Iodine Deficiency Disorders in Karnataka a review of epidemiological studies

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Iodine Deficiency Disorders in Karnataka a
review of epidemiological studies

• Girish N and Krishnamurthy U

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What we know

• IDD
• A major preventable public health problem
• Epidemiology
• A tool of public health
• Informs, guides and helps monitor public health
  programmes
• National Iodine Disorders Control Programme
  (NIDDCP)
• A concerted effort across the country

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What we would like to know

• With respect to Karnataka
• Estimate the burden
• Monitoring the implementation
• Evaluating the impact

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What did we do

• Desk review of epidemiological studies
• Search strategy
• Pubmed search
• Manual searching of
• Available reports
• Accessible records

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Karnataka
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Historical background

• WHO sponsored Government of India workshop on IDD
  at Hyderabad in December 1984
• Sensitised Government of Karnataka enquired about
  Goitre cases
• Sharada Dhanwantari Hospital, Sringere Tq,
  Chikkamagalur Dt reported seeing more number of
  cases
• DHO, Chikamagalur Dt reported 5 10 prevalence
• Goitre Cell, DGHS GoI surveyed 3 talukas of
  Chikkamagalur dt (Sringeri, Mudigere and Koppa)
  in 1986 Prevalence was 41
• GoK launched the NGCP with 100 central
  assistance Goitre Cell established at the Bureau
  of Nutrition, DHFWS, GoK in 1988-89

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IDD related studies in Karnataka

• Jalaja S et al 1988 to 1991
• MICES, 1995
• Tiwari et al, 1998
• Kapil Umesh et al, 2001
• Sugunammanni and Jalaja, 1994
• Pereira P et al, 1998
• Rao RS et al, 2002
• Avinash K R et al, 2002
• NFHS 2 and 3
• NNMB surveys 1995 and 2005
• ongoing resurveys by GoK

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NFHS results - 1

• NFHS 3
• Children 6 59 months, living in HHs using
  adequately Iodised salt
• All India - 47.5
• Kerala - 70.2
• TamilNadu - 39.0
• Karnataka - 37.8
• Andhra Pradesh - 28.7

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NFHS results - 2

• NFHS 3
• Presence of adequately iodised salt in Households
• All India - 51.1
• Kerala - 73.9
• TamilNadu - 41.3
• Karnataka - 43.3
• Andhra Pradesh - 31.0

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NFHS - Karnataka

• Salt Iodisation at Household level
• NFHS 2 43.4
• NFHS 3 43.3
• Plausibly due to
• Inadequate time given to measure the impact
• Wrong choice of indicator (process v/s impact)
• Or have we reached a plateau??

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Goiter Endemic Areas
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Situation, 2001

• Adequate Salt Iodine content
• Overall 15.8 (12.9 18.6)
• Severity of IDD Problem (Median UIE)
• Mild Davanagere, Bellary, Gulbarga, DK,
  Bijapur, Kolar
• Moderate Kodagu, Shivamoga
• No Problem UK, Chikamagalur, Udupi other
  district
• UIE lt20mcg Shivamoga (31) Kodagu (26) DK
  (18)

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Progress 2001
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NNMB surveys

• 1995
• 2005
• 1.3 (5 12 year olds)
• 3.3 (12-17 year olds)
• 0.7 (Adults)
• 2009
• 120 villages in tribal areas (completed)
• 120 villages in rural Karnataka (ongoing)

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Results from resurveys
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UIE, 2009

• District lt20 µgm gt100 µgm
• Kodagu 38.5 46.2
• Mysore 17.4 67.4

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Results to be considered

• Belgaum district
• Kolar District (Fluorosis survey in Kaiwara)
• Goitre cases reported during 2001-02, 2002-03,
  2003-04

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Acknowledgements

• Bureau of Nutrition, DHFWS, GoK
• Mr Gopal B, Scientific Officer and I/c Technical
  Officer
• Mrs Subbalakshmi B N, Assistant Statistical
  Officer

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The causation paradox

• Three lessons from the tale of improving water
  supply and sanitation which improved public
  health which is now part of the "collective
  consciousness" of public health
• Firstly, effective intervention does not always
  need accurate knowledge of disease causation
• the development of sanitary measures largely
  preceded the germ theory
• Secondly, environmental measures may be more
  effective than changing individual behaviour
• "passive" protection through piped drinking water
  and sewerage systems worked better than educating
  the public to improve "active" hygienic
  practices.
• Thirdly, universal measures may be better than
  targeted measures in reducing health inequalities
  
• better water supply and sanitation reached people
  at all social levels.

Johan P Mackenbach Sanitation pragmatism works
in medical milestones at http//www.bmj.com/cgi/c
ontent/full/334/suppl_1/s17