Iodine deficiency disorder


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Iodine Deficiency Disorders refer to a spectrum of health consequences resulting from inadequate intake of iodine. The adverse consequences of iodine deficiency lead to a wide spectrum of problems ranging from abortion and still birth to mental and physical retardation and deafness, which collectively known as Iodine Deficiency Disorders (IDDs).

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Iodine deficiency disorder

  1. 1. IODINE DEFICIENCY DISORDER (IDD)Prepared By Presented withSAgun PAudel Arati Kunwar
  2. 2. INTRODUCTIONIodine is essential for human health as it is aconstituent of thyroid hormones, which play animportant role in physical and mental development.Iodine is one of the leading causes of preventablemental retardation and brain damage in the world.Iodine deficiency not only leads to goiter andcretinism but also to a much broad spectrum ofdisorders.
  3. 3. Iodine deficiency is the single mostcommon cause of preventablemental retardation and braindamage in the world. The deficiencyhas an immediate effect on childlearning capacity, womens health,the qualities of life in communitiesand economic productivity.The normal requirement of iodinefor human beings averages 150 μgper person per day.
  4. 4. When people consume diet lackingsufficient iodine several importanthealth consequences known asiodine deficiency disorder (IDD) willresult.Iodine deficiency is a major publichealth problem for populationsthroughout the world, particularlyfor the pregnant women and youngchildren.
  5. 5. Definition Iodine Deficiency Disorders refer to a spectrum of health consequences resulting from inadequate intake of iodine. The adverse consequences of iodine deficiency lead to a wide spectrum of problems ranging from abortion and still birth to mental and physical retardation and deafness, which collectively known as Iodine Deficiency Disorders (IDDs).31/08/2012 Iodine Deficiency Disorder 5
  6. 6. Spectrum of IDD
  7. 7. Most important consequences of the spectrumof IDD are:• Goiter• Mental retardation• Hypothyroidism• Cretinism• Increased morbidity and mortality of infantsand neonates31/08/2012 Iodine Deficiency Disorder 7
  8. 8. Risk factorsFollowing is a list of potential risk factors thatmay lead to iodine deficiency:• Low dietary iodine• Selenium deficiency• Pregnancy• Exposure to radiation• Increased intake/plasma levels of goitrogens, such as calcium31/08/2012 Iodine Deficiency Disorder 8
  9. 9. • Sex (higher occurrence in women) • Smoking tobacco • Alcohol (reduced prevalence in users) • Oral contraceptives (reduced prevalence in users) • Perchlorates • Thiocyanates • Age (for different types of iodine deficiency at different ages)31/08/2012 Iodine Deficiency Disorder 9
  10. 10. Epidemiology• Iodine deficiency is the single most important cause of preventable mental retardation. Globally more than two billion (or over 38% of the population living in 130 countries) are estimated to be at risk of IDD and 260 million people in Africa are at risk and 150,000 are affected by goiter.Source: 200731/08/2012 Iodine Deficiency Disorder 10
  11. 11. Distribution of Iodine Deficiency in Developing Countries31/08/2012 Iodine Deficiency Disorder 11
  12. 12. According to WHO a goitre rate above 5%constitutes a public health problem. A profileanalysis from different studies in differentcountries showed that from all babies born toiodine deficient mothers, 3% will have severmental and physical damage, 10% show moderatemental retardation and the remaining 87% showsome form of mild intellectual disability.31/08/2012 Iodine Deficiency Disorder 12
  13. 13. Iodine deficiency world wide Proportion of Population population with UI < 100WHO Regions with UI < 100 g/L g/L (in (%) millions)Africa 47.6 48.342The Americas 14.1 9.995Eastern 55.4 40.224 MedierranenEurope 59.9 42.206South East 39.9 95.628 AsiaWestern 19.7 36.082 PacificTotal 36.9 272.438 WHO, UNICEF & International Council for the Control of Iodine Deficiency Disorders
