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Edited by Dr. Chandrakant S. Pandav (AIIMS) Dr. M.A. Ansari ( Salt Commissioner)

Edited by Dr. Chandrakant S. Pandav (AIIMS) Dr. M.A. Ansari ( Salt Commissioner) Mr. S. Sundaresan (Former Salt Commissioner) Dr. M.G. Karmarkar (ICCIDD). Advisory Committee Dr. Rajan Sankar (GAIN) Dr. Victor M. Aguayo (UNICEF) Miss Melanie Galvin (MI)

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Edited by Dr. Chandrakant S. Pandav (AIIMS) Dr. M.A. Ansari ( Salt Commissioner)

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  1. Edited by Dr. Chandrakant S. Pandav (AIIMS) Dr. M.A. Ansari (Salt Commissioner) Mr. S. Sundaresan (Former Salt Commissioner) Dr. M.G. Karmarkar (ICCIDD) Advisory Committee Dr. RajanSankar (GAIN) Dr. Victor M. Aguayo (UNICEF) Miss Melanie Galvin (MI) Dr. B.K. Tiwari (MoHFW) Dr. KunalBagchi (WHO) Mr. David Haxton (ICCIDD) Dr. Peter Jooste (ICCIDD) Dr. Michael Zimmermann (ICCIDD)

  2. Contributors Dr. KapilYadav (ICCIDD) Dr. Rahul Srivastava (AIIMS) Dr. Rakeshkumar (ICCIDD), Ms. RijutaPandav (ICCIDD), Mr. PritamTanwar (ICCIDD), Dr. ArijitChakrabarty (GAIN), Dr. Anil Kumar (ICCIDD), Dr. DenishMoorthy (ICCIDD), Ms. SmitaPandav (ICCIDD), Dr. K. Anand (AIIMS), Dr. M.M. Godbole (SGPGI), Dr. N. Kochupillai (AIIMS), Mr. SuvabrataDey (MI), Mr. Pankaj Jain (MI), Dr. Karanveer Singh (UNICEF), Dr. NidhiChaudhary (WHO)

  3. Web link http://www.iqplusin.org/Iec.htm Sixth Edition June, 2011 Fifth Edition : February, 2010 Fourth Edition : September, 2008 Third Edition : September, 2005 Second Edition : June, 2005 First Edition : January, 2005 Also available in following Indian languages Hindi, Guajarati, Kannada, Tamil, Telugu

  4. Vision for the Nation “With our resources and the money we spend, we could easily accomplish three times what we do, in half the time we normally take, if we were to operate in mission mode with a vision for the nation”. Dr. A. P. J. Abdul Kalam11thPresident of India (2002-2007)(“Ignited Minds”)

  5. Salt for Freedom And Iodized Salt For Freedom from Preventable Brain Damage Outline Iodine and its importance • Consequences of Iodine deficiency • Burden of Iodine deficiency • Methods to control IDD • The Kangra Valley study • New evidence: From Goitre to IDD • Iodised salt production • Iodised salt coverage • Key Issues in IDD • The way forward

  6. Iodine and thyroid hormone • Iodine is an essential micronutrient, i.e. needed in a minute quantity daily • Total quantity present in body is (15-20 mg) mostly in thyroid gland • Iodine is required for production of thyroid hormones: Tri-iodothyronine (T3) and Thyroxine (T4)

  7. Functions of Thyroid hormones Thyroid hormones act on nearly every cell in the body Physical growth and development Optimum mental development Regulation of body metabolism Heat generation & maintenance of body Temperature

  8. Iodine Metabolism simplified Iodine in diet Absorbed throughout Gastro Intestinal tract Circulates as Plasma Inorganic Iodide (PII) in blood <5% of Iodine 90-95% of Iodine Thyroid Gland For synthesis of T3/T4 Renal excretion as Urinary Iodine

  9. Daily Iodine requirement • Average daily requirement of iodine per person is 150 µg – this fits on the tip of hair ! • Lifetime requirement for 70 years is 5 gms – one teaspoonful ! Source: Assessment of iodine deficiency disorders and monitoring their elimination. A guide for programme managers. Third edition. 2007; WHO/UNICEF/ICCIDD, Geneva.

