JAGRITI VOL. III, ISSUE 3, SEPTEMBER 2005
Item
- Title
- JAGRITI VOL. III, ISSUE 3, SEPTEMBER 2005
- extracted text
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IN THIS ISSUE
• India bans
non-iodised salt
• ICCIDD press
briefing
VOL. Ill, ISSUE 3, SEPTEMBER 2005
• Consumers want
there children to
be healthy and
intelligent
India Bans Non-lodised Salt - A Significant Step
Wednesday, June 15, 2005 was a special day for India's
children. On this day, the Minister for Health and Family
Welfare, Dr. A. Ramadoss announced the Government of
India's decision to re-instate the ban on the production
and sale of non-iodised salt for human consumption.
excessive flooding, soils in certain areas have become
deficient and the food grown there does not have enough
iodine. Salt is considered the best vehicle to counter the
deficiency as it is consumed by all. Marine fishes are also
rich in iodine but sea salt is a poor source of iodine.
The Minister said that this move will reinforce India’s
commitment to accelerate young child survival and
development. This is a significant step, if the country's
annual 25 million newborns are to grow up protected
from brain damage and physical deformity.
According to the National Family and Health Survey-ll,
around 70 per cent of India’s population consumes salt
with some amount of iodine. But only 49 per cent uses
adequately iodised salt. However, this figure fell to 37 per
cent after the lifting of the ban on the sale of non-iodised
salt. Further, great variations also exist in the consumption
of iodised salt, across socio-economic and urban-rural
divide. The consumption of adequately iodised salt is
significantly low among the rural masses, the
economically backward classes and the members of the
scheduled castes and tribes.
Iodine Deficiency Disorder (IDD) is a major public
health problem. Of the 312 districts surveyed by the
Ministry of Health, 254 showed that people suffered
from iodine deficiency. As a result the Tenth Five-Year
Plan has aimed at universal access to iodised salt,
Minister Ramadoss said.
Dr. A Ramadoss (Minister of Health & Family Welfare) addressing the
GOI-UNICEF meeting, Dr. C. S. Pandav (Prof. AllMS), Mr. R K. Hota
(Secretary Health & Family Welfare), Ms. Reva Noyyar (Secretary,
Department of Women & Child Development) and Mr. Cecilio Adorna,
(Unicef Representative to India).
The ban is a part of a May 27, 2005, notification on
amendment of the Prevention of Food Adulteration rules,
1955, controlled by the Union Ministry of Health and
Family Welfare. The notification invited comments to be
submitted in the next two months. Under standard
protocol, a final decision will be taken only after reviewing
all comments.
If accepted, the amendment would ensure that non
iodized salt is not available in the market tor human
consumption; it would be available only for limited
purpose, including preservation, medicinal and industrial
i zq use. The amendment aims to protect people from iodine
^^jieficiency, which can cause cretinism, goitre and loss of
fid
IQ- Food is the main source of iodine, but due to
He also participated in a live salt testing demonstration.
Children led by Bharat Scouts and Guides showed the
gathering how they could use salt testing kits to tell the
difference between iodised and non-iodised salt.
"All children have a right to enjoy a secure and healthy
childhood so that they can grow up to fulfill their full
potential," said Cecilio Adorna, UNICEF Representative
to India. He appealed to all stakeholders - salt producers,
traders, village level-vendors and the government, to see
that the implementation process is successfully achieved.
Widespread information and education is needed to
spread the message that iodising salt is safe, simple and
affordable, he added.
The estimated annual requirement for iodized salt for
human consumption in India is 5 milion tons. But, despite
having the capacity to iodize 13 milion tons, at already
installed iodisation plants, India currently only iodizes 4.4
milion tons, a fraction of which is exported. This situation
exists even though salt iodisation is technically simple,
cheap, safe and sustainable.
HI
croft hi
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•
From the unreal lead me to the real;
From darkness lead me Io light;
From death lead me to immortality.
Editorial Board
Dr Chandrakant S Pandav
Chief Editor
Dr. Anjit Chakrabarty
Managing Editor
Patrons:
ICCIDD Vision & Mission
VisiomThe vision of ICCIDD is a world virtually free from Iodine
Deficiency Disorders with national endeavors to maintain optimal
iodine nutrition primarily through consumption of iodized salt,
which should be made easily available and affordable for all
people for all times.
Mission: The mission of ICCIDD is to provide a focused
advocacy to governments and development agencies, of a
continued priority for iodine nutrition, providing technical
expertise in a multidisciplinary approach.
Dedication: ICCIDD dedicates itself to programs fully supported
at the national level for permanent, sustained success and will
work with all partners and national entities towards that end.
Shri Mohan Dharia
Chief Patron
Dr Kalyan Bagchi
Patron
Shri R V Pillai, IAS (retd.)
Patron
Editorial
Dear Colleagues,
Iodine deficiency is the single largest cause of preventable
Editorial Advisers:
Dr Prabha Ramalingaswami
Shri L M Jain, IAS (retd.)
mental retardation. Of 25 million children born in India each
year, half are unprotected against iodine deficiency disorder,
Prof N K Ganguly
whose symptoms also include deaf-mutism and severely
Prof M G Karmarkar
reduced levels of productivity.
Shri S Sundaresan
Adv. Makarand Adkar
Shri Bejon Misra
Editorial Assistants:
15th June 2005 was a special day for India's children. On this
day the , the Minister for Health and Family Welfare, Dr. A.
Ramadoss announced the Government of India's decision to re
instate the ban on the production and sale of non-iodised salt
Smt Saroja Narayanan
for human consumption. This is a significant step, if the country's
Shri Pritam Singh
annual 25 million newborns are to grow up protected from
Shri Bharat Kataria
brain damage due to iodine deficiency.
Circulation
Shri Pritam Singh
A press briefing was organized by ICCIDD on 9th August 2005 at Hotel Samrat, New Delhi
to brief the media on the importance of iodisation of salt and the Govt, of India's decision
to reinstate the ban on production of non-iodised salt meant for human consumption.
Printed & Published by:
Nutrition is increasingly being recognized as one of the most important indicators of
Dr C S Pandav
on behalf of ICCIDD
development all over the world. Good nutrition is the material basis for human resource
development.
Malnourished children tend to have low I.Q., impaired cognitive
Contact Address:
Room No 28, CCM Building,
Old OT Block, All India Institute
of Medical Sciences, New Delhi110029 Tel: 011 -26588522
against the single largest cause of brain damage among children in India". Let us
E-mail: cpandav@iqplusin.org
contribute towards making India as knowledge superpower!
development affecting their school performance and productivity in their later lite.
"Consider iodised salt as a vaccine that costs 10 poise per person per year and protects
Website: www.iqplusin.org
Designed & Printed at
Pathfinders, Lajpat Nagar
Ph.: 26295066
Dr. Chandrakant S. Pandav
Regional Coordinator, ICCIDD-South Asia Region.
2
Government of Indio bans sale of non-iodised salt
for human consumption: A step in the right direction.
(Rajan Sankar', Chandrakant S. Pandav1
2)
The recent announcement by the government of India on 27th May
2005 that it intends to reimpose the ban on the sale of non-iodised
salt for human consumption is a welcome public health measure
and a step in the right direction for addressing the most important
cause of preventive brain damage due to Iodine Deficiency
Disorders (IDD).
future neuropsychological development of the child (13, 14, 15,
16). Recent studies also support the possibility of improving the IQ
of many children from areas with mild iodine deficiency by
ensuring an iodine intake sufficient to achieve a urinary iodine
concentration greater than 100 pg per litre (17). It has also been
reported that risk of attention deficit and hyperactivity disorder is
greater in children born to mothers with mild iodine deficiency and
hypothyroxinemia (18). Studies have clearly shown the
pervasiveness of iodine deficiency and the focus of IDD elimination
is on prevention of brain damage.
Iodine deficiency at critical stages during pregnancy and early
childhood results in impaired development of the brain and
consequently in impaired mental function. Iodine deficiency
continues to be the leading cause of potentially preventable
mental retardation (1, 2). Elimination of iodine deficiency is an
important health and social development goal for most
governments and its elimination is within reach and would be an
unprecedented success story in the field of public health and
public nutrition.
The goal to eliminate iodine deficiency was first adopted at the
World Summit for Children in 1990, where Heads of States and
Government from more than 70 countries established a number of
goals to improve and protect children's lives. India is a signatory.
Elimination of iodine deficiency has consistently been a goal in the
country's Five Year Plans and Prime Minister's 20-point program.
India was pioneer in both recognizing iodine deficiency as a
national public health problem and providing iodised salt to its
population. Iodised salt was first made available in 1956 during a
seminal study on goitre prevention and control led by Professor
Ramalingaswami in the Kangra district of Himachal Pradesh (3).
While only a few countries in the 1980s had recognized iodine
deficiency as a public health problem or established a National
IDD control programme, by 1962 India had launched a National
Goitre Control Programme (NGCP) (4). When NGCP began, it
was a targeted programme, aiming to identify districts of goitre
endemicity and subsequently make available iodised salt in these
identified endemic districts (4). By the early 1980s, data collected
from different regions of the country revealed that iodine deficiency
was a public health problem in all the states and union territories of
the country (3, 5). Around this time, convincing evidence was
accumulating on the need for optimal iodine intake for normal
physical and mental development. In the light of increasing
evidence of existence of iodine deficiency in most parts of the
country, the scope of NGCP was expanded to cover the entire
country and it was decided to iodise all salt for human
consumption by, (Universal Salt Iodisation) 1990, in a phased
manner. The NGCP was rechristened as National Iodine
Deficiency Disorders Control Programme (NIDDCP) in 1992.
