JAGRITI VOL. II, ISSUE 3, JULY 2004
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- JAGRITI VOL. II, ISSUE 3, JULY 2004
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Dear Colleagues,
Dr. John Thornton Dunn is no more. He passed away
on April 13th, 2004 succumbing to a heart attack.
John, as he was fondly known in his vast circle of friends,
was an ardent advocate for promotion of elimination of
iodine deficiency disorders. He always emphasized the
role of the media, especially the print media, as it has
the advantage of sharing and communicating information
and experiences on a regular basis and had a wider
reach. Befitting this, John was the Editor of the IDD
Newsletter of International Council for Control of Iodine
Deficiency Disorders, a position he held from its first issue
published in August 1985 to the latest issue of February
2004. He had numerous professional commitments and
responsibilities including that of the Executive Director
of ICCIDD.
The ICCIDD Editorial Team of the Regional Newsletter
are particularly indebted to Dr. John Dunn for it was John
who inspired us and advocated the need for a Regional
Newsletter. Looking back, it was probably due to this
bonding that John himself released the first Issue of IQ+
Jagriti in Singapore in December 2003 at the ICCIDD
Satellite Symposium during the Conference of AsiaOceania Thyroid Association.
It will be our endeavor to continue with the media-vision
of Dr. John Dunn since John's departure may have caused
a sudden vacuum in the publication of the International
IDD Newsletter. As we pay our homage to John, we
rededicate the Regional Newsletter and redouble our
efforts to carry on with the zeal he has shown. We will
cherish our association with John.
On behalf of the regional team, I wish to convey our
heartfelt sympathy to Ann, his wife and family.
This issue of the Newsletter also covers the book release
function of "Towards The Global Elimination of Brain
Damage Due to Iodine Deficiency". This is the twelfth
publication of ICCIDD in partnership with the Oxford
University PressTrJQhn made an important contribution
both in planning and preparation of the book which is
dedicated to the memory of John T. Dunn.
Regional Coordinator,
ICCIDD-South Asia Region.
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ICCIDD Publications in partnership with
Oxford University Press
Name of Publications
Year
The Story of Iodine Deficiency An International Challenge in Nutrition
1989
La Historic De La Deficiencia De Yodo (Spanish)
1992
L'Histoire de la Carence en lode (French)
1992
SOS For A Billion - The conquest of
Iodine Deficiency Disorders - 1 st Edition
1994
SOS For A Billion - The conquest of
Iodine Deficiency Disorders - 2nd Edition
1996
SOS For A Billion - (Hindi) 1 st Edition
1996
SOS Pour Un Milliard - French
1997
The Story of Iodine Deficiency (Hindi)
1997
YES - Worthwhile Investment in Health Economic Evaluation of
IDD Control Programme in Sikkim
1997
Iodine Deficiency Disorders in Livestock Ecology & Economics
1997
Dr. John T. Dunn (center) releasing the Regional
Newsletter, "IQ+ Jagriti", in Singapore in December,
2003. Also seen in the picture are Dr. Cres Eastman
11
Iodine in Pregnancy
1998
left), Regional Coordinator (Pacific) and Dr. C.S. Pandav
12
Towards the Global Elimination of
Brain Damage due to Iodine Deficiency
2004
(right), Regional Coordinator (South Asia).
ICCIDD Vision & Mission
’77 w*/)/cP/W
ffoV)*7f 37^<7 W
Vision:The vision of ICCIDD is a world virtually free from Iodine Deficiency
From the unreal lead me to the real;
Disorders with national endeavors to maintain optimal iodine nutrition primarily
From darkness lead me to light;
through consumption of iodized salt, which should be made easily available
From death lead me to immortality.
and affordable for all people for all times.
Editorial Board
Mission: The mission of ICCIDD is to provide a focused advocacy to governments
and development agencies, of a continued priority for iodine nutrition, providing
Dr Chandrakant S Pandav
technical expertise in a multidisciplinary approach.
Chief Editor
Shri Peter Parekattil
Dedication: ICCIDD dedicates itself to programs fully
Managing Editor
supported at the national level for permanent, sustained
Dr Denish Moorthy
Technical Editor
Patrons:
success and will work with all partners and national entities
towards that end.
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KHMI ■
Shri Mohan Dharia
Chief Patron
John served as Secretary of the ICCIDD from its beginning in 1985.
Dr Kalyan Bagchi
He was responsible for all necessary documentation and administration
Patron
for the ICCIDD organization. He initiated the Monthly Update in
Shri R V Pillai, IAS (retd.)
February 1993 and continued its production to the present. He set
Patron
up and maintained the ICCIDD data bank on Country IDD Status
(CIDDS).
