National iodine deficiency disorder control programme

1. National Iodine Deficiency Disorder Control Programme By Dr. Polly Nula

2. What is iodine? Nutrient needed in a minute quantity daily. Recommended daily intake: 150 μ g (Micronutrient) Total quantity present in body is (15-20 mg) mostly in thyroid gland

3. What is iodine? Iodine: Essential component of thyroid hormones, which are needed for: - Optimal mental & physical development - Regulation of body metabolism (Generation & utilization of body energy)

4. Sources of iodine Food is the main source of iodine Meat, fish & dairy products Vegetables, cereals High amounts in sea fish & seaweeds Sea salt is a poor source of iodine

5. Iodine deficiency – Disease of the soil Gradual leaching of iodine from soil due to: Melting of Glaciers Floods Rivers changing course

6. Iodine : Daily requirements Age Group Iodine Requirement ( µg/day ) 0 – 11 months 50 12 – 59 months 90 6 – 12 years 120 > 12 years 150 Pregnant & Lactating Women 200 [WHO, UNICEF, ICCIDD: Recommended iodine levels in salt and guidelines for monitoring their adequacy and effectiveness. WHO/NUT/96.13. Geneva. 1996 ]

7. Spectrum of IDD Goiter Cretinism Spontaneous Abortions, Stillbirths, BirthDefects Defects of Speech & Hearing, Squint, Psychomotor defects Loss of 13 IQ points, Leading Cause of Mental handicap

8. Iceberg of IDD

9. Iodine deficiency disorders: A public health problem - 1 Worldwide distribution

10. Iodine deficiency disorders: A public health problem High risk groups: - Pregnant & lactating women - Pre-school children Elimination of IDD: - is an important developmental social goal for governments (UNGASS 2002; MDG – 2015) - is possible UNGASS: United Nations General Assembly Special Session on Children MDG: Millennium Development Goals

11. Our primary concern To ensure that: Every population should & Every mother & child must Get their daily supply of iodine

12. Iodine consumption on daily basis for all times to come Daily requirement of iodine per person is 150 µg – fits on the tip of hair ! Lifetime requirement for 70 years is 5 gms – one teaspoonful ! However, this daily requirement has to be met daily, for all times to come “Daily consumption of adequately iodized salt is a healthy habit”

13. Vehicle for iodine : Salt One food item consumed every day, by everybody in fixed quantities Rich or poor, urban or rural area, man or woman, child or adult Average daily consumption in India per person is 10 gm Iodization of salt is a simple process Cost of salt iodization is : 10 paise /person/year

14. Iodized salt – The panacea for iodine deficiency Promotion of Iodized Salt Consumption

15. HISTORY: Kangra Valley Study Pioneer study conducted in Kangra District of Himachal Pradesh, by Prof. V. Ramalingaswami

16. From evidence to program The Kangra Valley study (1956-1972) Study design Community based Prospective controlled trial Study area Kangra Valley, Himachal Pradesh Divided into 3 zones –A , B , C Study period 1956 - 1972 Study duration 16 years Study population 1,00,000 School age children Outcome variable Goiter prevalence among school age children

17. From evidence to program – The Kangra Valley study (1956-1972) ADMINISTRATIVE INTERVENTION AD AAAA Legislation (ban on sale of non- iodized salt in study area) Iodized salt distributed through government shops No price difference between iodized and non-iodized salt

18. From evidence to program The Kangra Valley study (1956-1972) Conclusions AA Iodine supplementation in the form of adequately iodized salt on a regular and continuous basis reduces goiter prevalence Recommendations Establish a National Goiter Control Programme (NGCP) As a result, National Goiter Control Program established in 1962 conclusions RECOMMENDATIONS

19. Scenario after Kangra Valley study National Goiter Control Program (NGCP) launched at the end of Second Five Year Plan (1962) Aims : 1) Initial survey to identify endemic areas 2) Production & Supply of iodized salt to endemic areas 3) Impact assessment surveys after five years Approach : District specific program

20. NGCP: Low priority Goiter: - is painless - not a cause of death - has been perceived as a cosmetic problem only - socio-cultural norm in some groups Therefore, NGCP received low priority from the viewpoint of government as a national public health program, and also from the population

21. 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 view 1962-1983 Current view 1984 onwards

22. NATIONAL IODINE DEFICIENCY DISORDER CONTROL PROGRAM. In August, 1992 the National Goitre Control Programme(NGCP) was renamed as National Iodine Deficiency Disorders Control Programme(NIDDCP). Objective: ( i ) Initial surveys to assess the magnitude of the Iodine Deficiency Disorders. (ii) Supply of iodated salt in place of common salt. (iii) Health Education & Publicity. (iv) Resurveys to assess the impact of iodated salt after every 5 years. (v) Laboratory monitoring of iodated salt and urinary iodine excretion.

23. Achievements: To ensure use of only iodated salt the sale of non-iodated salt was banned under Prevention of Food Adulteration Act, 1954, Establishment IDD Control Cell in the State Health Directorate A National Reference Laboratory for monitoring of IDD.

24. Achievement- Spot qualitative testing Setting up one district level IDD monitoring laboratory Cash grants The standards for iodated salt have been laid down under PFA Act, 1954.

25. IEC Activities . To intensify the IEC activities a communication package by way of video films posters/danglers and radio/TV spots have been finalized. IDD spot has been telecast on Doordarshan (National Network)

26. Use of iodized salt – at house hold level North East:- NFHS –2, 1998-99 DLHS-2002 91% 52% 88% 59% 84% 57% 80% 59% 79% 47% 67% 70% 63% 55% Mizoram Manipur Arunachal Assam Sikkim Nagaland Meghalaya

27. Estimated percentage of Household consuming adequately Iodized Salt Bhutan 95% China 93% Vietnam 77% Thailand 74% Bangladesh 70% Indonesia 65% Nepal 63% India 50% Myanmar 48% UNICEF-2003

28. PREVALENCE OF IDD IN MANIPUR SURVEY REPORT: Year of survey No.of persons covered No. of goiter IDD cases P.R 1970 3806 1363 32.0% 1980 4292 1133 25.6% 1992 4969 1050 21.1% 1996 7956 1034 13.0%

29. IMPLEMENTATION OF NIDDCP IN MANIPUR IDD CELL - Estd. in 1987 as NGCP with creation of post & staff posting -Function as NIDDCP since 1992. IDD MONITORING CELL - Estd. in IDD Cell, Medical Directorate. - Lab Tech. & Lab Asst. posted since 1996.

30. Thank Q Dandi March

31. Thank Q