Why iodise salt? Everyone needs and consumes salt, usually in
fairly constant daily amounts. The average daily intake per person
in India being 10 gms. The sources of salt are usually limited,
making them feasible for addition of iodine. The techniques for
iodisation are simple and well established. Addition of iodine to
salt does not affect the appearance or taste of salt and is usually
well accepted by the consumer. Therefore, salt iodisation is the
preferred strategy for elimination of iodine deficiency and is being
currently practiced in more than 130 countries. In India, over the
past few years, considerable progress has been made in improving
the availability and accessibility of quality iodised salt to the
population across the country. Iodised salt production increased
from 0.2 million tons in 1983 to more than 4 million tons in 2000
(19). This is an increase of 20 times in a short span of 17 years! The
infrastructure to produce the required quantity of iodised salt has
been established and the proportion of population consuming
iodised salt has the potential to reach or exceed 90%. For this to
happen, we need to accelerate our efforts.
The ban on the sale of non-iodised salt was lifted in September
2000. In April 2001,the freight for transporting salt by rail was
hiked. These measures resulted in a significant drop in the
household coverage of iodised salt. NFHS-2 (1998-99) (20)
showed that 49.3 percent of the household in the country were
consuming adequately iodised salt; in the RCH survey (2001 -2)
(21), this dropped to 37 percent. The RCH survey showed that in
several northern states, the coverage at household level was
abysmally low, exposing huge number of newborns unprotected
from brain damage.
Iodine is required for the synthesis of thyroid hormones. Thyroid
hormones play a determining role in the process of early growth
and development of most organs, especially that of the brain
(6, 7). Iodine deficiency at critical stages during foetal and early
postnatal life results in impaired development of the brain and
consequently in impaired mental function. Extensive studies have
shown very clearly that part of the foetal thyroxine is of maternal
origin, disproving the old concept that maternal thyroid hormones
do not cross the placenta (8, 9). On the contrary, maternal
thyroxine is crucial for brain development in early foetal life,
including the first trimester, before the onset of foetal thyroid
function (10, 11, 12). Several recent publications have drawn
attention to the role of thyroid hormone status of the mother on the
1.
2.
Why this legislation and compulsory salt iodisation? Can people
have a choice? There are situations in which "free to choose" is all
wrong and this is one of them. Individuals often cannot make good
choices when the benefit is preventive or in the future. Every
government has a responsibility to protect population health.
Universal salt iodisation has positive externalities when benefits of
salt iodisation accrue to society as a whole, the government's role
Indian Coalition for Control of Iodine Deficiency Disorders (ICCIDD)
Prof & Head, Centre for Community Medicine, AllMS & Regional Coordinator, ICCIDD for South Asia.
3
5.
is to encourage greater-production. There are ideological debates
on the individual freedom and choice that is brought in to argue
against compulsory iodisation. Public health experts who see
iodine deficiency as a critical problem should lead the fight against
the ideological arguments tilted in the direction of doing nothing. It
is helpful to remember that the history of government interventions
on behalf of public health, from fluoridation of water to the
campaign against smoking, is one of consistent life-enhancing
success. Let us strive to make iodised salt available, accessible and
affordable to every one of India's citizens and for all time to come.
goitre and endemic cretinism. Report of ICMR Task Force Study. Nev/
Delhi 1989.
6.
7.
Delange F. The role of iodine in brain development. Proc Nutr Soc
8.
Vulsma T, Gons MH and de Vijlder JJM. Maternal-foetal transfer of
2000;59:75-79.
thyroxine in congenital hypothyroidism due to a total organification defect
or thyroid agenesis. N Engl J Med 1989; 321:13-16.
9.
The government also needs to introduce series of programmatic
interventions. The NFHS-II (1998-99) survey showed that the
people in low-socio-economic strata have the least coverage of
iodised salt. These are the people who consume salt produced by
small-scale manufacturers who often fail to iodize salt adequately.
The government needs to focus on the small scale salt producers,
so as to ensure that the poorest of the poor benefit from consuming
iodised salt. There is need to reduce freight on iodised salt, and to
increase the availability of wagons for transport of iodised salt
throughout the country. There are cost-concerns regarding iodised
salt, because iodine is imported from other countries. The
government should exempt iodine for iodised salt from import duty
and sales tax, as iodised salt is like a, "vaccine for optimum brain
development". NFHS-II (1998-99) also showed lack of awareness
among people regarding iodised salt and its benefits. This requires
appropriate, sustained and intensive Information, Education &
Communication (IEC) campaign. There is also a need for external
independent quality assurance program to make sure that all
iodised salt produced is of good quality.
11.
Vulsma T. Transplacental transfer of thyroid hormones. In: The Thyroid
and Age. Pinchera A, Mann K and Hostalek U. Eds. Stuttgart, Schattauer,
1998; pp 39-48.
10.
Morreale de Escobar G, Pastor R, Obregon MJ, Escobar del Rey F. Effects
of maternal hypothyroidism on the weight and thyroid hormone content of
rat embryonic tissues, before and after onset of foetal thyroid function.
Endocrinol 1985,117:1890-1900.
Escobar del Rey F, Pastor R, Mallol J, Morreale de Escobar G. Effects of
maternal iodine deficiency on the L-fhyroxine and 3,5,3' triiodo-L-
thyroxine contents of rat embryonic tissues before and after onset of foetal
thyroid function. Endocrinol 1986; 118:1259-1265.
12.
Evans IM, Sinha AK, Pickard MR, Edwards PR, Leonard AJ, Ekins RP
Maternal hypothyroxinemia disrupts neurotransmitter metabolic enzymes
in developing brain. J Endocrinol 1999,161:273-279.
13.
Haddow JE, Palomaki GE, Allan WC, Williams JR, Knighi GJ, Gagnon J,
O'Heir CE, Mitchell ML, Hermos RJ, Waisbren SE, FAid JD, Klein RZ.
Maternal
thyroid
deficiency during
neuropsychological
development
pregnancy and
of the child.
N
subsequent
Engl J
Med
1999;341:549-555.
14.
Pop VJ, Kuijpens JL, Baar AL\4 Verkerk G, Van Son MM, d.Vijlder JJ,
Vulsma T, Wiersinga WM, Drexhage HA, Vader HL. Clin Endocrinol
1999;50:149-155.
15.
Glinoer D, Delange F. The potential repercussions of maternal, foetal and
neonatal hypothyroxinemia on the progeny. Thyroid 2000;10:273-279.
16.
Delange F. Iodine deficiency as a cause of brain damage. Editorial. Post
Graduate Med J 2001 ;77:217-220.
Ending IDD once and for all depends on building and maintaining
a network of partnerships. Let us build a partnership and use it for
creating a full circle of communication that helps sustain political
will, stimulate demand for quality iodised salt, deliver the salt
efficiently, and create a healthy standard that can be sustained
from generation to generation.
17.
Santiago-Fernandez P, Torres-Barahona R, Muela-Martinez JA, RojoMartines G, Garcia-Fuentes E, Garriga MJ, Leon AG, Soriguer F.
Intelligence Quotient and Iodine Intake: A Cross Sectional Study in
Children. J Clin Endocrinol Metab 2004;89:3851-3857.
18.
Vermiglio F, Lo Presti VR Moleti M, Sidoti M, Tortorella G, Scaffidi G,
Castagna MG, Mattina F, Violi MA, Crisa A, Artemisia A, Trimarchi F.
"In the field of nutrition, as in politics the task is to do what is
possible without for getting to make possible what is
necessary"(22). It is eminently possible to sustain elimination of
Attention Deficit and Hyperactivity Disorders in the Offspring of Mothers
Expoosed to Mild-Moderate Iodine Deficiency: A Possible Novel Iodine
Deficiency Disorder in Developed Countries. J Clin Endocrinol Metab
IDD through universal salt iodisation.
2004;89:6054-6060.
References:
19.
1.
Delong GR, Bobbins J, Condliffe PG. Iodine and the Brain. Plenum Press,
2.
Stanbury JB. The damanged brain of iodine deficiency. Cognizant
Annual Report 2001-2002. Salt Department, Ministry of Commerce &
Industry, Department of Industrial Policy & Promotion, Government of
India.
New York. 1989;ppl-379.
20.
National Family Health Survey (NFHS-2) 1998-99, International Institute
for Population Sciences, ORC Macro.
Communication, New York. 1994, pp 1 -335.
21.
Sooch SS, Deo MG, Karmarkar MG, Kochupillai N, Ramachandran K,
Ramalingaswami V. Prevention of endemic goitre with iodised salt. Bull
District Level Household Survey Reproductive and Child Health (DLHS
RCH) 2002-2003
WHO 1973;49:307-312.
4.
Bernal J and Nunez J. Thyroid hormones and brain development.
European J Endocrinol 1995; 133:390-398.
Legislation is one essential step; but in itself is not sufficient to
achieve USI. Despite well meaning legislation, practice often lags
behind policy. Legislation presupposes an effective monitoring and
enforcement based on the partnership of salt industry and
governmental agencies. In such a partnership, the government
seeks improved public health, and the industry seeks protection
against competition with non-iodised salt.