  10. Iodine deficiency – A disease of soil ClimateChange Soil erosion Low Food availability Effect on Humans Effect on Animals

  11. Natural sources of Iodine • Food is the main source of iodine • Fish, Meat & dairy products • Vegetables, cereals • High amount of iodine in seaweeds & sea fish • If soil is deficient in Iodine then the food sources are likely to be deficient in iodine • In India, only a small proportion of population consume iodine rich sea foods and that too in very small quantity ** Sea salt is a poor source of iodine ** < 0.5 ppm of Iodine is present in Sea Salt

  12. Salt for Freedom And Iodized Salt For Freedom from Preventable Brain Damage Outline • Iodine and its importance Consequences of Iodine deficiency • Burden of Iodine deficiency • Methods to Control IDD • The Kangra Valley study • New evidence: From Goitre to IDD • Iodised salt production • Iodised salt coverage • Key Issues in IDD • The Way forward

  13. Earliest evidences of Goitre • Incantation against goitre from the period around 2000 BC are found in Atharva Veda • “Galaganda” was the name given by the early Hindu physicians Sushruta and Charaka (500 BC)

  14. Goitre has been known since the days of Lord Buddha and before (500 BC) Goitre This disorder may have been present from time immemorable among the populations of various parts of the world

  15. Importance of Iodine in Brain Development • 90% of human brain development occurs between 3rd month of pregnancy to 3rd year of life • First 1000 days of life (conception till the age of 2 years) are considered to be the critical period for brain development

  16. Importance of Iodine in Brain Development Iodine sufficient brain Iodine deficient brain • Diminished brain cell branching due to iodine deficiency • Diminished branching  Less connections  Lower IQ

  17. Importance of Iodine in Brain Development • Iodine deficiency results in permanent brain damage • Brain damage can be prevented by correcting iodine deficiency before & during pregnancy • Its vital that all pregnant & lactating mothers get their daily requirement of iodine (250 µg/day)

  18. Importance of Iodine in Brain Development According to WHO, Iodine deficiency in foetal life and early childhood remains single most important and preventable cause of mental retardation globally WHO (1994) Iodine and Health, WHO/NUT/94.4. WHO:Geneva

  19. Iodine Deficiency and IQ The Intelligence Quotient (IQ) score of children living in an iodine deficient environment is nearly 13 IQ points less than those living in iodine sufficient environments Social Wellbeing Physical Wellbeing Mental Wellbeing Even mild iodine deficiency can prevent children from attaining their full intellectual potential

  20. Effect of Iodine Deficiency on Humans

  21. Effect of Iodine Deficiency on Humans

  22. Effects of iodine deficiency on Livestock

  23. Severe Brain Damage: Tip of the Iceberg Severe Brain Damage Cretinism Goitre Loss of IQ Mild and Moderate Brain Damage Loss of Energy due to Hypothyroidism

  24. Iodine Deficiency and Nuclear Radiation • Iodine deficiency leads to increased susceptibility to nuclear radiation • During iodine sufficiency, the thyroid gland does not take up radioactive iodine Universal & adequate access of Iodised salt to combat future radiation risk

  25. Salt for Freedom And Iodized Salt For Freedom from Preventable Brain Damage Outline • Iodine and its importance • Consequences of Iodine deficiency Burden of Iodine deficiency 3. Methods to control IDD • The Kangra Valley study • New evidence: From Goitre to IDD • Iodised salt production • Iodised salt coverage • Key Issues in IDD • The Way forward

  26. Global Burden of IDD Moderate and mild iodine deficiency (20-99μg/l) Optimal (100-199μg/l) > 200 μg/l) No data

  27. Burden of IDD in India Total estimated population at risk of IDDs in India: 350 million Population at risk in Million Calculated based on 71% iodised salt coverage as per Coverage Evaluation Survey -2009 and Population of India (Census – 2011)

  28. Iodine Deficiency Disorder Endemic States Survey by Central & state Health Directorates, ICMR and Medical Institutes 365 Districts Surveyed and 303 were Endemic TD: Total Districts DS: Surveyed Districts ED: Endemic districts Endemic districts: Prevalence of Goitre ≥10%

  29. Iodine Deficiency Disorder Endemic States (Cont…) Survey by Central & state Health Directorates, ICMR and Medical Institutes 365 Districts Surveyed and 303 were Endemic TD: Total Districts DS: Surveyed Districts ED: Endemic districts Endemic districts: Prevalence of Goitre ≥10%

  30. Salt for Freedom And Iodized Salt For Freedom from Preventable Brain Damage Outline • Iodine and its importance • Consequences of Iodine deficiency • Burden of Iodine deficiency Methods to control IDD • The Kangra Valley study • New evidence: From Goitre to IDD • Iodised salt production • Iodised salt coverage • Key Issues in IDD • The way forward

