NATIONAL IODINE DEFICIENCY DISORDER CONTROL PROGRAMME DR BAGDI , JT'DIRECTOR DR' S'D'KULKARNI , DY'D

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NATIONAL IODINE DEFICIENCY DISORDER CONTROL
PROGRAMMEDR BAGDI , JT.DIRECTORDR.
S.D.KULKARNI , DY.DIRECTORDIRECTORATE OF HEALTH
SERVICESMUMBAI
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Salt Freedom Platinum jubilee of
Dandi March (12th March 6th April 1930-2005)
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• Iodine is essential dietary element-required for
  THYROID HORMONES T3, T4.
• Its iodinated molecule of Es-Am-Acid Tyrosine.
• Iodine - essential micronutrient. Requirement -
  100-150 microgms/day for normal human growth and
  development.
• Thyroxin is essential for Calorigensesis, ,
  Thermoreguration, Protein Synthesis
• Promotion of Nitrogen, Retention,
  Glycogenolysis, intestinal absorption of glucose
  , Lipolysvis , Uptake of glucose

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IDD Problem Pyramid

• It's worldwide major public health problem.
  Globally 1.5 billion- risk of Iodine deficiency
  disorders.
• The pyramid shows the visible effects of Iodine
  Deficiency Disorders (IDD) Goitre and Cretinism
  account only for 1--10 of these,
• Whereas 90 of the effects remain hidden.

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• 1962 Commenced Goiter control programme
• 1972 N I D D C P
• A) Problem is not restricted to Goiter belt
  but extremely prevalent all over the country.
  No state it is free.
• b) So also Iodine deficiency is not limited
  to Goiter Cretinism but wide spectrum
  -------Deaf Mutism M.R.
• Impairment of intellectual function.
• 54 million Goiter
• 2.2 million Cretium
• 6.6 million mild
  neuro deficiency.

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Spectrum of Iodine Deficiency Disorders

• Abortion
• Still births
• Congenital Anomalies
• Increased Perinatal Mortality
• Increased Infant Mortality

• Foetus

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Spectrum of Iodine Deficiency Disorders

• Neurological Cretinism
• Mental Deficiency
• Deaf Mutism
• Spastic Diplegia
• Squint

• Foetus

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Spectrum of Iodine Deficiency Disorders

• Myxedematolous Cretinism
• Dwarfism
• Mental Deficiency
• Psychomotor defects

• Foetus

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Spectrum of Iodine Deficiency Disorders

• Neonatal Goitre
• Neonatal Hypothyroidism

• Neonate

• Goitre
• Juvenile Hypothyroidism
• Impaired Mental Function
• Retarded Physical Development

• Child and Adolescent

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Spectrum of Iodine Deficiency Disorders

• Goitre with its complications
• Hypothyroidism
• Impaired Mental Function

• Adult

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• Iodine deficiency disorders is Public Health
  problem.
• 200 million at risk of Iodine deficiency
  disorders.
• 70 million suffer for goiter and Iodine
  deficiency disorders.

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Iodine Deficiency

• Consumption of crops/plants grown on iodine
  deficient soil leads to iodine deficiency in
  population.
• Superficial layer of soil is important -
• Heavy Rains Flooding Deforestation
• Iodine Requirement
• 0-5 yrs 10 micro g
• 6-12 yrs 120 micro g
• above 12 yrs 150 micro g
• Pregnancy 200 micro g

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Effect of Iodine Deficiency

• 1) Worlds single most significant cause of
  preventable brain damage and M.R. is Deficiency
  of Iodine.
• 2) With every passing hour 10 children are being
  born in our country, who will no attain their
  optimum physical and mental potential due to
  iodine deficiency.

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• Current Research indicates that iodine deficiency
  result in lowering the average intelligence of
  the entire school age population by as much as 10
  to 15. 12 points so 400 millions IQ points are
  missed by 40 million children.
• So preventing deficiency raises the learning
  capacity of school children and improves school
  performance.

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Iodine Deficiency A Public Health Problem

• Iodine deficiency in pregnant woman may cause
  miscarriages, stillbirths, and birth defects.
• Iodine deficiency impairs growth and development
  of children.

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Iodine Deficiency A Public Health Problem

• Children with iodine deficiency may grow up
  stunted, less active, mentally retarded with
  impaired movements, speech or hearing.
• Iodine deficiency also causes goitre
• The majority of people in South-East Asia are at
  risk from iodine deficiency disorders.

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Iodine deficiency disorders HRD

• 1)Iodine in pregnancy available to foetus.
• ?
• Decreased synthesis of Thyroxin.
• ?
• Prevents the normal development of foetal brain
  and body
• ?
• Neonatal-chemical Hypothyroidism
• Limits Intellectual growth
• ?
• Fetal brain damage (irresponsible)

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Implications of Loss of IQ

• Poor scholastic performance
• ?
• Frequent failures/grade repetitions
• ?
• Absenteeism / Drop outs
• ?
• Reduced impact on economic and social
  development

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Classification of Goiter

• As per World Health Organization Grade-0 No
  palpable or visible
• Grade-1 Mass in the neck consistent with
  enlarged thyroid
• Palpable but not visible.
• Moves upward in the neck as the subject swallows
• Grade -2 Swelling in the neck - visible
• Consistent with enlarged thyroid when the neck is
  palpated.

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Iodine Deficiency Disorders prevalence criteria
for classification as a significant.
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Loss of IQImplications

• 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 environment.

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Survey done in last 5 years.
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NAGPUR 11.72
C,PUR 7.29
CC,
NANDED 1.42
ANAGAR 11.6
2000-2001
222
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NASHIK 15.00
Abad 14.4
HINGOLI 12.8
2001-2002
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WARDHA 10.3
GADCHIROLI 7.9
RATNAGIRI 10.89
2002-2003
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NADURBAR 20.3
GONDOA 14.2
2003-2004
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YEOTMAL 10.23
SATARA 3.83
2004-2005
S,DHURG 11.22
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2000-2001
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2001-2002
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2002-2003
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2003-2004
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2004--2005
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LABORATORY EXAMINATION OF SALT SAMPLES
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URINARY-IODINE ESTIMATION PUB.HEALTH LAB.
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IODISED SALTP.F.A. ACT/RULES

• Essential Food item under provisions of A.15.01
  OF APPENDIX B OF Prevention of food Adulteration
  (PFA) Rules 1954
• Food Inspectors empowered to prosecute for
  sub-standard iodised salt
• Imprisonment not less than 6 months---3yrs
• FINE not less than rs.1000/
• notification

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Burden Of I.D.D. IN INDIA CHINA
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Cost of Iodine for Salt Iodisation
Cost benefit ratio 110
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Supply (Push) - Government
TENTH Five Year Plan (2002-2007)

• Effforts to reduce price differentials between
• iodised non-iodised salt

• More cost effective targeting of the PDS to
• address macro and micronutrient deficiencies

Volume II Sectoral Policies and
Programmes NUTRITION
Iodised Salt
PLANNING COMMISSION GOVERNMENT OF INDIA, NEW DELHI
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Actions expected from PUBLIC HEALTH EXPERTS

• 1) Adequate samples-- 40 salt sample/ per month.
• 2) Move the office of the Jt. Commissioner/Asst.
  Commissioner FDA for penal Action as per
  provision as per Act.
• 3) Awareness in society about Iodine deficiency
  disorders by
• Newspaper write up
• Workshop
• Advocacy in review meeting
• Review of the progress in monthly meeting.
• Mahila Melava

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Thank You
THANK YOU