3.
Indian Council of Medical Research. Epidemiological survey of endemic
22.
Beaton G.H. Bengoa J.M. Nutrition and health in perspective An
Pandav CS, Mohan R, Karmarkar MG, Subramanian A, Nath LM. Iodine
Introduction in Nutrition in (P 20). Preventive Medicine Edited by G.H.
deficiency in India. Natl Med J India 1989;2 (1): 18-21.
Beaton and J.M. Gengoa, World Health Organization, Geneva, 1976.
ReprintedI with kind permission from Notional Medical Journal of India
(Ref.: NMJi Editorial ’Ban on Sale of Non-iodized Salt for Human Consumption: A step in the right direction
*,
authors. Rajan Sanxar, Cnandrakant S. Pandav). Volume 18, Number 4 (Jul/Aug 2005)
4
Regional Consultation Meet on Nutrition
(for Western States/Union Territories)
at Yashada, Pune on 19-20 May, 2005,
Food and Nutrition Board, Department of Women and Child Development
Ministry of Human Resource Development, Government of India
Nutritional Status of the population represents a national economic
asset. Nutrition of young children and women reflects the
developments of a country. Nutrition during pregnancy and early
childhood determines the health of the individuals during their
entire life span. Thus, nutrition is critical for the survival and well
being of current and succeeding generations.
The Governments of India has been implementing a number of
programmes for improving the nutrition and health of its
population. There have been significant achievements in the
nutritional status of people since the independence but the current
levels of malnutrition are still unacceptably high. Nearly 47% of the
preschool children are underweight, 68% or preschool children are
anaemic, 0.7% suffer from vitamin A deficiency signs and more
than 10% suffer from iodine deficiency disorders.
□
To facilitate inter sectoral coordination mechanism at
different levels and networking with professional institutions
like Food and Nutrition Departments of Home Science
Colleges, Preventive and Social Medicine Departments of
Medical Colleges and established NGOs in the field.
In order to achieve a multi sectoral forum for deliberating on
important nutrition issues, the State Secretaries incharge of
Women & Child Development, Health and Family Welfare and
Education and their Directors from the Western States/UTs were
invited. Food and Nutrition experts from Home Science Colleges
of this region, Medical Colleges, established NGOs and
representatives of National and international organisations were
invited both to share their experiences with the participants as well
as to facilitate networking in the region for accelerating the
progress in achieving nutrition goals.
Micronutrient deficiencies relating to vitamin A, iron, folic acid and
iodine afflict a large percentage of the population resulting in
reduced immunity, poor cognitive development, high morbidity
and mortality.
The Hon'ble Minister of State for Women and Child Development
(WCD), Government of India and Ministers of WCD and Health &
Family Welfare from Maharashtra were invited for inaugurating
the Consultation Meet on Nutrition and to share their experiences
with the participants, respectively. The senior policy makers from
the Government of India were also invited.
Malnutrition is a multifaceted problem requiring a multi sectoral
approach. The National Nutrition Policy (1993) identified nutrition
with development. As such various developmental programmes
need to integrate nutritional concerns and make nutrition
improvement and explicit objective of their programmes. Advocacy
of senior programme managers towards the consequences of
malnutrition, the important role of nutrition in accelerating the
development and simple solutions for preventing and controlling
the problem of malnutrition is a primary pre-requisite for achieving
There were about 102 participants comprising of representatives
from Central and State Governments, Home Science and Medical
Colleges, Field Units of Food and Nutrition Board (FNB), NGOs
and National & International Organisations.
nutrition goals.
With this aim, the Food and Nutrition Board (FNB), Department of
Women and Child Development, the nodal Department for
nutrition has been organising Regional Consultation Meets on
Nutrition in the country. The first Regional Consultation Meet was
organised for North Eastern States at Shillong on 17-18 February,
2005. The second Regional Consultation Meet on Nutrition
involving the States/UTs of Maharashtra, Gujarat, Goa, Dadra &
Nagar Haveli, Lakshadweep and Daman & Diu was organised at
Yashwantrao Chavan Academy of Development Administration
(YASHADA), Pune on 19-20 May, 2005.
The multi sectoral participation along with experts from
professional institutions of these States would . not only help
integrate nutritional concerns in respective programmes of
women and child development, health and family welfare and
education departments but would also help build linkages with
experts from Home Science and Medical Colleges and NGOs.
Objectives:
To sensitise policy makers towards the magnitude of the
problem of malnutrition and its consequences on human
resource development, productivity, economic growth and
national development.
□
To update the knowledge on vital nutrition issues like infant
and young child feeding, micronutrient malnutrition, nutrition
monitoring, mapping and surveillance, and nutrition
education, training and advocacy.
Participants: A Profile
Anaemia levels in pregnant and lactating mothers and adolescent
girls is a cause of concern.
□
□
To review the experiences of the States in promoting nutrition of
the people through ICDS and other programmes and
innovative approaches, if any and help share experiences
between States in the region.
5
A presentation on "Malnutrition: A Call for Urgent Action" was
made by Smt. Shashi P Gupta, Technical Adviser, Food and
Nutrition Board, DWCD, GOI with a view to enumerate the
magnitude of the problem of malnutrition, its serious
consequences on all spheres of human life, the cost of
malnutrition to the nation and the need for improving nutrition of
the people for accelerating the pace of national development. It
was pointed out that the thrust of the National Nutrition Policy
adopted by the Government in 1993 was to integrate nutritional
concerns in policies and programmes of various developmental
sectors so that nutrition is promoted through a multi sectoral
approach. The broad strategies required for addressing
malnutrition included building alliances with various stakeholders,
monitoring nutrition levels of vulnerable groups on regular basis,
promoting appropriate infant and young child feeding to prevent
the onset of malnutrition in children, addressing micronutrient
malnutrition in a holistic manner giving due emphasis to
fortification of common foods and horticultural interventions and
undertaking vigorous awareness campaign to reach nutrition
information in regional languages to all parts of the country.
Smt. Revo Nayyar, Secretary, Department of WCD, GOI
highlighted the Objectives of the Consultation Meet in her address.
At the outset she highlighted the importance of nutrition for
cognitive development, growth and health of children, the need for
ensuring nutrition of the girl child, adolescent girls, pregnant and
lactating women to break the intergenerational cycle of
malnutrition and ensuring optimum nutrition for all for better
productivity and economic growth. The complex nature of the
problem .of malnutrition and the need for having a multi-pronged
strategy for prevention and control of malnutrition was explained by
her. The importance of inter-sectoral coordination mechanism for
achieving convergence between various developmental
programmes of the Government as directed by the National
Nutrition Policy of the Government of India in 1993 was also
stressed. She mentioned that simple solutions to the complex
problem of malnutrition were available and the need was to bring
nutrition issues centre stage so that high priority could be assigned
to interventions addressing various forms of malnutrition.
The inter sectoral forum of this Consultation Meet was considered
ideal for helping various stakeholders to identity strategies for
addressing malnutrition and developing network with like minded
organisations. She expressed that the country has the best
Nutritionists, doctors, institutions etc and still the nutrition goals laid
down for the Eighth and Ninth Five year Plans have also not been
achieved. The high level of anaemia, under nutrition among
children and infant mortality rates continue to be a cause of
concern. Urgent steps were needed to reduce the infant mortality
rate, maternal mortality rate and malnutrition levels and improve
the longevity of the people.
Dr. C. S. Pandav, Professor of Community Medicine, AllMS made
a presentation on, "Addressing Iodine Deficiency Disorders". He
narrated how non-iodised salt was responsible for iodine related
deficiencies and the need for urgent attention before it was too
late. The impact of iodine deficiencies on human development
specially on cognitive development in terms of I. Q. was
addressed by him. He pointed out that iodine deficiency was
completely preventable with very simple means and awareness.
The mental retardation due to iodine deficiency was rampant
although it was totally preventable. He emphasized the need to
focus on mental retardation in the Information Education &
Communication (IEC) campaign. The regular consumption of
adequately iodised salt by all in different parts of the country was
needed to eradicate the scourge of iodine deficiency disorders as
a public health problem in India.
She pointed out that a mix of interventions would be required for
addressing the problem of malnutrition. Besides nutrition and
health interventions, access to safe drinking water and sanitation,
introducing nutrition in the curricula of school children and
reaching nutrition information to all through media were
important. An aggressive campaign for promoting exclusive breast
feeding for the first six months and initiating complementary
feeding at six months with home based complementary foods was
required to ensure nutrition for the whole life span as well as for
reducing infant mortality rate.
Smt. Shashi R Gupta, Technical Adviser (FNB), DWCD extended a
Vote of Thanks to the Hon'ble Ministers for their valuable
guidance, Department of Women and Child Development,
Government of Maharashtra and Director General, YASHADA,
Pune for their active support in organising this workshop and to all
the delegates who made it possible to participate in this two-day
Consultation meet from States/UTs of Western Region.
Smt. Reva Nayyar, Secretary, DWCD also spoke on the subject to
further highlight the importance of addressing malnutrition in a
mission mode.
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15
Regional Consultation Meet on Nutrition
(for Eastern States) Held at Bhubaneswar on 18-19 July, 2005,
Food and Nutrition Board, Department of Women and Child Development
Ministry of Human Resource Development, Government of India
□
Nutrition is increasingly being recognized as one of the most
important indicators of development all over the world. Good
nutrition is the material basis for human resource development.
