“NATIONAL IODINE DEFICIENCY DISORDER CONTROL PROGRAM”

PRAMOD KUMAR

INTRODUCTION

• Iodine is essential micronutrient. It is required at 100-150 micrograms daily for normal human growth and development. Deficiency of nutritional iodine in the food/ diet is called as Iodine Deficiency Disorders.

• It affects people of all ages, both sexes and different socioeconomic status.

• Iodine deficiency during pregnancy leads to decreased availability of iodine to the fetus.

Life stages EffectFetus - Abortion

- Stillbirth- Congenital anomalies- Increased perinatal mortality- Increased infant mortality- Neurological cretinism- Mental deficiency, deaf, mutism- Septic diplegia squint- Myxedematous cretinism- Dwarfism - Psychomotor defects

Neonate - Neonatal goiter- Neonatal hypothyroidism

Child and Adolescent

- Goiter- Juvenile hypothyroidism\- Impaired mental function- Retarded physical development

Adult - Goiter - Hypothyroidism- Impaired mental function

BURDEN OF DISEASE:• Iodine deficiency disorders are worldwide major public

health problem.

• They affect a large segment of population in all continents of our planet and have been with us from generations.

• As per information, more than 1.5 bollion people all over the world are at risk of IDD.

• IDD are preventable in 130 countries, affecting 13% of the world population.

• In India, it is estimated that more than 350 million people are at risk, while the number of persons suffering from IDD is above 71 million.

cont..•Among newborns, 8.1 million and among

pregnant women, 8.9 million are at risk of IDD.

•The surveys conducted by ICMR AND Medical institutes have clearly demonstrated that not even a single state/ union territory is free from the problem.

•Sample surveys have been conducted in 28 states and 7 union territories, which have revealed that out of 324 districts surveyed , 263 districts are IDD endemic.

PREVENTION:•The simplest method to prevent the broad

spectrum of IDD is to consume Iodated salt daily.

•The supply of iodated salt is to ensure availability of not less than 150 micrograms of iodine per person per day.

NATIONAL IODINE DEFICIENCY DISORDER CONTROL PROGRAMINTRODUCTION:

• Realizing the magnitude of the problem , the government of India launched a 100 percent centrally assisted National Goiter Control Program (NGCP) in 1962. In august 1992, National Goiter Control Program (NGCP) was renamed the National Iodine Deficiency Disorder Control Program (NIDDCP) with a view to cover a wide spectrum of Iodine Deficiency Disorder like mental and physical retardation, deaf-mutism, cretinism, still-births, abortion etc.

GOAL:

•The government’s goal of NIDDCP is to reduce the prevalence of iodine deficiency disorders below 10 percent in the entire country by 2012 A.D.

OBJECTIVES:Survey to assess the magnitude of the Iodine Deficiency Disorder.

Supply of Iodated salt in place of common salt.

Resurvey after every 5 year to assess the extent of Iodine Deficiency Disorder and the impact of iodated salt.

Laboratory monitoring of isolated salt and urinary Iodine excretion.

Health education & publicity.

POLICY:• It had been established that consumption of iodated

salt is the best and simplest way to prevent and control IDD.

• Based on the recommendation of the central council of health in 1984, the govt. of India took a policy decision to iodated the entire edible salt in the country by 1992 in a phased manner. The program started in 1986 in April.

• The central govt. has issued the notification banning the sale of non-iodated salt for direct human consumption in the entire country with effect from 17th may, 2006 under the prevention of food adulteration act 1954.

NODAL MINISTRY:

•The ministry of health & family welfare is the nodal ministry for policy descisions on National Iodine Deficiency Disorder Control Program (NIDDCP).

IODINE DEFICIENCY DISORDER CELL OF DIRECTORATE GENERAL OF HEALTH SERVICES:

The Central Nutrition and Iodine Deficiency Disorders cell at the Directorate General of Health Services (DGHS) is responsible for the implementation of NIDDCP in the country. The important activities of IDD are as follows:•Technical guidance to the states/UTs.

