Iodine Deficiency Disorders Control Program Research Articles

Diethylcarbamazine citrate-fortified salt for lymphatic filariasis elimination in India.

Lymphatic filariasis (LF) is a vector-borne neglected tropical disease, causing permanent disability. The disease is debilitating and widespread, leading to tremendous productivity and economic loss. The Government of India (GOI) prioritized the elimination of LF through the annual mass drug administration (MDA) programme in 2004 and continued with a single dose of diethylcarbamazine citrate (DEC), 6 mg/kg of body weight, plus albendazole annually over a period of 5-6 years. The GOI had set the target to achieve LF elimination by 2015 and now by 2030. The progress so far has been suboptimal. Much remains to be done as about 84 per cent of the total 328 endemic districts are still under MDA. The major challenge in implementing MDA is poor compliance. It is necessary to have a feasible alternative strategy addressing the above challenge to achieve the desired goal of LF elimination. At this juncture, a well-researched approach, i.e. the use of DEC-fortified salt, also advocated by the World Health Organization, as a unique form of MDA, is proposed. As per this strategy, a low dose of DEC (0.2% w/w) is added to the cooking salt at the manufacturing facility of iodized salt and consumed by the LF-endemic communities for about two years. Many examples of successful use of this strategy for LF elimination in small- and large-scale trials have been documented in India and several other endemic countries in the world. Implementing DEC-iodine-fortified salt is a safe, less expensive, more efficient and prompt approach for achieving the elimination of LF in India. Adverse effects are none or minor and self-limiting. The DEC-fortified salt strategy can easily piggyback on the existing countrywide deployment of iodized salt under the National Iodine Deficiency Disorders Control Programme (NIDDCP), which has achieved a great success in reducing iodine-deficiency disorders such as hypothyroidism. This existing robust programme can be leveraged to launch DEC-fortified salt for the community. If implemented appropriately, this strategy will ensure the complete cessation of LF transmission within two years from its introduction. If the said strategy is implemented in 2022, it is expected that India will be able to achieve the LF elimination by 2024, much before the global target of 2030.

Performance Evaluation of Iodine Deficiency Disorder Control Program in Chikmagalur District: A Cross-Sectional Community-Based Survey.

Routine evaluation of Iodine Deficiency Disorders (IDDs) is done through a national program called National Iodine Deficiency Disorder Control Program (NIDDCP). The aim of this study is to determine the goiter prevalence, to estimate salt Iodine and urinary Iodine levels. An institution-based cross-sectional study was conducted among 2700 school children across seven taluks of Chikmagalur. A total of 2700 children aged 6 to 12 years were selected from 30 clusters by multistage sampling method. The iodometric titration method and Sandell-Kolthoff method were used for the estimation of salt and urinary Iodine, respectively. Descriptive and Inferential statistics were used. The prevalence of goiter was 13.0%. About 153 (28.3%) salt samples had inadequate iodine content (<15 ppm). Median Urinary Iodine Excretion was 126 μg/L. Chikmagalur district is still at risk of a significant public health problem which needs timely interventions and appropriate measures to prevent further consequences due to IDDs.

Assessment of Iodine Deficiency among School-Going Children of Age Group 6 to 12 Years in Kachchh District, Gujarat State: Cross-Sectional Hospital-Based Study

Aim Iodine deficiency disorder (IDD) is the cause of preventable brain damage, mental retardation, and stunted growth and development in children. This study aimed to detect the prevalence of IDD in Kachchh district, Gujarat, by testing urinary iodine excretion levels and iodine intake of salts in school-going children. Methods A cross-sectional study was conducted and the level of iodine deficiency was assessed in 223 school children of both sexes, aged 6 to 12 years from four taluka s, that is, subdivisions, of the Kachchh district by estimating urinary iodine using Sandell–Kolthoff reaction along with iodine content in edible salt samples by MBI kit (STK-Spot testing kit, MBI Kits International, Chennai, TN, India). Results The median urinary iodine level was found to be 194 μg/L, indicating no biochemical iodine deficiency in the region. In the study areas, 1% of the population showed a level of urinary iodine excretion < 50 μg/L. About 83% salt samples had iodine level more than 15 ppm and the iodine content in salt samples less than 15 ppm was only about 17%, indicating the salt samples at households contain iodine in adequate level. Conclusion There is a need of periodic surveys to assess the change in magnitude of IDD with respect to impact of iodized salt intervention. Furthermore, to strengthen National Iodine Deficiency Disorders Control Program, factors should be identified. There is also a need to prevent and reimpose the ban on the sale of noniodized salts in Gujarat.