Editorial Advisers:
He became Executive Director in 2001 and his performance in this
Dr Prabha Ramalingaswami
role was exemplary. He took new initiatives to strengthen work in
Shri L M Jain, IAS (retd.)
the Regions by personal visits. He was responsible for establishing
Prof N K Ganguly
Prof M G Karmarkar
Shri S Sundaresan
the additional
Regional
Coordinator position for the
Asia Pacific Region. He facilitated the development of the International Resource Laboratories
fo Iodine (IRLI) Network and continued his work as Editor of the IDD Newsletter.
Adv. Makarand Adkar
Shri Bejon Misra
John was an unusually able and intelligent person. This was concealed partially by his
humility and generous acceptance and appreciation of others. He had an excellent
Editorial Assistants:
critical mind and a phenomenal memory.
Smt Reema Sujith
Shri Pritam Singh
Shri Bharat Kataria
He was a superb pianist with an incredibly detailed knowledge of classical music. He
provided instant support for impromptu songs rendered by ICCIDD Board Members at
Annual Meetings!
Circulation
John was above all a warm human being-with great charm and good humour. He was
Smt Saroja Narayanan
a truly civilised man and universally popular with his colleagues in the ICCIDD and
beyond.
Printed & Published by:
Dr C S Pandav on behalf of ICCIDD
We are fortunate to have known him-we are the poorer for his loss but are richer for his
presence among us throughout the life of the ICCIDD.
Contact Address:
Room No 28, CCM Building,
We extend our deepest sympathy to Ann, herself a notable scientist who collaborated with
Old OT Block, All India Institute of
John in his laboratory work. To their three children, Cathy, Peggy and Bob we extend
Medical Sc 522
our deep sympathy and also to other family members on their sudden tragic loss.
E-mail: cpandav@iqplusin.org
Website: www.iqplusin.org
Designed & Printed at
Pathfinders, Lajpath Nagar
Ph.: 26295066
We have included an 'In Memoriam7 page to John Dunn in the recently released book
'Towards the Global Elimination of Brain Damage due to Iodine Deficiency7 to which
he contributed so significantly.
Basil Hetzel, Chairman Emeritus ICCIDD
IDD Elimination- A Global Progress Report
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need was felt particularly in the professional groups and among the programme managers of micronutrient
A
deficiency elimination on having a status report. It is quite timely that the Micronutrient Initiative, Ottawa
and the UNICEF, New York have jointly brought out a well-documented publication appropriately titled
"Vitamin & Mineral Deficiency - A Global Progress Report".
Appreciating the need and importance of communicating the contents of the report, we reproduce portions of the
report pertaining to elimination of iodine deficiency disorders The full report can be viewed at www.micronutrient.org.
Ed.
Part 1 : Damage Assessed, Progress Recorded:
By the year 2000, iodine was being added to
Iodine deficiency is estimated to have lowered the
approximately two-thirds of the developing world's salt
intellectual capacity of almost all of the nations reviewed
and approximately 70 million new-borns each year were
Iodine
protected against the threat of mental impairment. Today,
deficiency in pregnancy is causing almost 18 million
over 100 nations have salt iodisation programmes. Some
babies a year to be born mentally impaired.
of the world's poorest countries — including Bangladesh,
by as much as 10 to 15 percentage points.
Part 2 : A Job Less than Half Done: Iodine - A solution
to the problem of iodine deficiency has been available
for more than 80 years. Beginning in Switzerland in
1921 and in the United States in 1924, most industrialized
nations have mandated or permitted the iodisation of
salt. In
India, the effectiveness of iodised salt was
demonstrated in the 1950s in a landmark study by the
late Vulimiri Ramalingswami. But for most of the 20th
Cameroon, Eritrea, and Nigeria - have all passed the
70% mark for salt iodisation. The People's Republic of
China, which made a commitment to universal salt
iodisation following the World Summit for Children in
1990, iodised 90% of its salt in under 10 years.
(Extract of) Figure 1 : Countries Ranked by Percentage
of Households Consuming Iodised Salt, - 2000-2003
Country
century, other priorities prevented the developing world
from address the problem. When the consequences of
IMMI
Estimated % of households
using iodized salt
SOUTH. ASIA
even moderate iodine deficiency began to be appreciated
Bhutan
95
in the 1980s, international agencies like UNICEF and
Bangladesh
70
Nepal
63
ICCIDD began to press the case for the iodisation of
household salt world-wide.
India
50
There followed a decade of remarkable efforts by scientists
Pakistan
17
and researchers, regulators and inspectors, governments
Afghanistan
15
and non-governmental organizations, and by thousands
of individual salt producing companies all over world.
UNICEF led the global effort. Aid donors like the Canadian
International Development Agency (CIDA) provided much
of the initial funding. Non-governmental organizations
made major contributions (most notably the Kiwanis
EAST ASIA AND PACIFIC
China
93
Viet Nam
77
Lao PDR
75
Thailand
74
Indonesia
65
Myanmar
48
Mongolia
45
most them private and many of them small, responded
Philippines
24
to the call.
