1. NATIONAL IODINE DEFICIENCY DISORDER CONTROL PROGRAMME DR BAGDI, JT.DIRECTOR DR. S.D.KULKARNI, DY.DIRECTOR DIRECTORATE OF HEALTH SERVICES MUMBAI

2. Salt : Freedom Platinum jubilee of Dandi March (12 th March – 6 th April 1930-2005)

4. Iodine is essential dietary element-required for THYROID HORMONES T3, T4. Iodine is essential dietary element-required for THYROID HORMONES T3, T4. Its iodinated molecule of Es-Am-Acid Tyrosine. Its iodinated molecule of Es-Am-Acid Tyrosine. Iodine - essential micronutrient. Requirement - 100-150 microgms/day for normal human growth and development. Iodine - essential micronutrient. Requirement - 100-150 microgms/day for normal human growth and development. –Thyroxin is essential for – Calorigensesis,, Thermoreguration, Protein Synthesis –Promotion of Nitrogen, Retention, Glycogenolysis, intestinal absorption of glucose, Lipolysvis, Uptake of glucose

5. IDD Problem Pyramid It's worldwide major public health problem. Globally 1.5 billion- risk of Iodine deficiency disorders. It's worldwide major public health problem. Globally 1.5 billion- risk of Iodine deficiency disorders. The pyramid shows the visible effects of Iodine Deficiency Disorders (IDD) Goitre and Cretinism account only for 1--10% of these, The pyramid shows the visible effects of Iodine Deficiency Disorders (IDD) Goitre and Cretinism account only for 1--10% of these, Whereas 90% of the effects remain hidden. Whereas 90% of the effects remain hidden. 1%-10% 5% - 30% 30% - 70% Goitre & Cretinism Some brain damage Less active population due to decreased thyroid function (hypothyroidism)

6. 1962Commenced Goiter control programme 1972 N I D D C P 1972 N I D D C P A) Problem is not restricted to Goiter belt but extremely prevalent all over the country. No state it is free. b) So also Iodine deficiency is not limited to Goiter; Cretinism but wide spectrum -------Deaf Mutism M.R. Impairment of intellectual function. 54 million Goiter 2.2 million Cretium 6.6 million mild neuro deficiency. 6.6 million mild neuro deficiency.

7. Spectrum of Iodine Deficiency Disorders Foetus Foetus Abortion Still births Congenital Anomalies Increased Perinatal Mortality Increased Infant Mortality

8. Spectrum of Iodine Deficiency Disorders Neurological Cretinism –Mental Deficiency –Deaf Mutism –Spastic Diplegia –Squint Foetus Foetus

9. Spectrum of Iodine Deficiency Disorders Foetus Foetus Myxedematolous Cretinism –Dwarfism –Mental Deficiency Psychomotor defects

10. Spectrum of Iodine Deficiency Disorders Neonat e Neonat e Neonatal Goitre Neonatal Hypothyroidism Child and Adolescent Goitre Juvenile Hypothyroidism Impaired Mental Function Retarded Physical Development

11. Spectrum of Iodine Deficiency Disorders Adult Adult Goitre with its complications Hypothyroidism Impaired Mental Function

12. Iodine deficiency disorders is Public Health problem. Iodine deficiency disorders is Public Health problem. 200 million at risk of Iodine deficiency disorders. 200 million at risk of Iodine deficiency disorders. 70 million suffer for goiter and Iodine deficiency disorders. 70 million suffer for goiter and Iodine deficiency disorders.

13. Iodine Deficiency Consumption of crops/plants grown on iodine deficient soil leads to iodine deficiency in population. Superficial layer of soil is important - Heavy Rains Flooding Deforestation Iodine Requirement 0-5 yrs 10 micro g 0-5 yrs 10 micro g 6-12 yrs 120 micro g above 12 yrs 150 micro g Pregnancy 200 micro g

14. Effect of Iodine Deficiency 1) World’s single most significant cause of preventable brain damage and M.R. is Deficiency of Iodine. 2) With every passing hour 10 children are being born in our country, who will no attain their optimum physical and mental potential due to iodine deficiency.

15. Current Research indicates that iodine deficiency result in lowering the average intelligence of the entire school age population by as much as 10 to 15. 12 points so 400 millions IQ points are missed by 40 million children. Current Research indicates that iodine deficiency result in lowering the average intelligence of the entire school age population by as much as 10 to 15. 12 points so 400 millions IQ points are missed by 40 million children. So preventing deficiency raises the learning capacity of school children and improves school performance. So preventing deficiency raises the learning capacity of school children and improves school performance.

16. Iodine Deficiency A Public Health Problem Iodine deficiency in pregnant woman may cause miscarriages, stillbirths, and birth defects. Iodine deficiency in pregnant woman may cause miscarriages, stillbirths, and birth defects. Iodine deficiency impairs growth and development of children. Iodine deficiency impairs growth and development of children.

17. Iodine Deficiency A Public Health Problem Children with iodine deficiency may grow up stunted, less active, mentally retarded with impaired movements, speech or hearing. Children with iodine deficiency may grow up stunted, less active, mentally retarded with impaired movements, speech or hearing. Iodine deficiency also causes goitre Iodine deficiency also causes goitre The majority of people in South-East Asia are at risk from iodine deficiency disorders. The majority of people in South-East Asia are at risk from iodine deficiency disorders.

