JAGRITI VOL. IV, ISSUE 3 SEPTEMBER 2006.pdf
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IN THIS ISSUE
• Report from
Sri Lanka
• Medical Geology
• 59th WHO, RC,
Meeting, Dhaka
• (EC Campaign
with BSG
• 1st Panel Meeting
of the
Western Region
W j
Sustainable Elimination of Iodine Deficiency Disorders
Tracking Progress
“ Another Success Story
VIA
The Intelligence Quotient (IQ) score of
children living in an iodine deficient
environment is nearly 13 IQ points less than
those living in iodine sufficient environments
Poor scholastic performance
Meeting with the President of Sri Lanka
Frequent failures I grade repetitions
o
o
The
President
of
Sri
Lanka,
His
Excellency
Mr. Mahinda Rajapaksa (R) and Dr. Chandrakant Pandav (L).
Absenteeism I Dropouts
Dr. Pandav appraised the President of the ICCIDD-MI initiative
in Sri Lanka to improve the quality of iodised salt on a
Impact: Retarded social & economic growth
sustainable basis. Dr. Pandav congratulated the President for
the successful progress towards sustainable elimination of IDD.
Build a Country Suitable for Children
"A theme in our Presidential election campaign was to build a country suitable for children. We will plan education, higher education and
vocational training on a national scale to help our children and youth to improve their talents and knowledge and do everything possible
to brighten the lives of our future generation. I recall here what the great Chinese philosopher Confucius said thousands of years
ago. "If you are planning for a year grow paddy, If you are planning for ten years plant trees. If you are planning for a century
educate people". If we are building our country we should look at this century in which we live and make our national plans accordingly. It
is with such a broad vision that we should formulate education policies. I appeal to this August assembly not to consider our interventions
for the sake of education as relief assistance but as investments for the sake of the country. During the recent election campaign I was able
to read the UNPs election manifesto. I wish to state sincerely that in their manifesto there were several valuable points that should be
appreciated. Among them the concept English for All on page 35 drew my attention. I wish to inform you that I hope to implement the
concept with some revisions while giving Members of the main Opposition the credit for it. I wish to remind that according to Mahinda
Chintana political colours cannot measure good things. We will fully safeguard the right to free education. We will take steps to teach the
mother tongue - Sinhala and Tamil - and English to every child. Every child will be provided with a free mid day meal. We shall improve
laboratory, language teaching, computer, library, sports and other facilities in all Maha Vidyalayas and other government schools. We will
raise 325 schools to the highest level selecting one school from each Secretariat Division. The education service will be depoliticised and
a number of steps will be taken for the welfare of teachers and employees in the educational administrative service. One challenge is
providing higher education to all those passing the advanced level. The government will accept the challenge. We will increase the
number of university admissions and improve facilities in universities. We will also raise the Mahapola and student allowance by Rs. 500.
We also take steps to introduce changes in the vocational training under life skills programme. We shall increase training opportunities in
the state sector from 60,000 to 100,000 to accommodate school leavers. A 100 more vocational training centres will be set up and 500
community schools will be established under the Vocational Training authority to increase livelihood opportunities. "■
- From the policy statement made by President of Sri Lanka, His Excellency Mahinda Rajapaksa at the opening of the
New session of Parliament, 25th November2005
SRfitT HT
HI
ICCIDD Vision, Mission & Dedication
Vision:The vision of ICCIDD is a world virtually free from Iodine Deficiency
Disorders with national endeavors to maintain optimal iodine nutrition primarily
through consumption of iodised salt, which should be made easily available
From the unreal lead me to the real;
From darkness lead me to light;
From death lead me to immortality.
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
Editorial Board
nutrition, providing technical expertise in a multi disciplinary approach.
Dr Chandrokant S Pandav
Dedication: ICCIDD dedicates itself to programs fully supported at the
national level for permanent, sustained success and will work with all partners
Chief Editor
Dr. Ari jit Chakrabariy
Managing Editor
and national entities towards that end.
Editorial
Patrons:
Shri Mohan Dharia
Chief Patron
Dr Kolyan Bagchi
Patron
ShriRV Pillai, IAS (retd.) ■
Patron
Dear Colleagues,
A consultative meeting to "Review & Develop New
Strategies of Salt Iodisation in Sri Lanka", was organised
by the Ministry of Healthcare and Nutrition. Sri Lanka is
now ready for external evaluation of tracking progress
towards sustainable elimination of Iodine Deficiency
Editorial Advisers:
Dr Prabha Ramalingaswami
Disorders. Sri Lanka is another success story after Bhutan
in the South East Asia Region.
Shri L M Jain, IAS (retd.)
Prof N K Ganguly
Prof M G Karmarkar
Shri S Sundaresan
It is our privilege to acknowledge the contribution of our
partner agencies in the preparation of the report on IDD
Sri Lanka.
Request for articles pertinent
to Iodine Deficiency
Disorders
ICCIDD is compiling a database of
both indexed and non-indexed articles
pertinent to IDD in India from 1947
onwards. We aim to make the
database accessible online free of
charge. To assist this process our
readers are kindly requested to forward
any relevant articles/material to either
the postal or e-mail address. Your
effortswill be duly acknowledged.
Adv. Makarand Adkar
Included in this issue is an article by Chandrasekara
Shri Bejon Misra
Dissanayake who is a Geoscientist from Sri Lanka. The
article contains excerpts about global health risks due to iodine deficiency.
Editorial Assistants:
Smt Saroja Narayanan
Shri Pnlam Singh
Mr. Amit Shuklo
Circulation
The 59th Session of WHO's Regional Committee for South-East Asia concluded with a call for a
strong commitment and joint endeavours for health development by the Member States. It noted
with satisfaction the progress in the implementation of WHO's collaborative programmes and
activities in the Region. The Committee deliberated on several issues of importance to the countries
and adopted resolutions on subjects of regional priority.
Shri Pritam Singh
Also included in this issue are the reports from "Awareness Workshop", organised at
Visakhapatnam, India by the Salt Department and the First Meeting of the Western Region Panel of
Printed & Published by:
salt and iodised salt producers organised by ICCIDD-MII in Ahmedabad.
Dr Chandrakant S
Pandav
on behalf of ICCIDD
A report of IEC activity organised in collaboration with our partners Bharat Scouts & Guides and a
Contact Address:
Room No 28, Old OT Block,
CCM, All India Institute of Medical
report on Recce for newer partners for IEC activities is part of this issue.
As we approach 21 st October, Global IDD Day, we reiterate our commitment towards elimination
of iodine deficiency disorders (IDD) and achieve Universal salt Iodisation. Thanks to the concerned
Ministries of Government of India and the efforts of partner agencies for the central ban on sale of
Sciences, New Delhi-29
non iodised salt is in place in India. It is gratifying to note that iodised salt production in India for the
Tel: 011-26588522
year 2005-2006 has reached 4.96 million tonnes. India is now on track and making steady
E-mail: cpandav@iqplusin.org
progress towards sustainable elimination of Iodine Deficiency Disorders.
Website: www.iqplusin.org
Printed at
Sona Printers Pvt. Ltd.
F-86/1 Okhla Industrial Area Phase-1
New Delhi-110020
Ph.: 41616566,26811313
Dr. ChandrakantS. Pandav
Regional Coordinator - South Asia Region
"Review and Develop New Strategies of Salt Iodisation Programme in Sri Lanka"
Consultative Meeting at Colombo, 5,h September, 2006-A Report
he Ministry of Healthcare and Nutrition, Sri Lanka organised a
T
the Government of Sri Lanka to achieve Universal Salt Iodisation (USI) by
Consultative Meeting at Colombo on 5'h September 2006 to
2001 and elimination of IDD by 2005 in response to the goals set at the
"Review and Develop New strategies of the Salt Iodisation
World Summit for Children in 1990.
Programme in Sri Lanka." Presentations included recent survey report of
In her presentation Dr. Renuka told that Sri Lanka has eliminated IDD as a
the Medical Research Institute, Department of Healthcare and Nutrition,
public health problem on a national scale. However, the prevalence of
work related to iodised salt in food control unit of Ministry of Health,
goiter still remains in the Western, Central and Uva provinces. There is
research on thyroid antibodies in school children and experiences of IDD
also a problem of availability of adequately iodised salt at household level
elimination in others countries.
in Northern Province. Though Sri Lanka has attained adequate iodine
Objective of the Meeting:
To critically review the strategies and make recommendations to
nutrition status, it needs to continue to pay special attention to IDD in
endemic areas to avoid re-emergence of IDD as a public health problem.
strengthen the salt iodisation programme so as to achieve the final goal of
On the other hand a significant proportion of urine samples in North
elimination of iodine deficiency disorders in Sri Lanka.
Central and Northern Provinces showed iodine contents that were high
signaling the need for strengthening the quality assurance systems at
different levels.
As IDD can re-emerge despite the present efforts and successes,
Dr. Renuka made the following recommendations based on her study on
"Iodine Nutrition in Sri Lanka, 2005"
I.
To reinvigorate the inter-sectoral National Iodine Committee
covering all the involved institutions.
II.
To maintain the provision of technical and logistical capacities for the
assessment of iodine in salt and urine at National Reference
Participants:
Laboratory so as to facilitate the sustainability.