Cambodia
14
whose 600,000 members in 83 countries have raised
more than US $70 million for salt iodisation programmes).
Not the least, thousands of the world's salt producers,
The statistical tables are given in the report for each of
therefore still not reaching, in any reliable way, the 300
80 countries. The current best-estimate of the prevalence
million people at the bottom of the economic pyramid
of iodine deficiency as measured by the total goitre rate
who tend to use poorer grades of salt. If iodised and
or TGR is presented in these . This is a measure that must
non-iodised salt are both available in the market place,
be treated with caution. On the one hand, goitre (the
and if the iodised product is even slightly more expensive,
swelling of the thyroid gland) is a clinical symptom and
the poor will be effectively excluded.
is therefore likely to underestimate the extent of the
underlying problem. On the other hand, the TGR is a
population-wide figure that does not yet reflect recent
advances in salt iodisation. Nonetheless the TGR is an
indicator to which all nations should attend. It is now
accepted that any country with a TGR of 10% or more
is likely to suffer a population-wide lowering of intellectual
capacity by between 10% and 15% (with all that this
Recent data from UNICEF confirms that this concern is
not limited to India. Across 28 countries studied, the
richest fifth of the population were found to be 50% more
likely to be consuming iodised salt than the poorest 20%.
In some, the inequality is extreme; among the poorest
fifth of the population in the Philippines only just over
10% are estimated to be consuming iodised salt as
opposed to more than 50% among the richest fifth.
implies for families and communities, for educational
investments and school performance, for individual
A realistic overview must also acknowledge that achieving
productivity and for national development efforts).
salt iodisation is only half the battle. Sustainability is all.
And in 2004 there are worries that salt iodisation levels
Of the 80 countries reviewed, all but 14 have a TGR in
excess of 10% and 24 of those nations, including some
are slipping back in countries such as India’, Indonesia,
Bolivia, Russia and Vietnam.
of the most populous like India and Pakistan, have rates
of 20% or more.
India, with the largest number of iodine deficient people,
appears to have allowed salt iodisation to slip back
These rate are now on the decline in almost all nations
as salt iodisation begins to deliver its benefits. But 60%
or 70% is not enough. Every year 50 million children are
still being born without the protection that iodine offers
to the growing brain and body. Approximately 18 million
of these children will suffer some significant degree of
mental impairment.
Iodine deficiency therefore remains the single greatest
cause of preventable mental retardation in the world
today.
Salt Pyramid
The road to universal iodisation is now likely to become
steeper. The one third of the developing world's people
who are not yet protected by iodised salt are, by and
towards 50%. Iodine deficiency is reported to be re
surfacing in the Balkans, and in some Central Asian
Republics the level of salt iodisation has fallen towards
the 25% mark — lower than in many parts of Africa. In
Bangladesh, after remarkable early successes, the
momentum of the iodisation efforts seems to have stalled
at a point well short of the goal of universal iodisation.
Globally the proportion of people consuming iodised
salt is thought to have fallen from 70% to about 65%
since the year 2000. If true, this means that 5 million
fewer children are being protected from mental impairment
every year. With few exceptions, it is not the capacity
of countries to iodise salt that has decreased; it is
the commitment that is showing signs of faltering.
large, the more marginalized populations - economically,
Significantly, the People's Republic of China
culturally, or geographically - and are likely be more
on past the already achieved 90% target and towards
difficult io reach.
100% salt iodisation. A key to this sustained effort has
In India, for example, a fifteen-year effort had brought
iodised salt to almost two-thirds of the population by the
is pressing
been China's formal five-yearly review process designed
not only to monitor progress, budgets, training, and best
practice but to renew high-level political commitment to
year 2000; but by and large it is the more expensive
grades of salt that have been iodised. Protection is
universal salt iodisation.
There is much that can be learnt from such experiences
iodine supplementation - either by weekly tablets or by
as countries struggle to sustain political will and to find
consuming iodised salt. Similar studies revealed a 20%
practical solutions to particular logistical problems at the
to 30% incidence of endemic goitre among schoolchildren
national level. To facilitate this mutual learning, an
in Austria, Northern Italy and Germany.
International Network for the Sustained Elimination of Iodine
Deficiency has been created with the aim of drawing on world
wide expertise to solve particular problems and fill in the major
gaps in salt iodisation's progress.
In the United states, the alarm was first raised in Michigan
in 1918 when it was revealed that over 30% of men
medically examined for war service had been found to
have enlarged thyroid glands. Many were declared unfit
In overview, this initial push towards salt iodisation in the
for service. By 1923 an Iodised Salt Committee had been
1990s has brought remarkable progress; but there are
formed, including physicians and representatives of the
signs that momentum may be getting lost in the early
Salt Producers Association.
years of the 21 st century. This is, therefore, a critical time.
