Title: Prevalence of goitre and utilization of Iodised salt in Uttarakhand

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Title Prevalence of goitre and utilization of
Iodised salt in Uttarakhand

• S.Kishore, A.K.Srivastava, K.S.Negi

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Introduction

• Iodine deficiency resulting in goitre recognized
  since centuries.
• Also leads to brain damage of fetus as well as
  infants as well as irreversible retarded
  psychomotor and mental development.
• Worlds single most significant cause of
  preventable brain damage and mental retardation.
• Problem statement
• World
• WHO reports 261 million suffering from brain
  damage associated with IDD including 10 million
  cretins.

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• Problem statement
• INDIA
• Major public health problem.
• Always thought that goitre and cretinism
  significant in himalaya goitre belt.
• BUT now No state in India free from iodine
  deficiency.
• Of 239 districts in 25 states and 4 union
  territories, 197 endemic for IDD.
  (ReferenceStatus report of NIDDCP)
• Based on estimates of population at risk of IDD
  with a cut off point 10 of total goitre rate.
• Estimated that with every passing hour 10
  children will not achieve optimum mental and
  physical potential.
• ICMR study identified total of 3011 cretins (1130
  males and 1881 females) (Reference ICMR task
  force study)

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Objectives

• To estimate the magnitude of the problem of
  endemic goitre and endemic cretinism in the
  selected district of Uttarakhand.
• To compare the severity of IDD in general
  population and among school going children
• To estimate the proportion of population in the
  selected district consuming adequate iodised salt
  ( 15 ppm).

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Methodology

• Uttarakhand Two regions a) Garhwal
  b) Kumaon
• Garhwal 07 districts whereas Kumaon 06
  districts
• One district from Garhwal region (Rudraprayag)
  and one district from Kumaon region (Bageshwar)
  selected by random sampling technique.
• Each district had population of approximately 2.5
  lakh.
• Rudraprayag is at the distance of 192 Km from
  HIHT, Dehradun while Bageshwar is 308 Km from
  HIHT Dehradun

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• Both Bageshwar and Rudraprayag were divided into
  five sectors.
• Sample size (for each sector on random sampling
  basis)
• - 1 of the total population surveyed
• - 5 of school children, both boys and girls
  in equal proportions
• - For salt samples about 10 gm. of salt
  collected in polythene bag from 200
  families/shops in each sector and analyzed using
  spot testing iodine kits (MBI Kits)

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• The survey was carried out with the help of
  respective medical officer of the PHC.
• Criteria for diagnosis of endemic goitre along
  with grading as laid down in policy guidelines of
  NIDDCP and ICCIDD were explained to MOs.
• Deputy CMO was given the overall responsibility
  of monitoring and supervising the field work,
  checking the completeness of form and collection
  of salt samples.
• A total of 4798 persons from general population
  and 5447 children of school going population in
  the age group of 5-14 years examined for goitre
  and cretinism.

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• A total of 1993 salt samples were collected and
  analyzed by MBI kits which is a starch based test
  for iodine content in salt and manufactured in
  Chennai
• Universal salt iodization (USI) is the most
  widely practised intervention in eliminating
  iodine deficiency disorders (IDDs) .
• Salt iodine testing is an important process
  indicator for monitoring progress towards USI.
• Under the National Iodine Deficiency Disorders
  Control Programme in India, iodization of salt is
  the recommended strategy, with the level of
  iodization fixed at a minimum of 15 parts per
  million (ppm) at the consumer level and 30 ppm at
  the production level.

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• Iodine spot-testing kits (MBI Kits) do not
  require any infrastructure, are inexpensive, and
  most importantly, provide immediate results
  suitable for rapid feedback.
• The kits give either a qualitative or a semi
  quantitative estimation of the iodine content.
• MBI kits give a semi quantitative estimate of
  iodine content of the salt.
• Kit categorizes salt samples as having an iodine
  content of 0, 7, 15, or 30 ppm. In addition to
  monitoring, iodine spot-testing kits are powerful
  tools for advocating good health and educating
  consumers about health.
• Programme managers use them as the sole tool for
  monitoring iodine content

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Results and Discussion

• Among the general population goitre was detected
  in 1.2 of the population .
• 0.42 of the school children suffered from
  goitre.
• 43.8 of the general population each was in Grade
  I and Grade IIa goitre while majority of the
  school going children (86.9) were in Grade I
  goitre.
• 8.6 and 4.4 school going children were in grade
  II and III respectively.
• In general population the prevalence of goitre
  was found to be 3 times more among females (1.8)
  than among males (0.6).
• 62.4 of the population were found to be
  consuming salt samples having content 15 ppm.

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• However earlier study in 2003-04 from Dehradun in
  Garhwal region and Nainital districts in Kumaon
  region have shown higher prevalence of IDD to be
  5.3 and 4.6 respectively in general population
  (4 5 times higher than present study)
• Similarly prevalence among school children was
  also 6.6 and 3.7 respectively (gt 10 times
  higher than the present study)
• Level of iodisation of salt was almost similar
  (68.5 and 61.0 respectively) in both district.
• Study conducted by ICMR, New Delhi and by IDD
  nutrition cell, DGHS, MOHFW, 1998 have also shown
  endemic goitre to be prevalent in 8 districts of
  Uttarakhand.

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• Present study shows that the state of Uttarakhand
  is in transition phase from iodine deficient to
  iodine sufficient.
• Growing awareness of the manifestation of IDD,
  and its impact on socio economic development as
  well as on individual health and development, led
  to great acceleration of utilising iodine salt.
• Also ban on sale of non iodised salt has also led
  to decline in prevalence of IDD and increase in
  consumption of iodised salt ( 15ppm).
• Despite encouraging result, still further
  strengthening needed for system monitoring of the
  quality of iodised salt being used.
• IEC activity also needs strengthening so that
  iodised salt consumption becomes 100.

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Thank you all for patience listening