NIDDCP

1. “NATIONAL IODINE DEFICIENCY
DISORDER CONTROL PROGRAM”
PRAMOD KUMAR

2. INTRODUCTION
• Iodine is essential micronutrient. It is required
at 100-150 micrograms daily for normal human
growth and development. Deficiency of
nutritional iodine in the food/ diet is called as
Iodine Deficiency Disorders.
• It affects people of all ages, both sexes and
different socioeconomic status.
• Iodine deficiency during pregnancy leads to
decreased availability of iodine to the fetus.

3. Life stages Effect
Fetus - Abortion
- Stillbirth
- Congenital anomalies
- Increased perinatal mortality
- Increased infant mortality
- Neurological cretinism
- Mental deficiency, deaf, mutism
- Septic diplegia squint
- Myxedematous cretinism
- Dwarfism
- Psychomotor defects
Neonate - Neonatal goiter
- Neonatal hypothyroidism
Child and
Adolescent
- Goiter
- Juvenile hypothyroidism
- Impaired mental function
- Retarded physical development
Adult - Goiter
- Hypothyroidism
- Impaired mental function

4. BURDEN OF DISEASE:
• Iodine deficiency disorders are worldwide major
public health problem.
• They affect a large segment of population in all
continents of our planet and have been with us from
generations.
• As per information, more than 1.5 bollion people all
over the world are at risk of IDD.
• IDD are preventable in 130 countries, affecting 13% of
the world population.
• In India, it is estimated that more than 350 million
people are at risk, while the number of persons
suffering from IDD is above 71 million.

5. cont..
• Among newborns, 8.1 million and among pregnant
women, 8.9 million are at risk of IDD.
• The surveys conducted by ICMR AND Medical
institutes have clearly demonstrated that not even a
single state/ union territory is free from the problem.
• Sample surveys have been conducted in 28 states and
7 union territories, which have revealed that out of
324 districts surveyed , 263 districts are IDD
endemic.

6. PREVENTION:
• The simplest method to prevent the broad
spectrum of IDD is to consume Iodated salt daily.
• The supply of iodated salt is to ensure availability
of not less than 150 micrograms of iodine per
person per day.

7. NATIONAL IODINE DEFICIENCY
DISORDER CONTROL PROGRAM
INTRODUCTION:
• Realizing the magnitude of the problem , the government
of India launched a 100 percent centrally assisted
National Goiter Control Program (NGCP) in 1962. In
august 1992, National Goiter Control Program (NGCP)
was renamed the National Iodine Deficiency Disorder
Control Program (NIDDCP) with a view to cover a wide
spectrum of Iodine Deficiency Disorder like mental and
physical retardation, deaf-mutism, cretinism, still-births,
abortion etc.

8. GOAL:
• The government’s goal of NIDDCP is to reduce
the prevalence of iodine deficiency disorders
below 10 percent in the entire country by 2012
A.D.

9. OBJECTIVES:
Survey to assess the magnitude of the Iodine Deficiency
Disorder.
Supply of Iodated salt in place of common salt.
Resurvey after every 5 year to assess the extent of Iodine
Deficiency Disorder and the impact of iodated salt.
Laboratory monitoring of isolated salt and urinary Iodine
excretion.
Health education & publicity.

10. POLICY:
• It had been established that consumption of iodated salt
is the best and simplest way to prevent and control IDD.
• Based on the recommendation of the central council of
health in 1984, the govt. of India took a policy decision to
iodated the entire edible salt in the country by 1992 in a
phased manner. The program started in 1986 in April.
• The central govt. has issued the notification banning the
sale of non-iodated salt for direct human consumption in
the entire country with effect from 17th may, 2006 under
the prevention of food adulteration act 1954.

11. NODAL MINISTRY:
• The ministry of health & family welfare is the
nodal ministry for policy descisions on National
Iodine Deficiency Disorder Control Program
(NIDDCP).

12. IODINE DEFICIENCY DISORDER CELL
OF DIRECTORATE GENERAL OF
HEALTH SERVICES:
The Central Nutrition and Iodine Deficiency
Disorders cell at the Directorate General of Health
Services (DGHS) is responsible for the
implementation of NIDDCP in the country. The
important activities of IDD are as follows:
• Technical guidance to the states/UTs.
• Intersectoral coordination at Central level and
maintenance close liaison with the ministry of
Industry/transport etc.