Eliminating iodine deficiency demands a renewed drive
to iodise the salt consumed by the poorest third of the
population in each nation. The fact that two-thirds of the
developing world's salt has been iodised should not be
taken to mean that the world is two-thirds of the way
towards the goal' indeed to say that the half-way point
had been reached would be to overstate the case.
The element iodine was discovered in 1811, but almost
a century passed before it was established that lack of
iodine caused the swelling of the thyroid gland commonly
known as goitre.
On May 1, 1924, six local salt companies began loading
iodised salt on the shelves of Michigan's grocers. Later
that same year, the Morton salt company began marketing
iodised table salt nation-wide under the headline 'Children
protected against simple goitre are found to be superior
in development'. In Michigan itself newspaper adverts
boosted sales, and by 1932 iodised salt accounted for
90% to 95% of all sales.
Meanwhile, Europe was also moving towards salt
iodisation - swiftly controlling goitre, cretinism, and the
milder forms of iodine deficiency. Illustrating the need to
maintain vigilance, the problem now appears to be re-
Following research in 1921 showing that 90% of Zurich
emerging in parts of Australia, Belgium, France, Germany,
schoolchildren were suffering from goitre, the Government
Italy, Poland, the Balkans, the Commonwealth of
of Switzerland become the first in the world to recommend
Independent States, and in the Central Asian Republics.
F--------------- -------------—------------------------------------------ :--------
“People are a nation’s greatest resource.
Our greatest asset will be an educated
and capable workforce.
Our Government will work along with
State governments to set up public spending
on education, to universalize access to
elementary education and to improve
the quality of our education. ”
The Intelligence Quotient (IQ) score of children living
in an iodine-deficient environment is nearly 13 points
less than those living in iodine-sufficient environments.
IMPLICATIONS OF LOSS OF IQ
Poor scholastic performance
o
o
Absenteeism / Drop Outs
o
Frequent failures/grade repetitions
Dr. Manmohan Singh
Prime Minister ofIndia
(in his address to the Nation on June 24, 2004)
Reduced impact on economic and social development
\____
BOOK RELEASE
Report by special correspondent
nternational Council for Control of Iodine
D
The book was released at a solemn function held in New
Deficiency Disorders (ICCIDD) has brought
Delhi on Monday, May 31, 2004. Her Excellency, Mrs.
out a publication, entitled "Towards The Global
Michelle Marginson, Deputy High Commissioner,
Elimination of Brain Damage Due to Iodine
Australian High Commission to India, released the book
Deficiency". This is the twelfth in the series
in the presence of a select audience. In her Keynote
of publications ICCIDD has in partnership with Oxford
Address, Mrs. Marginson traced the longstanding
University Press. The book presents empirical insights
association of the Australian Government with the ICCIDD
based on decades long research programs and
right from the days of its inception in 1986.
implementation activities in all parts of the world. Notable
is the emphasis and focus given to the developing
countries. It is a commendable effort that brings out the
inclusive circle of "research-policy-programimplementation and back to research".
The history of addressing the problem of elimination of
Others who addressed the invitees included
Dr. Basil Hetzel (Chairman Emeritus of ICCIDD),
Ms. Eileen Stewart (First Secretary, Canadian High
Commission to India, Dr. Werner Schultink (Chief-CDN
Section, UNICEF-lndia), Dr. Monir Islam (Director Health
WHO-SEARO), Mrs. Veena Rao, IAS (Joint Secretary,
iodine deficiency disorders is well-described in the book.
Department of Women & Child Development, Government
it also makes a demarcation between pre -1990 situation
of India), Dr. R. Sankar (The Micronutrient Initiative),
and developments thereafter, when National Governments,
Dr. M. G. Karmarkar (Senior Adviser, ICCIDD).
iodized salt producers and major international agencies,
Dr. Chandrakant S. Pandav (Regional Coordinator,
e.g. UNICEF, WHO, the Ml and the ICCIDD made
ICCIDD) presented and anchored the event. All the
concerted and coordinated efforts, which resulted in
speakers, inter-alia, mentioned the success of inter-agency
achieving the present level of success.
collaboration and past successful efforts jointly with
The book unwraps a fount of information for the students
at all levels in the field of public health and nutrition. It
serves as an analytical document for policy makers. It
ICCIDD in combating the age-old scourge of IDD. They
all emphasized the need and commitment for sustainability
of programs for its elimination successfully.
brings together global experience for program managers.
Representatives from various national and international
It can also be used to provide guidelines for professionals,
organizations (Ministry of Health & Family Welfare, Indian
and equally well by groups at the grassroots levels.
Council for
Institute
The Editorial Team comprises
Medical Research, National
\
Dr. Basil Hetzel (Senior Editor),
Dr.
Francois
Dr.
John
UNICEF,
Dunn,
Dr.
Jack
Venkatesh
Mannar
World Bank, WHO,
Delange,
Dr.