Performance evaluation of Iodine Deficiency Disorder control Program in Mandya District

Background: Considering the burden of Iodine Deficiency Disorders in our country, Government of India has an exclusive national health program to prevent it from becoming a major public health concern. To attain its objectives, National Iodine Deficiency Disorder Control Program (NIDDCP) undertakes routine evaluation of the Program all over the country. Aim &amp; Objective: To determine the prevalence of Goitre, to estimate Iodine content in salt samples and Iodine excretion in urine samples of schoolchildren aged between 6 to 12 years in Mandya district. Settings and Design: A cross sectional institutions based survey was conducted among schoolchildren from the villages in selected clusters of Mandya district. Materials and Methods: Probability Proportional to Size sampling method was used to select 30 clusters. 90 children aged between 6 to 12 years from each cluster were screened. Salt Iodine content was ascertained by Iodometric titration method and urinary Iodine excretion was estimated by Sandell-Kolthoff method. Statistical analysis used: Frequency, proportions and mean were calculated and inferential statistics were used. Results: Prevalence of Goitre was 4.4%, with higher prevalence among girls. 49.8% salt specimens lack adequate iodine (&lt;15ppm) at household level. Median UIE was 164 Micrograms /litre. Conclusions: As per the impact indicators, IDD is not a public health concern in Mandya district as of now.

Assessment of Iodine in Salt Samples from North Delhi Schools

Iodine is an essential micronutrient required for normal thyroid function, growth, and development. Iodine deficiency can lead to a variety of health and developmental consequences known as Iodine Deficiency Disorders (IDDs). Realizing the magnitude of the problem and to ensure its prevention by 100% consumption of adequately iodized salt (≥15ppm), National Iodine Deficiency Disorders Control Programme (NIDDCP) is being implemented in India. However, periodic assessment of the salt used is needed to ensure the same. Hence, with the objective of assessment of iodine, household salt samples were collected from students of four schools in North Delhi in October 2019. Awareness programme was also planned among the school children in view of Global Iodine Deficiency Disorders Prevention Day. The iodine content of the salt was estimated by standard iodometric titration method. 10 (10.4 %) salt samples were found to have iodine content &lt; 15 ppm. Reasons for low iodine content in the 10 samples need to be assessed along with the information regarding the type of salt used. Measures need to be taken to ensure 100 % consumption of adequately iodized salt (≥ 15 ppm). Also, such periodic assessment should be undertaken to find out the situation in different schools.

Knowledge and practice of mothers of school-going children regarding iodized salt and its association with the psychology testing of the students.

Context:Iodized salt is the mainstay intervention to tackle iodine-related disorders. In spite of the government's efforts to make iodized salt available in more than 90% of the households across the country, there are sketchy details on its use. Since the main propagators of this intervention are the mothers cooking in kitchen, this study was conceived, as a corollary to a larger micronutrient assessment study among school-going children.Aims:The aim of this was to assess knowledge, practice of mothers of school-going children (6-16 years) regarding use of iodized salt, and to see any association between the simple psychological testing of the children and the iodine content of the salt used in home kitchen and the contributing factors thereof.Methods and Materials:A cross-sectional study was conducted by interviewing mothers of 240 school-going children of age groups 6-11 years and 12-16 years from six schools of Bhubaneswar using a semi-structured questionnaire regarding their knowledge on iodine and its deficiency and the practice of using iodized salt. MBI kit was used to assess the iodine content of salt used at home. The psychology adeptness of students was assessed using the standardized and validated coding, standard progressive matrices, and colored progressive matrices tests.Statistical Analysis:Analysis was done using SPSS version 16, wherein the sociodemographic data were shown in proportions, and the iodine content was taken as the dependent continuous variable and means reported. For the sake of associations with intelligence and cognition, a binary logistic regression model was drawn.Results:It reports that 47.5% of mothers knew that iodized salt is good for health and iodine content measured using MBI kit was 15 ppm and above for 71.7% of the sample. Further, iodine content in salt is seen as protective for cognition and also for IQ.Conclusions:The knowledge of the mothers’ needs reinforcement regarding iodine and related disorders and the benefits of iodized salt. The aim of the National Iodine Deficiency Disorders Control Program can only be achieved by generating awareness, regular follow-up, and improving the iodization of salt.