A total of 80 participants from four sectors (Health, Academics, Salt
Industry, Bilateral and International Agencies) attended the meeting.
III.
To integrate indicators of IDD elimination into the national system of
health information, in particular the household coverage of
There were 51 participants from the Health Sector, 4 from the Salt Industry
iodised salt.
and 8 from the Bilateral and International Agencies. 1 7 participants were
from the other sectors related to effective implementation of USI.
IV.
To ensure annual surveys.
Proceedings of the meeting:
V.
To conduct nation wide IDD survey using the principle of
Annual Cyclic Monitoring.
The meeting was addressed by Dr. Athula Kahandaliyanage, Director
General of Health Services. Programme overview & Objectives were
VI.
explained by Dr. C.K. Shanmugarajah, Director Environmental and
VII.
Occupational Health. A Presentation by Dr. Renuka Jayatissa was made
on the findings of Medical Research Institute (MRI) on "Iodine Nutrition in
Sri Lanka, 2005." Dr. Jayatissa is a Consultant Nutritionist at MRI. The
post tea session included a presentation by Dr. K. Premawardhana,
Consultant Endocrinologist, Wales University - UK on Thyroid antibodies
To support operational research in the field of eliminating IDD.
To inform Salt producers to verify the salt quality prior to purchase
from salterns.
VIII.
To register all the salt producers under the Ministry of Health for easy
follow up.
In his presentation on "Thyroid Autoimmunity in Sri Lanka" Dr. K.
in school children and a presentation by Dr. Pandav (ICCIDD Regional
Premawardhana stated that the majority of Thyroglobulin Antibody (TgAb)
Coordinator, South Asia) on Experiences of IDD Programme from other
in post-iodination Sri Lanka are polyclonal and most likely non-
countries, namely Bhutan, India & Turkmenistan.
pathological. TgAb prevalence falls with time and that a few subjects
expressing oligoclonal TgAb have persistent TgAb activity and were
These
presentations were
later followed by Open Session and
subsequently by Group Discussions. The deliberations of Group
Discussions were presented to the Plenary Session for final approval by all
TPOAb positive. He also said that the variability of salt iodine content is a
cause for concern and recommended strong monitoring to ensure steady
levels of iodine.
the participants.
The Ministry invited Dr. Chandrakant S. Pandav, UNICEF-ICCIDD
Dr. Shanmugarajah told that substantial progress has been achieved in Sri
Lanka. However, he emphasized that one should not forget monitoring. "It
can reemerge, as a public health problem in SriLanka therefore, sustained
vigilance is needed in its elimination ". He reiterated the commitment of
Consultant to attend the meeting and make a presentation on his
experience with other countries with regard to salt iodisation programmes.
■
Dr. Pandov shared the experiences of India, Turkmenistan and Bhutan. He
emphasized that while Turkmenistan & Bhutan have achieved the success,
India is steadily progressing towards it. In India, the consumption of
adequately iodised salt was about 50% in 1998 which had dropped to
37% in 2003 and has come up to 57% in 2005. The ban on sale of non
iodised salt was lifted in 2000 and has now been reinstated w.e.f. 17 May,
I
2006. A persistent advocacy in this regard is being made by ICCIDD to
the policy makers in India. In Turkmenistan, there is an impressive political
commitment as evidenced by three Presidential Decrees in last 10 years.
Puttalam Salt Ltd, Puttalam, Progress of Civil Work
The recommendation is to build on this success to other micronutrients.
The administrative infrastructure in Turkmenistan is effective and in place
Status of Criteria for Monitoring IDD Progress in Sri Lanka
for on-going implementation and monitoring of sustainability of IDD
elimination. Inviting Member of the Livestock as a Member of the Co
Indicators
Goals
Status
ordination committee should be considered. Turkmenistan should
Salt Iodisation
Proportion of households using
adequately iodised salt
>90%
91.2%
Urinary Iodine
Proportion below 100 pg/l
Proportion below 50 /7g/l
<50%
<20%
29.9%
7.5%
Programmatic Indicators
Attainment of the indicators
At least 8 of 10
introduce Annual Cyclical Monitoring Protocol. There are five provinces in
Turkmenistan. Select one province every year by rotation. The whole
country will be covered in five years time.
In Bhutan a strong Departmental and Ministerial level commitment exists.
Regular annual cyclic monitoring system with periodic internal evaluation
exists in Bhutan.
He also reiterated that Sri Lanka has made commendable progress in
9
elimination of IDD and has met the goals. Sri Lanka should now call for an
external evaluation to declare IDD elimination.
MI-ICCIDD Initiative in Sri Lanka
Status of Programmatic Indicators met in Sri Lanka
I.
An effective functional national body (council or committee)
responsible to government for the national program. It should be
MI-ICCIDD addresses a major concern area in salt iodisation. Of the salt
multidisciplinary with a chairman appointed by the Minister of Health
produced by the two major salt producers viz. Lanka Salt Ltd. and Puttalam
-
Salt Ltd., only 30% is iodised in the factory according to legal health/trade
Healthcare and Nutrition
standards. The balance bulk of 70% is iodised by the cottage industry,
whose process is neither monitored nor controlled.
National Iodine Committee established under the Ministry of
II.
This leads to a mismatch in the quality of iodised salt. The objective of the
Evidence of political commitment to USI & elimination of IDD
-
Strong political commitment by H.E. The President of Sri Lanka
MI-ICCIDD programme is to eliminate this shortcoming through enabling
and the Minister of Health to make proper iodisation standards
the two main salt producers to iodise the salt produced by cottage industry.
and ensure that the iodisation programme is a success
This is through a donor grant by MI-ICCIDD for two new factories
III.
including salt washeries, crushers, centrifuges and iodisation plants.
Appointment
This will ensure that all the salt leaving the two factories will fall within the
-
legal parameters of USI.
a
responsible
executive officer for IDD
Director, Environmental and Occupational Health appointed as
a responsible focal point for IDD Elimination Programme by the
The pictures depict the current status of civil constructions at Lanka Salt
Ltd. and Puttalam salt Ltd. Machinery is in fabrication in India for
of
elimination program
Director General Health Services
IV.
installation and commissioning at both factories, presently scheduled for
Legislation or regulations for USI, ideally covering both human &
agricultural salt
December, 2006/January, 2007.
V
In place since 1995. Only for human consumption
Commitment to assessment & reassessment of progress towards
elimination with access to laboratories able to provide accurate data
on salt & urinary iodine
VI.
Yes, in place,
A program of public education & social mobilization on importance
of IDD & consumption of iodized salt
—
Yes, in place through health education bureau, Ministry of
Healthcare and Nutrition
■
I•
r«“ VII
Regular data on salt iodine at the factory, retail & household levels
__
Yes, by public health inspectors through quarterly returns
VIII. Regular laboratory data on UIE in school age children with
appropriate sampling for higher risk areas
_
IX.
Yes, with the cyclic monitoring data from MRI
Cooperation from the salt industry in maintenance of quality control
_
Yes, with having regular meeting with them
the efforts to eliminate the iodine deficiency in Sri Lanka, national IDD
survey was conducted to assess the status of iodine nutrition.
A cross sectional study of children from 60 primary schools in Sri Lanka
was carried out. Thirty schools were randomly selected from districts that
demonstrated urine iodine levels between 100-200 pg/L. Thirty children
were randomly selected from each school for the study. Thyroid glands of
children aged 6-9 years were measured by palpation and graded
according to the WHO, UNICEF and the ICCIDD joint criteria. Iodine
content of household salt samples was analysed. Casual urine samples
X.
A database for recording of results of regular monitoring procedures
were analysed for urinary iodine.
particularly for salt iodine and UIE
A total of 1900 children were studied. Adjusted prevalence of goiter
XI.
Yes, MRI maintains a data base forsalt iodine and UIE
(3.8%), was higher in girls than boys and ranged from 0.5% to 10.3% in
If available neonatal TSH monitoring with mandatory public
the different provinces. Median urinary iodine concentration in 1,879
reporting
samples was 154.4 jUg/L ranging from 6.1 to 1754.8jUg/L. The results of
-
Pilot study conducted and method was established at MRI.
Not done on routine manner due to cost.
1,594 salt samples also showed that 91.2% of households consume
iodised salt. The frequency distribution of urinary iodine levels shows that
34.7% of the children had urine iodine levels in the 'adequate' range with
Executive Summary of the "Iodine Nutrition Status in Sri
Lanka 2005"- A report
200/yg/L). Only 0.1 % of children had very low urinary iodine values of <
28.9% with lower values (< 100 pg/L) and 35.5% with higher values (>
Iodine deficiency is the single most common cause of preventable mental
20/;g/L. This study results in comparison with the study carried out in year
retardation and brain damage in the world. It decreases child survival and
2000 showed a reduction in the goiter rate from 20.1% to 3.8%;
impairs growth and development. Iodine deficiency was recognized as a
increased urinary iodine levels from 145.3 p/g/L to 154.4 /Jg/L and
public health problem in Sri Lanka following the 1986 national survey that
increased household consumption of iodised salt from 49.5% to 91.2%.
documented total goiter prevalence of 18.2%. In 1995, the Government
of Sri Lanka launched "Universal salt Iodisation" (USI) as the mainstay of
With private-public partnership and financial and technical support from
iodine deficiency control. With strong private-public partnership and
eliminating iodine deficiency as a public health problem. The challenge
financial and technical support from external development partners, the
ahead is sustaining the gains and achievements made through the IDD
Ministry of Healthcare and Nutrition intensified the USI. In continuation of
elimination programme.
external development partners, Sri Lanka has achieved the goals of
IODINE NUTRITION STATUS IN SRI LANKA
^2005^
Acknowledgement
This is to acknowledge the following who have contributed
to the preparation of this report:
1.
