NATIONAL IODINE DEFICIENCY DISORDER

CONTROL PROGRAM
 INTRODUCTION

• Iodine is an essential micronutrient required daily at 100-150 micrograms for

normal human growth and development.

• The surveys conducted by the Directorate General of Health Services, Indian

Council of Medical Research, Health Institutions and the State Health Directorates,
it has been found that out of 414 districts surveyed in all the 29 States and 7 UTs,
337 districts are endemic i.e where the prevalence of Iodine Deficiency Disorders
(IDDs) is more than 5%

Source : https://dghs.gov.in/content/1348_3_NationalIodineDeficiency.aspx
 BURDEN OF DISEASE

• Iodine deficiency has been identified all over the world. It has caused
significant health problems in 130 countries and affect 740 million people. One
third of the world population is exposed to the risk of IDD.

• It is estimated that in India alone, more than 6.1 crore people are suffering from
endemic goiter and 88 lakh people are mental/ motor handicaps.

• It is estimated that more than 71 million persons are suffering from goiter and
other iodine deficiency disorders like mental retardation, deaf mutism, squint,
and neuromotor defects.
 CONTROL PROGRAMME

• Following the successful trial of iodised salt in Kangara valley, Himachal Pradesh in 1962,
India has launched 100% centrally sponsored the National Goiter Control Programme.

• In August, 1992 the National Goitre Control Programme (NGCP) was renamed as
National Iodine Deficiency Disorders Control Programme (NIDDCP) with a view of wide
spectrum of Iodine Deficiency Disorders like mental and physical retardation, deaf
mutism, cretinism, still births, abortions etc.

• Research over the past three decades has shown that iodine deficiency has a significantly
wider spectrum,

Source : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6366256/
 CLASSIFICATION OF GOITRE

• Grade Description :
• Grade 0: No palpable or visible goitre/no goitre.

• Grade l: A mass in the neck that is consistent with an enlarged thyroid that is palpable but not
visible when the neck is in normal position. It moves upward in the neck as the subject
swallows. Nodular alteration (s) can occur even when the thyroid is not enlarged/goiter palpable
but not visible.

• Grade 2: A swelling in the neck that is visible when the neck is in a normal position and is
consistent with an enlarged thyroid when the neck is palpated/goitre visible and palpable.
 ENDEMICITY OF IDD

• Rapidly changing environmental conditions leading to melting of glaciers,

frequent floods, change of river beds and loss of forest cover have led to
depletion of the iodine from the top layers of the soil.

• The resultant low iodine content of soil leads to low iodine in livestock and
vegetation dependent on these soil and also in humans consuming these live
stocks and vegetations

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6366256/
 IDD PR EVALENCE INDICATOR S AND CR ITERIA FOR
CLASSIFYING IDD AS A SIGNIFIC ANT PUBLIC HEALTH PROBLEM
 IDD AND ECONOMY

• It has been estimated that one point increase in a nations’ average IQ is

associated with 0.11 per cent annual increase in gross domestic product (GDP),
thus IDD elimination can potentially contribute to 1.5 per cent GDP growth
annually.

• The Indian population is prone to IDDs due to deficiency of iodine in the soil
and thus both animal and plant source food grown on the iodine-deficient soil.
Universal Salt Iodization (USI) has been recognized as a key strategy for
control of IDD.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6366256/
• In 1994, the World Health Organization (WHO) and the United Nations
Children's Fund (UNICEF) Joint Committee on Health Policy recognized USI
as a safe, cost-effective and sustainable strategy to ensure sufficient intake of
iodine by all individuals.
• Salt iodization, which costs less than ₹0.2 per person per year and has been
rated as one of the most cost-effective development interventions (ratio of
1:81) by Copenhagen Consensus Statement 200821 and subsequently again in
201222.
• India has made impressive progress in control of IDDs with successful
adoption and scaling up of USI in the country. According to National Iodine
and Salt Intake (NISI) survey, 2014-2015, currently, 78 per cent of households
in India are consuming adequately iodized salt.

• In 2018, an original article has stated that IDD control programme in India is a
public health success story, with 92 per cent of the population consuming
iodized salt.