National Consultation-cum-Brain Storming Session on Fortification of Edible Salt with Micronutrients

Micronutrient malnutrition (MNM) can affect all age groups, but young children and women of reproductive age tend to be among those most at risk of developing micronutrient deficiencies. In India, Iodine Deficiency Disorders and Iron Deficiency Anaemia are important Public Health problems.No state in India is free from iodine deficiency. Out of 343 districts surveyed, 286 are reported have Iodine Deficiency Disorders. Iron Deficiency Anaemia is reported in about 60% population across all age groups. The magnitude of vitamin B12 Deficiency is reported to be about 47% in urban population of Delhi while Zinc Deficiency is reported in about 44% amongst Indian children. In addition, there are other micronutrients and minerals like folic acid which are of public health concern.&#x0D; &#x0D; Fortification of food is one of three primary strategies to combat micronutrient deficiencies. Fortification is defined by the World Health Organization (WHO) and the Food and Agricultural Organization of the United Nations (FAO) as "the practice of deliberately increasing the content of an essential micronutrient, i.e. Vitamins and minerals (including trace elements) in a food irrespective of whether the nutrients were originally present in the food before processing or not, so as to improve the nutritional quality of the food supply and to provide a public health benefit with minimal risk to health”. Food fortification is one of the most cost effective ways to make up for the deficient vitamins and minerals in low quality diets. Edible salt is the most widely used food vehicle for fortification with micronutrients.&#x0D; &#x0D; Fortification of salt with iodine, under the National Iodine Deficiency Disorders (IDD) Control Programme, has been the strategy in operation in the entire country as a universal policy since 1962 to combat IDD. This has led to prevention and control of IDD in the country. In 1970s, an attempt was made to develop Iron fortified salt (IFS) or edible salt fortified with Iron. Efficacy trials and multi-centric effectiveness trials were conducted and documented positive results. However, with the policy focus on Universal Salt Iodization Programme in the country, IFS was not introduced in the country.&#x0D; &#x0D; Subsequently in 1980s, the National Institute of Nutrition (NIN), India, Hyderabad developed edible salt fortified with Iron and Iodine, referred to as double fortified salt (DFS) or NIN-DFS. Efficacy studies were conducted with DFS with mixed results. Large scale effectiveness trials (under public health intervention conditions/programmatic conditions) have not been undertaken. In 1980s, another formula for production of DFS, using the encapsulation process for fortification of salt with iron and iodine, was developed by Micronutrient initiative (MI) - referred to as Micronutrient Initiative (MI) formula or MI-DFS. Both DFS-NIN and DFS-MI formulae are being used by Tamil Nadu State Government for ICDS and Mid-Day Meal Programme in the state. In 1990s, Sunder Chemicals also produced DFS using its own formula and undertook efficacy trials. The Human Nutrition Laboratory, Swiss Federal Institute of Technology, Switzerland also has a DFS formula, which has not been used or tried in India. However, findings from efficacy trials of this DFS are available in the peer review scientific journals.&#x0D; &#x0D; To date, only one multi-micronutrient fortified edible salt (MMNS) has been produced in India. This was produced by Sundar Chemicals Pvt Ltd., a private sector undertaking, in 1990s.Edible Salt is fortified with 10 micronutrients, namely, Iron, Iodine, vitamin A, vitamins B1, B2, B6, B12, Folic Acid, Niacin and Calcium. The results of the efficacy trials have been published in peer reviewed scientific journals. A positive impact has been documented on the micronutrient status of the beneficiaries consuming such fortified salt.&#x0D; &#x0D; The Ministry of Women and Child Development has adopted a policy that NIN-DFS is to be utilized for the feeding component of the ICDS programme. There are more than 10 salt producers who have been recognized by NIN as producers of double fortified salt using NIN-DFS formula and are supplying DFS to ICDS in selected states. In Tamil Nadu state, the mid- day meal programme in schools also use DFS, produced by Tamil Nadu Salt Corporation, using NIN or MI formulae.

