NATIONAL IODINE NATIONAL IODINE DEFICIENCY DISORDER DEFICIENCY DISORDER CONTROL PROGRAMME CONTROL PROGRAMME DR BAGDI , JT.DIRECTOR DR BAGDI , JT.DIRECTOR DR. S.D.KULKARNI , DY.DIRECTOR DR. S.D.KULKARNI , DY.DIRECTOR DIRECTORATE OF HEALTH SERVICES DIRECTORATE OF HEALTH SERVICES MUMBAI MUMBAI
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NATIONAL IODINE DEFICIENCY DISORDER CONTROL PROGRAMME DR BAGDI, JT.DIRECTOR DR. S.D.KULKARNI, DY.DIRECTOR DIRECTORATE OF HEALTH SERVICES MUMBAI.
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NATIONAL IODINE NATIONAL IODINE DEFICIENCY DISORDER DEFICIENCY DISORDER CONTROL PROGRAMMECONTROL PROGRAMME
DIRECTORATE OF HEALTH SERVICESDIRECTORATE OF HEALTH SERVICESMUMBAIMUMBAI
Salt : Freedom
Platinum jubilee of Dandi March(12th March – 6th April 1930-2005)
• Iodine is essential dietary element-required for Iodine is essential dietary element-required for THYROID HORMONES T3, T4. THYROID HORMONES T3, T4.
• Its iodinated molecule of Es-Am-Acid Tyrosine.Its iodinated molecule of Es-Am-Acid Tyrosine.
• Iodine - essential micronutrient. Requirement - Iodine - essential micronutrient. Requirement - 100-150 microgms/day for normal human growth 100-150 microgms/day for normal human growth and development.and development.
– Thyroxin is essential for – Calorigensesis, , Thyroxin is essential for – Calorigensesis, ,
Thermoreguration, Protein SynthesisThermoreguration, Protein Synthesis
absorption absorption of glucose , Lipolysvis , of glucose , Lipolysvis ,
Uptake of glucoseUptake of glucose
IDD Problem PyramidIDD Problem Pyramid• It's worldwide It's worldwide
major public major public health problem. health problem. Globally 1.5 Globally 1.5 billion- risk of billion- risk of Iodine deficiency Iodine deficiency disorders.disorders.
• The pyramid The pyramid shows the visible shows the visible effects of Iodine effects of Iodine Deficiency Deficiency Disorders (IDD) Disorders (IDD) Goitre and Goitre and Cretinism Cretinism account only for account only for 1--10% of 1--10% of these, these,
• Whereas 90% of Whereas 90% of the effects the effects remain hidden. remain hidden.
1%-10%
5% -30%
30% - 70%
Goitre & Cretinism
Some brain damage
Less active population due to decreased thyroid
function (hypothyroidism)
19621962Commenced Goiter control programmeCommenced Goiter control programme 1972 N I D D C P1972 N I D D C P
A) Problem is not restricted to Goiter A) Problem is not restricted to Goiter belt but extremely prevalent all belt but extremely prevalent all
over over the country. No state it is free.the country. No state it is free.b) So also Iodine deficiency is not b) So also Iodine deficiency is not limited to Goiter; Cretinism but wide limited to Goiter; Cretinism but wide
Iodine DeficiencyIodine DeficiencyConsumption of crops/plants Consumption of crops/plants grown on iodine deficient soilgrown on iodine deficient soil leads leads to iodine deficiency in population.to iodine deficiency in population.Superficial layer of soil is important - Superficial layer of soil is important -
Heavy Rains Flooding DeforestationHeavy Rains Flooding DeforestationIodine RequirementIodine Requirement
Effect of Iodine Effect of Iodine DeficiencyDeficiency
1) World’s single most 1) World’s single most significant cause of significant cause of preventable brain preventable brain damage and M.R. is damage and M.R. is Deficiency of Iodine.Deficiency of Iodine.
2) With every passing hour 2) With every passing hour 10 children are being 10 children are being born in our country, who born in our country, who will no attain their will no attain their optimum physical and optimum physical and mental potential due to mental potential due to iodine deficiency.iodine deficiency.
• Current Research indicates that Current Research indicates that iodine deficiency result in iodine deficiency result in lowering the average lowering the average intelligence of the entire school intelligence of the entire school age population by as much as age population by as much as 10 to 15. 12 points so 400 10 to 15. 12 points so 400 millions IQ points are missed by millions IQ points are missed by 40 million children.40 million children.
• So preventing deficiency raises So preventing deficiency raises the learning capacity of school the learning capacity of school children and improves school children and improves school performance.performance.
