iodine deficiency disorder

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Prepared By                    Presented with
SAgun Paudel                    Arati Kunwar
Iodine is essential for human health as it is a
constituent of thyroid hormones, which play an
important role in physical and mental development.

Iodine is one of the leading causes of preventable
mental retardation and brain damage in the world.
Iodine deficiency not only leads to goiter and
cretinism but also to a much broad spectrum of
Iodine deficiency is the single most
common cause of preventable
mental retardation and brain
damage in the world. The deficiency
has an immediate effect on child
learning capacity, women's health,
the qualities of life in communities
and economic productivity.

The normal requirement of iodine
for human beings averages 150 μg
per person per day.
When people consume diet lacking
sufficient iodine several important
health consequences known as
iodine deficiency disorder (IDD) will

Iodine deficiency is a major public
health problem for populations
throughout the world, particularly
for the pregnant women and young
             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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Spectrum of IDD
Most important consequences of the spectrum
of IDD are:
• Goiter
• Mental retardation
• Hypothyroidism
• Cretinism
• Increased morbidity and mortality of infants
and neonates

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                 Risk factors
Following is a list of potential risk factors that
may lead to iodine deficiency:
• Low dietary iodine
• Selenium deficiency
• Pregnancy
• Exposure to radiation
• Increased intake/plasma levels of goitrogens,
  such as calcium

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  • Sex (higher occurrence in women)
  • Smoking tobacco
  • Alcohol (reduced prevalence in users)
  • Oral contraceptives (reduced prevalence in
  • Perchlorates
  • Thiocyanates
  • Age (for different types of iodine deficiency at
    different ages)

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• 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: 2007

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             Distribution of Iodine Deficiency in Developing

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According to WHO a goitre rate above 5%
constitutes a public health problem. A profile
analysis from different studies in different
countries showed that from all babies born to
iodine deficient mothers, 3% will have sever
mental and physical damage, 10% show moderate
mental retardation and the remaining 87% show
some form of mild intellectual disability.

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     Iodine deficiency world wide
                        Proportion of                       Population
                          population                          with UI < 100
WHO Regions
                          with UI < 100 g/L                   g/L (in
                          (%)                                 millions)
Africa                                             47.6                     48.342
The Americas                                       14.1                       9.995
                                                   55.4                     40.224
Europe                                             59.9                     42.206
South East
                                                   39.9                     95.628
                                                   19.7                     36.082
Total                                              36.9                   272.438
  WHO, UNICEF & International Council for the Control of Iodine Deficiency Disorders
Country             Total POP.            Population at risk (TGR > 10%)              Endemic goitre prevalence

                                              Number                    %                 Number                    %

Bangladesh               97 438                37 150                  38.1                10 225                 10.5

Bhutan                    1 446                 1 466                  100.                  946                  65.4

Burma                    39 920                14 545                  36.5                 5 694                 14.3

India                    746 010              149 588                  20.0                  7.3

Indonesia                161 003               29 773                  18.5                 9 759                  6.1

Nepal                    16 386                15 099                  92.0                 7 555                 46.1

Sri Lanka                16 099                10 565                  65.6                 3 112                 19.3

Thailand                 52 709                20 439                  38.8                 7 740                 14.7

TOTAL                  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
 Demographic Yearbook 1981/1982
• 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 – a
handbook of monitoring and quality control. UNICEF, ROSCA, New Delhi. January 1985.

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• 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-aged
children) .
• 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.

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Only     35%      of    the
respondents had heard
educational       messages
about iodized salt and very
few of the respondents
(19%) knew about the
importance of iodized salt
for health.

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Iodine deficiency in pregnancy causes more than
200,000 babies a year in Nepal to be born
mentally impaired; even mildly or moderately
iodine-deficient children have IQs that are 10 to
15 points lower than those not deficient.

Source: A National Development Priority THE WORLD BANK

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Iodine deficiency disorders (IDD) affect an estimated 10
million Nepalese nationwide.

A Goitre prevalence of 41.5% among females and
38.4% among males among school-aged children 6-14

Source: Nepal Micronutrient Status Survey -1998
The estimated percent of households consuming
salt with some iodine is 91%. The estimate of
households consuming adequately iodized salt
(15ppm or above) is 63%.

Sourced from the Between Census Household Information, Monitoring and Evaluation System 2000- BCHIMES.

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       Prevention and Control of IDD

Iodine deficiency is a significant environmental
problem. Iodine is essential for the synthesis of
thyroid hormones and cannot be synthesized by
the body.
Leaching of iodine from the soil due to erosion of
heavy rain, deforestation, overgrazing and clearing
lead to loss of iodine from the soil and water.

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Subsequently the iodine content would be low
in water, animal and plant products originated
from such iodine deficient soils. Hence, an
iodine deficient environment requires the
continued addition of iodine.

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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.

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• Universal salt iodization
- Iodization of salt for both human and
livestock consumption is required
- Use iodized salt in the food industry
to the population on a continuous and
self sustaining basis

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               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 Lugol's iodine at regular
             • Iodization of water supplies by addition
               of iodine solution

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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.

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     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 Sinkiang

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       Policy and legislation in Nepal
Legislation on IDD: Currently, there is legislation
concerning the status of IDD in Nepal. It was
enacted in 1999 and makes the iodization of salt
manditory at a level of 50 PPM of iodine at the
production level.
The legislation has not been significantly revised
since, although there are no published
government documents concerning IDD.

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    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
    The agency that is responsible for addressing
    IDD is the Nutrition Section, Child Health
    Division, of the Department of Health Services
    under the MOHP.

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             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.

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• Evaluation of IDD status
  through National Survey and
  integrated mini- surveys for
  Vitamin A, iodized salt and
• Iodized salt warehouse
  constructions in various parts
  of country.
• Development of Iodized Salt
  Act in 1998.

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• 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
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 • 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
 • 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 1985
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             THANKYOU !

07/10/2012      Iodine Deficiency Disorder   35

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