18. Iodine deficiency disorders & HRD 1)Iodine in pregnancy available to foetus.  Decreased synthesis of Thyroxin.  Prevents the normal development of foetal brain and body  Neonatal-chemical Hypothyroidism Limits Intellectual growth Limits Intellectual growth Fetal brain damage (irresponsible)

19. Implications of Loss of IQ Poor scholastic performance Poor scholastic performance Frequent failures/grade repetitions Frequent failures/grade repetitions  Absenteeism / Drop outs Absenteeism / Drop outs  Reduced impact on economic and social development Reduced impact on economic and social development

20. Classification of Goiter As per World Health Organization Grade-0 No palpable or visible As per World Health Organization Grade-0 No palpable or visible Grade-1 Mass in the neck consistent with enlarged thyroid  Palpable but not visible.  Moves upward in the neck as the subject swallows Grade -2 Swelling in the neck - visible  Consistent with enlarged thyroid when the neck is palpated.

21. Iodine Deficiency Disorders prevalence & criteria for classification as a significant. IndicatorMildModSevere Goiter Grade >0 10-19.9/ 1000 20-21.1 / 1000 > 30 / 1000 Median U.I.E. ( microgms /ltr.) 50-9920-49 < 20

22. Loss of IQ Implications 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 environment. 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 environment.

23. Survey done in last 5 years. Year Name of the district 1999-2000 Kolhapur, Sangli, Parbhani, Osmanabad, Akola, Amravati 2000-2001 Ahmednagar, Raigad, Solapur, Sindhudurg, Nanded, Nagpur, Chandrapur 2001-2002 Thane, Ratnagiri, Nasik, Pune, Aurangabad, Hingoli 2002-2003 Ratnagiri, Latur,Beed, Wardha, Gadchiroli 2003-2004 Jalgaon, Nandurbar,Gondia

24. ANAGAR 11.6 222222 2000-2001 NAGPUR 11.72 NANDED 1.42 CC,CC, C,PUR 7.29

25. 2001-2002 NASHIK 15.00 Abad 14.4 HINGOLI 12.8

26. 2002-2003 RATNAGIRI 10.89 WARDHA 10.3 GADCHIROLI 7.9

27. 2003-2004 NADURBAR 20.3 GONDOA 14.2

28. 2004-2005 SATARA 3.83 S,DHURG 11.22 YEOTMAL 10.23

29. 2000-2001 Sr.No. Name of District Year of survey No. of Goitre (1000 population) 1Ahmednagar2000-0111.06 2Nanded2000-011.42 3Nagpur2000-0111.72 4Chandrapur2000-017.29

30. 2001-2002 Sr.No. Name of District Year of survey No. of Goitre (1000 population) 1Nashik2001-0215.00 2Aurangabad2000-0114.04 3Hingoli2001-0212.08

31. 2002-2003 Sr.No. Name of District Year of survey No. of Goitre (1000 population) 1Ratnagiri2002-0310.89 2Wardha2002-0310.03 3Gadchiroli2002-03 7.09 7.09

32. 2003-2004 Sr.No. Name of District Year of survey No. of Goitre (1000 population) 1Nandurbar2003-0420.03 2Gondia2003-0414.02

33. 2004--2005 SR.NO.DISTRICT NO.OF GOITRE/1000 POPULATION 1SATARA3.83 2SINDHUDURG11.22 3YEOTMAL10.23

34. LABORATORY EXAMINATION OF SALT SAMPLES YearSamplesBelow 15 Ppm Nil Iodine Content % Of Sub- standard Samples 2002--035394163256040.64 2003--044423147612836.26 2004--057319222115932.51

35. URINARY-IODINE ESTIMATION PUB.HEALTH LAB. YearTotal Samples50-99 microgms20-50Below 20 2002108417068118 2003124138310224 2004 2005 1725 777 212 85 45 41 26 27

36. IODISED SALT&P.F.A. ACT/RULES Essential Food item under provisions of A.15.01 OF APPENDIX B OF Prevention of food Adulteration (PFA) Rules 1954 Essential Food item under provisions of A.15.01 OF APPENDIX B OF Prevention of food Adulteration (PFA) Rules 1954 Food Inspectors –empowered to prosecute for sub-standard iodised salt Food Inspectors –empowered to prosecute for sub-standard iodised salt Imprisonment not less than 6 months---3yrs Imprisonment not less than 6 months---3yrs FINE not less than rs.1000/ FINE not less than rs.1000/ notification notification

37. Burden Of I.D.D. IN INDIA& CHINA Country Newborns Unprotected in millions(%) per year India13.0(50%) China1.3(7%)

39. Cost of Iodine for Salt Iodisation Total annual requirement of iodised salt in India for 1,000 million population @ 5kg / person/ year 5 million tons Iodine required for Salt iodisation @30ppm (30gm/ton) 150,000kg (150 tons) Price of iodine @Rs. 750/kg Therefore total price for 150 tons Rs. 11.25 million Cost of iodine/ person/year 11.25 paisa * Cost benefit ratio 1:10

41. 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 TENTH Five Year Plan (2002-2007) Volume II Sectoral Policies and Programmes NUTRITION PLANNING COMMISSION GOVERNMENT OF INDIA, NEW DELHI

42. Actions expected from PUBLIC HEALTH EXPERTS 1) Adequate samples-- 40 salt sample/ per month. 1) Adequate samples-- 40 salt sample/ per month. 2) Move the office of the Jt. Commissioner/Asst. Commissioner FDA for penal Action as per provision as per Act. 2) Move the office of the Jt. Commissioner/Asst. Commissioner FDA for penal Action as per provision as per Act. 3) Awareness in society about Iodine deficiency disorders by 3) Awareness in society about Iodine deficiency disorders by Newspaper write up Newspaper write up Workshop Workshop 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