Iodine Deficiency - PowerPoint

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					IDD Problem Pyramid
• It's worldwide major public health problem. Globally 1.5 billion- risk of Iodine deficiency disorders. • The pyramid shows the visible effects of Iodine Deficiency Disorders (IDD) Goitre and Cretinism account only for 1--10% of these, • Whereas 90% of the effects remain hidden.

Goitre & Cretinism Some brain damage Less active population due to decreased thyroid function (hypothyroidism)

1%-10% 5% -30%

30% - 70%

Effect of Iodine Deficiency
1) World’s single most significant cause of preventable brain damage and M.R. is Deficiency of Iodine.

2) With every passing hour, 10 out of 150+ children, who are born in our country, will not attain their optimum physical and mental potential due to iodine deficiency.

3)- Current Research indicates that iodine deficiency result in lowering the average intelligence of the entire school age population by as much as 10 to 15 points “So 400 millions IQ points are missed by 40 million children”.
4)- Therefore, preventing deficiency, raises the learning capacity of school children and improves performance in school .

Iodine Deficiency
A Public Health Problem

• Iodine deficiency in pregnant woman may cause miscarriages, stillbirths, and birth defects. • Iodine deficiency impairs growth and development of children.

Iodine Deficiency
A Public Health Problem

• Children with iodine deficiency may grow up stunted, less active, mentally retarded with impaired movements, speech or hearing. • Iodine deficiency also causes goitre • The majority of people in South-East Asia are at risk from iodine deficiency disorders.

Indicators from wealth Index
100 80 60 40 20 0 Lowest Second Stunted Middle Wasted Fourth Underweight Highest
Source: NFHS - III

Key Indicators by Caste / Tribe
100 80 60 40 20 0 SC Stunted ST Wasted OBC Underweight Others
Source: NFHS - III

Household Characteristics Assam Vs. India
100 90 80 70 60 50 40 30 20 10 0

79.8 67.4 56 42 30 53

Households in Rural area

Low Standards of Living



% of Household using Adequate Iodized salt

% of HH by degree of Iodization of Salt 100 80 60 40 20 0
Assam India Rural India

53.4 43.9 36.2 23.8 8.7 29.6

51.8 25.5


Not Iodized

7 PPm

15 + PPM

Percentage of Iodized salt consumption – All Districts of India

Iodine Deficiency (ID), A world-wide public health problem
• ID affects 7 % of the world population
• Pregnant women and young children are the population groups most susceptible to ID • Brain development is impaired by ID which results in delay in child’s psychomotor development and low IQ Iodine deficiency is the first preventable cause of brain damage in childhood “ID compromises National development”

Role of Iodine
• Iodine is a micronutrient, present as minute amounts in the body:
- Essentially in the thyroid gland - Role: Synthesis of thyroid hormones

• Thyroid hormones are required for :
- Growth - Organ development, especially brain - Metabolism: utilization of nutrients by the body, especially energy and proteins

Iodine deficiency, A significant environmental problem
• Iodine is essential: it cannot be synthesized by the body • Insufficient iodine intake is the primary cause of ID • Iodine is present in almost all food products, in particular sea products • Leaching of iodine from the soil due to erosion and exacerbated by heavy rains, deforestation, overgrazing and clearing leads to a loss of iodine from soil and water, and subsequently a low iodine content of animal and non-animal products. • This occurs in mountainous areas at high altitude and in alluvial plains A teaspoon of iodine is all that’s required in a lifetime

Health consequences of iodine deficiency
• Low dietary supply of iodine results in :
- Reduction in the production of thyroid hormones and, - Hypothyroidism

• Pregnant women and young children are the most susceptible to ID
- Hypothyroidism during pregnancy causes impaired fetal development and brain damage which leads to :


Delay in psychomotor development Cretinism

Spectrum of Iodine Deficiency Disorders (IDD)
• Pregnancy
– – – – Stillbirths and increased prenatal mortality Congenital anomalies Cretinism Psychomotor defects

• Childhood and Adolescence
– – – – Goiter Neonatal/Juvenile hypothyroidism Retarded mental and physical development Diminished school performance

• Adult
– – – – Goiter and it’s complications Hypothyroidism Impaired mental function Increased susceptibility to radioactivity

Prevention and control of iodine deficiency
In order to prevent ID in iodine deficiency areas, iodine must be provided through supplementation or food fortification  Supplementation with iodized oil Advantage :
• Given once a year ( oral form) • Can target at risk group

Disadvantage :
• Depends on logistics

 Fortification Advantage :
• Large coverage • Well accepted by the population and does not need its active participation

Disadvantage :
• Need of reliable monitoring system • Expensive

Salt : recommended food vehicle for iodization
 Among the most common food vehicles used for iodization (bread, milk, water and salt), salt has been chosen for the following reason :
• • • • • • Salt is consumed by everyone Salt production is generally centralised Salt iodization is easy to implement Salt iodization can be implemented at a reasonable cost Colour, taste and odour of salt are not affected by iodization Salt quality can be easily monitored at production, retail and household level

“Universal Salt Iodization (USI) is the strategy recommended & Accepted by ALL”.

Choice of fortificant and level of iodization
• Choice of fortificant
> Iodide has been used as a salt fortificant for the last 80 years. It is still used in many European countries > Iodate was introduced as fortificant 50 years ago, It is more soluble and stable than iodide and is preferred for humid and warm climates

• Level of salt iodization
– Iodized salt should provide 150µg iodine/day so that urinary iodine concentration is within the range of 100-200 µg/l – The recommended level of iodine in salt is 20 to 40 mg iodine/kg/salt, assuming :

 20% loss between the point of production and the household  20% loss during cooking

Conditions required for an effective salt iodization programme
 To be safe
• • Reliable surveillance system for monitoring quality control and quality assurance Level of salt consumption compatible with healthy diet

 To be sustainable
• • • Commitment of the government and salt industry Need of Partnership Legislation

 To have a large population coverage, including the population groups the most at risk
• Monitoring of household coverage

 To correct iodine deficiency by ensuring adequate iodine intake
• Assessment of iodine status (UIE) in regular Intervals

Elimination of iodine deficiency International commitments
 At global level
** ID elimination
• • • • • • • World Health Assembly ( 1990,1993,1996 and 1999) World Summit for Children (1990) International Conference on Nutrition (1992) UN General Assembly- Special Session for children (2002) “ Achieve elimination of iodine deficiency disorders by year 2005” UNICEF/WHO Mid-Decade goal (1994) WHA : 1992,1996 and 1999

** USI as the recommended strategy for IDD elimination

 At regional level
** ID elimination
• • • Africa (1996) : Regional Conference on IDD ( Harare) America ( 1994) : Declaration of Quito Eastern Mediterranean : WHO Regional Committee ( 2000)

Iodine deficiency is still a public health problem The challenge for the forthcoming years are :
• To improve the quality of information on the magnitude of iodine deficiency • To increase household coverage with iodized salt • To strengthen collaboration between all partners committed to elimination of iodine deficiency, • To strengthen surveillance system for :
 Quality of iodized salt ( QA/QC)  Population’s iodine status