National Iodine Deficiency Disorder Control Programme

1. National Iodine Deficiency Disorder Control Programme Moderator: Prof. P.R.Deshmoukh Presenter: Rohan R Patil

2. Defination • Iodine deficiency disorders (IDD) refer to all of the consequences of iodine deficiency in a population that can be prevented by ensuring that the population has an adequate intake of iodine. - World Health Organization

3. Spectrum of Iodine Deficiency Disorders

4. Iceberg of IDD

5. The hourglass of IDD Iodine Deficiency = Goiter = Visible Swelling No Pain, Cosmetic problem Cretinism: A rare event = LOW PRIORITY Brain Damage Lack of Energy - hypothyroidism Learning Disability, ↑Deaths  Child Development & Child Survival  Human Resource Development = HIGH PRIORITY Historic view1962-1983 Current view1984 onwards

6. Defination of Iodine Deficiency Disorder as Public Health problem Epidemiological criteria for assessing the severity of IDD based on the prevalence of goitre in school-aged children

7. Defination of Iodine Deficiency Disorder as Public Health problem Epidemiological criteria for assessing iodine nutrition based on median iodine concentrations of school age children ( 6 years)

8. Defination of Iodine Deficiency Disorder as Public Health problem Epidemiological criteria for assessing iodine nutrition based on median or range in urinary iodine concentrations of PREGNANT WOMEN IDD could be defined as a public health problem if

9. Cause of Iodine Deficiency: Iodine Deficiency: How’s Affected

10. Magnitude of the problem among Indian states: (NIN study in 2003)

11. Magnitude of problem across Maharashtra:

12. Estimated % of household consuming adequately iodized salt:

13. Use of iodized salt in households:

14. Use of iodized salt in households: (NFHS III) • r

15. PIONEER STUDY CONDUCTED IN KANGRA DISTRICT OF HIMACHAL PRADESH (1956-68) • Location: Kangra Valley, Himachal Pradesh. Divided into 3 zones –A , B , C • Type of study: Community based • Study Period: 1956 – 1968 • Outcome variable: Goiter prevalence among school age children

16. STUDY DESIGN • Baseline survey in 1956 • Salt distributed to three zones • Zone A : Salt + Potassium iodide • Zone B : Plain salt • Zone C : Salt + Potassium iodate • 15 gms of salt/person/day • So as to ensure 200 µg of iodine/person/day

17. Prevalence of Goitre in Zone B (Plain salt till 1962, then KI salt) Prevalence of Goitre in Zone A (KI Salt) Prevalence of Goitre in Zone A (KIO3 Salt)

18. Kangra Valley Study • Conclusion: Iodine supplementation in the form of adequately iodized salt on a regular and continuous basis reduces goiter prevalence • Recommendation: To establish National Goiter Control Programme.

19. National Goiter Control Programme Launched at the end of second five year plan (1962) Aims: • Initial survey to identify endemic areas • Production & Supply of iodized salt to endemic areas • Impact assessment surveys after five year

20. NGCP activities (1962-1983) • Goiter is a painless disorder which less liable to cause mortality. • NGCP received low priority from the view point of government as a national public health programme and also from the population

21. Universal Salt Iodization: (1983) • GOI policy decision to iodize all salt meant for human consumption – Universal Salt Iodization (USI) • Private sector was permitted and encouraged to produce iodized salt • “Elimination of goiter” was included in Prime Minister’s 20-point National Development Program

22. National Salt Iodization • Decision Phase: Enable a decision supported by mobilization of industry, setting of standards and regulation • Implementation Phase: Ensure infrastructure for iodization and packaging of all human and livestock salt. Support with quality assurance and communications. • Consolidation Phase: Once the goal of USI achieved, it needs to be sustained through ongoing external evolution monitoring and periodic evolution.

23. Changing Status of legislation (1968-2005): • 1968: Iodized salt brought under PFA Act • 1983: Policy decision taken for Universal Salt Iodization • 1983: Iodized Salt brought under revised PFA Act • 1997: Sale & storage of non-iodized salt banned • 2000(May): GOI decided to lift ban on sale of non-iodized salt. • 2000 (Sept): Ban on sale of non- iodized salt was lifted.

24. An ICMR task force study, 1989 • Location: 14 districts of 9 states • Type of study: Community Based • Type of Population: Rural (all age groups, both sexes) • Study Design: Multistage random sampling • Sample Size: 4,09,923 • Year of data collection: 1984-86

25. PREVALENCE OF GOITRE & CRETINISM IN STUDY DISTRICTS

26. National Iodine Deficiency Disorders Control Programme (NIDDCP) Objectives and components • Surveys to assess the magnitude of the Iodine Deficiency Disorders. • Supply of iodated salt in place of common salt. • Resurvey after every 5 years to asses the extent of Iodine Deficiency Disorders and the Impact of iodated salt. • Laboratory monitoring of iodated salt and urinary Iodine excretion. • Health education. & Publicity

27. National Iodine Deficiency Disorders Control Programme (NIDDCP) GOAL: • To reduce the prevalence of iodine deficiency disorders below 10 percent in the entire country by 2012 A.D.

