National Iodine Deficiency Disorders Control Programme

Dr. Subhash Pandey

State Nodal Officer

Directorate of Health & Family Welfare, Chhattisgarh, Raipur.

Presentation Overview

Part A: About National Iodine Deficiency Disorders Control Program

Part B:Facts about Iodine and Iodized Salt

Part C:Chhattisgarh State at a Glance

Part -A

About National Iodine Deficiency Disorders Control Program

GOALS

To Reduce the prevalence of Iodine Deficiency Disorders below 10% in the entire country by 2012

Achieve Universal Access to Iodized Salt

Source: 11th Five Year Plan, Govt. of India

OBJECTIVES

1. Surveys to assess the magnitude of the Iodine Deficiency Disorders

2. Supply of Iodated salt in place of common salt.

3. Re-survey after every 5 years to assess the extent of Iodine Deficiency Disorders and the impact of iodated salt.

4. Laboratory Monitoring of Iodated Salt and Urinary Iodine Excretion

5. Health Education & Publicity

Spectrum of Iodine Deficiency Disorders

Foetus: 1. Abortions2. Still Births3. Congenital Anomalies4. Increased PNMR5. Neurological Cretinism 6. Myxedematotous Cretinism

Spectrum of Iodine Deficiency Disorders

Neonate: Neonatal GoitreNeonatal Hypothyroidism

Child & Adolescent:Juvenile HypothyroidismImpaired Mental Function

Retarded Physical development

Adult: Goitre with its complicationHypothyroidismImpaired Mental Function

Effect on people : HUMANS Health & Socioeconomic impact

Effect on animals : LIVESTOCK Clinical & Reproductive disorders,decreased productivity

Low Availabilityof iodine : PLANTS Iodine poor feeds &

fodders

Soil Erosion : WATER, SOIL Environmental iodine deficiency

Iodine Deficiency – A Disease of The Soil

Brain Cell Growth

Iodine Deficiency Iodine Sufficiency

Iodine Deficiency is the single most

common cause of preventable mental retardation

School age children living in

iodine deficient environment

on an average, have

13 I.Q. points

less than those living in

iodine sufficient environments

Iodine Deficiency & Learning Abilities

Iodine Deficiency = Goitre = Visible Swelling

No Pain = Not a cause of Mortality = Cosmetic problem

Cretinism rare

IDD – The Hourglass

Historic View

Current View

Mental & Physical growth

Loss of Energy-hypothyroidism

Learning Disability, Poor Motivation

Child Development and Child Survival

Human Resource Development

IDD Prevalence Indicators and Criteria for classifying IDD as

significant public health problem

Indicator Mild Moderate Severe

Goitre Grade >0

5-19.9% 20-29.9% >30%

Urine Iodine Excretion (Microgram/L)

50-99 20-49 <20

Part -B

Facts about Iodine & Iodized Salt

What is Iodine?

Iodine is an essential micronutrient supporting some of the most vital functions of the human body.

What is Iodated Salt?

• Iodated salt is common salt containing minute quantities of an iodine compound

• Iodated salt looks, tastes and smells exactly like ordinary salt.

• The Govt. of India has issued notification banning the salt of non iodized salt for direct human consumption with effect from 17th May, 2006.

How much Iodine does a person normally need?

The average daily adult requirement is 150 micrograms

Average lifetime’s requirement of an individual less than a teaspoonful.

From where do we normally get Iodine?

• Present in its natural state in the soil and in water.

• Normal requirement comes from crops grown on iodine-rich soil.

• When the soil lacks iodine, crops grown on that soil are deficient in this essential micronutrient.

• People who live on iodine-deficient land and eat its crops regularly, do not get their daily requirement of this essential element.

How do we know if salt contains Iodine?

A low cost testing kit is available which allows to test for the iodine content of the salt on the spot.

Part - C

Chhattisgarh State at a Glance

Iodine consumption

NFHS III :• Adequate iodine in salt: 55% households• Inadequate iodine in salt: 24% households• No iodine in salt: 21% households

SSM Oct 2008:• Salt tested for iodine content was found satisfactory in 97% samples (n=29,539)

Prevalence of IDD and status of NIDDCP in Chhattisgarh : Table showing the number of districts

surveyed & found endemic

State No. of Districts Surveyed

No. of Districts Found Endemic

IDD LAB

Chhattisgarh 2

(Sargujja, Jashpur)

2 No

Status of Iodine Deficiency Survey in Sarguja District

42% School Age Children (6-12 years) of Sarguja district had Urinary Iodine Excretion below 99 micrograms/L

(Source: National Institute of Nutrition, ICMR, 2003)

Status of NIDDCP implementation in Chhattisgarh

a. Mass awareness about Iodine Deficiency disorders among community have been generated using print, folk and electronic media , through NGOs and public awareness campaigns.

b. The State Nodal officer for NIDDCP, Dr. Subhash Pandey has been regularly attending discussions on Doordarshan on the importance of iodine and related disorders.

c. Mass Public awareness to use Iodized salt through demonstration by salt testing kits was telecast in the months of Oct’ 08 & Oct’ 09 four times in Kalyani Programme of Doordarshan.

d. The 21st of October is celebrated as “Global Iodine Deficiency Disorder (IDD) Prevention Day ” every year and marked by educational workshops, seminars and attended by several line departments like (DWCD, Food and Civil Supplies, P&RD)

Status of NIDDCP in Chhattisgarh State

Special Campaign in the Month of October since 2006- SSM

• During the October round of SSM every year, Salt Testing Kits are used testing salt for its iodine content at the vaccination session sites and alsoduring House hold surveys.

• Visits are made by the LHV or ANM to the households of few pregnant women and there cooking salt is tested for its iodine content.

• 10,000 such salt testing kits are distributed to all sub centers, PHCs, CHCs and Urban areas.

NIDDCP – Budgetary Provisionsunder NRHM

Activity Proposed Amount Proposed

Amount Approved

2009-10

Remarks

1 Establishment of IDD Control Cell

4.50 6.00 The State Govt. may modify the PIP as per allocation.2 Establishment of IDD

Monitoring Lab.2.50 3.50

3 Health Education and Publicity.

3.00 6.00

4 IDD Surveys 1.50 2.50

Total 11.50 18.00

Innovative activities in the state• Iodized salt is distributed by Deptt. Of State Civil

Supplies through PDS• Total Iodized salt distributed per month is 7500

Metric ton • 37 lacs poor families are benefited by providing

Iodized salt (Amrit Namak), free of cost.• Iodine content of salt "Amrit" is 30 P.P.M., is of

ISI standard and has PFA specifications. • Special Iodized salt for above poverty line

families is Mahamaya Salt is also supplied by State Civil Supplies Deptt.

Innovative activities in the state

• The following has been the distribution details of Iodized salt (Amrit Namak) in the state:– 2003-04 1889.00 MT

– 2004-05 30916.14 MT

– 2005-06 46909.00 MT

– 2006-07 53823.00 MT

– 2007-08 64047.00 MT

– 2008-09 58743.54 MT

– 2009-10 55753.78 MT (till Oct 09)

Activities Undertaken• One trained Laboratory Technician is working at

the District Hospital Raipur for investigations related to estimation of iodine content.

• Budgetary provisions under the NIDDCP for SC/ST is allocated for IEC activities, medicines and others supplies.

• Under this scheme, Rs.1.27 lakhs for IEC activities and Rs. 2.20 lakhs for procuring medicines in year 2009-10 have been distributed to all districts.

• In Year 2009-10 each district was given Rs. 8000/- from the state budget to perform similar activities