This document summarizes the National Iodine Deficiency Disorder Control Programme in India. It discusses that iodine is an essential nutrient needed in small amounts daily, and a deficiency can lead to goiter and other disorders. The Kangra Valley study from 1956-1972 showed that iodizing salt reduced goiter prevalence and led to the establishment of the National Goiter Control Programme in 1962. While initial efforts had low priority and success, renaming it the National Iodine Deficiency Disorders Control Programme in 1992 and increased awareness of issues like brain damage and child development helped boost the programme. Surveys show rising household use of iodized salt nationwide and in states like Manipur, with prevalence of iodine deficiency disorders

1. National Iodine Deficiency
Disorder Control Programme
By
Dr. Polly Nula

2. What is iodine?
• Nutrient needed in a
minute quantity daily.
Recommended daily intake:
150 μg (Micronutrient)
• Total quantity present in body
is (15-20 mg)
mostly in thyroid gland

3. What is iodine?
• Iodine: Essential component of thyroid
hormones, which are needed for:
- Optimal mental & physical development
- Regulation of body metabolism
(Generation & utilization of body energy)

4. Sources of iodine
• Food is the main source of iodine
– Meat, fish & dairy products
– Vegetables, cereals
• High amounts in sea fish & seaweeds
• Sea salt is a poor source of iodine

5. Iodine deficiency – Disease of the soil
Gradual leaching of iodine from soil due to:
Melting of Glaciers
Floods
Rivers changing course

6. Iodine : Daily requirements
Age Group
Iodine Requirement
(µg/day)
0 – 11 months 50
12 – 59 months 90
6 – 12 years 120
> 12 years 150
Pregnant & Lactating
Women
200
[WHO, UNICEF, ICCIDD: Recommended iodine levels in salt
and guidelines for monitoring their adequacy and
effectiveness. WHO/NUT/96.13. Geneva. 1996 ]

7. Spectrum of IDD
Goiter
Cretinism
Spontaneous Abortions, Stillbirths, BirthDefects
Defects of Speech & Hearing, Squint,
Psychomotor defects
Loss of 13 IQ points,
Leading Cause of Mental handicap

8. Iceberg of IDD
1% - 10%
Cretinism
5% - 30%
Some brain damage
30% - 70%
Loss of energy due to
hypothyroidism

9. Iodine deficiency disorders:
A public health problem - 1
Worldwide distribution

10. Iodine deficiency disorders:
A public health problem
• High risk groups:
- Pregnant & lactating women
- Pre-school children
• Elimination of IDD:
- is an important developmental social goal for
governments
(UNGASS 2002; MDG – 2015)
- is possible
UNGASS: United Nations General Assembly Special Session on Children
MDG: Millennium Development Goals

11. Our primary concern
To ensure that:
• Every population should
&
• Every mother & child must
Get their daily supply of iodine

12. Iodine consumption on daily
basis for all times to come
• Daily requirement of iodine per person
is 150 µg – fits on the tip of hair !
• Lifetime requirement for 70 years is 5
gms – one teaspoonful !
• However, this daily requirement
has to be met daily, for all times to
come
• “Daily consumption of adequately
iodized salt is a healthy habit”

13. Vehicle for iodine : Salt
• One food item consumed every day,
by everybody in fixed quantities
• Rich or poor, urban or rural area,
man or woman, child or adult
• Average daily consumption in India
per person is 10 gm
• Iodization of salt is a simple process
• Cost of salt iodization is :
10 paise/person/year

14. Iodized salt – The panacea
for iodine deficiency
Promotion of Iodized Salt Consumption

15. HISTORY:
• Kangra Valley
Study
• Pioneer study
conducted in
Kangra District
of
Himachal
Pradesh, by
Prof. V.
Ramalingaswami

16. From evidence to program
The Kangra Valley study (1956-1972)
Study design
Community based
Prospective controlled trial
Study area
Kangra Valley, Himachal
Pradesh
Divided into 3 zones –A , B ,
C
Study period 1956 - 1972
Study duration 16 years
Study population
1,00,000 School age
children
Outcome variable
Goiter prevalence