Dr. Renuka Jayatissa, Medical Research Institute,
Colombo, Sri Lanka
&
urfcsfO
2.
Ministry of Healthcare and Nutrition, Sri lanka
3.
Mr. Mahinda Gunawardena, ICCIDD, Sri Lanka
4.
Dr. Aberra Bekele, UNICEF, Sri Lanka
Of Stones and Health: Medical Geology in Sri Lanka
Excerpts from an article by Chandrasekara Dissanayake
Source:http://www.sciencemag.org/cgi/content/summary/309/5
We Are What We Eat and Drink
736/883, Science 5 August 2005: Vol. 309. no. 5736, pp. 883 - 885
On our planet, the chemical elements flow through the different planetary
DOI: 10.1126/science. 1115174, Essays on Science and Society
compartments, including the atmosphere, hydrosphere, lithosphere, and
biosphere. Humans and animals are part of these cycles. The chemical
Summary
elements pass into and out of them, too, in a complex biogeochemical
Geoscientists are usually known for their
cycle. Obviously, then, the chemistry of any local geological environment
studies of rocks and minerals and the
must have a direct influence on the chemical make-up of those living
distributions of these on Earth, but this
there. This is most readily seen in places where humans live in particularly
group of scientists has been expanding its
intimate contact with the local physical environment, as is the case with
discipline into surprising new territory by
rural people living in tropical countries. Those living on lands with heavily
linking geology with human and animal
impoverished soils, such as in Maputaland, South Africa, have such a low
health. Known as medical geology, this
intake of essential elements that a very large percentage of the population
emerging specialty is gaining momentum.
Chandra
Dissanayake,
suffers from a variety of diseases caused by severe mineral imbalances.
Professor of
Likewise, in other areas, there is an excess intake of elements due mainly
geology at the University of Peradeniya, Sri
to the abundance of certain elements in the environment. This leads to
Lanka, outlines some of the major areas of
high incidences of mineral toxicity, such as the widespread and tragic
medical geology in both his homeland
arsenic poisoning in India and Bangladesh.
and beyond, covering topics such as the
link between naturally occurring fluoride in drinking water and a
Even though many other factors—among them life-style, sex, age,
disfiguring tooth condition; global health risks due to iodine deficiency;
migrations, and food habits—affect health, imbalances in the supply of
the widespread practice of eating dirt; the potential for hard water to serve
inorganic elements exert marked influences on both human and animal
protective roles against cardiovascular disease; and the apparent
health. Anomalies in the local abundances of trace elements, for
paradox that people living in regions marked by high levels of natural
example, have a large impact on food chains. As it was more than 500
radioactivity do not seem to suffer adverse health effects from their
years ago, it remains relevant to bear in mind the basic law of toxicity as
interact with their geological
defined by Paracelsus (1493-1541), the father of pharmacology: "All
surroundings, discoveries made by medical geologists can have
substances are poisons; there is none which is not a poison. The right
enormous consequences for the well-being of people all over the world.
dosage differentiates a poison and a remedy." Even water, when
exposure.
Because
people
must
consumed too quickly and in inordinate amounts, can be lethal.
Excerpts from the article
To most people, geology is a subject concerning rocks and minerals and
their distributions on Earth. As an earth science, of course, geology also
deals with physical processes of the Earth, such as mountain building,
coastal and river dynamics, and desert formation. Few people know that
geoscientists have expanded their discipline by linking human and animal
health with geology. The fundamental basis for this expansion, which has
spun into a specialty known as medical geology, is the unique
One of the primary objectives of medical geologists, therefore, is to
determine the optimal exposures for people to the essential elements in
order to maintain or improve health. Diseases such as hyperkalemia (due
to excess potassium), hypercalcemia (due to excess calcium), and
hyperphosphatemia (due to excess phosphorus) exist in various parts of
the world even though potassium, calcium, and phosphorus are essential
dietary elements.
interdependence of the different living and nonliving components that
I have studied a number of specific cases that illustrate how optimal
make up the Earth. The basic building blocks of the Earth—the rocks and
amounts of trace elements are needed to maintain good health and how
minerals—must, therefore, have a bearing on the health of the human and
an imbalance in these elements can lead to disease.
animal populations that live on these earthy materials.
The "Geochemical Disease": Iodine Deficiency
Once a little-known specialty among a few geologists around the world,
medical geology is now recognized as a field unto itself. Established by the
International
Union of Geological Sciences in early
1990, the
Commission on Geological Sciences for Environmental
Planning
(COGEOENVIRONMENT) has defined medical geology as "the science
It has been estimated that nearly 30% of the world's population is at risk for
some form of iodine deficiency disorder (IDD). Insufficient intake of iodine
is the world's most common cause of mental retardation and brain
damage with 1.6 billion people at risk, 50 million children already
affected, and 100,000 more adding to their ranks every year.
dealing with the influence of ordinary environmental factors on the
geographical distribution of health problems in man and animals." It now
IDDs are particularly severe in tropical regions. The resulting large
has developed into a truly fascinating new science, with potentially
populations of people with impaired mental function have serious direct
enormous consequences for the well-being of people around the world.
and indirect impacts on all aspects of life in these places.
Humic substances rich in organic matter in the environment also are
known to play a major role in the speciation and geochemical mobility of
chemical elements such as iodine. The in-ground conversion of chemical
species into toxic or nontoxic forms has important implications for the
health of individuals living in a particular geochemical habitat. Iodine is
strongly fixed by humus, and soils rich in humus therefore tend to be rich in
iodine. However, the bioavailability of that iodine, which depends on the
pH conditions, often is very low. Because iodine is strongly fixed by clay
and humus, these materials may function as "geochemical goitrogens,"
particularly in the tropical environment. Interestingly, in the Kalutara
district-an area close to the sea on the west coast of Sri Lanka (and
therefore only minimally affected by last December’s tsunami)--the
endemic goiter rate is high despite the proximity to the sea. This clearly
supports the hypothesis that the environment contains goitrogens, which
trap the iodine and make it far less available to the people living in the
area.
The geochemistry of iodine and its chemical species has a marked
influence on the prevalence of IDDs, including endemic goiter (see last
figure). Collectively, these IDDs are often referred to as “geochemical
diseases" in view of their etiology in the geological environment. The sea is
a major source of iodine, so there often is a relationship between the
incidence of IDDs in a region and that region's distance from the sea. In
- Reproduced with permission from Chandrasekara Dissanayake. The
author is at the University of Peradeniya, Peradeniya, 20400 Sri Lanka.
E-mail: cbdissa@hotmail.com
general, the farther away from the sea, the less iodine is available. Other
factors such as atmospheric circulation, however, may play a role in iodine
- The Editorial Board would like to thank Mr. Dick Hanneman, President
availability, as does topography. In many mountainous regions, for
of Salt Institute, Virginia, U.S.Aand ICCIDD Board Member for drawing
example, iodine abundance is quite low, with a concomitant increase in
our attention to this article.
Iodine Deficiency Disorders.
Sri Lanka - Fact File
1.
Total Population
2.
GDP per capita (Inti $, 2004):
3.
Life expectancy at birth years
M/F
4.
:
:
59.2/64.0
:
16/12
Total health expenditure
121
Per capita (Inti $, 2003)
7.
68.0/75.0
Child mortality
M/F (per 1000)
6.
3,800
Healthy life expectancy at
Birth M/F (years, 2002)
5.
20,743,000
Total health expenditure
As % of GDP (2003)
:
3.5
Figures are for 2004 unless indicated.
Source: The World Health Report 2006
59 th Session of the Regional Committee, WHO-SEA Region
Dhaka, 22-25 August, 2006: A Report
he Fifty-ninth session of the WHO Regional Committee (RC) for
In his address Dr. Samlee Plianbangchang, Regional Director, WHO
WHO-SEA Region was held in Dhaka, Bangladesh, from 22-25
South-East Asia Region, singled out the spread of avian influenza
T
August 2006. It was attended by representatives of all the eleven
throughout the world as the most daunting health challenge. He also
Member States of the Region, UN and other agencies, nongovernmental
emphasized the importance of addressing the Millenium Development
organizations having official relations with WHO, as well as observers. A
Goals towards achieving poverty reduction. He emphasized that placing
total number of 73 participants and observers attended the meet. ICCIDD
health services at the grassroots level would ensure that the health benefits
was represented by Dr. Chandrakant S. Pandav, Regional Coordinator
reached the poor, the marginalised and the underprivileged.
(South Asia) who made a statement at the meet.
In his welcome address, H.E. Dr. Khandakar Mosharraf Hossain
A joint inauguration of the RC and the Twenty-fourth meeting of the
committed on behalf of the health ministers, to advance regional
Ministers of Health was held on 20th August 2006. H.E Begum Khaleda
cooperation in health, and to take steps to ensure that the health related
Zia, Prime Minister of the People's Republic of Bangladesh, delivered the
MDG's can be achieved by 2015.
inaugural address.