•Intersectoral coordination at Central level and maintenance close liaison with the ministry of Industry/transport etc.

cont..• Coordination of the various facets of NIDDCP in states/ UTs.• Undertaking independent IDD surveys and monitoring in

various states/UTs.

• Imparting training to the state health to whom personnel, involved in NIDDCP.

• Collection, compilation and analysis of relevant data from states/UT with a view to render more effective and meaning advice.

• Monitoring of the quality control of iodated salt at production level through the salt commissioner and at the distribution & consumer level through the state health directorate.

cont..

•Monitoring the procurement and distribution of iodated salt in States/UTs.

•Managing the IEC activities at apex level.\

•Managing the financing and other physical aspects of state level IDD cells.

STATES/UNION TERRITORY IDD CELL:

Each state government has an IDD control cell, which is responsible for:• Checking iodine levels of iodated salt with

wholesalers & retailers with in the state and coordinating with the food & civil supplies department.

• The distribution of iodated salt with in the state through open market & public distribution system.

• Creating demand for iodated salt.

• Monitoring consumption iodated salt.

cont..

•Conducting IDD surveys to identify the magnitude of IDD in various districts.

•Conducting training.

•Dissemination of information, education and communication.

CURRENT STATUS OF PROGRAM:• 31 states/ UTs have established Iodine Deficiency

disorder control cells in their state health directorate.

• 30 states/UTs have already setup Iodine deficiency disorders monitoring laboratories while the remaining states are in the process of establishing same.

• 365 districts have been surveyed tell now.

• In a survey carried out by ICMR, central and state health directorate and medical institutions, 365 districts were surveyed and out of which 303 districts were found to be endemic.

cont..• To raise the awareness, song and drama division through

their fields unit have been carrying out extensive special interactive programmes/ activities in 200 high focused districts in 16 states of the country.

• IDD spots are being telecast through the Doordarshan daily, in all 14 regional languages, are broadcast by the All India Radio through its 37 Vividha Bharti channels and 129 primary channels.

• Message about IDD and consumption of Iodated salt on computerized railway reservation tickets.

• Global IDD prevention Day is celebrated in districts on 21 october every year.

ACHIEVEMENTS OF PROGRAM:• The salt production policy has been liberalized and

permitting production by the private sector. 824 private units have been licensed by the salt commissioner, out of which nearly 532 units have commenced production so far.

• The ministry of railway is providing priority arrangements (category ‘B’) for the transportation of iodated salt. This priority is second to that of defense.

• Since may 2006 the central government has issued notification banning the sale of non iodated salt in country.

cont..• Standard for iodated salt have been laid down

under prevention of food adultration act 1954. These stipulate that the iodine content of salt production and consumption levels should be at least production and consumption levels should at least 30 and 1 ppm respectively.

• The NIDDCP has been included in the 20 point program of the prime minister.

• Each state and UT has been advised to established to established an IDD control cell in their state/ UT.

cont..• Cash grants are also provided by the central

government for health education and publicity campaign to promote the consumption of iodated salt.

• The nutrition and IDD cell of the directorate general of the health services carrying out surveys and training of staff.

• A national reference laboratory for the monitoring of IDD has been set up at the Bio-chemistry and biotechnology division of the National Center for disease control, delhi, for training medical and paramedical personnel and monitoring the iodine content of salth & urine.

cont..• For ensuring quality control of iodated salt at

consumption level, testing kits for ‘on the spots’ qualitative testing have been distributed to all the district health officers.

• A program implementation committee under the chairmanship of director general of health services has been constituted to review the program.

• A central streering committee has been set up under the chairmanship of secretary (health and family welfare) for effective coordination with other sectors.

INFRASTRUCTURE:• National Iodine Deficiency Disorder controls program

at the central level is being managed by adviser (Nutrition) of the directorate general of health services.