• However, still significant percentage of the population continues to consume

inadequately iodized salt or nil iodine salt . There is a need to reach the
unreached population and cover the ‘last mile’ of USI success story of India.
 GOAL OF NIDDCP :

• 1. To bring the prevalence of IDD to below 5% in the country

• 2. To ensure 100% consumption of adequately iodated salt (15ppm) at the

household level.
 OBJECTIVES:

• 1. Surveys to assess the magnitude of Iodine Deficiency Disorders in the districts.

• 2. Supply of iodated salt in place of common salt.

• 3. Resurveys to assess iodine deficiency disorders and the impact of iodated salt after every 5
years in the districts.

• 4. Laboratory monitoring of iodated salt and urinary iodine excretion.

• 5. Health Education and Publicity.

 POLICY :

• In the recommendations of Central Council of Health in 1984, the Government

took a policy decision to Iodate the entire edible salt in the country by 1992.
The programme started in April, 1986 in a phased manner. To date, the
annual production of iodated salt in our country is 65 lakh metric tones per
annum.

• The Central Government has issued the notification banning the sale of non-
iodated salt for direct human consumption in the entire country with effect
from 17th May, 2006 under the Prevention of Food Adulteration Act 1954.

Source :https://dghs.gov.in/content/1348_3_NationalIodineDeficiency.aspx
 ORGANOGRAM OF IDDCP

• Central- Nutrition & IDD cell (under DGHS)

Nodal Officer – Advisor (nutrition) of DGHS.
IDD cell under Deputy Asst. DGHS + Research officer (IDD) + Team

• State – Independent state IDD cell State Health Directorate

State Program Officer
IDD monitoring laboratories
• District – Salt surveys
Front line workers ANM and ASHA.
FINANCIAL ASSISTANCE TO ALL STATES /UTS FOR
THE FOLLOWING:

• Human resource of State IDD Cell i.e Technical Officer, Statistical Asst. & LDC and State IDD monitoring
laboratory i.e. Lab Technician & Lab Assistant.

• Health education and publicity activities including global IDD Day activities.

• Conducting district IDD survey/resurvey to assess magnitude of IDD.

 FINANCIAL ASSISTANCE TO ALL STATES /UTS
FOR THE FOLLOWING:

• Procurement of salt testing kits by State/UTs for IDD endemic districts for creating awareness at the
community level about consumption of iodized salt and monitoring of salt for presence of adequate
iodine at household level ( since 2013-14).

• Performance based incentive to ASHA @ Rs. 25/- per month for conducting 50 salt samples testing by
STK at household/community level (since 2013-14).

• Under NIDDCP financial assistance is also being provided to Salt Commissioner’s Office, Jaipur, (M/o
Industries) which is responsible for promoting production of iodated salt, monitoring, distribution and
quality control of Iodated salt at the production level through nine quality control laboratories

Source : https://dghs.gov.in/content/1348_3_NationalIodineDeficiency.aspx
 IDD CELL OF DIRECTORATE GENERAL OF HEALTH
SERVICES

• 1. Technical guidance to the States/UTs.

• 2. Intersectoral coordination at Central level and maintenance of close liaison with the
Ministry of Industry trransport etc.

• 3. Coordination of the various facets of NIDDCP in States/UTs

• 4. Undertaking independent IDD surveys and monitoring in various States/UTs.

• 5. Imparting training to the State Health to whom Personnel, involved in

NIDDCP.

• 6. Collection, compilation and analysis of relevant data from States/UT with a

view to render more effective and meaningful advice.
• Monitoring of the quality control of iodated salt at production level through the
salt Commissioner and at the distribution and consumer level through the State
Health Directorate.

• Monitoring the procurement and distribution of iodated salt in States/UTs.