Malnourished children tend to have low I.Q., impaired cognitive
development affecting their school performance and productivity in
their later life. Anaemia and Chronic Energy Deficiency in women
results in low birth weight babies. Malnutrition during pregnancy
and early childhood has life long implications on the health of an
individual as it predisposes the person to diet related chronic
diseases like diabetes, hypertension, cardiovascular diseases etc in
later life.
To review the experiences of the States in promoting nutrition of
the people through ICDS and other programmes and
innovative approaches, if any, and help share experiences
between States in the region.
□ To update the knowledge on vital nutrition issues like infant and
young child feeding, micronutrient malnutrition, nutrition
monitoring, mapping and surveillance, and nutrition
education, training and advocacy.
□
Nutrition is an issue of survival, health and development of current
and succeeding generations. Improved nutrition is, therefore,
critical to development, health, productivity, economic growth and
national development.
To facilitate inter sectoral coordination mechanism at different
levels and networking with professional institutions like Food
and Nutrition Departments of Home Science Colleges,
Preventive and Social Medicine Departments of medical
Colleges and established NGOs in the field.
The cost of Malnutrition to the economy of a nation is extremely
high. According to a study coordinated by Department of WCD
and conducted by the Administrative Staff College of India (ASCI),
Hyderabad, malnutrition reduced India's GDP by 3-9% during the
year 1996. The report also brings out that the cost of treating
malnutrition is 27 times more than the investment required for
its prevention.
Malnutrition is a multifaceted problem the determinants of which
vary from food inadequacy at household level to illiteracy,
inadequate access to health care, hygiene and sanitation, poor
infant and young child feeding practices, ignorance about nutrition
and health, poor status of women and low purchasing power.
Efforts to prevent and control malnutrition, therefore, have to be
multi pronged.
Advocacy of senior programme managers towards the
consequences of malnutrition, the important role of nutrition in
accelerating the development and simple solutions for preventing
and controlling the problem of malnutrition is a primary pre
requisite for achieving nutrition goals.
Profile of the Participants
In order to achieve a multi sectoral forum for deliberating on
important nutrition issues, the State Secretaries incharge of Women
and Child Development, Health, Food, Panchayati Raj and
Education and their Directors from the Eastern States were invited.
Food and Nutrition experts from Home Science Colleges of this
region, Medical Colleges, established NGOs and representatives
of National and international organisations were invited both to
share their experiences with the participants as well as to facilitate
networking in the region for accelerating the progress in achieving
nutrition goals.
With this aim, the Food and Nutrition Board, Department of
Women and Child Development, the nodal Department for
nutrition is organising Regional Consultation Meets on Nutrition in
the country. The first Regional Consultation Meet was organised for
North Eastern States at Shillong on 17-18 February, 2005 and the
second for Western States was organised at Yashwantrao Chavan
Academy of Development Administration (YASHADA), Pune on 1920 May, 2005.
There were about 77 participants comprising of representatives
from Central and State Governments, Home Science and Medical
Colleges, Field Units of Food and Nutrition Board (FNB), NGOs
and National & International Organisations.
The third Regional Consultation Meet on Nutrition for Eastern
States involving the States Bihar, Jharkhand, Orissa and West
Bengal was organised at The New Marrion Hotel, Bhubaneswar on
18-19 July, 2005.
The two-day Programme of the Regional Consultation Meet on
Nutrition had seven sessions in all. There were five Technical
Sessions in addition to Inaugural and Valedictory Sessions.
Objectives
□
To sensitise policy makers towards the magnitude of the
problem of malnutrition and its consequences on human
resource development, productivity, economic growth and
national development.
Presentations on critical issues of nutrition in the areas of infant and
young child nutrition, micronutrient malnutrition, nutrition
monitoring, mapping and surveillance, nutrition and health
7
education, intersectoral coordination for nutrition promotion from
eminent national and international experts were scheduled in the
Technical Sessions. Experiences of States in Improving Nutrition
Scenario along with Innovative Approaches, if any, were included
in the first Technical Session.
should have basic nutrition information. The syllabi should be
reviewed and nutrition content incorporated utilizing the
expertise of FNB and NIN.
>
School children can prove to be the best change agents. NIN
has converted FAO publication "Feeding Minds, Fighting
Hunger" publication to suit Indian system. The Indian module
on "Feeding Minds, Fighting Hunger" should be incorporated
in primary, secondary and senior secondary school curricula.
5
Effective positioning of infant and young child feeding in
ICDS, RCH, NRHMetc.
>
Optimal breast feeding i.e., early initiation, exclusive breast
feeding for the first six months and continued breast feeding
upto two years and beyond along with complementary feeding
introduced at six months of age, was considered critical for
child survival, development and health. Exclusive breast
feeding for first six months and continued breast feeding for
another six months along with adequate complementary
feeding has shown to reduce infant mortality rate by 16%
(Lancet 2003).
Recommendations
A detailed account of deliberations of the two day Consultation
Meet on Nutrition held at Bhubaneswar itself is full of innovative
ideas and success stories. The recommendations are, however,
presented herewith a view to reiterate the same.
1.
Malnutrition is a drain on economy and a silent
emergency requiring urgent multi pronged action
>
Malnutrition is a drain on economy and adversely affects
national development. Thus, malnutrition is a Silent
Emergency and requires innovative measures for its
prevention and control. A multi pronged action involving all
developmental sectors was required urgently to address the
problem of malnutrition in a time bound manner.
>
The action and progress to be monitored in months and not
years.
>
Priority to infant and young child feeding has to be reflected in
national/state/local plan resourcesand goals.
>
Urban malnutrition was as bad as rural picture if not worse,
and deserved due emphasis.
>
2.
Panchayati Raj Institutions (PRI) for convergence and
effective delivery of services at periphery
Effective positioning of infant and young child feeding in ICDS,
Reproductive and Child Health (RCH), National Rural Health
Mission (NRHM) and others focusing on best possible start to
life, survival, growth and development, maternity protection
and family support is required.
>
Adopting I translating National Guidelines on Infant and
Young Child Feeding, integrating these in the training curricula
under ICDS, Reproductive and Child Health, Panchayati Raj
Institution and Rural Development needs to be undertaken
on priority.
State Level Coordination Mechanism is essential for policy
initiatives and greater synergy between various programmes. A
centrally sponsored Food and Nutrition Mission at State level could
be the best option to address the problem of malnutrition in a
mission mode.
>
ICDS monitoring to include indicators on early initiation of
breast feeding, exclusive breast feeding for first six months,
complementary feeding with home based foods from six
months along with continued breast feeding up to two years
or beyond .
4.
Better Linkages between ICDS and Department of
Elementary Education and Literacy
>
>
"Balwarg" comprising of 3 to 6 year old children need
preschool education as well as supplementary feeding and
micronutrient supplements. Such children covered under
'Sarva Shiksha Abhiyan
*
sho.uld be provided quality preschool
education and nutrition through convergence between MID
Day Meal and LCDS as Education has a separate teacher for
*.
'Balwarg
Facts like breast feeding prevents obesity, it has economic
value, exclusive breast feeding prevents HIV in infants, etc.
need io be utilized in Behavioural Change Communication.
>
Reposition ICDS with a focus on under twos. Deliver Infant and
Young Child Feeding (IYCF) counseling as a service in ICDS.
>
BPNI's network in States and Districts to be utilized for skill
development training, capacity building and awareness
generation on IYCF.
6.
Promoting production of low cost processed and fortified
complementary foods for infants and young children at
District, Block and Village levels
>
Production of low cost processed and fortified blended foods
for ICDS beneficiaries utilizing Self Help Women Groups
needs to be promoted at district and block levels.
>
Self Help Women Groups to be the owners of such production
units (2 MT capacity/day) with one time financial assistance as
has been done in Orissa.
>
Public Private partnership for reaching 'Sattu
*
like instant infant
mixes at village shops should also be explored.
Out of the six services provided through ICDS, three and a half
services concerned health sector. Convergence of services was
important and the Panchayati Raj Institutions could be utilized to
achieve convergence. Interface between Government and PRI
system needs to crystallize.
3.
>
Food and Nutrition Mission at the State Level
The existing training institutions under Education like Block
Resource Centres (BRCs), Cluster Resource Centres (CRCs)
(for a group of villages in good middle school) and Distirct
Institute for Education and Training (DIET) should be utilized
for training ICDS personnel too. One training centre could
. take care of two ICDS projects.
>
Joint Committee of Education and ICDS should look after both
programmes for better convergence.
>
Nutrition Education should become an important service
under ICDS.
>
Syllabi of all formal and non-formal educational systems
8
■ ■ ■
■ ■
Meals for primary school children should be fortified with
essential micronutrients.
7.
Addressing critical stages of life cycle adopting life cycle
approach
>
Focus on prenatal care and counseling, under threes,
pregnant and lactating mothers and adolescent girls.
>
Iodised salt and fortified supplementary foods should be made
available to people through fair price shops.
>
Emphasis on early action and preventive approach is required.
>
>
Joint Training and Supervision of ICDS and Health personnel
for synergetic impact
Fortification of cereals with iron and folic acid, salt with iron
and iodine needs to be adopted on priority.
11.
Vigorous Awareness Campaign on Nutrition
>
Joint training of ICDS and health personnel is essential.