Iodate induced toxic retinopathy: a case report

BackgroundIodine deficiency is a common preventable cause of intellectual and developmental disabilities. Iodine in the form of potassium iodate is added to the common salt under the National Iodine Deficiency Disorder Control Program in India. Overdose of iodate can lead to retinal toxicity.Case presentationWe hereby present a case of a 34 year old male patient who presented to us 10 years following iodate ingestion. There was widespread outer retinal atrophy, foveal atrophy and sub-retinal fibrosis noted on fundus evaluation. The fundus fluorescein angiogram was suggestive of window defects while the scotopic electroretinogram showed diminished amplitude pointing towards a grave prognosis.ConclusionsExcessive ingestion of potassium iodate can lead to outer retinal atrophy due to its toxicity to the retinal pigment epithelium and photo-receptors. The degree of damage is dependent on the ingested dose.

National Iodine Deficiency Disorders Control Programme: Current status & future strategy.

Iodine deficiency disorders (IDDs) constitute a significant public health problem globally. In India, the entire population is prone to IDDs due to deficiency of iodine in the soil of the sub-continent and thus both animal and plant source food grown on the iodine-deficient soil. IDDs encompass the spectrum of disability and disease and include goitre, cretinism, hypothyroidism, abortion, stillbirth, brain damage, learning disabilities, mental retardation, psychomotor defects, hearing and speech impairment. Iodine deficiency is known to be the single largest cause of preventable brain damage. IDDs with their causal association with brain development, cognition, and learning disabilities impair the human resource development and progress of the country. The children born in iodine-deficient regions on an average have 13.5 intelligence quotient (IQ) points lesser than children born in iodine-sufficient regions. IDD control programme in India is a public health success story, with 92 per cent of the population consuming iodized salt. The partnership between government agencies, academic institutions, salt industry, development agencies and civil society has been key to achieve this success story. The sustainable elimination of iodine deficiency in India is within reach, what is required is accelerated and coordinated effort by all key stakeholder at national and State level.

Past, present, and future of iodine deficiency disorders in India: Need to look outside the blinkers.

Iodine deficiency disorders (IDDs) have been recognized as one of the major nutritional disorders throughout the world affecting 200 million people who are at risk and another 71 million suffering from goiter and other IDDs. These groups of disorders can affect every stage of life, but most vulnerable age group is between 6 and 12 years and these disorders together constitute the single largest preventable cause of brain damage leading to learning disabilities and psychomotor impairment. The existence of endemic goiter in an extensive belt along the southern slopes of the Himalayas, Alps, and Andes has long been described, but consistently high prevalence of IDDs outside the endemic zones and failure to attain goals set by the National Iodine Deficiency Disorder Control Program questions the strategy and achievements till date. Therefore, the present article is an attempt to critically examine the program since inception in India.

Assessment of iodine concentration in dietary salt at household level in Morocco.

BackgroundFollowing WHO recommendations, Morocco adopted in 1995 the universal salt iodization (USI) as a strategy to prevent and control iodine deficiency disorders. In 2009, the standard salt iodine concentration was adjusted to 15–40 mg/kg. The success of USI for the control of iodine deficiency disorders requires an evaluation of iodine concentration in salt prior to assessing the iodine nutritional status of a population.MethodsIn our study we refer to the anterior studies that were made in Morocco in 1993 and 1998. 178 salt samples from households were tested for iodine using spot-testing kits. The iodometric titration method was used to analyze accurately the concentration of iodine in the 178 household salt samples. An empiric polling method was adopted, using a non-probability sampling method; across the different twelve regions in the country.ResultsThe median and interquartile range iodine concentration in salt was 2.9 mg/kg (IQR: 2.4-3.7). The results show that only 25 % of households use iodized salt. The recommended iodine concentration in salt of 15–40 mg/kg was met only in 4.5 % of salt samples. The bulk salt is used by 8 % of households. All samples of this bulk salt were found in rural areas. According to nonparametric appropriate tests used, there is no significant difference in iodine concentrations between regions, between urban and rural areas and between packaged and bulk salt.ConclusionsTwo decades since introducing legislation on Universal Salt Iodization, our survey shows that generalization of iodized salt is far from being reached. In 2015, only a quarter of Moroccan households use the iodized salt and only 4.5 % of salt is in conformity with regulations. The use of bulk salt by households in rural areas constitutes a major obstacle to the success of USI. The National Iodine Deficiency Disorders Control Program can only be achieved if an internal follow-up and a control of external quality of program is put in place.