Ling,
OUP,ICCIDD,
India
and
sustainable elimination
All
of
society representatives,
social activists, public
contributing authors,
experts in the field of
Institute
Medical Sciences, civil
The
thirty four in all, are
The
Micronutrient Initiative,
Dr. Chandrakant S.
Pandav.
health & Family Welfare,
World Food Programme,
health professionals)
Dr. Basil S. Hetzel, Chairman Emeritus of ICCIDD receiving the first copy
of the book from H. E. Mrs. Michelle Marginson, Deputy High Commisioner
attended the function and
of Australia to India, as Dr. C.S. Pandav looks on
used the occasion for
of Iodine Deficiency Disorders (IDD) with experiences
transcending the geographical boundaries in the
international arena of public health.
interactions and sharing. Individuals and institutions who
made contributions in bringing out the book were
acknowledged and felicitated in the course of the function.
From the blurb
This book provides a comprehensive account of the global effort directed at sustainable elimination of an ancient
scourge of mankind, IDD or the iodine deficiency disorders. This condition is the most common preventable cause
of brain damage in the world today with 2 billion people at risk and over 20 million affected. And yet this is
preventable. All that is required is a daily intake of iodine, best provided through the vehicle of iodized salt.
The book describes the great progress that has been made since 1990 when the goal of elimination was unanimously
accepted by the UN World Summit for Children and by the World Health Assembly (WHA). By the year 2000
approximately 70 per cent of households had access to iodized salt, indeed a remarkable achievement.
The book also describes the development, since 1990, of an informal global partnership between the people, the
salt industry and sovereign governments of IDD affected countries, with the support of international agencies such
as WHO, UNICEF and the World Bank, bilateral agencies in Australia, Canada, The Netherlands, Belgium, Sweden,
and the USA, Kiwanis International, The Gates Foundation (through UNICEF), and technical agencies such as
ICCIDD and Ml.
In 2002 the UN General Assembly Special Session (UNGASS) on Children set a new elimination goal for 2005.
The progress in the 130 IDD affected countries is reviewed in detail with careful definition of the reasons for success
or failure, followed by a comprehensive discussion of the sustainability aspect of the elimination of IDD.
The urgent need for coverage of the remaining 30 per cent of households as well as consolidation of the existing
achievements depends on sustained political will, which follows community awareness and understanding of the
problem by governments and their people.
As Dr. Gro Harlem Brundtland, Director General of WHO said in 1999 at the World Health Assembly, 'When
elimination of IDD is achieved it will be a major and total public health triumph, ranking with smallpox and polio'.
The book is available at ICCIDD Secretariat in New Delhi. Price - US $ 20/- (Special price in India Rs. 595/-)
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Launch of the book “Towards the
Global Elimination of Brain Damage
due to Iodine Deficiency" at UNICEF
Headquarters, New York.
From L to R: Dr. Jack Ling, Chairman
ICCIDD; Dr. Ian Darton-Hill, Senior
Advisor Micronutrients Nutrition
Section UNICEF; Dr. Kul Gautam,
Dy. Executive Director UNICEF;
Dr. Basil S. Hetzel, Chairman Emeritus
ICCIDD; Dr. Nita Dalmiya, UNICEF
Project Officer Micronutrients;
Dr. Chandrakant S. Pandav, Regional
Coordinator ICCIDD-South Asia Region.
National Workshop on Micronutrients
24th & 25th November 2003
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The Indian Council of Medical Research (ICMR), India's premier medical research body, conducted a two day
workshop on 24th and 25th November 2003 in New Delhi, io deliberate on the current efforts to eliminate micronutrient
malnutrition. The 80 participants included Health Secretaries of the Ministry of Health from various states, experts
from the field of iodine, iron and vitamin A deficiency elimination, nongovernmental organizations, and international
agencies. The theme was to seek out strategies to improve the efficiency of the national programs that focus on
eliminating the deficiencies of these micronutrients, and to operationalize the recommendations of the 1 Oth Five Year
Plan.
Most part of the discussions was conducted under the ambit of working groups, formed for the three micronutrients
— IDD Working Group, IDA Working Group, and Vitamin A Working Group. The recommendations of the IDD Working
Group, chaired by Dr. Kalyan Bagchi and coordinated by Dr. Chandrakant Pandav, are given below.
Ed.
2.3
IODINE DEFICIENCY DISORDERS
1.
Tenth Five Year Plan (2002-2007) Goals
► Achieve universal access to iodized salt
►
Generate district-wise data on iodized
salt consumption
►
Reduction in the iodine deficiency disorders (IDD)
prevalence in the country to < 10% by 2010
2.
National Iodine Deficiency Control
Programme (NIDDCP):
This programme was initially named as National Goitre
Control Programme (NGCP) in 1962. However, in 1992
it was renamed as NIDDCP to give due importance to
the spectrum of physical and mental disorders caused
due to iodine deficiency affecting all stages of human
growth and development.
