaluation of IDD status through National Survey and integrated mini- surveys for Vitamin A, iodized salt and deworming.

• Iodized salt warehouse constructions in various parts of country.

• Development of Iodized Salt Act in 1998.


Recommendation• A monitoring system for IDD control and quality

control mechanisms must be established.• All salt should be checked for its iodine content

and monitoring procedures should be carried out on an on-going basis as part of routine health assessments.

• Stability of Iodine in Salt• National Nutrition Policy and Strategy should be

implemented properly.• Quality assurance


References:• MODULE of Iodine Deficiency Disorders For the For the Ethiopian Health

Center Team.• Monitoring and Evaluation System 2000- BCHIMES. • U• WHO, UNICEF & International Council for the Control of Iodine Deficiency

Disorders• Nepal Micronutrient Status Survey -1998• A National Development Priority THE WORLD BANK• Tyabji, R: The use of iodated salt in the prevention of iodine deficiency

disorders – a handbook of monitoring and quality control. UNICEF, ROSCA, New Delhi. January 1985.

• UN Demographic Yearbook 1981/1982 • Iodine deficiency disorders in nepal: monitoring and quality control of

iodated salt a report by m. G. KARMARKAR, ph.D. ,C. S. Pandav, m. D. ,All india institute of medical sciences new delhi – 110 029,may – june 1985


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Iodine deficiency disorder