• Managing the IEC activities at apex level. Managing the financial and other
physical aspects of State level IDD Cells.
 STATES/UNION TERRITORY IDD CELL

• Checking iodine levels of iodated salt with wholesalers and retailers within the State and
coordinating with the Food and civil Supplies Department.
• The Distribution of iodated salt within the State through open market and public distribution
system
• Creating demand for iodated salt.
• Monitoring consumption of iodated salt.
• Conducting IDD surveys to identify the magnitude of IDD in various districts.
• Conducting training.
• Dissemination of information, education and communication.
 CURRENT STATUS OF IODATED SALT

• Salt can be iodised with potassium iodide

or potassium iodate . However, in our
country the latter is preferred ,for its
stability and melting point by 530 degree
Celsius.
 STANDARDS OF IODATED SALT

• Under the prevention of Food and

Adulteration Act, Iodised salt means a
crystalline solid white, pale pink or light
gray in colour and free from physical
contamination.
 PACKAGING OF IODISED SALT

• The iodised salt manufacturers have been directed to pack iodated salt only in
polythene lined jute bag of permitted capacity 50 kg for bulk quanitity and in
polythene pouches of 500gms/1000gms for retail packing with the following
labels on it :
 Name of the Manufacturer
 Month and year of packing
 Iodine content
 Net Weight
 Batch Number
 MEASURES TAKEN FOR IMPROVING
QUALITY OF IODATED SALT

• Training of laboratory technician of IDD monitoring cell of state/UT.

• Prescribing the labelling standard of iodised salt.
• Establishment of iodated salt laboratories at different production centre of the
country.
 ACHIEVEMENTS:

• Over the years the Total Goiter Rate (TGR) in the entire country is reduced
significantly.
• Production of iodized salt in the country reached to 65.00 lakh MT which is
adequate to meet the requirement of population.
• The consumption of adequately iodated salt at household level has been
increased from 51.1% (as per NFHS III report 2005-06) to 71.1% (as per
Credentials evaluation sevice, CES report, 2009).
• Regulation 2.3.12 of Food Safety and Standards (Prohibition and Restriction on
Sales), Regulation, 2011 restricts the sale of common salt for direct human
consumption unless the same is iodized.
• National Reference Laboratory for monitoring of IDD has been set up at
NCDC, Delhi. Four Regional laboratories one each at NIN, Hyderabad,
AIIH&PH, Kolkata, AIIMS and NCDC, Delhi have been set up to conduct
training, monitoring, quality control of salt and urine testing.
• For effective implementation of NIDDCP 35 States/UTs have established IDD
Control Cells in their State Health Directorate. 35 States/UTs have set up State
IDD monitoring laboratories in their respective States/UTs.

• Extensive IEC activities have been carried out to create awareness about the
regular consumption of iodated salt in prevention and control of IDD through
Doordarshan, All India Radio, Directorate of Field Publicity, Song and Drama,
Directorate of Advertising and Visual Publicity.
 JOURNEY OF NIDDCP

• The journey of salt iodization programme in India can be broadly classified

into the following phases:
• i) Phase 1: Scientific research leading to programme (1956-1983);
• ii) Phase 2: From goitre to IDD (1983-2000);
• (iii) Phase 3: Lifting the ban on sale of non-iodized salt (2000-2005); and
• (iv) Phase 4: Reinstatement of ban on sale of non-iodized salt and
consolidation of sustainable elimination of IDD (Since 2005).
 FUTURE STRATEGY FOR ACHIEVING
SUSTAINABLE ELIMINATION OF IDD IN INDIA

• To accelerate the progress towards sustainable elimination of IDD in the

country, there is a need to invigorate the efforts at national and State level from
production to consumer level. There is a need to reposition the NIDDCP by
linking elimination of IDD to HRD of the country.

• The social process model based on four main components, Demand for Iodized
Salt (Pull), Supply of Iodized Salt (Push), Regular Reliable Representative
State Level Scientific Data and Data for Decision Makers and Sustained
Political Commitment needs to be followed.

Source : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6366256/
• There is a need for renewed focus and vigour to achieve USI in the country by
developing strategy to target and engage small-scale producer/difficult to reach
areas/marginalized population and strengthen monitoring of iodine content of
salt from production to consumer level.
TO A C C E S S P R O G R E S S I N S A LT P R O D U C T I O N I N I N D I A
 COMMENTS

• 1. Universal iodisation of salt has not been achieved even after a

decade has passed away when the taret was set to be achieved.
• 2. More strengthening of transportation of iodised salt by Railways and
roads is needed. Monitoring during transportation is usually not done
regularly.
• 3. Boosting up of political and bureaucratic commitment is required as
the problem of visible goiter has been reduced.
• 4. There is a difference in guidelines for assessment of IDD issued by
Indian Government and international organizations