2.1
DGHS
► Technical guidance on NIDDCP to states and Union
Territories
► Undertaking independent IDD surveys in the states
and Union Territories
Objectives:
The main objectives of the programme are:
► Imparting training in IDD to the state health personnel
► Baseline surveys to assess the magnitude of iodine
deficiency disorders in the districts
► To supply iodized salt in place of non-iodized salt
► To resurvey the districts after every five years to assess
the prevalence of iodine deficiency disorders and
impact of universal consumption of iodized salt
> Monitoring of iodine content of salt and urinary iodine
excretion levels in the population
> Nutrition and health education to improve the universal
consumption of iodized salt
The goal of NIDDCP is universal iodization of salt for
human consumption so as to reduce the prevalence of
IDD below 10% in endemic districts of the country.
2.2
Implementation
The Directorate General of Health Services (DGHS) of
the Ministry of Health and Family Welfare, Government
of India is the nodal agency for policy decisions
on the NIDDCP. The Salt Commissioner's Office under
the Ministry of Industry is responsible for monitoring the
production and distribution of iodized salt to all the states
arid Union Territories. The Salt Commissioner, in
consultation with the Ministry of Railways, arranges for
movement of iodized salt from the production sites to the
states and union territories on a priority basis.
The important activities being undertaken by the
NIDDCP are:
► Collection, compilation and analysis of relevant data
on IDD from the states
► Monitoring the distribution of iodized salt at consumer
level through the State Health Directorate/State
Prevention of Food Adulteration (PFA) Authority
DGHS/ Salt Commissioner/DWCD
► Intersectoral Coordination and maintenance of close
liaison with the Ministry of Industries., Railways,
Department of Women and Child Development,
Information & Broadcasting and various stake holders
of NIDDCP in the states and Union Territories.
Monitoring the quality of iodized salt at the production
level in collaboration with the office of the Salt
Commissioner.
Beneficiaries and Services
The beneficiaries of the program are the entire population
► IEC activities to generate awareness about IDD in the
country
of the country
►
2.4
Current status:
performance, effects of iodine deficiency on pregnancy
outcome (stillbirths, abortions, low birth weight and
Available data suggest that there has been substantial
mental handicap). New education and communication
increase in the availability and consumption of iodized
approaches also involving school children must be
salt during the 1990s. The National Family Health Survey
considered and successful experiences shared between
- 2 (NFHS-2) survey (1998-99) showed that 49 per cent
states.
of households use iodized cooking salt at the
recommended level of 15 parts per million (ppm) or
4.
more, whereas 22 per cent use salt containing less than
Increasing Supply of Iodized Salt
Support and encouragement of salt producers and salt
15 ppm of iodine. 28 per cent of the households use
traders to increase the supply of adequately iodized salt,
salt that is not iodized at all. The survey also reports that
Effective partnerships with the private sector should be
the low income group has the lowest percentage of
forged and continuously maintained.
population consuming adequately iodized salt. The recent
5.
Reproductive and Child Health (RCH) surveys (2002
2003) have reported a significant decline in the
PFA Act Implementation:
Modification of Prevention of Food Adulteration (PFA)
consumption of adequately iodized salt.
Act should be undertaken as under:
The data from NFHS - 2 shows that in coastal states like
Tamil Nadu, Andhra Pradesh, Kerala, and Gujarat, the
Current PFA Act
percentage of households consuming adequate iodized
salt is much lower than in many of the northern states.
Recommended
Amendments to the
PFA Act
One of the reasons could be that the salt transported by
road is not subject to any kind of quality control regarding
Non-bailable warrants if
the salt iodine content is
less than 30 ppm at the
production level and 15
ppm at the consumption
level.
iodization. This loophole in the law makes it possible for
transport of non-iodized salt by road to areas even beyond
250 km. Therefore, these states have ready access to
non-iodized salt.
Recommendations of the Workshop
Non-bailable warrants
and imprisonment
should be omitted.
Imprisonment for not less
than 6 months.
► In view of the country wide endemicity of Iodine
deficiency disorders (IDD) among population and also
keeping in view the serious consequences of IDD, the
NIDDCP should be accorded high priority.
Fine of up to Rs. 1000/-
► Implementation of State Ban on the sale of non
This rule should be
amended to include a
fine amount not less
than Rs. 10,000/.
iodized salt and Policy Support.
► There is a need for encouraging states like Kerala,
Gujarat, Maharashtra, which either do not have the
ban or have a partial ban, to implement the ban on
sale of non-iodized salt in the entire state. Other
The legal provisions to
prevent misbranding
(brand name, content,
MRP, batch number,
address) exist.
Detection of
misbranding of iodized
salt should be given
high priority.
Presently there is no
monetary fine.