>
>
Using a common mother-child growth and development card
by RCH and ICDS and an entitlement card for unreached
population would be desirable.
The link between nutrition education and health needs to be
emphasized. Awareness on consequences of malnutrition on
physical and mental growth, school performance, productivity
and economic growth needs to be generated.
8.
Monitoring of performance under ICDS to be based on
"Outcome indicators" and not "Process indicators" alone
>
Nutrition education should address family as a whole and not
just the women. Nutrition education should focus on
communication for behavioural change.
>
Monitoring of ICDS through Monthly/Quaterly Progress
Reports to be based on "Outcome" indicators like
improvement in nutritional status of the children rather than
"process" indicators like receiving supplementary food,
preschool education etc.
>
Advocacy and sensitisation of policy makers and
Parliamentarians should be undertaken to create
"Administrative" and "Political" will.
>
Networking with professional institutions like Food and
Nutrition departments of Home Science Colleges, Medical
Colleges and NGOs was needed to extend the coverage
under nutrition education.
>
Electronic media to be involved in Advocacy and Behavioural
Change Communication.
>
All commercial advertisements need to be censored and
celebrities need to dissociate themselves from the same.
9.
Ensuring 100% weighing efficiency in ICDS
>
Weighing efficiency was reported to be directly proportional to
reduction in malnutrition levels.
>
Universalisation of ICDS should also mean 100 % registration
of all children under three years, all under threes to be weighed
and all under three families to be provided with mother child
card.
>
Addressing micronutrient malnutrition in a holistic manner
>
Micronutrient malnutrition control requires concerted action
on all the five major strategies viz. Dietary Diversification,
Supplementation, Food Fortification; Horticultural
Interventions and Public Health Measures.
>
Ensuring universal coverage under Iron and folic Acid
supplementation programme and extending the anaemia
control programme to cover infants and adolescent girls needs
to be taken up on priority.
>
ICDS workers could identify moderate and severe anaemia
through pallor of mucosal membranes and take remedial
measures.
>
Importance of iodine in brain development to be emphasized
in communication efforts.
>
Vitamin A supplementation coverage should be universalised
for children under 3 years and all efforts made to cover
children up to 6 years. Household and community production
and consumption of red, yellow and green coloured fruits and
vegetables besides milk and eggs needs to be promoted.
10.
Fortification of Foods
>
Multipronged strategies with due focus on fortification is
required for addressing micronutrient malnutrition.
>
Micronutrient malnutrition has been effectively addressed
through fortification in West and also in some South American
and African countries. Fortified wheat flour in Darjeeling
district of West Bengal demonstrated a significant reduction in
anaemia (15 16 % in adolescent girls) in 18 months period.
>
Supplementary foods for ICDS beneficiaries and Mid Day
9
12.
Achieving Convergence between ICDS and RCH
>
Observe Nutrition and Health days in AWCs to increase
outreach coverage with focus on ANC, weighment,
immunisation and micronutrient supplementation.
>
Regular subcentre level meetings for better coordination
between AWWs, ANMs and PRI functionaries.
>
Continuous capacity building of AWWs and ANMs.
13.
Nutrition Monitoring, Mapping and Surveillance
>
The successful experiences of West Bengal and Orissa on
reducing malnutrition through Nutrition Monitoring, Mapping
and Surveillance need to be replicated in other States.
>
Community based monitoring to be adopted and Social audit
at the village level using social maps/para-maps done on a
regular basis.
>
Resources available with the ICDS could be utilized effectively
for monitoring and data analysis.
>
The Monitoring Procedure could be as under:
•
•
Data compilation at the Project level by CDPO.
District level compilation by the DPO
•
Electronic transmission and state level compilation at the
Directorate.
•
Data analysis with various indicators
•
Nutritional and growth monitoring on the basis of these
indicators and available resource maps.
•
Coordination Committees at State and District levels,
monitoring Committees at Subdivision and Project levels
and Village Level Committee at the AWC should be the
Monitoring Infrastructure.
NATIONAL CONSULTATION ON ICDS:
UNIVERSALISATION WITH QUALITY
Organised by
Department of Women and Child Development
Ministry of Human Resource Development, Government of India
with UNICEF cooperation
OBJECTIVES
• To share the national policy initiative for "ICDS Universalisation with Quality" with a wide spectrum of stakeholders and partners.
• To discuss key issues in " Universalisation of ICDS with Quality"/ in accelerating reductions in Infant Mortality, malnutition and enhancing early child
development.
• To learn from best practices and programme implementation experiences - What works well and why.
• To collectively formulate an operational plan for "A New Generation ICDS" - focusing on improved young child survival, nutrition and development
outcomes for children under three years.
OUTCOMES
• A shared vision of "A New Generation ICDS" focusing on improved young child survival, growth and development outcomes for children under three years.
• A strengthened vibrant partnership (across sectors, partners) for integrated early child development supporting "ICDS Universalisation with Quality"
• An Operational Framework for moving forward, linked to other sectoral policy initiatives (such as National Rural Health Mission, RCH II, Sarva Shiksha
Abhiyan, Total Sanitation Campaign).
PARTICIPANTS: A PROFILE
Around 150 participants: Representation from the following groups
• National and State DWCD Ministers, Secretaries, Policy makers, planners and officials from different sectors (WCD, Elementary Education, Health and
Family Welfare, Biotechnology, Rural Development, Drinking Water Supply), Planning Commission.
• State DWCD Secretaries, Directors, State teams, including programme functionaries.
• Experts & Resource person drawn from renowned institutions.
• Planners from Commissions (NCW), Central Social Welfare Board, National Advisory Council, Child Councils, professionals bodies (BPNI, ICCIDD,
INCLEN, IAPE, IAP, IMA).
• Planners from voluntary agencies and networks working on issues related to children and women, community based organisations, Panchayati Raj
Institutions, women's groups and parent support group.
• National Training & Research Institutions - NCERT, NIPCCD, NIN, NIHFW, AllMS & selected State Institutions.
• Development Partners Including - UNICEF, World Bank, CARE, WFR, WHO and others.
S
uniGeffie
NATIONAL CONSULTATION OF
STATE WCD MINISTERS & SECRETARIES
ON .
of Wonunt onii Child Development
Mwttftrtf pfiHimdB Raource Development
Government of MU
With UNICEF Cooperation
Status of Salt Iodisation: Efforts of Govterment of Bihar
By Dr. A. K. Tewary, State Programme Coordinator, State Nutrition Cell, Health Service, Govt, of Bihar
& Farhat Saiyed, Project Officer Child Development & Nutrition (CD & N), UNICEF, Bihar
As per the recent survey in Bihar the consumption of salt with
adequate iodine is around 40%. Almost two-thirds of the
households in Bihar are reported to consume salt with no iodine or
low iodine.
After the preparation of the Plan of Action (PoA) for Elimination of
IDD in Bihar, we initiated working towards building a system of
government commitment, as there was very low interest or priority
for IDD issues and that of iodized salt status.
We have brought together a State Level Task Force on IDD. This
committee has representatives from State Departments of Health,
Social Welfare, Secondary Education, Food and Civil Supplies, Salt
Traders Association, Salt Department, ICCIDD and Ml.
At the state level, the Chief Secretary was briefed on this issue and
on his direction a high level meeting was conducted on 7 June
under the Chairmanship of Development Commissioner in his
Chamber. The meeting was called by the Development
Commissioner to sensitize the Secretary, Secondary Education;
Secretary Planning; Director Health and Integrated Child
Development Scheme (ICDS) and Secretary Food and Civil
Supplies, to discuss the situation with regard to IDD I USI in the
state and share the Plan of Action and the Concept Note. The idea
was also to ensure that each department committed to this cause
issued directives to respective officers in the district. The purpose
was also to ensure that all levels, the Sector heads coordinate with
concerned partners and initiate necessary action to improve
monitoring of salt, promoting sale of iodized salt by the retailers
and at the same time convince families to purchase and use of
iodized salt at household level.
A.
The outcome of the meetings have been summarized
asunder:
1.
A total of 577 DCC members have been enrolled in 15 districts.
As much as 2250 members at the district level from various
sectors were sensitized on the IDD / USI.
3. A total of 193 block level meetings were conducted to sensitize
577 Medical Officers and about 30,000 field staff from
Primary Health Centers (PHCs) and Anganwadi Clinics
(AWCs). About 2,000 teachers are ready to take IDD activities
in schools from the blocks.
2.
4.
A total of 22 key members of Salt Traders Association from 15
districts were motivated to indent for better quality iodized salt
from Gujarat.
5.
Directives re-issued to Integrated Child Development Scheme
(ICDS) for using iodized salt in the supplementary food.
Similarly for the schools to use Iodised Salt (IS) in khichadi
cooked daily as a part of Mid Day Meal (MDM).
These directives were further forwarded to government
institutions, jails, restaurants etc.
7. Some District Magistrates (DMs) wrote back to the Health
Secretary to introduce iodised salt in the Public Distribution
System (PDS) so as to reach the population in their district that
was Below Poverty Line (BPL). This is one of the major points for
our State Task Force meeting Agenda.
8. Finally, District Magistrates (DMs) look forward to the state to
support their district in strengthening monitoring of salt quality
at the unloading stations.
6.
This approach gained complete support and cooperation from the
Secretaries in supplementing our efforts in 15 districts. These 15
districts are those which have salt unloading stations. Also the
availability of funds made us prioritize our efforts in limited areas.