17. From evidence to program –
The Kangra Valley study (1956-1972)
ADMINISTRATIVE INTERVENTION
AD
AAAA
– Legislation (ban on sale of
non- iodized salt in study area)
– Iodized salt distributed through
government shops
– No price difference between iodized
and non-iodized salt

18. From evidence to program
The Kangra Valley study (1956-1972)
Conclusions
AA
• Iodine supplementation in the form of
adequately iodized salt on a regular and
continuous basis reduces goiter prevalence
Recommendations
• Establish a National Goiter Control
Programme (NGCP)
• As a result,
National Goiter Control Program established in
1962
conclusions
RECOMMENDATIONS

19. Scenario after Kangra Valley study
National Goiter Control Program (NGCP)
launched at the end of Second Five Year Plan (1962)
Aims : 1) Initial survey to identify endemic areas
2) Production & Supply of iodized salt
to endemic areas
3) Impact assessment surveys after five years
Approach : District specific program

20. NGCP: Low priority
• Goiter:
- is painless
- not a cause of death
- has been perceived as a
cosmetic problem only
- socio-cultural norm
in some groups
• Therefore, NGCP received low priority from the
viewpoint of government as a national public
health program,
and also from the population

21. The hourglass of IDD
Iodine Deficiency = Goiter =
Visible Swelling
No Pain, Cosmetic problem
Cretinism: A rare event
= LOW PRIORITY
Brain Damage
Lack of Energy - hypothyroidism
Learning Disability, ↑Deaths
 Child Development & Child Survival
 Human Resource Development
= HIGH PRIORITY
Historic view
1962-1983
Current view
1984 onwards

22. NATIONAL IODINE DEFICIENCY
DISORDER CONTROL PROGRAM.
• In August, 1992 the National Goitre Control Programme(NGCP) was
renamed as National Iodine Deficiency Disorders Control
Programme(NIDDCP).
• Objective:
• (i) Initial surveys to assess the magnitude of the Iodine
Deficiency Disorders.
• (ii) Supply of iodated salt in place of common salt.
• (iii) Health Education & Publicity.
• (iv) Resurveys to assess the impact of iodated salt after
every 5 years.
• (v) Laboratory monitoring of iodated salt and urinary iodine excretion.

23. Achievements:
• To ensure use of only iodated salt the
sale of non-iodated salt was banned
under Prevention of Food
Adulteration Act, 1954,
• Establishment IDD Control Cell in the
State Health Directorate
• A National Reference Laboratory for
monitoring of IDD.

24. Achievement-
• Spot qualitative testing
• Setting up one district level IDD monitoring
laboratory
• Cash grants
• The standards for iodated salt have been laid
down under PFA Act, 1954.

25. IEC Activities
. To intensify the IEC activities a communication
package by way of video films posters/danglers
and radio/TV spots have been finalized. IDD
spot has been telecast on Doordarshan
(National Network)

26. Use of iodized salt – at house hold level
North East:-
NFHS –2, 1998-99
DLHS-2002
91%
52%
88%
59%
84%
57%
80%
59%
79%
47%
67% 70%
63%
55%

27. Estimated percentage of Household consuming
adequately Iodized Salt
95% 93%
77% 74%
70%
65% 63%
50% 48%
UNICEF-2003

28. PREVALENCE OF IDD IN MANIPUR
SURVEY REPORT:
Year of
survey
No.of
persons
covered
No. of goiter
IDD cases
P.R
1970 3806 1363 32.0%
1980 4292 1133 25.6%
1992 4969 1050 21.1%
1996 7956 1034 13.0%

29. IMPLEMENTATION OF NIDDCP IN
MANIPUR
• IDD CELL
-Estd. in 1987 as NGCP with
creation of post & staff posting
-Function as NIDDCP since 1992.
• IDD MONITORING CELL
- Estd. in IDD Cell, Medical Directorate.
- Lab Tech. & Lab Asst. posted since 1996.

30. Thank Q
Dandi March

31. Thank Q