A fine amount of not less
than Rs. 10,000 should
be imposed on the
states, which have the statewide ban, should be
encouraged to implement PFA more strictly. In that
context, the Ministry of Health and Family Welfare,
Human Resource Development, and Industry,
Government of India should communicate the urgency
concerned producer,
wholesaler and retailer.
in IDD elimination to the state governments, urging
them intensify efforts to implement the IDD control
program effectively.
3.
The modified PFA Act should be effectively enforced.
Demand Creation
’ 6.
Information, Education, CommunicationApC) irj^sages
regarding universal sa It iodizafiqj^jfl,^
shp'uldj
Monitoring of Iodine Content of Salt
Establishment of effective quality control and monitoring
system of iodine content of salt at all levels, as per the
shift from goiter to loss of IQ-5xid pqdr Scholastic
►
national guidelines should be carried out.
7.
Provision of salt testing kits
11.
Packaging of Iodized Salt
Salt Testing Kits should be made available to Multi
Iodized salt should also be packed in Vi kg consumer
purpose Workers (Male and Female), and Anganwadi
polythene packs at the production site itself to prevent
Workers for testing iodine levels at the household level.
iodine losses during transportation and storage.
Under the RCH Program, Kit A provided at the sub-center
level should also include 7 salt testing kits. Of these, one
12.
Support to Small Scale salt producers
kit each is to be provided to the Male and Female Multi
Small Scale salt producers should be encouraged to form
purpose health worker and one each to five Anganwadi
cooperatives and, in that case, Government of India
workers. The results of the analysis should be included
should provide iodization plants to these cooperatives.
in the monthly reporting forms, i.e. Form 9 of RCH for
13.
MP (male and Female) workers and appropriate forms
for Anganwadi Workers.
8.
Transportation of Iodized Salt
Rail transport is the most important means for transport
of iodized salt in India. The Ministry of Railways
Strengthening of Salt Department
should be requested to provide covered wagons for
There is a need to carry out rigorous monitoring of quality
transport of iodized salt, and ensure its regular and
of iodized salt at the production level. The activities should
periodic supply.
include upgrading of laboratory facilities, periodic and
14.
regular training of staff, and development of standard
economic Communities
protocol for monitoring, internal and external quality
assurance, development of a system for reporting and
dissemination of results, and development of Geographical
Information Systems (GIS) / Information Technology (IT)
road map of the Salt Department. These steps would be
effective and efficient only when the salt department
develops linkages with the health department so that
Ensuring Iodized Salt to Poor / Low Socio
In view of lower consumption of iodized salt by the low
income group, iodized salt should become part of Public
Distribution System (PDS) catering to population Below
Poverty Line (BPL). Many states are selling the salt through
the public distribution system (PDS) and there is a need
of universalizing the same.
Intersectoral Co-ordination
appropriate action is taken against the salt producers and
15.
traders who do not meet the set standards under the PEA.
There is a need for integration of IDD control program
9.
activities with prevention and control of iron and vitamin
Laboratory Facilities
There is a need for establishing regional IDD laboratories
for monitoring the iodine content of salt. At present there
are three laboratories (AllMS and NICD at Delhi, AIIPH
at Kolkata) carrying out estimation of urinary iodine
excretion levels. There is a need to strengthen these
A deficiencies. This has been successfully done under
the RCH program in Maharashtra and Gujarat. There is
a need for involvement of Panchayati Raj institutions for
effective implementation of NIDDCP at the district levels,
block and village levels.
laboratories and establish a standard protocol, including
16.
quality assurance, amongst these laboratories.
The Workshop reiterated the need for regular review
10. Annual Cyclic Monitoring and Information
Management
have been established for monitoring the implementation
Need for Regular Reviews:
meetings of the four committees for IDD elimination that
of NIDDCP. These Committees are: National Steering
There is a need of collecting data on iodized salt
Committee chaired by Secretary Health, Program
consumption and urinary iodine excretion level in the
Implementation Committee under Director General of
different districts of the country. About 120 representative
Health Services, National and State Level Lab Monitoring
districts should be covered each year for assessment of
Committee, National Level IEC Committee.
iodine content of the salt and urinary iodine excretion
level. This would ensure that, over 5 years, all the districts
Similar state level committees should be re-activated I
of the country would be covered. Standardized
constituted to include all stakeholders - Departments of
methodology and uniform indicators should be utilized
Health and Family Welfare, Education, Food and Civil
to collect, compile and analyze the collected data. This
Supplies, Women and Child Development, State Planning
data should be incorporated into a database of IDD
Commission, Managers from other programs like RCH,
indicators (including salt iodine, urinary iodine, goiter
ICDS, National agencies like Salt Department, ICMR,
rates), which should be available to all. This database
NIN, NIE, AllMS; Salt producers and traders, NGOs,
needs to be updated annually.
International agencies like UNICEF, Ml, ICCIDD, WHO.
►
Researchable Issues:
Operational Research
Basic Research
To determine feasible strategies for monitoring iodine
content of salt at different levels.