• An independent nutrition & IDD cell has been created under the deputy asst. director general (IDD) with support of research officer (IDD) assisted by a team comprising a technical assistant, a junior investigator, field assistants, field attendants, a computer and other ministerial staff.

• Each state is having their own IDD cell. Till now there now 31 IDD cells and 30 laboratories have been established.

FINANCIAL ASSISTANCE:

•Financial assistance is being provided to all the states/UTs in form of quarterlt advance release of funds w.e.f. 2002-03 for various components under the program.

IDDCP IN 12TH FIVE YEAR PLAN (2012-2017)

GOALS:Universal use of iodine fortified salt.

•to bring down prevalence of IDD below 5% in the entire country by 2017 AD.

•To ensure 100% consumption of adequately iodated salt (15 PPM) at the household level.

cont..•To achieve the same, following

indicators are given below:INDICATOR GOAL

Salt IodisationProportion of household consuming adequately iodised salt

>90%

Urinary IodineMedian in the general populationMedian in pregnant

 100-199ug/L150-249ug/L

Programmatic IndicatorsAttainment of indicatrors

At least 8 of 10

STRATEGIES:

IDD survey

Establishment of IDD Contrrol cells

Establishment of IDD Monitoring labs.

Training program.

cont..Production and distribution of iodated salt.

Health education and

publicity.

Community level iodated salth testing.

cont..

Incentive to ASHA for community

level awareness of iodated salt.

Strengthening of central IDD control cell.

Health education and publicity by the state/UTs.

WORLD HEALTH ASSEMBLY: 52TH RESOLUTION

Prevention and control of Iodine Deficiency Disorders•WHO is concerned about Iodine deficiency

that remains a major threat to the health and development of populations worldwide and that it may result in goiter, stillbirth and miscarriage, neonatal and juvenile thyroid deficiency, dwarfism, brain damage, intellectual impairment, deaf mutism, septic weakness and paralysis as well.

cont..•WHO calls for preventive and control of

Iodine deficiency in the world by all the governments, international organizations, bilateral agencies and non- governmental organizations in particular the International Council for Control of Iodine Deficiency Disorders (ICCIDD) to control and prevent iodine deficiency at global, regional and national levels. 

cont..The salt industry are requested for its collaboration and key role in making iodized salt available to populations at risk of iodine deficiency, and for its initiative in highlighting iodization of salt at international forum.

RESEARCH ARTICLEIODINE DEFICIENCY AMONG GOITER PATIENTS IN RURAL SOUTH SUDAN

• Background: It is estimated that 2.2 billion or approximately 30% of the world’s population live in iodine-deficient areas. In a 2005 study households consuming iodized salt in South Sudan increased from 40% to 73%. Despite this achievement, there are still many goiter cases in rural South Sudan and iodine deficiency remains as a major public health problem in this part of sub Saharan Africa. The purpose of this study therefore was to determine the prevalence of iodine deficiency among rural Southern Sudan goiter patients.

cont..• Methods: A cross-sectional study was carried out in

three South Sudan counties, adults with goiter were from three centers following a mobilization campaign that lasted 4 weeks for free medical care. They were clinically evaluated and completed interviewer administered questionnaires to determine their age, gender, diet, family history, drug history, and medical history. Urine samples were then taken for urinary iodine levels. The outcome was iodine deficiency measured as urinary iodine less than 100 μg per/ L. Multiple logistic regression was used to establish the factors associated with iodine deficiency in South Sudan. Ethical approval was obtained.

•Results: A total of 286 goitre patients were recruited. The mean age was 38 years (SD 9), 262(92%) were females (F: M ratio 11:1), and 257(90%) were rural- peasants, 25% (20/286) had moderate to severe iodine deficiency. 174 (62%) consumed non-iodized salts.

•Conclusion: Iodine deficiency is highly prevalent among rural South Sudan communities and a likely cause for goiters. Rural poor women are highly vulnerable.