13. cont..
• Coordination of the various facets of NIDDCP in states/
UTs.
• Undertaking independent IDD surveys and monitoring in
various states/UTs.
• Imparting training to the state health to whom personnel,
involved in NIDDCP.
• Collection, compilation and analysis of relevant data from
states/UT with a view to render more effective and
meaning advice.
• Monitoring of the quality control of iodated salt at
production level through the salt commissioner and at the
distribution & consumer level through the state health
directorate.

14. cont..
• Monitoring the procurement and distribution of
iodated salt in States/UTs.
• Managing the IEC activities at apex level.
• Managing the financing and other physical
aspects of state level IDD cells.

15. STATES/UNION TERRITORY IDD CELL:
Each state government has an IDD control cell, which
is responsible for:
• Checking iodine levels of iodated salt with
wholesalers & retailers with in the state and
coordinating with the food & civil supplies
department.
• The distribution of iodated salt with in the state
through open market & public distribution system.
• Creating demand for iodated salt.
• Monitoring consumption iodated salt.

16. cont..
• Conducting IDD surveys to identify the
magnitude of IDD in various districts.
• Conducting training.
• Dissemination of information, education and
communication.

17. CURRENT STATUS OF PROGRAM:
• 31 states/ UTs have established Iodine Deficiency
disorder control cells in their state health directorate.
• 30 states/UTs have already setup Iodine deficiency
disorders monitoring laboratories while the remaining
states are in the process of establishing same.
• 365 districts have been surveyed tell now.
• In a survey carried out by ICMR, central and state
health directorate and medical institutions, 365
districts were surveyed and out of which 303 districts
were found to be endemic.

18. cont..
• To raise the awareness, song and drama division through
their fields unit have been carrying out extensive special
interactive programmes/ activities in 200 high focused
districts in 16 states of the country.
• IDD spots are being telecast through the Doordarshan
daily, in all 14 regional languages, are broadcast by the All
India Radio through its 37 Vividha Bharti channels and 129
primary channels.
• Message about IDD and consumption of Iodated salt on
computerized railway reservation tickets.
• Global IDD prevention Day is celebrated in districts on 21
october every year.

19. ACHIEVEMENTS OF PROGRAM:
• The salt production policy has been liberalized and
permitting production by the private sector. 824 private
units have been licensed by the salt commissioner, out of
which nearly 532 units have commenced production so
far.
• The ministry of railway is providing priority
arrangements (category ‘B’) for the transportation of
iodated salt. This priority is second to that of defense.
• Since may 2006 the central government has issued
notification banning the sale of non iodated salt in
country.

20. cont..
• Standard for iodated salt have been laid down under
prevention of food adultration act 1954. These
stipulate that the iodine content of salt production
and consumption levels should be at least production
and consumption levels should at least 30 and 1 ppm
respectively.
• The NIDDCP has been included in the 20 point
program of the prime minister.
• Each state and UT has been advised to established to
established an IDD control cell in their state/ UT.

21. cont..
• Cash grants are also provided by the central
government for health education and publicity
campaign to promote the consumption of iodated salt.
• The nutrition and IDD cell of the directorate general
of the health services carrying out surveys and
training of staff.
• A national reference laboratory for the monitoring of
IDD has been set up at the Bio-chemistry and
biotechnology division of the National Center for
disease control, delhi, for training medical and
paramedical personnel and monitoring the iodine
content of salth & urine.

22. cont..
• For ensuring quality control of iodated salt at
consumption level, testing kits for ‘on the spots’
qualitative testing have been distributed to all the
district health officers.
• A program implementation committee under the
chairmanship of director general of health services has
been constituted to review the program.
• A central streering committee has been set up under
the chairmanship of secretary (health and family
welfare) for effective coordination with other sectors.