Prevalence and Factors Associated with Goitre among 6-12-year-old Children in a Rural Area of Karnataka in South India.

In India, endemic goitre is present in sub-Himalayan region and in pockets in states of Andhra Pradesh, Karnataka and Gujarat. Being a public health problem amenable for prevention, the assessment of prevalence of endemic goitre in an area helps in understanding whether the preventive strategies under National Iodine Deficiency Disorder Control Program (NIDDCP) have any impact on the control of endemic goitre. Hence, the current study was carried out to determine the prevalence, distribution and factors associated with iodine deficiency goitre among 6-12-year-old children in a rural area in south Karnataka. A cross-sectional study was conducted among 838 children, using a questionnaire adopted from Iodized Salt Program Assessment Tool and the tools prescribed by WHO for goitre survey. The prevalence of goitre in the study area was 21.9% (95% CI 19.2-24.8). There was higher prevalence of goitre among those having salt iodine <15 ppm than those with >15 ppm (P = 0.01; OR 1.59; 95% CI 1.10-2.29). In 10% of the children, urinary iodine excretion (UIE) was assessed and prevalence was higher among those with <100 μg/l of UIE than those with normal UIE, which was not statistically significant (P = 0.8, OR 1.36; 95% CI 0.62-2.96). Multiple logistic regression revealed that gender (P = 0.002; OR 1.7; 95% CI 1.21-2.35) was an independent variable associated with goitre. The study area was found to be moderately endemic for goitre based on the WHO criteria. Higher prevalence of goitre was found to be still associated with consumption of low iodized salt (<15 ppm) necessitating emphasis on monitoring of salt iodine levels in the study area. Though NIDDCP is being implemented since five decades in India, the burden of iodine deficiency disorders (IDDs) is still high demanding further impetus to the monitoring systems of the programme.

An overview of the development and status of national nutritional programs in India

Under nutrition is still a major problem in India and at the same time overweight and obesity are also beginning to affect a substantial proportion of the population. Macro and micronutrient deficiencies affect a significant proportion of the population. Children, pregnant, and lactating women are the most affected with the retardation of cognitive and physical growth, increased susceptibility to infections which ultimately affects productivity of the country. Hence, the Government has devised several national programs like Integrated Child development services (ICDS), National Iron + initiative, National Iodine deficiency disorder control program (NIDDCP) etc., The activities under each program have been listed and its impact as assessed by various evaluation programs has also been mentioned. The determinants of under nutrition are a result of a complex interaction between various factors articulated by UNICEF as immediate, underlying, and fundamental determinants. The fact remains that inspite of all the programs, household food security is determined by a more complex array of factors. Concerted effort and a convergence by all the programs are required with particular emphasis on gender equity. More attention is required in rural areas, scheduled caste and tribe people, very young children between 0-2 years, and the girl child.

Iodine deficiency status amongst school children in Pauri, Uttarakhand.

To assess the iodine deficiency status amongst school age children in district Pauri, Uttarakhand. 2067 children (age of 6-12 years) were included. Clinical examination of thyroid gland of each child was conducted. On-the-spot urine and salt samples were collected from children. Total Goitre Rate was found to be 16.8% and median Urinary Iodine Concentration level was 115 µg/L. Only 40.4% of salt samples had e 15 ppm of iodine. There is a mild degree of iodine deficiency in school age children in district Pauri. There is a need of strengthening the National Iodine Deficiency Disorder Control Program.