28. National Iodine Deficiency Disorders Control Programme (NIDDCP) POLICY • To iodate the entire edible salt in the country by 1992. The programme commenced in April 1986 in a phased manner • To enhance the production, demand and supply of iodated salt • 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

29. National Iodine Deficiency Disorders Control Programme (NIDDCP) Nodal Ministry: MOHFW • r IDD Cell Central Level: DGHS STATES/UNITON TERRITORY IDD CELL State Health Directorate

30. National Iodine Deficiency Disorders Control Programme (NIDDCP) Achievements: • The policy regarding production of iodated salt has been liberalized, permitting production by the private sector. • The annual production of iodated salt was raised from 5 lakh MT in 1985-86 to 49.83 lakh MT in 2005-06 expected to further rise to 50 lakh MT in the near future. • The Salt Commissioner, in consultation with the Ministry of Railways:-under priority category ‘B’; a priority second to that of Defence.

31. National Iodine Deficiency Disorders Control Programme (NIDDCP) • PFA, 1954: stipulate that the iodine content of salt at the production and consumption levels should be at least 30 and 15 ppm respectively. • Banning the sale of non iodated salt for direct human consumption in the country with effect from 17th May, 2006 • NIDDCP has been included in the 20 Point Programme of the Prime Minister.

32. National Iodine Deficiency Disorders Control Programme (NIDDCP) • To establish an IDD Control Cell in their State Health Directorates. Presently, 31 States/UTs have established such Cells. • A National Reference Laboratory for the monitoring of IDD has been set up • Four regional IDD monitoring laboratories has been set up

33. National Iodine Deficiency Disorders Control Programme (NIDDCP) • Cash grants are also provided by the Central Government for health education and publicity campaigns to promote the consumption of iodated salt. • For ensuring quality control of iodated salt at consumption level, testing kits for ‘on the spots’ qualitative testing have been distributed

34. National Iodine Deficiency Disorders Control Programme (NIDDCP) FINANCIAL ASSISTANCE PATTERN TO STATES/UT • Financial assistance is being provided to all the states/UTs’s in form of quarterly advance release of funds from 2002-03 for various components under the programme. IDD SURVEYS • Financial assistance of Rs. 25000 per district is being provided to State/UT IDD Control Cells for conducting surveys for assessing the magnitude of goiter and other IDD.

35. The stakeholders in Iodine Deficiency Disorder control Programme (IDDCP): • Elected representatives • Government ministries • Salt producers, importers and distributors • Concerned civic groups, Professional organizations • Nutrition, food and medical scientists

36. National Iodine Deficiency Disorders Control Programme (NIDDCP) Components • Political Support: Primarily at governmental level, through the minister of health and the executive group of government. • Administrative arrangements: A social model for a national IDD control programme

37. National Iodine Deficiency Disorders Control Programme (NIDDCP) • Indicators of IDD assessment:

38. National Iodine Deficiency Disorders Control Programme (NIDDCP) Indicators of IDD assessment:

39. Five year Plans TENTH Five Year Plan (2002-2007): • Effforts to reduce price differentials between iodised & non-iodised salt • More cost effective targeting of the PDS to address macro and micronutrient deficiencies NIDDCP FOR THE 11TH PLAN: • To bring down prevalence of IDD below 10% in the entire country by 2012 AD. • To ensure 100% consumption of adequately iodated salt (15 PPM) at the household level.

40. Why consumption of adequately iodized salt was decreased? • Government of India lifts ban on sale of Non-iodized salt • Increase in Rail Tariff – 1st April 2002 • Consequently increase in movement of iodized salt by road (especially from Rajasthan) • Currently, No mechanism in place for monitoring quality of iodized salt transported by road • Disappearance of most common visible effect of iodine deficiency i.e. goiter • Perception in people that : - iodized salt consumption is NOT required anymore Communication strategy • DID NOT focus on mental handicap as a consequence of iodine deficiency • WAS NOT commensurate with seriousness of problem both in terms of scale & frequency

41. Action to be Taken • Supply– Salt Industry Support Small scale salt producers • Potassium iodate subsidy Initial assistance for repair and maintenance of salt iodization plants • Technical & training support

42. INFORMATION, EDUCATION AND COMMUNICATION (IEC) • Radio/TV spots have been prepared and their broadcast/telecast is being carried out. • A 10 minutes video film on IDD has been prepared and is being distributed to the States. • Pamphlets have been developed for distribution to States & UTs. • Posters depicting the various facets of IDD manifestation have also been prepared. • Salt Testing Kits for the qualitative testing of iodated salt to show presence of iodine are being used for creating awareness among people, including those living in remote, rural areas and urban slums.

43. INFORMATION, EDUCATION AND COMMUNICATION (IEC) • Discouraging the production of large crystals of Bargara salt for edible use which cannot be iodated uniformly. • Sensitizing iodated salt manufacturers about their role in quality monitoring. • IEC activities have also been intensified in coordination with the Song & Drama Division, Directorate of Field Publicity DAVP Doordarshan & AIR with a view to promote the consumption of iodated salt among the masses.

44. Communication Challenges to overcome • A) Penetrate the system with key messages • B) Communication Themes

45. References: • WHO, Iodine status worldwide WHO Global Databaseon Iodine Deficiency, WHO:2004. • WHO, UNICEF, ICCIDD Assessment of iodine deficiency disorders and monitoring their elimination, A guide for programme managers, WHO:3 ; 2007. • Umesh Kapil. Current status of salt iodization and level of iodine nutrient in India African Journal of Pharmacy and Pharmacology Vol. 2 (3). pp. 066-076, May, 2008. • Pandav CS , Yadav K,Karmarkar MG. The Success story of Iodine Deficiency in India: Science, Statesman and Society Wisdom in Hindsight; ICCIDD New Delhi, Sept 2010. • ICMR task force study preliminary analysis of report 1989. • Revised Policy Guidelines On National Iodine Deficiency Disorders Control Programme October 2006