23. INFRASTRUCTURE:
• National Iodine Deficiency Disorder controls program
at the central level is being managed by adviser
(Nutrition) of the directorate general of health
services.
• An independent nutrition & IDD cell has been created
under the deputy asst. director general (IDD) with
support of research officer (IDD) assisted by a team
comprising a technical assistant, a junior investigator,
field assistants, field attendants, a computer and
other ministerial staff.
• Each state is having their own IDD cell. Till now there
now 31 IDD cells and 30 laboratories have been
established.

24. FINANCIAL ASSISTANCE:
• Financial assistance is being provided to all the
states/UTs in form of quarterlt advance release
of funds w.e.f. 2002-03 for various components
under the program.

25. IDDCP IN 12TH FIVE YEAR PLAN (2012-
2017)
GOALS:
Universal use of iodine fortified salt.
• to bring down prevalence of IDD below 5% in the
entire country by 2017 AD.
• To ensure 100% consumption of adequately
iodated salt (15 PPM) at the household level.

26. cont..
• To achieve the same, following indicators
are given below:
INDICATOR GOAL
Salt Iodisation
Proportion of household consuming
adequately iodised salt
>90%
Urinary Iodine
Median in the general population
Median in pregnant
100-199ug/L
150-249ug/L
Programmatic Indicators
Attainment of indicatrors
At least 8 of 10

27. STRATEGIES:
IDD survey
Establishment of IDD
Contrrol cells
Establishment of IDD
Monitoring labs.
Training program.

28. cont..
Production and
distribution of
iodated salt.
Health
education
and
publicity.
Community
level iodated
salth testing.

29. cont..
Incentive to
ASHA for
community
level awareness
of iodated salt.
Strengthening
of central IDD
control cell.
Health
education and
publicity by the
state/UTs.

30. WORLD HEALTH ASSEMBLY: 52TH
RESOLUTION
Prevention and control of Iodine Deficiency
Disorders
• WHO is concerned about Iodine deficiency that
remains a major threat to the health and
development of populations worldwide and that it
may result in goiter, stillbirth and miscarriage,
neonatal and juvenile thyroid deficiency,
dwarfism, brain damage, intellectual impairment,
deaf mutism, septic weakness and paralysis as
well.

31. cont..
• WHO calls for preventive and control of Iodine
deficiency in the world by all the governments,
international organizations, bilateral agencies
and non- governmental organizations in
particular the International Council for Control
of Iodine Deficiency Disorders (ICCIDD) to
control and prevent iodine deficiency at global,
regional and national levels.

32. cont..
The salt industry are requested for its
collaboration and key role in making iodized salt
available to populations at risk of iodine
deficiency, and for its initiative in highlighting
iodization of salt at international forum.

33. RESEARCH ARTICLE
IODINE DEFICIENCY AMONG GOITER
PATIENTS IN RURAL SOUTH SUDAN
• Background: It is estimated that 2.2 billion or
approximately 30% of the world’s population live in
iodine-deficient areas. In a 2005 study households
consuming iodized salt in South Sudan increased from
40% to 73%. Despite this achievement, there are still
many goiter cases in rural South Sudan and iodine
deficiency remains as a major public health problem in
this part of sub Saharan Africa. The purpose of this
study therefore was to determine the prevalence of
iodine deficiency among rural Southern Sudan goiter
patients.

34. cont..
• Methods: A cross-sectional study was carried out in
three South Sudan counties, adults with goiter were
from three centers following a mobilization campaign
that lasted 4 weeks for free medical care. They were
clinically evaluated and completed interviewer
administered questionnaires to determine their age,
gender, diet, family history, drug history, and medical
history. Urine samples were then taken for urinary
iodine levels. The outcome was iodine deficiency
measured as urinary iodine less than 100 μg per/ L.
Multiple logistic regression was used to establish the
factors associated with iodine deficiency in South
Sudan. Ethical approval was obtained.

35. • Results: A total of 286 goitre patients were
recruited. The mean age was 38 years (SD 9),
262(92%) were females (F: M ratio 11:1), and
257(90%) were rural- peasants, 25% (20/286) had
moderate to severe iodine deficiency. 174 (62%)
consumed non-iodized salts.
• Conclusion: Iodine deficiency is highly prevalent
among rural South Sudan communities and a likely
cause for goiters. Rural poor women are highly
vulnerable.