1.
Iodine Deficiency Disorders:
Prevention and Control
Dr. Khem R Sharma
AP, SPH&CM

2.
Introduction
• Iodine Deficiency Disorders (IDD) refers to all of the adverse effects
and consequences of iodine deficiency in a population that can be
prevented by ensuring an adequate intake of iodine.
• WHO estimates that 2 billion people around the world live in areas
that predispose them to risk of insufficient intake of iodine.
• Normal Iodine requirement: ____ μg/day

3.
Functions of Iodine

4.
Causes of IDD
Why soil is low in Iodine???

5.
Iodine Deficiency
Epidemiological assessment:
• Goitre control programs use the following indicators for assessment
of Iodine deficiency in the community
a) Prevalence of Goitre
b) Prevalence of Cretinism
c) Urinary Iodine Excretion (UIE) >100 μg/g of creatinine
d) T3, T4, TSH for thyroid function
e) Prevalence of Neonatal Hypothyroidism

6.
Severity of Goitre
• Mild IDD: - Goitre prevalence 5-20% in school children
- UIE 50-100 μg/g of creatinine
- can be treated with 10-25 ppm iodized salt
• Moderate: - Goitre prevalence up to 30%
- some hypothyroidism, median UIE 25−50 μcg/g creat.
- can be controlled with salt 25−40 ppm
• Severe IDD: - Goitre prevalence 30% or more
- median UIE <25 μg/g of creatinine
- require iodine as iodized oil

7.
The Problem of IDD
• The first countrywide survey of goiter, conducted in the mid-1960s,
found it to be endemic not only in the Hill and Mountain Districts but
also in the densely populated Southern Terai areas.
• Total Goiter Rate was as high as 55% in children.
• Government has implemented an intensive national program to
assure the elimination of IDD to achieve the Universal Salt Iodization
(USI) goal of at least 90% households consuming adequately iodized
salt.

8.
The Problem of IDD
• Various Surveys done over the years showed that the household
coverage of adequately iodized salt has increased from 55.2% in 1998
to 80% in 2011
• There are still some regional disparities, with coverage of iodized salt
much lower in the Far-west, Mid-west and Eastern Rural Hills

9.
Proportion of households consuming adequately iodized salt

10.
Prevention & Control of IDD
• The major methods to overcome IDD include
a) Fortification of salt with iodine compounds (USI)
b) Periodic injection of iodized oil:
- where IDD is severe
- isolated communities that are not readily accessible to iodized salt

11.
Other approaches to IDD prophylaxis
1) Diversification and modification of the habitual diet consumed in
the endemic areas with imported foods from outside.
2) Iodine supplementation of foods and water for human
consumption.
3) Iodine medications (notably oral administration of iodized oil) to
directly supplement the inhabitants at risk of IDD in endemic areas.
4) Active prophylaxis of domestic animals; use of iodine materials for
plants or iodine deficient soils.

12.
Elimination of Iodine Deficiency Disorders in Nepal
• Five-year National Plan of Action for the Elimination of Iodine
Deficiency Disorders was formulated in 1998
• Key priority actions
a) Legislation formulation to sustain and secure the USI program
b) Nationwide social awareness campaign
c) Development and implementation of quality assurance systems
d) Periodic surveys to track the progress of the program
e) Increase the availability of the adequately iodized salt throughout
the country.

13.
• In line with this, Nepal government has undertaken to eliminate IDD
by:
1) Universal Salt Iodization- 2 Child Logo
2) Health Education on foods rich in Iodine (seafish, kelp), avoiding
goitrogens and counsel high risk group (pregnant, children) on USI
3) Periodic Surveillance of production, distribution and monitoring of
Iodized salt (>50ppm at production and >15ppm at consumption)
Prevention & Control of IDD

14.
4) Distribution of Iodized salt at subsidized rates in remote/endemic
areas.
5) Social Marketing Campaigns to advocate for USI consumption
6) Periodic evaluation of IDD through national surveys like NDHS and
National Housing and Population Census etc.
Prevention & Control of IDD

15.
Specific Challenge Areas
• Specific challenge areas which guide the National Plan of Action.
1. There are multiple coordination structures, with limited multi-
sector engagement leading to poor collaboration and
harmonization between Ministries and Agencies at national and
district level
2. There is low coverage of adequately iodized salt in some areas of
the country, particularly in hard-to-reach areas and amongst
socially isolated communities

16.
Specific Challenge Areas
3. There is poor understand and awareness amongst consumers,
retailers and salt traders about iodine and the importance and
availability of packed iodized salt (Two Child Logo).
4. There is poor retention and losses of iodine in large crystal salt that
does not provide adequate iodine at the point of consumption
5. As the program matures, salt consumption and general food
consumption patterns change, the contribution of iodine from
iodized salt to the population is not known

17.
Any Questions/Comments??
Best Wishes