Thus, initiating a system of commitment from the government and
concerned partners was the first step taken in this direction. In each
of the 15 districts the District Magistrate (DM) formed a District
Coordination Committee (DCC) comprising of district heads of all
concerned partners and facilitated meetings to sensitize the issues
of IDD / USI and get directions on moving ahead, with sensitization
of block officials in about 193 blocks.
The DCC meeting has been completed in all districts. Only 11
blocks remain to be covered which will be completed by 8th of this
month. The meeting was attended by the following:
• Civil Surgeon
• District Program Officer
• District Welfare Officer
B.
Social Mobilization:
Strong social mobilization by a team of 15 District Mobilizers who
are coordinating with schools and AWCs to reach out to 200000
population each month. The aim is to spread knowledge on IDD
and use of iodized salt through various activities.
• District Education Officer
• District Supply Officer
• District Transport Officer
C.
• Representative from Police Department
• Food Inspectors
• Local Salt Traders
The Sector heads from Health, ICDS and Education further
conducted orientation and planning meetings in the blocks.
11
Assessment of Laboratories that for testing Iodine in Salt:
State Nutrition Cell undertook assessment of the lab situation in
all districts of the state. Govt. Of Bihar (GOB) is looking for funds
within to improve the functioning of these labs through support
in terms of materials such as chemicals, glass wares, or in
manpower (technicians), their training, or infra structural upliftment
of the labs etc.
Pamphlets Distributed By Bihar Salt Manufacturers Associations
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English Translation
Diseases Caused By Deficiency Of Iodine:
An Appeal To Wholesalers And Retailers Of Salt In Bihar
Pregnant Women
• The use of iodised salt for human consumption is necessary for healthy
pregnancy and to prevent diseases caused due to deficiency of iodine
like: Goitre, Deaf-Mutism, Mental retardation etc.
• Abortion or still birth
• Retarded growth & development of the Fetus
You play an important role in it.
• Dumb Deaf
• The salt that you sell should not only be tasty but also be healthy.
• Stunted growth
• Always sell good quality and adequately iodised salt.
• Birth of mentally retarded child/cretin
• Always store iodised salt away from heat and humidity and do not store
along with other food products.
Children
• Do not sell sub standard, inadequately iodised salt under any influence or
pressure. It is not only inhuman but also a punishable act under
Prevention of Food and Adulteration Act and Weight & Measures Act.
• Impaired mental function
• Difficulty in learning
• Please report about sale of substandard salt to local administrative
officer/Chief Medical officer/ Food Inspector/ UNICEF, Bihar/ Health
Depth, Bihar Govt, Patna or Bihar State Iodised Salt Manufacturers
Association, so that the responsible persons who are playing with the
health of common people can be booked.
• Impaired mental growth
• Impaired physical growth
• Deaf & Dumb
Adult
• UNICEF/ Govt, of India/ Govt, of Bihar is organizing testing for the
content of iodine in salt. It is mandatory that at the consumer level the
iodine content should be at least 15 PPM.
• Low energy
• Fatigue
• Low work progress
• Your valuable suggestions are important for Quality Assurance and
Quality Control.
• Goitre
• Please contribute your efforts towards National Program for the benefit of
the people.
Baba Salt, Manufacturer
Bawania, (Gujarat)
Jaydeep Salt Works,
Funded And Printed For The Benefit of People By Rajkumar Mishra,
General Secretary, Bihar State Iodised Salt Manufacturers
Association, Patna
State Task Force Meeting on Elimination of IDD in Bihar
Bihar is moving ahead to address various issues related to IDD and USI so as to increase the
sale, purchase and consumption of adequately iodised salt in 15 districts of the state. As a
member of the State Task Force (STF) for IDD in Bihar, the Regional Coordinator ICCIDD, South
Asia, Dr. Chandrakant S Pandav was invited to participate in the First meeting of STF on 4th
October 2005 at Patna, Bihar. Dr. Pandav made a presentation on "An Overview of the
Emerging Challenges in the Elimination of IDD in India".
The meeting was attended by Mr. Deepak Kumar, Secretary Health & Family Welfare, Bihar,
Mr. Bijaya Rajbhandari, State Representative UNICEF Bihar, Dr. Farhat Sayed, UNICEF Patna,
Dr. A. K. Tiwary, SPO, IDD State Nutrition Cell, Dr. (Capt.) S.N. Singh Director-in-Chief cum
Director State Nutrition Cell, Bihar
Awareness campaign Rakhi with a packet of iodised salt
Welcoming the central government's decision to ban the sale of
non-iodised salt, ICCIDD, in coordination with several NGOs
across the states and with the help of Mr. Dinesh Thacker, ICCIDD,
Extender, Gujarat distributed Rakhi with a packet of iodised salt.
NATIONAL NUTRITION WEEK
1-7 SEPTEMBER 2005
ShriArjun Singh
Micronutrient Deficiencies:
A Drain on Indian Economy
Master ol Human
Resource Devefopment
Sml Kanti Singh
Minister of Slate for Women
& Child Development
Vitamins and Minerals, also known
as Micronutrients, are vital for human beings.
Consequences of Deficiencies
Vitamin A Deficiency
Food Sources
’ Poor Growth of children.
* Increased morbidity due to: Diarrhoeal
diseases and Respiratory infections.
’ Increased mortality due to measles.
It was a novel concept incorporated by Indian Coalition for
Controlling Iodine Deficiency Disorders (ICCIDD), for creating
awareness among rural population on the benefits of iodised salt.
With Rakshabandhan as a backdrop for its campaign, the
organization felt that it may be able to reach the masses. This was
taken very well among the people and it helped them to
understand that only Iodised salt should be consumed.
' Whole milk,curd,
egg yolk, liver,butter,ghee.
■ Green.orange and red coloured
fruits and vegetables.
’ Increased risk of degenerative
diseases and cancer.
I “aiul/H
Trot
Folic Acid(Vi tami n)Deficiency
• Neural Tube Defects [birth defects)
in new boms.
* Anaemia in children and
' All foliage-dark green
leafy vegetables.
pregnant women.
Iron Deficiency Anaemia
■ Reduced physical work capacity.
(Low Productivity)
* Impaired Cognitive Functions and
Whole grain cereals, sprouted
pulses,dales,nuts and oilseeds,
green leafy vegetable, red meal,liver etc.
Brain Metabolism
(Poor Learning Ability).
* Reduced Immunocompetence
(Increased morbidities)
• Adverse Pregnancy Outcomes
(Maternal Deaths)
(Low Birth Weight)
(Obstetrical Risks)
qftnufifa qr anggrtgjrH if 'jugtti
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’ QZ
Z
IiiHialiVy
MJ
Iodine Deficiency
’ Abortions, Stillbirths,Congenital
anomalies,Increased Perinatal
Mortality,Squint,Deaf Mutism.
* Iodized salt, double fortified salt
English translation of the message
(iron arid iodine).
■ Seafoods.
Brain Damage.Dwarfism.
’ Lossof10-15IOpts
Impaired Mental function,
Retarded Physical
Development, Goitre.
I ICCIDD I
Dear Brother,
HEALTH EATING - HEALTH PEOPLE
FOR
BETTER PRODUCTIVITY AND ECONIMIC GROWRH
Food and Nutrition Board
Department ofWomen and Child Development
Ministry of Human Resource Development
Government of India
On the occasion of Rakshabandhan, I am enclosing a "Rakhi" along
with this letter. For your efforts towards eradication of Iodine
Deficiency Disorders, I am sending you the wishes of the children of
the whole India.
It is our belief that in result of your good work we all are safe.
do^2(X6'492
Advt. Brought out by Deptt. of Women & Child on National Nutrition
week from 1-7 Sept. 2005. It was a 3 quarter page advertisement
covering 143 newspapers all over the country in all the languages.
Expenditure incurred was Rs. 37,50,000/- (3.75 Millions)
Dated: 12-08-2005
May God bless your humanitarian efforts & this program for
eradication of Iodine Deficiency Disorders. We wholeheartedly wish
the slogan "Human Service is the service to the God" may corrie true,
& pray to God on this Holy Day.
Along with Rakhi, I am also enclosing one small packet of iodised salt
on this auspicious day of Rakshabandhan. Please use this in your
kitchen & make your promise sturdier.
In Tamil Nadu, Consumers want
their children to be healthy and intelligent
FEDCOT is the Federation of Consumer Organisations in Tamilnadu. In collaboration with
UNICEF, it started a campaign in Tamil Nadu in 2004. Its objectives were to:
1.
Create awareness about Iodine Deficiency Disorders (IDDs).
2.
Eradicate IDDs from Tamilnadu.
3.
Make the people of Tamil Nadu demand only iodised salt for human consumption.
4. Educate salt retailers to sell only iodised salt for human consumption.
FEDCOT launched the eradication of IDD programmes in 10 selected districts of Tamil
Nadu from September 2004 to 25th March, 2005. The Salt Department, Government of
India and the Government of Tamil Nadu simultaneously supported this programme. The
programme has been launched to cover all the districts in Tamil Nadu in three phases.
Survey result showing increase in
Iodine Salt brands in Tamil Nadu
People - consumers, traders and manufacturers - were made
aware of the ill effects of iodine deficiency. Awareness creation was
achieved through:
1.
Motivating traders selling common
consumption at the district level.
