1. National Iodine Deficiency Disorders Control Programme Dr. Subhash Pandey State Nodal Officer Directorate of Health & Family Welfare, Chhattisgarh, Raipur.

2. 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

3. Part -A About National Iodine Deficiency Disorders Control Program

4. GOALS To Reduce the prevalence of Iodine Deficiency Disorders below 10% in the entire country by 2012 Achieve Universal Access to Iodized Salt Source: 11 th Five Year Plan, Govt. of India

5. 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

6. Spectrum of Iodine Deficiency Disorders Foetus: 1. Abortions 2. Still Births 3. Congenital Anomalies 4. Increased PNMR 5. Neurological Cretinism 6. Myxedematotous Cretinism

7. Spectrum of Iodine Deficiency Disorders Neonate: Neonatal Goitre Neonatal Hypothyroidism Child & Adolescent: Juvenile Hypothyroidism Impaired Mental Function Retarded Physical development Adult: Goitre with its complication Hypothyroidism Impaired Mental Function

8. Effect on people: HUMANSHealth & Socioeconomic impact Effect on animals: LIVESTOCKClinical & Reproductive disorders, decreased productivity Low Availability of iodine: PLANTSIodine poor feeds & fodders Soil Erosion : WATER, SOILEnvironmental iodine deficiency Iodine Deficiency – A Disease of The Soil

9. Brain Cell Growth Iodine Deficiency Iodine Sufficiency Iodine Deficiency is the single most common cause of preventable mental retardation

10. 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

11. 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

12. IDD Prevalence Indicators and Criteria for classifying IDD as significant public health problem IndicatorMildModerateSevere Goitre Grade >0 5-19.9%20-29.9%>30% Urine Iodine Excretion (Microgram/L) 50-9920-49<20

13. Part -B Facts about Iodine & Iodized Salt

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

15. 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 17 th May, 2006.

16. 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.

17. 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.

18. 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.

19. Part - C Chhattisgarh State at a Glance

20. 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)

21. Prevalence of IDD and status of NIDDCP in Chhattisgarh : Table showing the number of districts surveyed & found endemic StateNo. of Districts Surveyed No. of Districts Found Endemic IDD LAB Chhattisgarh 2 (Sargujja, Jashpur) 2No

22. 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)

23. 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.

24. 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 21 st 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

25. 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 also during 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.

26. NIDDCP – Budgetary Provisions under NRHM Activity ProposedAmount Proposed Amount Approved 2009-10 Remarks 1 Establishment of IDD Control Cell 4.506.00The State Govt. may modify the PIP as per allocation. 2 Establishment of IDD Monitoring Lab. 2.503.50 3 Health Education and Publicity. 3.006.00 4 IDD Surveys1.502.50 Total11.5018.00

27. 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.

28. Innovative activities in the state The following has been the distribution details of Iodized salt (Amrit Namak) in the state: –2003-041889.00 MT –2004-0530916.14 MT –2005-0646909.00 MT –2006-0753823.00 MT –2007-0864047.00 MT –2008-0958743.54 MT –2009-1055753.78 MT (till Oct 09)

30. 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