The following people represented the UN and Specialised agencies who
The committee elected H.E. Dr. Khandakar Mosharraf Hossain, Minister
made a statement at the meet:
of Health & Family Welfare, People's Republic of Bangladesh, as
I.
Ms. Harriet Torlessse (UNICEF)
II.
Mr. Qaiser Khan (World Bank)
III.
Dr. Anders Nordstrom, Acting Director-General
Chairman, and H.E. Lyonpo (Dr) Jigmy Singay, Minister of Health, Royal
Government of Bhutan, as Vice-Chairman of the session.
The committee reviewed the report of the Regional Director covering the
session of the WHO-regional committee for South-East Asia is available
The following representatives of the nongevernmental organizations
made a statement at the 59* RC:
with WHO-SEA Regional office in Delhi.
I.
Dr. C.S. Pandav, Regional Coordinator, ICCIDD-South Asia
The committee decided to hold its Sixtieth session in Bhutan in 2007.
Recognising the importance of promoting nutrition and food safety in
II.
Prof. Rabiul Hussain, International Agency for
period 1 July 2005 to 30 June 2006. The draft report of the Fifty-ninth
Prevention of Blindness (IABP)
countries of the South-East Asia Region, the committee decided to hold
technical discussions on "Nutrition and Food Safety" prior to the sixtieth
III.
Dr. Enamul Kabir, Sight Savers International,
Royal Commonwealth Society for Blind
session.
Inaugurating the session H.E Begum Khaleda Zia, called for stronger and
IV.
more enduring cooperation among member countries of the region to
ensure greater equity in delivery of healthcare. She urged delegates to
introduce innovative financing methods to make health care affordable
Mr. Alain Aumonier, International Federation of
Pharmaceutical Manufacturers and Associations-(IFPMA)
V.
Dr. Bindeshwar Pathak, Sulabh International
Social Service Organisation
and within reach of all households.
VI.
Mr. Ajeet Bhardwaj, World Council of Optometry
Prime Minister of Bangladesh, Begum Khaleda Zia delivering the inaugural
address at the joint inaugural ceremony of the 24* session of South East Asian
Region (SEAR) Health Ministers and 59* session of WHO Regional Committee
meeting for Southeast Asia at Hotel Sheraton, Dhaka
Dr. Y. Oketani from Office International des Epizooties represented the
Inter-governmental Organisation who made a statement at the RC.
Dr. Pandav in his statement appreciated WHO's support in the formation
of ICCIDD in 1985. He informed the committee on the councils focus on
activities aimed at sustainable elimination of iodine deficiency disorders,
as well as its role in policy formulation through interaction with the
concerned policy-makers. Highlighting the significant implications of
paricipants from
Organisations:
Non-Governmental
I.
International Agency for Prevention of Blindness
II.
International Council for Control of Iodine Deficiency Disorders
III.
International Federation of Gynaecology and Obstetrics
IV.
International
of
Federation
Pharmaceutical
V.
International Pharmaceutical Federation
VI.
International Planned Parenthood Federation
VII.
Population Council
VIII.
Orbis International
attention of the committee. It was stated that inputs from Member
IX.
Sight Savers International
countries would make the document more comprehensive. The
X.
World Council of Optometry
specific assistance and collaboration to other countries in strengthening
the advocacy aimed at reducing IDD.
Medium-Term Strategic Plan (MTSP) 2008-2013
Various specific issues in the MTSP document were brought to the
Manufacturers
Association
iodine deficiency, Dr. Pandav shared with the committee ICCIDD's success
story pertaining to a country of the region and also offered council's
International
suggestions of all countries would be formally conveyed to the
Headquarters by the SEARO Secretariat for preparation of the final draft
Observers:
which would be submitted to the 120* session of the Executive Board in
I.
South-East Asian Region Medical Education (SEARME)
II.
Sulabh International Social Service Organisation
III.
WHO Country Office, Indonesia
January 2007 prior to its submission to the 60th World Health Assembly.
The assembly would review it and accord final approval along with the
2008-2009 Programme Budget.
Brief Report of Meetings with Country Delegates:
Participant Countries:
I.
Bangladesh
II.
Bhutan
III.
DPR Korea
IV.
India
I.
Bangladesh:
Dr.
Pandav
met
H.E.
Dr.
Khandaker Mosharraf Hossain,
Minister of Health & Family Welfare, People's Republic of
Bangladesh and Mr. A.K.M. Zafar Ullah Khan, Secretary, Ministry of
Health & Family Welfare and congratulated them for keeping the
Sustainable Elimination of IDD programme in Bangladesh on track.
V.
Indonesia
VI.
Maldives
Bangladesh. Dr. Pandav offered him the possible technical inputs
VII.
Myanmar
from the ICCIDD for subsequent iodisation in these units.
VIII.
Nepal
IX.
Srilanka
X.
Thailand
XL
Timor-Leste
Participants from
The minister informed Dr. Pandav of the establishment of refineries in
II.
Dr.
Pandav
met
H.E.
Lynpo
(Dr)
Jigmi
Singay,
Minister,
Ministry of Health, Bhutan and Secretary Health, Mr. Wangchuk
Dukpa and congratulated them on achieving USI and elimination of
IDD. Dr. Pandav urged them to maintain constant vigilance and
Embassies, UN &
continue the annual cyclical monitoring which will help to sustain the
Other Specialised
success achieved in eliminating IDD in Bhutan.
Agencies:
I.
Embassy of Japan
II.
United Nations Children's Fund (Regional Office of South Asia)
III.
United Nations Educational, Scientific & Cultural Organisation
IV.
United Nations Population Fund
III.
International Centerfor Diarrhoeal Disease Research
Paricipants from Inter-Governmental Organisations:
India:
Dr. Pandav met Mr. RK. Hota, Secretary Health and the Joint
Secretary Mr. Bhanu Pratap Sharma. Mr. Hota told Dr. Pandav that
the First meeting of the National Coalition for Sustained Iodine
Intake would soon take place. He reiterated his commitment for
strengthening the IEC for IDD elimination.
Participants from International Organisations:
I.
Bhutan:
IV.
Maldives:
Dr. Pandav met H.E. Dr. Abdul Azeez Yoosuf, Deputy Minister of
Health, Maldives and appraised him of the IDD situation there.
I.
International Organisation for Migration
Dr. Pandav told the Minister that since Maldives imports all its salt
II.
Office international des Epizooties
from India & Srilanka, it is eminently possible to monitor the iodine
content of the salt. It is necessary to introduce legislation. Dr. Pandav
urged the Hon'ble Minister to organize a meeting with the
traders so that they only import adequately iodised salt. The minister
was concerned about the price difference between common salt and
iodised salt. Dr. Pandav offered him the services of Dr. J. Jeyaranjan
who is a micro-economist based in Chennai in India to formulate the
strategies related to pricing and quality of iodised salt since most
of the salt imported from India is from Tuticorin. Dr. Pandav also told
the Minister that there was an issue with curing of tuna fish with
iodised salt (changes colour of tuna fish). However this has been
resolved. Use of iodised salt for curing does not bring about
discolouration in fish.
Nepal:
V.
Statement of Dr. Chandrakant S. Pandav, Regions
Coordinator, International Council for Control of Iodine
Deficiency Disorders (ICCIDD), South Asia
May I, on behalf of my colleagues in the International Council for Conlrc
of Iodine Deficiency Disorders (ICCIDD) first of all thank the Regional
Director for extending the invitation to attend the 59* Regional Committee
for South-East Asia that is being held at Dhaka, Bangladesh.
The 21” ICCIDD Board Meeting was held in New Delhi, India on 20-2 i
April 2006 and one of the important outcomes was the formation of
National Coalition for Sustained Iodine Intake (NCSII) in India.
ICCIDD has been a regular participant in the Annual World Health
Assembly, since 1994.
Dr. Pandav offered all possible help from ICCIDD to Nepal
when he met its representative, Dr. Nirakar Man Shreshtha, Chief
Specialist, Policy Planning International Cooperation Division,
Ministry of Health & Population, Nepal.
ICCIDD is the only organization, which focuses exclusively on the
sustainable elimination of iodine deficiency and is able to provide a wide
array of expertise including medical, nutritional, salt industry and
technical aspects related to IDD.
VI.
Sri Lanka:
The ICCIDD has also played pivotal role in policy formulation by regular
Dr. Pandav met the Sri Lankan High Commissioner in Bangladesh,
H.E. Mr. V. Krishnamoorthy and the Director General of
Health Services (DGHS), Dr. HAP Kahandaliyanage. Dr. Pandav
informed the Hon'ble High Commissioner about the
forthcoming"Consultative Meeting to Review & Develop New
Strategies of Salt Iodisation Programme in Sri Lanka" to be held at
Colombo on 5* September 2006, to which he has been invited to
interactions and has given inputs to the elected representatives,
parliamentarians and policy makers.
make a presentation on experiences with other countries. Dr. Pandav
informed him that his presentation would deal with the experiences
from Turkmenistan, Bhutan and India.
households had access to iodine by using iodised salt, thus preventing
more than 80 million newborns in the world annually from consequences
of iodine deficiency. This is not the time to rest. The effort should be more
vigorous now to reach the remaining 30% and then sustain the success.