2.
Motivating manufacturers to commit to producing only
iodised salt for human consumption.
3.
Simultaneously creating awareness among the general
public, especially women and students, through personal
involvement.
salt for direct
»Campaign in Schools
>
892 schools visited and 4,698 teachers motivated
>
Over 30,000 salt samples brought by students tested for
iodine.;
1 si Survey Sep-Oct 2004
1,453 Self Help Groups covered and 29,796 women
motivated.
40% increase in turnover in Tamil Nadu Salt Corporation's
sale of iodised salt.
Surveys and motivational Campaign covered extensively by
press with wide media publicity.
9 Non-lodised
Iodised
9 Total
2nd Survey Jan-Feb 2005
Mr. Peer Mohammed is a member of FEDCOT in
Tamil Nadu.
He was instrumental in mobilizing
consumer groups in that state.
Due to the dedicated efforts of these consumer
groups, almost 90% of the salt used for human
consumption in the state today is iodised. Such a figure is
6 District Workshops: 78 Salt Manufacturers/Traders, Health
Workers, Panchayatand Municipal Leaders participated.
remarkable, especially before any official ban on the sale of
non-iodised salt.
District Level Training Programme for Consumer Activists in
10 Districts.
Surveys Conducted: 11,472 shops were visited by their
activists and samples tested.
"Iodised salt is part of your consumer right to good health. If we
can
increase
the
- Mr. Peer Mohammed
demand
for
it,
so
can
you"
> Iodine is not expensive!
>
> It cost only 10 poise per person,
each year.
The success of FEDCOT is
an example.
>
It can be replicated in
Gujarat, Rajasthan,
Maharashtra... Bihar, UP,
MR.. In your state too.
>
Let's make this endeavour a
nationwide success. Join the
VOICE initiative.
> Large companies and MNC's do
not monopolise the production of
iodised salt.
> Salt production in India is in the
hands of national companies and
small and medium-scale
producers are playing a significant
role.
> 63% of households in
consume iodised salt.
Nepal
> 77% in Vietnam & and 95% in
Bhutan!
> We must all exercise our right to iodised salt. We can
make a difference to the well-being and
development of our communities.
CONSUMER VOICE
www.corenic.in
www.consumer-voice.org
Notional Consumer Helpline
> Daily consumption of iodised salt is a Healthy Habit.
1600-11-4000 (toll free)
Post Box No. 3306,
> Less than 50% of households in
India consume iodised salt.
> As a consumer, you have the right to healthful
products. You have the right to demand iodised salt.
15
New Delhi
110014, Indio
ICCIDD Press Conference:
"Declare unequivocal support to the proposed non-iodised salt ban"
A press briefing was organized by ICCIDD on 9th August 2005 at
Hotel Samrat, New Delhi. The briefing was co-ordinated by Accord
to sensitise the media on the importance of iodisation of salt and
the Govt, of India's decision to reinstate the ban on production of
non-iodised salt meant for human consumption.
Media attendance was overwhelming. A total of 26 persons from
the print media were in attendance, while 10 persons attended
from the electronic media which included 3 from Aaj Tak, 4 from
CNBC and 3 from DD.
Dr. ChandarakantS. Pandav briefed the media on the necessity for
universal salt iodisation and cleared the apprehensions regarding
salt iodisation. CNBC Awaaz subsequently carried a news clip on
09-August-05. The print media covered the event in various news
dailies between 1 Oth to 18th August 05. Some of the publications
which covered the event are, Dainik Tribune, New Delhi, Rajasthan
Patrika, New Dehi, Amar Ujala, New Delhi, Dainik Jagaran, New
Delhi, Rashtriya Sahara, New Delhi, Jansatta, New Delhi,
Navbharat Times, New Delhi, Dainik Tribune, New Delhi, The
Indian Express, New Delhi, Hindustan, New Delhi.
with iodine deficiency, which makes the situation so alarming," said
Dr. Chandrakant S. Pandav, Prof, and Head of the Department,
Community Medicine, AllMS, who lead the AllMS team in a media
briefing today. "Goiter and Cretinism are only the visible tips of the
iceberg. Iodine deficiency is destroying the brains of our children,
and this is going unnoticed" he added. Dr. Pandav is also the
Regional Coordinator ICCIDD and is one of the authorities on
iodine deficiency disorders in the country.
Against consequences of iodine deficiency as dire as physical
stunting in children, mental retardation, hearing loss, goiters,
hypothyroidism and speech impediments, the arguments being
raised against the proposed ban are unfortunately based on
incorrect informational and defy all evidence on record.
"The cost to iodise the entire amount of salt a person consumes in
one full year is a mere 10 paise. The cost if we don't ensure
consumption of adequately iodised salt will be mentally retarded
and physically stunted children. What's worse is that the damage
will be more widespread among the poorer sections of the society
where diets as such are deficient and it is rather unlikely that iodine
deficiency will be made up from other diet components", said Dr.
M.G. Karmarkar, President, ICCIDD and Former Prof. Laboratory
Medicine, AllMS. In a recently published paper by the Centre for
Community Medicine, AllMS, it has been shown that only 36 per
cent of the poor segment of the population consume adequately
iodised salt. In the same paper, the figures for medium and high
socio-economic status groups are 50% and 70% respectively.
Not only is salt iodisation inexpensive, not a single small-scale
manufacturer was affected during the previous ban in 1997. Infact,
for many of the smallest producers, business actually increased.
These are facts and are available on record.
The Press Release
Top scientists and doctors at AllMS declare unequivocal support to
the proposed non-iodised salt ban
"Consider iodised salt as a vaccine that costs 10 paise per person
per year and protects against the single largest cause of brain
damage among children in India"
New Delhi, August 9, 2005: Top scientists and doctors at the All
India Institute of Medical Sciences (AllMS), under the aegis of the
Indian Coalition for Control of Iodine Deficiency Disorders
(ICCIDD), today declared their support to the Government's
proposed ban on the sale of non-iodised salt. The scientists also
addressed some of the misgivings that have arisen around the
Government’s decision due to inadequate information and
appreciation of ground realities in India.
While the need for salt iodisation is relatively well understood,
many do not appreciate the gravity of the situation when it comes to
iodine deficiency disorders. Goiter and Cretinism are the only
evidently visible disorders that result from deficiency of iodine in the
diet; they, however, are not the most alarming. "Iodine Deficiency
is the single largest cause of menial retardation in India.
Unfortunately, mental retardation is' not immediately associated
Unfortunately, many of those opposing the ban are mistakenly
equating iodised salt to the premium packaged and branded salt
available in groceries and supermarkets. This comparison is then
being used to raise issue on the ban making salt expensive and out
of reach of the common person. Nothing could be farther from
the truth.
"70% of the iodised salt sold in India is and will continue to be of the
loose idoised salt variety. The cheapest, unbranded loose iodised
salt sells between Rs. 1.50 Rs. 2.50 per kg. The differences in price
between loose non-iodised and loose iodised salt will be
negligible." Said Dr. Pandav
There is no single argument against the upcoming ban that stands
up to reason, logic and evidence.
The need of the hour, say experts in Community Medicine, is for the
Government, medical institutions, the civil society and particularly
the producers to join hands and make this historic decision that will
safeguard the future of our young children. India's greatest strength
is the intellectual capital vested in the young and energetic minds of
its youth. Every effort must be made to ensure it.
What is the iodine status in India?
Iodine deficiency is a problem of public health importance in India
and no state/UT is totally free from iodine deficiency. Out of the
312 Districts surveyed by the Ministry of Health and Family Welfare
(MOHFW) Government of India, 254 were found to be endemic
for iodine deficiency.
The prevalence of IDD is not confined to the sub-Himalayan
region, as it was earlier believed. The survey shows that the malaise
exists all over the country.
In India, salt is iodized to a level of 30 ppm (parts per million,
i.e. 30 mg of iodine per 1 kg of salt) at the manufacturing stage,
allowing for up to 50 per cent loss during transit, storage
and distribution.
According to the National Family and Health Survey-ll, around 70
per cent of India's population consumes salt with some amount of
iodine. But only 49 percent uses adequately iodised salt. However,
this figure fell to 37 per cent after the lifting of the ban on the sale of
non-iodized salt. Further, great variations also exist in the
consumption of iodised salt, across socio-economic and urbanrural divide. The consumption of adequately iodised salt is
significantly low among the rural masses, the economically
backward classes and the members of the scheduled castes
and tribes.
Though over the past decade the government has taken various
initiatives, there still remains an alarming gap between the national
requirement of iodised salt and the actual production. With 890
iodisation plants in Gujarat, Rajasthan, Tamil Nadu, Orissa, West
Bengal, Assam and Andhra Pradesh, the nations total installed
capacity for manufacturing iodised salt stands at 12 million tons
per year that is far in excess of the annual requirement in India. The
under utilised capacity could be directed towards the export market
after meeting the domestic needs.
The current production figures indicate that the larger refineries
produced only 1.3 million tons, where as about 3.8 million tons is
manufactured by the small and medium salt producers. This is
against the annual requirement of 5.2 million tons. However, in
2002 only 4.2 million tons of iodised salt was manufactured and a
year later, in 2003, this figure fell to 4.1 million tons. The data
shows that not only a big role in production of iodised salt is played
by the middle and small-scale manufacturers but also the
requirements of the country are not being met, in spite of the
production capacity.
