1. National Iodine Deficiency Disorder Control Programme By Dr. Polly Nula

2. What is iodine? Nutrient needed in aminute quantity daily.Recommended daily intake:150 μg (Micronutrient) Total quantity present in body is (15-20 mg)mostly in thyroid gland

3. What is iodine? Iodine: Essential component of thyroid hormones, which are needed for: - Optimal mental & physical development - Regulation of body metabolism (Generation & utilization of body energy)

4. Sources of iodine Food is the main source of iodine Meat, fish & dairy products Vegetables, cereals High amounts in sea fish & seaweeds Sea salt is a poor source of iodine

5. Iodine deficiency – Disease of the soilGradual leaching of iodine from soil due to: Floods Melting of Glaciers Rivers changing course

6. Iodine : Daily requirements [WHO, UNICEF, ICCIDD: Recommended iodine levels in salt and guidelines for monitoring their adequacy and effectiveness. WHO/NUT/96.13. Geneva. 1996 ]

7. Spectrum of IDD Goiter Cretinism Spontaneous Abortions, Stillbirths, BirthDefects Defects of Speech & Hearing, Squint, Psychomotor defects Loss of 13 IQ points,Leading Cause of Mental handicap

8. Iceberg of IDD

9. Iodine deficiency disorders:A public health problem - 1 Worldwide distribution

10. Iodine deficiency disorders:A public health problem High risk groups: - Pregnant & lactating women - Pre-school children Elimination of IDD: - is an important developmental social goal for governments (UNGASS 2002; MDG – 2015) - is possible UNGASS: United Nations General Assembly Special Session on Children MDG: Millennium Development Goals

11. Our primary concern To ensure that: Every population should & Every mother & child must Get their daily supply of iodine

12. Iodine consumption on daily basis for all times to come Daily requirement of iodine per person is 150 µg – fits on the tip of hair ! Lifetime requirement for 70 years is 5 gms – one teaspoonful ! However, this daily requirementhas to be met daily, for all times to come “Daily consumption of adequatelyiodized salt is a healthy habit”

13. Vehicle for iodine : Salt One food item consumed every day,by everybody in fixed quantities Rich or poor, urban or rural area,man or woman, child or adult Average daily consumption in Indiaper person is 10 gm Iodization of salt is a simple process Cost of salt iodization is : 10 paise/person/year

14. Iodized salt – The panacea for iodine deficiency Promotion of Iodized Salt Consumption

15. HISTORY: Kangra Valley Study Pioneer study conducted inKangra District ofHimachal Pradesh, byProf. V. Ramalingaswami

16. From evidence to program The Kangra Valley study (1956-1972)

17. From evidence to program – The Kangra Valley study (1956-1972)ADMINISTRATIVE INTERVENTION ADAAAA Legislation (ban on sale ofnon- iodized salt in study area) Iodized salt distributed through government shops No price difference between iodized and non-iodized salt

18. From evidence to program The Kangra Valley study (1956-1972) conclusions ConclusionsAA Iodine supplementation in the form of adequately iodized salt on a regular and continuous basis reduces goiter prevalence Recommendations Establish a National Goiter Control Programme (NGCP) As a result,National Goiter Control Program established in 1962 RECOMMENDATIONS

19. Scenario after Kangra Valley study National Goiter Control Program (NGCP)launched at the end of Second Five Year Plan (1962) Aims : 1) Initial survey to identify endemic areas 2) Production & Supply of iodized salt to endemic areas 3) Impact assessment surveys after five years Approach : District specific program

20. NGCP: Low priority Goiter: - is painless - not a cause of death - has been perceived as a cosmetic problem only - socio-cultural norm in some groups Therefore, NGCP received low priority from the viewpoint of government as a national public health program,and also from the population

21. The hourglass of IDD Iodine Deficiency = Goiter = Visible Swelling No Pain, Cosmetic problem Cretinism: A rare event = LOW PRIORITY Brain Damage Lack of Energy - hypothyroidism Learning Disability, ↑Deaths  Child Development & Child Survival  Human Resource Development = HIGH PRIORITY Historic view1962-1983 Current view1984 onwards

22. NATIONAL IODINE DEFICIENCY DISORDER CONTROL PROGRAM. In August, 1992 the National Goitre Control Programme(NGCP) was renamed as National Iodine Deficiency Disorders Control Programme(NIDDCP). Objective: (i) Initial surveys to assess the magnitude of the Iodine Deficiency Disorders. (ii) Supply of iodated salt in place of common salt. (iii) Health Education & Publicity. (iv) Resurveys to assess the impact of iodated salt after every 5 years. (v) Laboratory monitoring of iodated salt and urinary iodine excretion.

23. Achievements: To ensure use of only iodated salt the sale of non-iodated salt was banned under Prevention of Food Adulteration Act, 1954, Establishment IDD Control Cell in the State Health Directorate A National Reference Laboratory for monitoring of IDD.

24. Achievement- Spot qualitative testing Setting up one district level IDD monitoring laboratory Cash grants The standards for iodated salt have been laid down under PFA Act, 1954.

25. IEC Activities . To intensify the IEC activities a communication package by way of video films posters/danglers and radio/TV spots have been finalized. IDD spot has been telecast on Doordarshan (National Network)

26. Use of iodized salt – at house hold levelNorth East:- 91% 88% 84% 80% 79% NFHS –2, 1998-99 67% 70% 63% 59% 59% 57% DLHS-2002 52% 55% 47% Sikkim Manipur Assam Meghalaya Nagaland Arunachal Mizoram

27. Estimated percentage of Household consuming adequately Iodized Salt 95% 93% 77% 74% 70% 65% 63% 50% 48% Bhutan China Thailand Vietnam Indonesia Nepal India Myanmar Bangladesh UNICEF-2003

28. PREVALENCE OF IDD IN MANIPURSURVEY REPORT:

29. IMPLEMENTATION OF NIDDCP IN MANIPUR IDD CELL -Estd. in 1987 as NGCP with creation of post & staff posting -Function as NIDDCP since 1992. IDD MONITORING CELL - Estd. in IDD Cell, Medical Directorate. - Lab Tech. & Lab Asst. posted since 1996.

30. Thank Q Dandi March

31. Thank Q