Iodine deficiency, as we all know, is the single most important cause of
preventable brain damage in the world today. Around the time of the
World Summit for Children (1990), 20% of households had access to
iodine by using iodised salt. By the end of 2000, almost 70% of
Ms. HarriotTorlesse:
VII.
My statement will briefly cover the following seven aspects on IDD
Dr. Pandav met Ms. Harriot Torlesse of the United Nations Children's
Fund (Regional Office for South Asia). She had some queries with
regard to salt sample titration reading of 5 or less, clarification on
concept related to iodine deficiency and urinary iodine and the IEC
materials that WHO & ICCIDD had prepared. Dr. Pandav clarified:
i.
ii.
iii.
Salt samples with titration reading of 5 or less need to be
treated as "0" or Nil iodine.
Refer to the editorial on, "Iodine Nutrition-More is Better",
which has appeared in the New England Journal of
Medicine, No. 26, Vol. 354:2819-2821; June 29, 2006.
The editorial clarifies the concept related to iodine deficiency
and urinary iodine. To quote, "The standard measure of iodine
nutrition in a community or country is the median urinary
iodine excretion, expressed in micrograms per liter. The
values correspond to 70 to 80 percent of the daily iodine
intake, which often varies widely among people in the
same community or country."
The IEC material that had been prepared by WHO & ICCIDD
would be sent through UNICEF, India office. Dr. Pandav also
offered Ms. Harriot 200 copies of ICCIDD's International
Newsletter and Regional IDD Newsletter for onward distribution
to concerned people in Bangladesh and all the possible
technical assistance for IDD activities.
I.-. B
■
M
K
________ ______________________________________
focusing on the SEA Region:
I.
Advocacy of IDD
II.
Monitoring
III.
Tracking Progress
IV.
Success story of Bhutan
V.
Status of other countries
VI.
Reporting to RC (SEARO) and WHA by the Member Countries
VII.
Areas where ICCIDD can be of specific assistance to the Regional
and Member Countries
I.
Advocacy of IDD
The problem of IDD is still largely perceived as equivalent to
"Goiter". People consider it a cosmetic problem and hence a low
priority issue. Focus should be more on the implications that iodine
deficiency has on the intelligence Quotient (IQ) of the child. It is the
quality of the human resources development that should be the
focus. Therefore, there is a need to strengthen the advocacy and
make the people & policy makers aware of the serious impact of
iodine deficiency to the people. The focus of research should now be
on to produce evidence on the quality of advocacy.
Countries that need attention are Maldives, Korea and Timor-Leste.
Maldives imports all its salt. Most of it is from India & Sri Lanka. It is
necessary to introduce legislation. There was an issue with curing of
tuna fish with iodised salt (changes colour of tuna fish). This has
Rather than having a single sector dealing with the issue, it will be
more pertinent to have a multisectorial approach where in all the
concerned agencies collaborate and contribute towards an effective,
efficient and sustained programme. Involvement of health,
education, industry & mines (dealing with salt & iodised salt) animal
husbandry and Public Distribution System (PDS) should bring
tangible results. Since IDD affects quality of human resource
development, these points should now feature in international
been resolved. Regarding DPR Korea, UNICEF China and ICCIDD
has an access to information. We are in touch with ICCIDD
colleague in China. Timor-Leste is going through difficult times which
is affecting IDD programmes.
forums like SAARC, ASEAN & ESCAR as well.
Besides these countries, continued advocacy is also required for
Monitoring
Nepal, Bangladesh, Indonesia, Thailand & India.
Achieving success is one part of the goal. Regular monitoring should
begin with focus on process of availability and accessibility of
adequately iodised salt at household level. Information, thus
collected, should be linked with corrective decision making process.
VI.
World Health Assembly (WHA)
IDD should be viewed as a health problem in the context of human
resource development. The member states should initiate the
Monitoring is the backbone which would track the success of the
programme regularly
process for information collection and sharing related to IDD so as to
enable reporting to the Regional Committee in 2007 and the Sixtieth
World Health Assembly in 2008 and every three years thereafter.
Tracking Progress
VII.
The review of the National programmes must be performed with
more regularity than now is the case by analyzing both primary and
secondary data. It is relatively easier to have a review of the already
available data. It can be taken up as a first step. Subsequently
primary review of the programmes can be undertaken.
IV.
Reporting to the Regional Committee (RC) - SEARO and
Areas where ICCIDD can be of specific assistance to the Regional &
Member Countries
i.
ii.
iii.
Success Story of Bhutan
Strengthening the advocacy on IDD
Giving technical inputs to the focal points
Development of reporting format for member countries to
report to RC (SEARO) and WHA
Bhutan is a success story. The challenge is to sustain the success.
Bhutan should be provided a platform to share the success with other
countries, not only in IDD and Nutrition fora but also in other fora
iv. Participation in Tracking Progress missions
What is needed is coming together of policy makers and scientific
where programme success story of health, nutrition or developement
our partners of private sector, the iodised salt producers towards a world
devoid of IDD, and a healthy society, thus, fulfilling the right of every child
programmes are being discussed.
fraternity - together they can start an odyssey into future ably supported by
to optimal physical and mental development.
We know the answer to "What needs to be done?" We must
now accelerate and share our efforts to find the answer to,
Status of other Countries
There are two more countries that are doing well in terms of IDD
"How is it to be done?" ICCIDD is committed to be a partner
in terms of moving ahead with, "How it is to be done?"
elimination. They are Srilanka & Myanmar. They are close to success
in 2007. We hope to receive a request from them for an independent
assessment.
Delegates at the 59* WHO-SEA Regional Committe Meeting, Dhaka, Bangladesh, 2005
11
Spreading Awareness on IDD
Bharat Scouts & Guides, Godpuri, Ballabhgarh, 23 August,2006
ICCIDD staunchly promotes collaborations and partnerships in all its
programmes with measurable level of succes. One such is the
partnesrship programme with Bharat Scouts & Guides (BSG), the largest
non-govemmental organisation with global presence.
The partnership programme with BSG & ICCIDD dates back to 1997. This
is a quotable example of "Partnership: Key" to Success. ICCIDD & BSG
together have been associated with the spreading of awareness for
prevention of Iodine Deficiency Disorders.
An awareness programme was organised by BSG at Godpuri village in
the State of Haryana. The village is about 30 kilometers from
Ballabhgarh. Ms. Geeta Rawat, the coordinator for the Godpuri Unit of
BSG requested ICCIDD for IDD awareness camp at her center. BSG has a
"3 L" (Life Long Learning) project running in Godpuri. The women from the
village are given training by a lady instructor on tailoring, stitching,
painting, embossed painting. The women come to the camp at 10 AM
and leave by 4 PM. Refreshments are provided to them by BSG.
4:-
In these camps BSG also arranges for health education to these women
on various topics. One such camp was organised on 23 August 2006
wherein ICCIDD contributed by educating women on IDD and the
benefits of consumption of iodised salt. The ICCIDD team from Delhi was
represented by Ms. Saroja Narayanan, Project Coordinator, Mr. Amit
Shukla, National Coordinator, Mr. Pritam Singh Tanwar and Mr. Rajesh
Lal. On this occasion the IDD film "Trishna" was also shown to the
audience. Posters on IDD were also displayed.
The event was well received by the audience. Booklets containing 20
questions on IDD were distributed. The testing of salt for the presence of
iodine by salt testing kit was demonstrated. Each of the women were given
a salt testing kit to help them test the salt at home and spread the
awareness.
In the end both the organisations thanked each otherfor their contribution
made towards the noble cause - that of ensuring optimum mental and
physical development of children.
Growth, Development and Behavioral Paediatrics
5,h National Conference of IAP Chapter, 9-10 September, 2006
he 5* National conference of IAP chapter focused on the Growth,
Development and Behavioral Paediatrics. It was organized by Lady
made by Dr. V.V. Khadilkar, Dr. Sangeeta Yadav, Dr. Meena Desai on
diagnostic approach to a short child, Growth Hormone Deficiency
Hardinge Medical College, New Delhi at the National Science
Academy, Bahadurshah Zafar marg, New Delhi* from 9-10 September,
Disorders and GH therapy. Case snippets related to short stature were
presented by Dr. Archna Dayal.
2006. Experts came from all over India and spoke on various issues
related to child's growth & development.
The next session was on Pubertal Growth which was chaired by Dr. Meena
Desai and Dr. Ashraf Malik. Speakers were Dr. Nalini Shah, Dr. Anju Seth,
The first session was chaired by Dr. Ksh Chourjit Singh & Dr. Jagdish
Chandra. The session dealt with "what is essential for child's brain & bone
growth". The first presentation was made by Dr. Arijit Chakrabarty,
ICCIDD on behalf of Dr. Chandrakant S. Pandav on "Iodine & Brain
Dr. Krishna Biswas.
T
Development". Dr. K.N. Agarwal spoke on "Iron & Brain development".
The next session was on Child Growth and was chaired by Dr. Arakhita
Swain & Dr. M.M.A. Faridi. Speakers were Dr. B.D. Bhatia, Dr. Dilip
Mukherjee and Dr. Anju Virmani who spoke on Intra-uterine growth,
Growth monitoring and bone age. These sessions were followed by panel
discussions.