Among the states producing salt, Gujarat accounts for about 71
per cent, Tamil Nadu 16 per cent, Rajasthan 9 per cent and others
share the balance 4 percent.
Discussions with known opponents of the ban
on non-iodised salt at Trivandrum, Kerala
The decision of Government of India to re-introduce the ban on
sale of non-iodised salt for direct human consumption, although
welcomed by many, has few opposing it. The opposition comes
principally by groups of Gandhians, Sarvodya Leaders, Swadeshi
Jagran Manch and few salt industry lobbies. The objections raised
vary from group to group, but some of the main reasons quoted
are: the policy of salt iodisation marginalizes small producers, it is a
ploy to provide entry into the salt trade to the MNCs, salt iodisation
is not needed in India, etc. All these are factually wrong and arise
largely due to lack of correct information. Therefore there is a good
chance of winning over many of those opposing the ban, by
providing them with correct information and allaying their fears.
In the year 2000, when the Government of India (GOI) revoked the
central ban, it was largely because of pressure from few activist
groups and salt industry lobby.
Opposition to the ban is likely to arise from the same quarters and
therefore, it was decided in a meeting with interagency partners,
that every effort should be made io contact the known resistance
points/groups and provide them with right information and try to
convince them of the need for salt iodisation. It was also decided
that we should work to organize support groups, comprising of.
important stakeholders in every region in the country who could
serve as resource persons to dialogue with those who oppose
the ban.
As a part of the strategy, the ICCIDD had organized a meeting in
Trivandrum. The meeting was attended by Prof. MG Karmarkar and
Dr R Sankar. The purpose was to meet with known opponents of the
ban on non-iodised salt and discuss with them and to meet with
government officials, academicians and office bearers of Indian
Medical Association (IMA), Kerala to enlist their support for the
ban.
and the crystal non-refined salt is efficient in eliminating iodine
deficiency.
>
Meeting with Dr Ambi, Professor Emeritus, Amrita Institute of
Medical Sciences, Kochi:
Dr Ambi is a senior professional and is highly regarded and
respected in the medical community and in the social sectors. He is
a multifaceted personality and is very active in the Malayalam
Theater and Television. Prof. MG Karmarkar and Dr Ambi are
friends for last 43 years and that helped very much.
Main points that emerged from the meeting:
>
Dr Ambi was appraised that there is likely to be objection from
some quarters in Kerala for the Gol's decision to reimpose the
ban on sale of non-iodised salt. He is fully aware of the groups,
individuals who are opposed to the ban. He briefed us on this
and helped us understand the dynamics involved.
>
He agreed to commit his time and serve as an Ambassador for
disseminating facts and figures to government officials and
opinion leaders and work towards improving iodised salt
coverage in Kerala.
>
He has assured that he will make his best effort to engage
those opposed to the ban and provide them with scientific
information on why it is necessary to enact and implement the
legislation in the interest of children and women.
>
He advised that UNICEF/ICCIDD should help in forming a
local coalition of stakeholders to serve as local resource
persons to nullify the resistance that is likely to prop up from
time to time.
>
He helped in getting appointment with some of the known
opponents of salt iodisation, like members of the Kerala
Sahitya Science Parishad (KSSP).
Meeting with Dr Raja Mohanan:
Dr Raja Mohanan, is a senior pediatrician, epidemiologist and is a
highly respected scientist in Kerala. He was the anchor person for
the IDD evaluation done in Kerala. He has access to bureaucrats,
politicians and civil society. He was kind enough to spend few hours
with us on 26th May 05 and arranged several meetings with key
persons. Important points that emerged from our meeting with
him were:
>
Form a coalition of local key stakeholders and support them to
sensitize the consumers, programme managers and others.
>
UNICEF and IMA partnership did a remarkably good work in
Kerala in educating the people on the need to have iodised
salt and his recommendation was to continue with the
partnership.
>
Work closely with the Department of Community Medicine,
Medical College Trivandrum, as the government looks up to
this department for public health policy decisions.
Meeting with Health Action for People:
>
The meeting was almost on the same lines as with Kerala
Sahitya Science Parishad (KSSP).
>
One major achievement of this meeting is that they have
assured us that they will support salt iodisation, provided, we
make it explicit that salt iodisation does not require refined salt
They were also provided information that salt iodisation has
not marginalized the small producers. Their share in the area
of land worked for salt production and quantity of salt
produced have remained more or less the same in the last two
decades.
Meeting in Women and Children hospital, Trivandrum:
>
Participants in the meeting were extremely supportive of salt
iodisation and the legislation to ban the sale of non-iodised
salt. They are ready to help in every possible way. Their main
suggestions are:
>
Form a coalition of stakeholders. The Department of
Community Medicine should take the lead. UNICEF could
support this coalition.
>
IMA Kerala will continue with their efforts to sensitize.
>
Dr Mohan Nair will take the lead and write in the local press
and also in the IMA news letter on IDD and the need for
iodised salt.
>
To assist in setting up laboratories for monitoring iodised salt
programme.
Meeting with KSSP:
>
After a difficult meeting, it was managed to get an assurance
from this group, that they will not oppose salt iodisation.
Sates providing access of Iodised Salt to Below Poverty Line (BPL) population
under Public Distribution System
States
Distribution System
Rs./kg
Type of Salt
Andhra Pradesh
Through PDS
2.00/kg
Oridinary Salt
4.00-4.50/kg
Refined Salt
Arunachal Pradesh
Through PDS
0.75/kg
-
Assam
Through PDS
2.80/kg
Unpacked Salt
4.00/kg
Poly Pack
Chattisgarh
Through PDS
0.25/kg
-
Delhi
Through PDS
5.50/kg
Refined Salt
Gujarat
Through PDS
0.50/kg
-
Himachal Pradesh
Through PDS
5.50/kg
Refined Salt
Haryana
Through PDS
3.50/kg
-
Jharkhand
Through PDS
Karnataka
Through PDS
3.00/kg
-
Orissa
Through PDS
1.80/kg
Loose Salt
3.80/kg
Poly Pack
________ 0.25/kg__________ -
Rajasthan
Through PDS
1 .OO/kg
-
Sikkim
Through PDS
2.90/kg
Crushed Loose Salt
Tripura
Through PDS
3.50/kg
Poly Pack
Tamil Nadu
Through PDS
2.50/kg
-
Hl NATION
New Delhi, Thursday, June 16,2005
(the (Baxetje of
A pinch of health salt
SANCHITA Shanna
'
•
*.
". i
■
’’ Jl •
w
%«r- ntt/
,
'
*
New Delhi, June 15
HO
NOW YOU won't need to buy
your salt with a pinch of it It
will come doubly fortified with
iron and iodine soon
"Iodising salt will become
mandatory from August 15. The
government is bringing in legis
lation for double fortification of
salt with iron and iodine, which
will be commercially produced
in a couple of months," said
health minister Anbumanl Ramadoss at UNICEFs Reproduc
tive and Child Health strategy
review meet
Iron-deficiency anaemia affects
70 per cent children and 75 per
cent pregnant women in the coun
try, and fortifying salt and food
with iron - especially for babies,
children, pregnant women and
the elderly - will help meet this
deficiency ’Initially, doubly forti
fying salt had stability problems
but the National Institute of Nu
trition, Hyderabad, has overcome
that and made it stable, paving the
19
Health Mix: Salt will
be fortified with
Iron and iodine
Deadline: Non-lodised salt will be
banned from August 15
way for its commercial fortifica
tion," said Ramadoss.
Iodising salt will not make
much difference to its price, as
the cost of iodisation is just 10
paise for one kg of salt, with sim
ple iodizing units costing about
Rs 1,000. Over two-thirds of the
iodised salt currently available
in India is already being pro
duced in small and medium units
(3.8 million tonnes of the annual
production
of
4.1
million
tonnes), with only 1.3 million
tonnes being manufactured in
large refineries. "Since non
iodised salt was banned too years
ago, the mechanism to iodise salt
is easily available everywhere. It
will not make much difference to
cost,” says Ramadoss.
The Ministry for Railways has
offered to lower freight charges
for salt to lower the price further.
Iodine for IQ
"Even mild iodine deficiency
has been shown to lower IQ by II
to 15 points. Studies in Indi;
have shown that children living
in iodine-deficient areas have
IQs 10-15 points lower than chil
dren in iodine-abundant areas,'
said Cecilio Adorna, representa
tive of UNICEF India. In India
of the 312 districts surveyed for
Iodine deficiency. 254 were fount
to have low levels of the essen
tial nutrient.
Vision for the Nation
"With our resources and the money we spend, we could easily accomplish three times
what we do, in halfthe time we normally take, ifwe were to operate in mission mode with
a visionfor the nation "
- Dr. A. P. J. Abdul Kalam
President ofIndia
("Ignited Minds")
Stt?
tydtod gtRd 11
Daily consumption of Iodised salt
is a healthy habit
Sustaining Elimination of IDD
IOCIDD
Publishing any material in IQ+ Jagriti does not necessarily mean ICCIDD's endorsement of the
views expressed therein or the results quoted.
Materials for publication, subscription request, comments may be sent to: Dr. Chandrakant S Pandav
Address: Room No 28, CCM Building, Old OT Block, All India Institute of Medical Sciences, New Delhi 110029
E-mail: cpandav@iqplusin.org
Position: 2467 (8 views)