  31. High Risk Population Entire population is at risk of IDD t i n r E e Pregnant Women and Children High Risk n P o o p i t u a l Control of IDD among pregnant women, lactating women and early childhood would prevent irreversible brain damage

  32. High Risk Population…2 Targeting Pregnant and Lactating Mother Healthy Mother Healthy Children Healthy Family Healthy Nation

  33. Our Primary Objective To ensure that: Every individual should & Every mother & child must Get their daily requirement of iodine

  34. Salt: Ideal Vehicle for Iodine Urban/Rural Summer/Winter • Iodisation does not impart any color, taste or smell to the salt • Iodisation is simple, effective, cheap and easy process • Production of salt is limited to few centres hence monitoring of quality becomes relatively easy • Delivers Iodine in physiologically adequate quantity Universally consumed by every one Males/Females Rich/Poor

  35. Iodised salt and vaccines Vaccines are biological substance which prevent against a specific disease Iodised salt, can be compared to a vaccine which protects against irreversible brain damage Vaccine Iodised Salt

  36. Salt for Freedom And Iodized Salt For Freedom from Preventable Brain Damage Outline • Iodine and its importance • Consequences of Iodine deficiency • Burden of Iodine deficiency • Methods to Control IDD The Kangra Valley study • New evidence: From Goitre to IDD • Iodised salt production • Iodised salt coverage • Key Issues in IDD • The Way forward

  37. The Kangra Valley Study (1956 – 1972) Legacy of The Legend of Science & Society Prof. V. Ramalingaswami 8th August 1921 – 28th May 2001 Pioneer study conducted in Kangra District of Himachal Pradesh Kangra Himachal Pradesh

  38. The Kangra Valley Study (1956 – 1972)

  39. The Kangra Valley Study (1956 – 1972) Zone A Zone C Zone B • 15 gms of salt/person/day to ensure 200 µg of iodine/person/day • Salt produced by Hindustan Salts Ltd. at Sambhar lake (Rajasthan) with UNICEF assistance

  40. The Kangra Valley Study (1956 – 1972) 42% Control Group Zone B(Salt+KIO3) 40% Zone A, B, & C Zone A Zone B Zone C Intervention 19% Goitre Prevalence in % 15% 15% 8% 5% Zone C Zone A Zone B

  41. The Kangra Valley Study (1956 – 1972) Conclusions Iodine supplementation in the form of adequately iodized salt on a regular and continuous basis reduces Goitre prevalence Recommendations Establish a National Goitre Control Programme (NGCP) As a result, NGCP established in 1962. Program was renamed as National Iodine Deficiency Disorders Control Program (NIDDCP) in 1992

  42. Salt for Freedom And Iodized Salt For Freedom from Preventable Brain Damage Outline • Iodine and its importance • Consequences of Iodine deficiency • Burden of Iodine deficiency • Methods to Control IDD • The Kangra Valley study New evidence: From Goitre to IDD • Iodised salt production • Iodised salt coverage • Key Issues in IDD • The Way forward

  43. The hourglass of IDD Iodine Deficiency = Goitre No Pain, Cosmetic problem Cretinism: A rare event (Low Priority) Historic view1962-1983 Current view1984 onwards Brain Damage Lack of Energy, Hypothyroidism, Learning Disability, ↑Deaths Child Development & Child Survival HRD (HIGH PRIORITY)

  44. Evolution of IDD control in India

  45. National Iodine Deficiency Disorder Control Programme - 1992 • In June 1992, the NGCP, in recognition of the spectrum of disorders due to iodine deficiency was re-designated as; National Iodine Deficiency Disorders Control Programme (NIDDCP) Reduce the prevalence of Iodine Deficiency Disorders below 10 percent in the entire country by 2012 A.D.

  46. Salt for Freedom And Iodized Salt For Freedom from Preventable Brain Damage Outline • Iodine and its importance • Consequences of Iodine deficiency • Burden of Iodine deficiency • Method to control IDDs • The Kangra Valley study • New evidence: From Goitre to IDD Iodised salt production • Iodised salt coverage • Key Issues in IDD • The way forward

  47. Total salt production in India • Total salt production in India in 2010 was 24 million tons • India is the 3rd largest salt producing country in the World after China & United States of America and 2nd largest iodised salt producing country after China • Iodised salt production in 2010 (5.8 million tons) exceeded the target production (5.2 million tons)

  48. Refined and unrefined iodised salt production (million tons)

  49. Refined iodised salt production (million tons) - 2010 (86%) (8%) (6%) (100%)

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