Iodized Salt Consumption in Sudan: Present Status and Future Directions

Iodine Deficiency Disorders (IDD) Control Programme in Sudan adopted salt iodization as the long-term strategy in 1994. In 2000, it was found that less than 1% of households were using adequately-iodized salt. The objectives of this study were to: (i) study the coverage and variation of different geographical regions of Sudan regarding access to and use of iodized salt, (ii) explore the possible factors which influence the use of iodized salt, (iii) develop recommendations to help in the implementation of the Universal Salt Iodization (USI) strategy in Sudan. This paper is based on the Sudan Household Health Survey (SHHS) dataset. A total sample of 24,507 households was surveyed, and 18,786 cooking salt samples were tested for iodine levels with rapid salt-testing kits. Nationally, the percentage of households using adequately-iodized salt increased from less than 1% in 2000 to 14.4%, with wide variations between states. Access to iodized salt ranged from 96.9% in Central Equatoria to 0.4% in Gezira state. Population coverage with iodized salt in Sudan remains very low. The awareness and political support for USI programme is very weak. National legislation banning the sale of non-iodized salt does not exist. Utilization of the already-existing laws, like the National Standardization and Metrology Law (2008), to develop a compulsory national salt specification, will accelerate the USI in Sudan.

Evolution of iodine deficiency disorders control program in India: A journey of 5,000 years

Iodine deficiency disorders (IDD) has been documented since around 5,000 years. However, geological factors like frequent glaciations, flooding, and changing of course of rivers has led to iodine deficiency in soil. As a result everyone remains at risk of IDD, if optimum intake of iodine is not sustained. Evolution of the IDD control program in India has been a dynamic process. The model of IDD control program in India provides important lessons for successful implementation of a national health program. In formulating National Health Programs; policy environment, scientific inputs, political will, and institutional structure for decision making are necessary but not sufficient. Continuous and dynamic generation of reliable and representative state and national level data, proactive recognition of values of key stakeholders and addressing them through sustained advocacy, development of partnerships among stakeholders, institutional continuity, and mentorship are critical for achieving sustainability of results.

IODINE LEVEL OF IODIZED SALT REQUIRED IN ENDEMIC AREA

Iodized salt had been used in many countries for long term iodine deficiency disorders (IDD) control program. Several things should be considered related to iodine loss in iodized salt, e.g. iodine loss during cooking that may effect the effectivity of the program. Too high iodine level on the other hand, will cause health problems such as iodine-induced hyperthyroidism (IIH) and autoimmune thyroiditis. The purpose of this study was to know the level of iodine in iodized salt required in endemic area to meet the iodine recommended daily allowance (RDA) of 150 ?g/person/day. This study was a field trials using treatment by subyect design. Ten schoolchildren were selected systematically to get ten clusters of schoolchildren families. All members of the families were 33 persons (2 families were droped out). Urine examination showed the mean of urine iodine excretion (UIE) 84.8 ± 32.11 ?g/L and 208.1 ± 89.24 ?g/L of non-iodized salt and iodized salt consumption respectively. Salt intake was 6.64 g/person/day and iodine loss during cooking was 25%. Iodine level of iodized salt required in mild endemic area was 22 ppm at consumer level or 32 ppm at production level. This result was slightly higher than the minimum range (30 ppm) and much lower than the maximum range (80 ppm) was the level of iodine in iodized salt that was detemined by the government (30-80 ppm). Based on this finding, the range of iodine level in iodized salt production should be rivised according to the endemicity of area (mild, moderate, and severe).

Economic evaluation of iodine deficiency disorder control program in Sikkim: A cost effectiveness study

