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National Iodine Deficiency
Disorders Control Programme (NIDDCP)
Introduction:
Iodine Deficiency Disorders (IDD) affect a large
number of population living in all the
continents of our planet.There is an increasing evidence of wide-spread
distribution of environmental
iodine deficiency not only in the
Himalayan region but also in Sub
Himalayan terai areas, riverine
area and even the coastal regions .
The survey conducted by the Central
and State Health Directorates,
ICMR and Medical Colleges
have clearly demonstrated that
not even a single state/UT is free
from the problem of Iodine Deficiency Disorders . District
level IDD surveys have been conducted in
25 States and 4
Objectives
Realizing the
magnitude of the problem the
Government of
i) Initial
surveys to assess the magnitude of
the Iodine Deficiency Disorders.
ii) Supply of iodised salt in place of common
salt.
iii) Resurveys to assess the impact of iodised
salt after every 5 years.
In August
1992, the National Goitre Control
Programme (NGCP) was renamed
as National Iodine
Deficiency Disorders Control
Programme (NIDDCP) with a view to emphasise wide spectrum disorders caused due
to iodine deficiency.
Beneficiaries
All people
residing in endemic and non endemic
areas for IDD. The endemic area
is given priority.
Activities
and Services :
The
following activities are organised under
the NIDDCP
Production
and Distribution of Iodised Salt
On
the recommendations of Central Council of Health in 1984, the Government decided to iodise the entire
edible salt in the country
by 1992. This policy decision was implemented
w.e.f. April, 1986 in a phased manner.The iodised salt production
was liberalizd to private sector.
About 641 private manufactures were given licenses by Salt Commissioner out of
which nearly 532 units have
commenced production. These
manufacturers have annual production capacity
of iodised salt of more than 60
lakh tons (which is adequate for the entire country).
The annual production of iodised salt has increased from 5 lakh metric tons
in 1985-86 to 45 lakh metric tons in 1996-97. This is expected to further rise to 50 lakh metric tones in near
future.
Funds have been provided to Salt Commissioner's
Office for maintaining the
quality control of iodised salt
produced at production level. The Salt Commissioner in consultation with
the Ministry of the
Railways arranges for the transportation of iodised salt from the production centres
to the consuming States on a high priority (category 'B' a priority
second to that for defence).
The
Salt Commissioner has been initiating action to
install iodisation plant in the different states and to improve
packaging of iodated salt to prevent
iodine loss during transit.The State
Government have been advised to include iodised salt under public Distribution
System (PDS).
Notification
for banning use of non-iodised salt
To
ensure use of only iodised salt, the sale of non iodised salt
has been completely
banned under Prevention
of food Adulteration Act, 1954,
in 22 States and 5 Union Territories and
partial in 2 States .
There is no ban notification in
State Kerala.The Central Council
of Health in its meeting held in 1995
has again urged
the remaining State
Governments to issue notification banning the sale of salt other than iodised
salt. Realising the
importance of iodine deficiency
in relation to human resource development, NIDDCP has
been included in 20 point pogramme of
Prime Minister.
Establishment
of Goitre Cell :
For
effective monitoring and proper implementation of NIDDCP all the States and UTs
have been advised to establish IDD control Cell
in the State Health Directorates. Presently 27 States
and
Information
education and communication activities
The
Central Government provide funds to states and UTs for production of health education material and carrying out health education activities
on IDD as well as for undertaking
IDD
surveys.
To intensify the IEC activities a communication
package by way of video films,
posters/danglers and radio/TV spots have
been produced. TV
video Spots on
consequences of Iodine Deficiency and the benefits of consuming iodised salt
are being regularly telecasted through
the National Network of Doordarshan.
The standards
for iodised salt have been laid
down under PFA, act 1954. This stipulate that the iodine content of
salt at the production and consumption level should be at least 30 and 15 ppm
respectively .
Intersectoral
Co-ordination :
NIDDCP activities
require integrated efforts
of multiple agencies like
Industry, Railways, Health
etc. The focus
of NIDDCP activities has now been shifted from health department to
multi
and interdisciplinary participation.
Laboratory
Support:
A National Reference Laboratory for monitoring
of IDD
has been set up at the
Bio-chemistry division of National
Institute of Communicable Diseases,
Delhi for training
medical and paramedical personnel and monitoring the iodine content
of salt and urine.
District level IDD monitoring laboratories are also
being setup in all
the States who
have issued ban
notification (complete/partial) for testing iodine content of salt and
urinary iodine excretion which are the
most effective tools for proper implementation of IDD Control Programme. An allocation
of Rs. 75,000 per laboratory has been provided. For
the year
1996-97, budget provision has
been made for setting
up of one
IDD Monitoring Laboratory in each State/UT.
For ensuring
the quality control
of iodated salt
at consumption level, testing
kits for on the spot
qualitative testing of salt have been distributed to all
District Health Officers in
states.
During the
9th Five plan, it is proposed
to strengthen Monitoring of
NIDDCP to achieve the goal of universal
iodisation of salt. NIDDCP monitoring will be carried out at
the district level both by regular
checking of iodised salt as well as urinary iodine excretion. It is also
proposed to bring down the incidence of
IDD in all districts of the country below 10% level by
2000 A.D.
Training under NIDDCP Programmes :
Regular
training Programmes in Management and Monitoring of National
Iodine Deficiency Disorders Control Programme for
the Regional Directors of Health
and Family Welfare as well as the State
level Technical Officers are being organised regularly by the Directorate General of Health Services
at New Delhi. Training Programmes for
laboratory Technicians from the State
level IDD Monitoring Laboratories
are also being
organised by the Directorate General of Health Services
every year.
Monitoring
and Reporting System:
A
monitoring information system has been
developed in many states based on
a fixed number of salt samples
tested by the multipurpose workers. The MPWs use the
spot testing kit for this
purpose.
In addition to monitoring the use of iodised salt, this testing
kit has been proved to be an effective health education
tool for promoting the consumption of iodised salt.
Iodised
salt Vs Iodised oil in Prevention of IDD:
The
inexpensive technology, a time honoured and time tested one,
for the control of goitre is the iodation of common
salt. Programmes for goitre control must rest squarely and socially on
this technology. Periodic parenteral
administration of iodated oil
(not presently manufactured in India) has been suggested as an
alternative approach especially in
areas inaccessible to common salt. It is difficult to imagine any areas in
been a steep rise in the HIV seropositivity rate
among drug addicts in
Evaluation:
The status
of salt iodisation and iodine
deficiency in different states
has been extensively assessed
by different research studies in recent years. The available data
shows that the strategy
of salt iodisation has been
successful in the country in prevention and control of
iodine deficiency disorders. More
than 70% of population was found
consuming iodised salt. (Table 5,6,7,8,9).
The
research studies conducted has
identified following areas which
require strengthening:-