  14. 14. ESTIMATED POPULATIONS AT RISK AND PREVALENCE OF ENDEMIC GOITRE INEIGHT COUNTRIES OF THE WHO SOUTHEAST ASIAN REGION (numbers in 1000)Country Total POP. Population at risk (TGR > 10%) Endemic goitre prevalence Number % Number %Bangladesh 97 438 37 150 38.1 10 225 10.5Bhutan 1 446 1 466 100. 946 65.4Burma 39 920 14 545 36.5 5 694 14.3India 746 010 149 588 20.0 7.3Indonesia 161 003 29 773 18.5 9 759 6.1Nepal 16 386 15 099 92.0 7 555 46.1Sri Lanka 16 099 10 565 65.6 3 112 19.3Thailand 52 709 20 439 38.8 7 740 14.7TOTAL 1 131 011 278 605 24.6 99 349 8.8 TGR = Total Goitre Rate (prevalence) Percentages shown are percentages of total populationSource: Clugston and Bagchi (1985, p. 14) and for total population data UN 14 Demographic Yearbook 1981/1982
  15. 15. • It is estimated that approximately 516 million people in Asia are at risk due to environmental iodine deficiency, with about 176 million actually goitrous. In Nepal, about 14 million people are at risk of which 8 million are goitrous.Source: Tyabji, R: The use of iodated salt in the prevention of iodine deficiency disorders – ahandbook of monitoring and quality control. UNICEF, ROSCA, New Delhi. January 1985.31/08/2012 Iodine Deficiency Disorder 15
  16. 16. NEPAL• Currently only 63% of households in Nepal are using adequately iodized salt.• The proportion of low UIE values (<100μg/l)was 39.1% (adult women and school-agedchildren) .• The prevalence of low UIE is highest among women in the Terai zone. It is still high as a public health problem in that group.31/08/2012 Iodine Deficiency Disorder 16
  17. 17. Only 35% of therespondents had heardeducational messagesabout iodized salt and veryfew of the respondents(19%) knew about theimportance of iodized saltfor health. 31/08/2012 Iodine Deficiency Disorder 17
  18. 18. Iodine deficiency in pregnancy causes more than200,000 babies a year in Nepal to be bornmentally impaired; even mildly or moderatelyiodine-deficient children have IQs that are 10 to15 points lower than those not deficient.Source: A National Development Priority THE WORLD BANK31/08/2012 Iodine Deficiency Disorder 18
  19. 19. Iodine deficiency disorders (IDD) affect an estimated 10million Nepalese nationwide.A Goitre prevalence of 41.5% among females and38.4% among males among school-aged children 6-14years.Source: Nepal Micronutrient Status Survey -1998
  20. 20. The estimated percent of households consumingsalt with some iodine is 91%. The estimate ofhouseholds consuming adequately iodized salt(15ppm or above) is 63%.Sourced from the Between Census Household Information, Monitoring and Evaluation System 2000- BCHIMES.31/08/2012 Iodine Deficiency Disorder 20
  21. 21. Prevention and Control of IDDIodine deficiency is a significant environmentalproblem. Iodine is essential for the synthesis ofthyroid hormones and cannot be synthesized bythe body.Leaching of iodine from the soil due to erosion ofheavy rain, deforestation, overgrazing and clearinglead to loss of iodine from the soil and water.31/08/2012 Iodine Deficiency Disorder 21
  22. 22. Subsequently the iodine content would be lowin water, animal and plant products originatedfrom such iodine deficient soils. Hence, aniodine deficient environment requires thecontinued addition of iodine.31/08/2012 Iodine Deficiency Disorder 22
  23. 23. The following methods are intended as a major strategy:1. Food fortification:• Fortification of foods with iodine is an effective means of long-term prevention and control of many iodine deficiencies, and one that has been shown to be cost effective in many countries.31/08/2012 Iodine Deficiency Disorder 23