Iodine Deficiency Iodine Deficiency A Public Health ProblemA Public Health Problem
•Iodine deficiency Iodine deficiency in pregnant in pregnant woman may woman may cause cause miscarriages, miscarriages, stillbirths, and stillbirths, and birth defects.birth defects.
•Iodine deficiency Iodine deficiency impairs growth impairs growth and development and development of children.of children.
Iodine Deficiency Iodine Deficiency A Public Health ProblemA Public Health Problem• Children with iodine Children with iodine
deficiency may grow up deficiency may grow up stunted, less active, stunted, less active, mentally retarded with mentally retarded with impaired movements, impaired movements, speech or hearing.speech or hearing.
• Iodine deficiency also Iodine deficiency also causes goitrecauses goitre
• The majority of people in The majority of people in South-East Asia are at risk South-East Asia are at risk from iodine deficiency from iodine deficiency disorders.disorders.
criteria for classificationcriteria for classification as a significantas a significant..
IndicatorIndicator Mild Mild Mod Mod Severe Severe
Goiter Goiter Grade >0Grade >0
10-10-19.9/19.9/10001000
20-21.1 20-21.1 //10001000
> 30 /> 30 /10001000
Median Median U.I.E. U.I.E. ((microgmsmicrogms/ltr.) /ltr.)
50-9950-99 20-4920-49 < 20 < 20
Loss of IQLoss of IQImplicationsImplications
• The intelligence The intelligence Quotient (IQ) score Quotient (IQ) score of children living in of children living in an iodine-deficient an iodine-deficient environment is environment is nearly 13 IQ points nearly 13 IQ points less than those less than those living in iodine-living in iodine-sufficient sufficient environment.environment.
Survey done in last 5 years.Survey done in last 5 years.
• Essential Food item under provisions of Essential Food item under provisions of A.15.01 OF APPENDIX B OF Prevention of A.15.01 OF APPENDIX B OF Prevention of food Adulteration (PFA) Rules 1954food Adulteration (PFA) Rules 1954
• Food Inspectors –empowered to prosecute Food Inspectors –empowered to prosecute for sub-standard iodised saltfor sub-standard iodised salt
• Imprisonment not less than 6 months---Imprisonment not less than 6 months---3yrs3yrs
• FINE not less than rs.1000/FINE not less than rs.1000/
• notificationnotification
Burden Of I.D.D. IN INDIA& CHINA
CountrCountryy
Newborns Unprotected in Newborns Unprotected in millions(%) per yearmillions(%) per year
IndiaIndia 13.0(50%)13.0(50%)
ChinaChina 1.3(7%)1.3(7%)
Estimated % of huseholds consuming adequately iodised
Total annual requirement of iodised Total annual requirement of iodised salt in India for 1,000 million salt in India for 1,000 million population @ 5kg / person/ yearpopulation @ 5kg / person/ year
5 million tons5 million tons
Iodine required for Salt iodisation Iodine required for Salt iodisation @30ppm (30gm/ton)@30ppm (30gm/ton)
150,000kg150,000kg
(150 tons)(150 tons)
Price of iodine @Rs. 750/kg Price of iodine @Rs. 750/kg
Therefore total price for 150 tonsTherefore total price for 150 tonsRs. 11.25 Rs. 11.25 millionmillion
Cost of iodine/ person/yearCost of iodine/ person/year 11.25 paisa11.25 paisa
* Cost benefit ratio 1:10
Consumption of adquately iodised salt according to SE status in India (NFHS-II, 1998-99)
3650
7864
50
22
Adquate 36 50 78
Inadquate 64 50 22
Low SES Medium High SES
Supply (Push) - Government
• Effforts to reduce price differentials between iodised & non-iodised salt
• More cost effective targeting of the PDS to address macro and micronutrient deficiencies
… Iodised Salt
TENTHFive Year Plan(2002-2007)
Volume IISectoral Policies and Programmes
NUTRITION
PLANNING COMMISSIONGOVERNMENT OF INDIA, NEW DELHI
Actions expected fromActions expected from PUBLIC HEALTH EXPERTS PUBLIC HEALTH EXPERTS
• 1) Adequate samples-- 40 salt sample/ per 1) Adequate samples-- 40 salt sample/ per month.month.
• 2) Move the office of the Jt. 2) Move the office of the Jt. Commissioner/Asst. Commissioner FDA for Commissioner/Asst. Commissioner FDA for penal Action as per provision as per Act.penal Action as per provision as per Act.
• 3) Awareness in society about Iodine 3) Awareness in society about Iodine deficiency disorders by deficiency disorders by
• Newspaper write upNewspaper write up• WorkshopWorkshop• Advocacy in review meeting Advocacy in review meeting • Review of the progress in monthly meeting.Review of the progress in monthly meeting.• Mahila Melava Mahila Melava