Edible salt iodization and iodized oil injections are the two most commonly used vehicles for iodine supplementation. In year 1989, the state government of Sikkim was planning to implement Iodine Deficiency Disorder control program in state and had following two options to choose from, based on existing knowledge; a) a salt iodization program, b) an iodized oil injection program. No information was available at that point of time on comparative advantages of the above stated two approaches. To identify the most cost-effective alternative for IDD elimination in Sikkim, amongst the following 3 alternatives: a) Iodized salt program (ISP), b) Iodized oil injection program (IOP) to high risk group, c) no preventive program. Study population was the general population of state of Sikkim, India in year 1990. Cost- effective analysis was undertaken comparing 3 alternative programs, targeted towards IDD elimination in state of Sikkim. Identification, measurement and valuation of the costs of ISP and IOP and identification and measurement of the consequences of IDD were done to carry out the cost-effective analysis. Visible goiter person years (VGPY), endemic cretinism, IDD attributable death were used to assess the health consequences/disease burden of IDD. The cost per VGPY, endemic cretinism and IDD attributable death were Rs 76.67, Rs 24,469 and Rs 9,720, respectively for ISP. The cost per VGPY, endemic cretinism and IDD attributable death were Rs 75.82, Rs 19,106 and Rs 7,709, respectively for IOP. The results of the analysis showed that iodized oil program is more cost-effective for prevention of irreversible IDDs than the iodated salt program in state of Sikkim, India.

Economic evaluation of iodine deficiency disorder control program in Sikkim: A cost-benefit analysis

Iodine deficiency disorders (IDDs) are the most common cause of preventable brain damage globally. The strategy of prevention and control of iodine deficiency is based on iodine supplementation. Edible salt iodization and iodized oil injections are the two most commonly used vehicles for iodine supplementation. The objective of the study was to conduct a cost-benefit analysis of the two programs of iodine supplementation, i.e., iodized salt program (ISP) and iodized oil program (IOP) against no preventive program (NPP) option. The study was conducted in 1990 in the state of Sikkim in India. The costs were calculated on the assumption of universal coverage of ISP and coverage of IOP among all children aged 0-14 years and women in the age group of 15-44 years. Direct and indirect cost of ISP and direct cost of IOP was computed based on the costs of year 1991. The discount rate taken was 10% and all the costs were converted to the year 2010 using wholesale price index (WPI) data. Consequences in terms of health effects, Social/emotional effects, and resource use were included. The discounted cost of ISP and IOP was Rs. 59,225,964 and Rs. 46,145,491, respectively. In ISP, 64.1% of the total cost was required for salt iodization, 17.6% for monitoring, and 18.3% for communication. In IOP, 50.9% of the costs were required for iodized oil; rest was for syringes and needles, manpower expenses, travel, and communication. Total resource saving was Rs. 95,566,220 for ISP and Rs. 92,177,548 for IOP. Incremental benefit for ISP was Rs. 36,340,256 and Rs. 46,032,057 for IOP. The cost-benefit ratio for ISP was 1.61 and 2.00 for IOP. IOP has a higher cost-benefit ratio for prevention of IDDs than ISP in the state of Sikkim, India.

Iodine status in late pregnancy and psychosocial determinants of iodized salt use in rural northern Viet Nam

To establish iodine status among pregnant women in rural northern Viet Nam and explore psychosocial predictors of the use of iodized salt in their households. This prospective study included pregnant women registered in health stations in randomly-selected communes in Ha Nam province. At recruitment (< 20 weeks of gestation), sociodemographic factors, reproductive health, intimate partner relationship, family violence, symptoms of common mental disorders and use of micronutrient supplements were assessed. During a second assessment (> 28 weeks of gestation) a urine specimen was collected to measure urinary iodine concentration (UIC) and iodized salt use was assessed. Predictors were explored through univariable analyses and multivariable linear and logistic regression. The 413 pregnant women who provided data for this study had a median UIC of 70 µg/l; nearly 83% had a UIC lower than the 150 µg/l recommended by the World Health Organization; only 73.6% reported using iodized salt in any form in their households. Iodized salt use was lower among nulliparous women (odds ratio, OR: 0.56; 95% confidence interval, CI: 0.32-0.96); less educated women (OR: 0.34; 95% CI: 0.16-0.71); factory workers or small-scale traders (OR: 0.52; 95% CI: 0.31-0.86), government workers (OR: 0.35; 95% CI: 0.13-0.89) and women with common mental disorders at recruitment (OR: 0.61; 95% CI: 0.38-0.98). The decline in the use of iodized salt in Viet Nam since the National Iodine Deficiency Disorders Control Programme was suspended in 2005 has placed pregnant women and their infants in rural areas at risk of iodine deficiency disorders.