To study the relevance of different indicators of iodine
status in pregnancy and suggest suitable indicators for
screening for iodine deficiency during pregnancy.
INFORMATION SHARING
► Nutrition Foundation of India and Centre for Research on Nutrition Support Systems organized a Workshop
on the theme of "Nutrition in the Medical Curriculum" in New Delhi from 28th to 30th April, 2004. Technical
support for the same was provided by Medical Council of India, Directorate General of Health Services, Ministry
of Health & Family Welfare, Indian Council of Medical Research, National Academy of Medical Sciences and
Department of Biotechnology.
► Resource Mobilization Workshop was organized by DSPRUD-WHO in New Delhi from 24th to 26th May, 2004.
The Resource persons were Dr. Finlay Craig from U.K. and Ms Jacqueline Sawyer from WHO Geneva.
► The book "Towards The Global Elimination of Brain Damage Due to Iodine Deficiency" was released at a
specially held function in New Delhi on 31st May 2004. This is the twelfth publication of ICCIDD in arrangement
with Oxford University Press.
► Regional workshop on "Sustaining Universal Salt Iodization in the Northeastern Region" at Guwahati - 25th &
26th June, 2004
Forthcoming Events:
► Eighth South East Asia Regional Scientific Meeting of International Epidemiological Association at Jhansi, India
from 5th to 8th December 2004.
Latest Articles on Iodine / IDD in indexed and unindexed journals
S.No
Title
1
Current Status of Iodine Nutriture and Iodine Content of Salt in Andhra Pradesh
By: Umesh Kapil, Preeti Singh., Priyali Pathak
Indian Pediatrics, Vol 41, No 2, February 2004 Pg 165-169
2
Goitrogenic Content of Indian Cyanogenic Plant Food and their IV Anti-thyroidal Activity
By: Amar K Chandra, Sanjukta Mukhopadhyay, Dishari Lahari, Smritiratan Tripathy
Indian Journal of Medical Research, No.5, Vol. 199, May 2004, Pg 180-185
3
Elimination of Iodine Deficiency Disorders in Delhi
By: Umesh Kapil, Vani Sethi, Geetanjali Goindi, Priyali Pathak & Preeti Singh
Indian Journal of Pediatrics, Vol 71, No.3, March 2004 Pg 211 -212
4
Iodine Deficiency & Development of Brain
Vani Sethi & Umesh Kapil Indian Journal of Pediatrics, Vol 71, No. 4, April 2004 , Pg 325-330
5
Iodine Nutritional Status of School Children in a Rural Area of Howrah District in Gangetic West Bengal
By: Amar K Chandra, Smritiratan Tripathy, Dishari Lahari & Sanjukta Mukhopadhyay
Indian Journal of Physiology & Pharmacology, Vol 48, No.2, April 2004, Pg 219-224
|.1 ■
ICCIDD acknowledges the contribution of UNICEF
in bringing out this. Issue of the Newsletter.
►
Some children find a grain of salt the size of a hen's egg. The grain eventually finds its way into the hands of the king.
Nobody knows or can discover what it is until a hen is observed pecking the salt. It is then realized that it is foodstuff.
The king wants to know where it came from but none of his advisers have seen the likes of it before. It is suggested that
perhaps the peasants know about its origins. The oldest peasant, bent double with age, wrinkled, toothless, deaf and blind
is brought before the king. This peasant knew only of small grains but informed the king that his father might know. The
father came, walking with a stick, looked at the grain and after listening to the king s questions, answered that he could
throw little light on the mystery but his father was sure to know. The grandfather was sent for and soon arrived, walking
erect without the aid of even a stick. The bright-eyed grandfather informed the king in a strong voice that in his youth
such grains were everywhere, but that was in a time when the-whole of the land belonged to all of the people, when land
could not be owned, only ond's'Own labour. The king asked two final questions: why did such grains grown in the soil in
those days but not at present, an^what was the old man's secret of youth — after all he had all his teeth and his eyes were
good unlike his grandson's and/Shlike his son, could walk without the aid of a stick. The ancient one answered that
recently people had lost interest in work and wanted to live on the labour of others. In his time people ate what they
produced, were satisfied with what they had and did not look upon the possessions of others with greed.
Adapted from "On the Salt March" by Thomas Weber
Published by HarperCollins Publishers India, 1997
ipfacT gvfcn I
Daily consumption of Iodised salt
is a healthy habit
ICCIDD
Publishing any material in,IQ+ Jagriti does not necessarily mean ICCIDD's endorsement of the vi
views
expressed therein or the results quoted.
Materials for publication, subscription request, comment; may be sent to: Dr. Chandrakant S Pandav
Address: Room No 28, CCM Building, Old OT Block, All I idia Institute of Medical Sciences, Netf Delhijl 10029
. E-mail: cpandav@iqplusin.org
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