The post lunch session commenced with Management of short child which
was chaired by Dr. S.A. Krishna and Dr. Anju Virmani. Presentations were
Making his presentation on this occasion, Dr. Arijit Chakrabarty of
ICCIDD said that thyroxine is essential for brain growth during the 3rd
week of intrauterine life to the 3rd year of post natal life. Iodine is thus
essential to be provided in adequate quantity to the growing foetus and
the growing child for optimal brain development. Iodine deficiency
besides causing goiter can result in other forms of iodine deficiency
disorders which includes reduction of 13 IQ points.
The main IAP conference is scheduled to be held in January, 07 at
Mumbai. The Journal of Growth, Development & Behavioral Paediatrics
would be released on that occasion. A detailed report of the conference is
awaited and shall be carried in the subsequent issues of the newsletter.
Awareness Workshop for Salt Producers of Andhra Pradesh
12th September 2006, Visakhapatnam - A Report
dvocacy and Dissemination workshop was held on 12* September,
A
2006 at Vishakapatnam for salt producers of Andhra Pradesh (AP)
and Orissa. The workshop was organised by the Salt
Commissioners office, Government of India.
There was a very good response to the above workshop. More than 100
Salt manufactures, iodised salt producers and traders of Andhra Pradesh
and Orissa, attended the function.
The following dignitaries were present:
I.
Mr. N. Raghuveera Reddy, Hon'ble Minister for Civil Supplies,
Govt, of Andhra Pradesh
II.
Mr. Konatala Ramakrishna, Honzble Minister for Commercial Taxes,
Govt, of Andhra Pradesh
III.
Mr. Naresh Chaturvedi, Addl. Secretary, Ministry of Industry,
Govt, of India (GOI)
IV.
Dr. B. K. Tiwari, Advisor (Nutrition), Ministry of Health, GOI
V.
Dr. R.C. Jamtani, Advisor (Industries) Planning Commission, GOI
VI.
Mr. K. Ramakrishna, Member of Legislative assembley (MLA), AP
VII.
Mr. D.Srinivasa Rao, MLA, Andhra Pradesh
VIII.
Mr. Bhanwar Lal, Commissioner for Civil Supplies,
Govt, of Andhra Pradesh
IX.
Mr. S. Sundaresan, Salt Commissioner, Government of India
X.
Dr. Sucharita Murty, Director, Institute of Preventive Medicine,
Govt, of Andhra Pradesh
XI.
Ms. Anuradha, Director of Women and Child Welfare,
Government of Andhra Pradesh
Inaugurating the workshop, Mr. N. Raghuveera Reddy, Hon'ble Minister
for Civil supplies, Government of Andhra Pradesh, highlighted the
ailments (like abortions, mental retardation, deaf mutism, goitre, etc.)
caused due to deficiency of iodine in the body. He said that organisations
like WHO, UNICEF and ICCIDD are already making pioneering efforts to
eliminate IDD. He added that, taking into consideration the compulsory
usage of iodised salt for human consumption, Andhra Pradesh is the first
state in the country to form a Coalition Committee for ensuring 100% use
of iodised salt for edible purposes. He said that the Hon'ble Chief Minister,
being a doctor, knows the importance of iodine for Public Health. He
assured the manufacturers of iodised salt all help from the State
Government and scotched all rumours that the ban notification of the
Government of India is indirectly aimed to help the corporate giants to
market their product. He admitted that any new programme will face
problems. He called for a positive approach and added he will not
hesitate to convene a meeting at Hyderabad with the iodised salt
producers and officials to sort out any small issues. He informed that the
State Government has made arrangements for supply of refined, iodised
salt @ Rs. A/- per kg through the 42,000 Fair Price Shops across the State
to the Below Poverty Line (BPL) category of the population.
«'<■ J*
•ak- M
l-ijj-- I Jr
if"
Mr. Konatala Ramakrishna, in his Presidential address, informed the
gathering that he was himself a salt manufacturer and was aware of the
difficulties of the small scale sector. He said that the Hon'ble Chit i Minister
of Andhra Pradesh readily agreed to his recommendation to totally
exclude iodised salt (branded/non-branded) from imposition of 4% tax
(VAT). He assured full cooperation from his department. He said that salt
iodisation is not a big issue, rather, we are neglecting it. He asked all the
iodised salt manufacturers to fix a target of 1 year, within which all the
problems should be sorted out. He asked the officers concerned to
prepare an Action Plan and implement it. He cautioned that any defaulters
among the iodised salt producers who do not cooperate with the
Government, will be punished and action will be taken against them.
Earlier, welcoming the gathering, Dr. M.A. Ansari, Deputy Salt
Commissioner said that this is the fourth in the series of workshops
conducted by the Salt Department. The earlier ones were in Rajasthan,
Gujarat and Tamil Nadu. In his Felicitation address, Mr. S. Sundaresan,
Salt Commissioner, GOI said that this workshop assumes significance
because of the notification of the Government of India making use of
iodised salt compulsory for human consumption, effective from 17 May,
2006. Tracing the history of the salt industry in post-independent India, he
said that we have come a long way and now export about 30 Lakh tonnes
of salt to 36 countries. As against the demand of 7 Lakh tonnes of salt in
Andhra Pradesh, both for edible and industrial purposes, he said that the
production is hardly 3 lakh tonnes and hence Andhra Pradesh gets salt
from Tamil Nadu and Gujarat. He appealed to the Hon'ble Ministers of
the State Government present at the meeting, to consider exemption of
salt manufacturers from the NALA tax collected prior to 2000. He
informed that no other State Government is levying this burden on the salt
manufacturers. He exhorted the iodised salt producers to increase their
production and said that out of 15,000 tonnes of iodised salt produced in
AP 3,500 tonnes are sent to Orissa and only 2000 tonnes of iodised salt is
consumed in the State. He asked the iodised salt producers to make use of
the attractive price offered by the Civil Supplies Corporation and give a
note of caution that the Salt Department may even go to the extent of
imposing a condition in the lease deed that 25% of their production
should be compulsorily iodised. He informed that the Salt Department will
soon set up Model Salt Farms in Naupada, Chinnaganjam, districts of
Orissa at a cost of Rs. 350,000 to educate the small scale salt
manufacturers on the procedures to be adopted in the field to produce
good, quality salt. He listed out various measures that the Salt department
is implementing for upliftment of labour welfare, with the cooperation of
the AP State Housing Corporation.
In his speech and presentation, Dr. B.K. Tiwari, Advisor, (Nutrition),
Ministry of Health, Government of India, emphasised the importance of
iodine, which is one of the four micronutrients, essential for the human
body. He said that only 150 micrograms of iodine is required by the
human body daily, which means just a teaspoon for the entire life but this is
not a one-time consumption for life-time. He also said that 130 countries
of the World are implementing the salt iodisation program.
Mr. Bhanwar Lal, Commissioner of Civil Supplies, requested the iodised
salt producers not to move non-iodised salt to Orissa under the garb of
iodised salt. He appealed to them to help achieve Universal Salt
Iodisation. He traced the efforts of the Civil Supplies Corporation in the
past 2 years to make available iodised salt in all the fair price shops across
particular in Andhra Pradesh and said 16 plants have been repaired so far
and 1050 kg of Potassium Iodate has been issued.
Mr. Amalin Patnaik of UNICEF, Orissa, strongly advocated for stoppage of
the present illegal movement of non-iodised salt from northern borders of
Andhra Pradesh to Orissa for edible purposes.
the state and assured that all assistance will be given to the iodised salt
producers for marketing their product. He thanked ICCIDD/MI for
Mr. D. Venkateswara Rao, President of Andhra Pradesh State Salt
repairing 16 salt iodisation plants and also for distributing Potassium
Manufacturers Association, (based at Naupada) told the gathering that, a
iodate to the small salt manufacturers.
series of meetings held on the iodisation program changed the mindset of
the salt producers. He said that the Civil Supplies Corporation earlier
agreed to take crystal iodised salt for distribution through PDS but now are
insisting on refined, powder salt. He requested for exemption from NALA
Mr. Naresh Chaturvedi, Addl. Secretary, Ministry of Industry, asked the
iodised salt producers to keep in mind the quality aspect and emphasised
the need for concerted efforts from all stakeholders in this program.
Intervening before the speech of Hon'ble Minister for Commercial taxes,
Mr. V. Nageswara Rao, one of the iodised sali producers, representing the
unorganised sector from Naupada, complained that the Government was
trying to encourage big corporates by making use of iodised salt
compulsory. He made a scathing attack on the Salt Department for not
supplying enough Potassium Iodate a few years back at Naupada. He
requested the State Government to extend the concessions given for
agricultural farmers in supply of electrical power, to the iodised salt
producers also. He said that they were prepared to supply, common salt at
Rs. 2/- per kg to the Government and asked the State Government to take
it and iodise it. He requested for sufficient machinery and sufficient iodine,
for iodising salt.
tax from the year 2000 for the salt lands.
Mr. Viswanatha Babu, Member, Central Advisory Board for Salt and
Iodised Salt producer from Chinnaganjam, requested the Civil Supplies
Corporation to completely purchase 1 Lakh tonnes of iodised salt from
Chinnaganjam and felt disappointed that the Civil Supplies Corporation
has placed orders only for 4 loads of iodised salt (i.e. 40 tonnes) for the
entire District and between March to September 2006, only one
consignment has moved.