  24. 24. • Universal salt iodization- Iodization of salt for both human andlivestock consumption is required- Use iodized salt in the food industryto the population on a continuous andself sustaining basis31/08/2012 Iodine Deficiency Disorder 24
  25. 25. 2. Supplementation In areas with lack of transportation and small salt producers are available • Administration of iodized oil capsule • Direct administration of iodine solution such as Lugols iodine at regular intervals • Iodization of water supplies by addition of iodine solution31/08/2012 Iodine Deficiency Disorder 25
  26. 26. 3. Health education Create awareness about the consequences of iodine deficiency disorder, specially for high risk groups (infants, pregnant and lactating women) Advise the people to use iodized salt for household consumption Educate the public to eat iodine rich food items like sea fish, kelp, etc and avoid goiterogenic foods.31/08/2012 Iodine Deficiency Disorder 26
  27. 27. 4. Set surveillance technique to monitor the distribution of adequately iodized salt in the community. Severe IDD: a dwarfed cretin woman with a barefoot doctor of the same age from the Hetian district in Sinkiang31/08/2012 Iodine Deficiency Disorder 27
  28. 28. Policy and legislation in NepalLegislation on IDD: Currently, there is legislationconcerning the status of IDD in Nepal. It wasenacted in 1999 and makes the iodization of saltmanditory at a level of 50 PPM of iodine at theproduction level.The legislation has not been significantly revisedsince, although there are no publishedgovernment documents concerning IDD.31/08/2012 Iodine Deficiency Disorder 28
  29. 29. Government Agency to Address IDD There is legislation governing IDD in Nepal. It was passed in 1955 and has been revised since. Salt iodization is mandatory at the level of 20-60 ppm. The agency that is responsible for addressing IDD is the Nutrition Section, Child Health Division, of the Department of Health Services under the MOHP.31/08/2012 Iodine Deficiency Disorder 29
  30. 30. 31/08/2012 Iodine Deficiency Disorder 30
  31. 31. Government actions in IDD• Universal salt iodization as sole strategy to address IDD.• Distribution of iodized salt in remote districts at subsidized rates.• Implementation of Iodized Salt Social marketing Campaign.• Monitoring of iodized salt at the entry points, regional and national levels.31/08/2012 Iodine Deficiency Disorder 31
  32. 32. • Evaluation of IDD status through National Survey and integrated mini- surveys for Vitamin A, iodized salt and deworming.• Iodized salt warehouse constructions in various parts of country.• Development of Iodized Salt Act in 1998. 31/08/2012 Iodine Deficiency Disorder 32
  33. 33. Recommendation• A monitoring system for IDD control and quality control mechanisms must be established.• All salt should be checked for its iodine content and monitoring procedures should be carried out on an on-going basis as part of routine health assessments.• Stability of Iodine in Salt• National Nutrition Policy and Strategy should be implemented properly.• Quality assurance 31/08/2012 Iodine Deficiency Disorder 33
  34. 34. References: • MODULE of Iodine Deficiency Disorders For the For the Ethiopian Health Center Team. • Monitoring and Evaluation System 2000- BCHIMES. • U • WHO, UNICEF & International Council for the Control of Iodine Deficiency Disorders • Nepal Micronutrient Status Survey -1998 • A National Development Priority THE WORLD BANK • Tyabji, R: The use of iodated salt in the prevention of iodine deficiency disorders – a handbook of monitoring and quality control. UNICEF, ROSCA, New Delhi. January 1985. • UN Demographic Yearbook 1981/1982 • Iodine deficiency disorders in nepal: monitoring and quality control of iodated salt a report by m. G. KARMARKAR, ph.D. ,C. S. Pandav, m. D. ,All india institute of medical sciences new delhi – 110 029,may – june 198531/08/2012 Iodine Deficiency Disorder 34
  35. 35. THANKYOU !31/08/2012 Iodine Deficiency Disorder 35