Pass The Salt

DDS, or Iodine Deficiency Disorders, have never been on the government list of priority health  issues. Till now, that is. A recent cross-country study by the Directorate General of Health Services, Indian Council of Medical Research and state health directorates have thrown up alarming figures. The study says “no state is free from iodine deficiency disorder. Out of 324 districts surveyed in 28 states and Union territories, 263 are endemic—where the prevalence of IDDS is more than 10 per cent”. The survey also says a large number of pregnant women in rural India as well as adolescent children are becoming victims of iodine deficiency.

While goitre is traditionally the disease associated with iodine deficiency, other problems are becoming prevalent now, including physical and mental retardation, dwarfism, abortions and still-births. “Apart from the visible manifestation in the form of goitre (where the thyroid glands swell up), our studies in UP and Bihar showed a large number of neo-natal cases of thyroid hormone deficiency, which means a large number of children are born with the disorder,” says Dr Chandrakant S. Pandav, Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS).

Iodine is an essential micronutrient of which an average daily intake of 100-150 micrograms is essential for normal growth and development. It is estimated that over 71 million people suffer from goitre and other IDDS in India. Except for a few types of goitre, most other conditions are irreversible. But they can easily be prevented by regular consumption of iodised salt.

Edible salt does not naturally contain iodine. While seafood is usually a good source of iodine, even coastal areas have shown an increase in iodine deficiency. The sale of non-iodised salt is banned in India under the Prevention of Food Adulteration Act, 1954. The Centre is now implementing a National Iodine Deficiency Disorders Control Programme (NIDDCP) across the country.

The important components of the programme are iodine deficiency disorders survey/re-survey, supply of iodised salt in place of common salt, laboratory monitoring of salt and urinary iodine excretion and health education and publicity. Under the programme, funds are provided to states for establishment of an IDDS cell, monitoring laboratory, survey/re-survey and information, education and communication (IEC) activities. Further, salt-testing kits are being supplied to all states to be used by health workers for monitoring as well as creating awareness at the community level. The government’s goal with NIDDCP is to reduce idd cases to below 10 per cent in the country in the next two years. Globally, iodised salt is recognised as the cheapest and most sustainable way to prevent and control these disorders.

According to the AIIMS surveys, there is a significant disparity in consumption of adequately iodised salt in rural (only 41.1 per cent) and urban (71.5 per cent) households. This despite iodised salt production in India showing tremendous progress over the last two decades. The current production of iodised salt in India is 54 lakh tonnes as against only 8 lakh tonnes in 1986-87. Still, Dr Pandav says, “there’s  a need to establish a quality assurance system at the production end to ensure adequate levels of iodine in salt”. And if idd cases are to be brought under control, we need to look at better distribution models too.