Mr. Bhanwar Lal clarified that the procurement policy of the Civil Supplies
Corporation is very clear and asked the iodised salt producers to adhere
to the quality specifications under PFA Act. He said that the Civil Supplies
Corporation would very much wish to purchase iodised salt from the local
producers, avoiding the huge transport cost for bringing iodised salt from
Technical Sessions
Gujarat and effect a saving to the Government.
The 1st Technical session (in the post-lunch period) was chaired by
The Joint collectors of Srikakulam and Vizianagaram districts explained
that they are prepared to procure iodised salt and supply to 1800 fair
Dr.B.K. Tiwari and consisted of Dr. Ranganathan of National Institute of
Nutrition, Hyderabad, Dr. Lakshmi Bhavani of UNICEF, Hyderabad,
Dr. B. Sowbhagya Lakshmi, Dy. Director, Institute of Preventive Medicine,
Hyderabad, Dr. Dileep Kumar, Department of Endocrinology of
Andhra Medical College, Visakhapatnam. Each of the above speakers
made their presentation, extolling the importance of iodine for the human
body.
price shops and 3500 schools. They asked the iodised salt producers to
supply good quality iodised salt.
Mr. A.K. Sharma, Asst. Salt Commissioner, pointed out the poor
performance of iodisation program in Andhra Pradesh.
Mr. RM. Chowgule, Supdt. of Salt, Humma, dwelt on the progress of
iodisation program in Orissa. There were 2 speakers representing the
Dr. B. Sowbhagya Lakshmi, Dy. Director, Women & Child Welfare in her
presentation, gave details of the survey conducted by them in 3 North
NGO, Mr. I.G. Kurmanatha Rao, President, Federation of Consumers
Association, Ms. Tulsi Swarna Lakshmi, Project Officer, Concern for World
Coastal AP Districts of Srikakulam, Vizianagaram and Visakhapatnam.
She indicated that even the women in the girijan/trible areas are aware of
Wide, who advocated that they can promote marketing skills and that
efforts should be made to bring all salt farmers into one grade.
the importance of iodised salt and that in the plains, 60% of the samples
indicated no iodine, in the fringe areas 56% and in the tribal areas 52%.
Mr. Suggu Bheemeswara Reddy, President, Minor Licensees Association,
Naupada, said that all discussions should be held in Telugu only and that
Dr. Ranganathan of NIN, Hyderabad made a presentation about the low
cost technology for iodised salt developed by them.
the small iodised salt producers were not able to follow. He wanted the
training program to be conducted for operating the iodisation plant. He
Dr. Laxmi Bhavani of UNICEF, Hyderabd, gave a spirited appeal to the
iodised salt producers that they should not have any second thoughts on
this issue and informed that the results of a recent survey conducted by
them showed that only 37.7% of the population use iodised salt while
said that they were prepared to produce iodised salt if they are given
potassium iodate and the iodisation plants.
Mr. Kota Mallikarjuna Rao, President of Minor Licensee's Association
62.3% are not using it. She said that District Task forces will be set up soon
Bheemunipatnam, listed the demands of the small
manufacturers of AP as under:
to monitor the use of iodised salt.
I.
Free supply of power
Dr. Saraswati Bulusu of The Micronutrient Initiative India, New Delhi,
explained the role of Ml in India in collaboration with ICCIDD and in
II.
Financial assistance for bore wells to supplement sea brine
III.
Permission to lift sea sand for consolidation of crysta 11 iser beds
scale salt
giving concessions on electrical power has to be decided by the Electricity
IV.
Financial assistance for realignment of bunds
V.
To give patta to the existing manufacturers, instead of lease
Regulatory Authority of India. He agreed to the suggestion for extending
In the Valedictory Ssession,
chaired
by Mr.
S.
Sundaresan,
Salt Commissioner, GOI, the plan of action was unfolded by Mr. C.
Raghu, Superintendent of Salt, SC's Office, Jaipur, by defining the role of
each stake-holder.
financial support for digging bore-wells but this should be only after
experimenting and success of trials and also for permitting use of sea sand
for consolidation of crystalliser beds.
The
meeting
concluded
with
a
Vote
of Thanks
proposed
by
Dr. Jaipal Singh, Dy. Salt Commissioner, Chennai.
In his concluding remarks, the Salt Commissioner efficiently answered the
queries raised by the iodised salt producers. He said that the question of
First Row: R to L: Smt. Soubhagya Laxmi, Dy. Director, Women &
Child Welfare, Dr. R Sucharita, Director, Institute of Preventive
Medicine, Hyderabad, Dr. Laxmi Bhavani, UNICEF Hyderabad,
Dr. Saraswati Bulusu, Ml India, New Delhi
SALTCOMWSS
DCPARTMENT'
.
VISAKHAPA^
Participants: Dr. Saraswati Bulusu, Ml India, New Delhi,
Dr. Laxmi Bhavani, UNICEF Hyderabad atthe Workshop
Making a Point: Mr. N. Raghuveera Reddy, Hon'ble Minister for Civil
supplies, Govt. Of Andhra Pradesh in Conversation with
Mr. S. Sundaresan, Salt Commissioner, GOI. Mr. Konatala
Ramakrishna, Hon'ble Minister for Commercial Taxes,
Govt, of AP looks on.
Field Visit of Orissa
A Report by Mr. Amit Shukla
Purpose of the visit
XVI.
Dr. Sudershan Das, Asst. Director, IDD Cell, Govt, of Orissa
To interact with the iodised salt producers of Orissa and try to find ways
XVII.
Amblin Pattnaik, Consultant, UNICEF
and means to extend ICCIDD-MII support in order to make them
more competitive.
XVIII.Mr. Ashok Patro, Secy, Local NGO, Bhanjanagar
Observations
Places visited
I.
II.
I.
Humma
i.
Office of Deputy Suprintendent of Sa It, Orissa Circle
ii.
Salt Inspector's office
the major cause for poor production. The other important reason
was because of more small producers, the land processing has
become a challenge in the region. He further praised the efforts of
Ganjam
I.
At Humma Salt office: The office is in a very old building, with very
poor infrastructure. We met Inspector Mr. Nayak, who
briefed us on the adverse weather condition of the region as one of
Office of
Humma-Binchinapalli
Cooperative Sales Cooperation
Production
ICCIDD-MII support to small producers for improved iodisation.
and
II.
III.
Suralo- Bahuda Salt manufacturers Cooperative Society office
IV.
Sumandi-Salt fields
V.
Salt Analysis Laboratory at Bhubaneswar
The laboratory at Humma for salt analysis is non functional and the
salt samples are being sent to Bhubaneswar for testing.
Persons Met
We could see heap of Naupada salt on the roadside that is coming
through road route in the name of iodised salt, which is in fact not
iodised. It is sold at lower cost and on credit to the local
wholesale traders. This creates poor market for the local salt
I.
Mr. T. Venkata Krishnaya, President Humma Binchinapalli Production
producers.
II.
Sri K.A. Reddy, Secretary, President Humma Binchinapalli Production
Meeting with the salt producers
III.
Sri Goutam Palloi, President Humma Salt Manufacturers Association
IV.
Sri Puma Ch. Pottnaik, Chemist, Bahuda Society
V.
Sri A.K. Nayak, Inspector Salt Department, Humma
VI.
Dhirendra Nath Panda, Secretary, PAID- Local NGO
VII.
Mahendra Kumar Panda, Account Assistant, H&BSalt, Ganjam
VIII.
Sri Biswanath Padhy, Chemist, H & B Salt, Ganjam
A meeting of the salt producers was organised in presence of the salt
inspector and local NGO representatives at the Humma & Binchinapalli
salt producer's Cooperative office in Ganjam. Mr. Amit Shukla explained
them the obective of ICCIDD-MII project very clearly. It was made clear to
the salt producers that ICCIDD-MII will only support small iodised salt
manufacturers and those producers who are willing to produce additional
iodised salt. The support towards repair and purchase of Salt Iodisation
plants on cost sharing basis was also discussed which was welcomed by
IX.
Sri Machiraan Palai, Sr. Clerk, H & B Salt, Ganjam
X.
Sri T. Shankar Rao, Iodine Plant Mechanic, Ganjam
It was also explained to the producers that they should utilise this
opportunity for making Orissa, a salt sufficient state and make USI a
XI.
Abhimanyu Nayak, President, Bahuda Society
success in India.
XII.
Mr. Khir Sindhu Sahu, Secretary, Bahuda Society
XIII.
Dhruv Ch. Behera, Member, Bahuda Society
XIV.
Mr. RK. Nanda, Inspector, Salt Analysis Lab, Bhubaneswar
The producers requested for organising a sensitization workshop for the
salt labourers on iodisation and quality improvement. Some of the
producers also suggested for a experience-exchange visit to Tuticorin or
any other place with better production process.
XV.
Mrs. Ashalata, Chemical analyst, Salt Analysis Lab, Bhubaneswar
Mr. Amit Shukla & Mr. Satyanidhi Rao of ICCIDDMll interacting with Mr. P.K.Nanda,
Superintendent of Salt, Bhubaneswar
III.
the producers.
Mr. Amit Shukla of ICCIDD-MII interacting with
members of Humma Salt Manufacturers
Association, Humma
ICCIDD-MII Officials at Office
Superintendent of Salt, Humma, Orissa
of the
The producers olso mentioned the requirement of salt crushers and more
The following observations were made:
importantly a washery to improve the quality of the salt.
I.
The department undertakes survey of IDD in the state with help of
medical officers and also organises awareness on importance of
Meeting with Bahuda salt society
iodine in the state. The last survey done was in 2002 by VSS Medical
Bahuda salt society office and their field is located about 200 km from
College, Burla in 4 districts of western orissa. Only goitre survey was
Bhubaneswar and the connectivity is also very poor. The society is having a
office building which has been built with assistance from Govt, of Orissa.
done. However, they have not done any salt or urine sample testing
till date.
Almost 80% of their members are illiterate and are in the BPL category. The
President Secretary and the Members extended a warm welcome to the
II.
They also coordinate with Department of Civil Supplies and food
members of ICCIDD-MII project team. They discussed in detail about the
inspectors for collecting salt samples from retailers all across the state
ICCIDD Objective and support. The encouraging things observed were:
and get it tested for iodine content in state laboratory. When we
enquired, if they are getting 20% of the expected salt samples & then
I.
They have a regular chemist from their village.
II.
They have received an iodisation plant from UNICEF in 1997 but
have kept that in a very good condition, painted, under cover and
there is no follow up. Dr. Das expressed his inability due to lack of
also made a garage to keep that. They want to modify it so that it can
be easily shifted to the platforms in the distant places in the fields. Mr.
Rao interacted and inspected the plant and agreed to their proposal.
III.
IV.
man power, funds, etc for proper monitoring and follow up.
He agreed io the proposal of Mr. Amit Shukla to form a Committee at the
state level for strengthening Universal salt Iodisation (USI) in Orissa. He
assured his full cooperation for this.
The secretary was asked to submit a proposal. It was suggested to
Meeting at Salt analysis laboratory, Bhubaneswar
them that ICCIDD-MII can consider their proposal on cost sharing
The chemical analyst Mrs. Ashalata explained Mr. Amit Shukla in detail
basis to which the producers agreed.
about the procedures they are adopting to test the iodine quantity and
They also requested for support wherein the quality of the salt can be
NaCI content in the common salt. She also shared the details of giving the
further improved. ICCIDD-MII team suggested about washery (on
code to each sample, documentation and reporting.
cost sharing basis). The producers accepted the proposal and further
She further shared that 90% of the salt coming to Orissa through train
told that they can get better price for better quality salt. They
route are either non-iodised or inadequately iodised. She travels to
requested IQCIDD-MII for providing a washery on cost sharing
Bhadrak, Cuttack, Sambalpur, Bolangir to collect the samples & is
basis.
regularly reporting to the Salt Superintendent Office.
There was also a request to strengthen their laboratory and training
She was requested to train the chemist of Bahuda society to which she
for their chemist Mr. Pattnaik . It was proposed that the chemist can
agreed but asked to get an official letter from Suprintendent office.
be trained
for 2/3 days at Bhubaneswar Salt Department
Laboratory. Accordingly, Mr. Amit has spoken to Dr. M.A.
Mr. RK. Nanda, inspector for Balsore region suggested for experience
Anasriforthetraining of the chemist at salt department's lab. The
exchange visit of the salt laborers to AP/Tamilnadu for learning better
department has agreed to extend the support.
technique of salt production. He welcomed the idea of cost sharing for
providing iodisation plant.
Meeting with Assistant Director, IDD cell, Government of Orissa
Government of Orissa has an IDD cell under Directorate of Health
Services, which is represented by Assistant Director, Dr. Sudershan Das.
Mr. Amit Shukla was accompanied by Dr. Prasant Saboth in this
field visit.
The IDD cell has been formed in the year 1987. He is a senior
Gynaecologist and is posted in the department for last one year.
Salt Manufacturers repairing ihe
Iodisation Plant at Basuda, Orissa
Salt
ICCIDD Officials along with Basuda Salt
Manufacturers Association Members
The Chemist at the Salt Testing laboratory, GOI,
Bhubaneswar along with ICCIDD-MI Official
First Western Region ICCIDD Panel Meeting
9,h Sept 2006, Ahmedabad
IV.
It was suggested to involve the Indian Medical Association and other
medical associations for awareness and quality assurance activity.
V.
The panel discussed that the BPL population can be best targeted by
distribution of iodised saltthrough PDS system.
VI.
There has to be a sustainable long term policy by Ministry of Railways,
Government of India regarding allotment and freight for
transportation of iodised salt. ICCIDD mentioned that they are in
regular touch with the officials of the railway ministry.
VII.
The new suggested criteria's of distribution of KIO3 has to be
submitted to ICCIDD-MII by the panel. The producers suggested that
the support under ICCIDD-MII project should be extended to all the
iodised salt manufacturers ratherthan a group of producers/Traders.
VIII.
The producers also mentioned their issue about the concerns raised
against production of crystal iodised salt. ICCIDD replied that the
concern raised against the production of crystal salt by producers
would be discussed in the interagency meetings.
It was agreed that the approach of collaborative efforts has to be
IX.
adopted and all the organisations should recognise each others
efforts. ICCIDD mentioned that only salt producers can make the
USI successful with the support from Government.
The members suggested that the panel should also work against
stringent norms of PEA Act. They suggested that the concerns related
to the PFA act should be raised to appropriate levels.
X.
It was suggested that ICCIDD-MII can tie up with other organisations
like Lions club, Rotary etc to broaden the scope of activities.
meeting was organised by ICCIDD at Confederation of Indian
Industry (Cll) office Ahmedabad with the salt producers of Gujarat
Io find out ways to increase the production of iodised salt. ICCIDDMll was represented by Dr. Chandrakant S. Pandav and Mr. Amit Shukla.
The meeting was attended by Mr. D.L. Meena, Deputy Salt Commissioner,
Gujarat, Ms. Ripal Patel, Cll, Mr. D.S. Jhala, President, Indian Salt
Manufactures Association, Mr. Bachubhai Ahir, President, Gandhidham
Chambers of Commerce & Industry, Mr. Hiralal Parekh, President, Kandla
A
Salt Manufacturers Association, Mr. RN. Rao, Vice President, ISMA, Mr.
Nakul Agarwal, Proprietor, Bhagandas and Sons, Mr. Babbhai Panchalk,
Halwad, Mr. Haribhai Patel, Mr. Bharat A Patel, Patdi and Mr. Yogendra
Desai, Kharagoda.
Highlights
I.
All the participants agreed and supported the Universal Salt
Iodisation (USI) and assured about their continued support for USI.
They agreed that the iodisation process is also commercially viable
forthem.
II.
III.
The producers suggested that there is a strong need for creating
more awareness regarding salt iodisation, especially in rural parts
of India. They suggested this approach would ensure
sustainability of USI.
Exploring Opportunities of IDD Awareness Campaign
Sonepat, 5th September 2006
"Srijan" is an NGO which is connected with youth development
programmes in Sonepat, Haryana. The organization is spearheaded by
Mr. Dinesh Kumar. It has adopted 40 educational institutes in Sonepat and
has been in contact with more than 100,000 school children. Mr. Dinesh
Kumar organises motivational lectures for these school children to help
them decide forthemselves what they would like to become professionally
delivered his lectures on importance of consumption of iodised salt and
about the organisation ICCIDD.
It was felt by the ICCIDD team that Mr. Dinesh Kumar's organization is a
good platform to spread IDD awareness and ICCIDD can partner with the
organisation. However, it was also felt that the activities need to be spread
which are currently localized to Sonepat area.
and contribute to the growth of the nation.
On hearing about this mandate, the ICCIDD decided to send its
representatives to Sonepat to assess the activities of Srijan and find out the
feasibility of spreading IDD awareness through them. ICCIDD was
represented by Dr. Arijit Chakrabarty and Ms. Shalini Chakrabarty. They
observed three lectures delivered by Mr. Dinesh Kumar out of which two of
them were in a B.Ed College and one was in a school affiliated Io CBSE
board. The students were from class XI & XII.
Since 5* September is celebrated as a teachers day, Mr. Dinesh Kumar
read out excerpts from his book named "Icchha Se Sankalp Aur Phir
Chamatakar", authored as well as published by him. Dr. Chakrabarty also
WTORT
Htn <i rr -nu qir:n ti 'hhi jtuh n 'jr
ryTl rfWR T W0WK
RIGHT OF EVERY CITIZEN TO RECEIVE A GOOD HEALTH SERVICE
"If is our responsibility to protect the free health service and the Government will guarantee the right of
every citizen to receive a good health service. The hospital system will be developed and steps will be taken
to improve disease control methods and health education.
More doctors and nurses will be recruited and their services will be given to the rural sector. We will also
implement the Senaka Bibile drugs policy."
"I appeal to this august assembly not to consider our interventions for the sake of education as relief
assistance but as investments for the sake of the country."
- From the policy statement made by President of Sri Lanka, His Excellency Mahinda Rajapaksa at the
opening of the new session of Parliament 25,h November2005
_
Daily consumption of Iodised salt
is a healthy habit
'a
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, Room No 28,
Old OT Block, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi 110029 E-mail: cpandav@iqplusin.org
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