I D D N E W S

V O L . X I V, I S S U E 1 , M A R C H 2 0 1 6

Bangladesh visit by South Asia IGN/ICCIDD Team for strengthening Universal Salt Iodisation programme and providing

Quality Assurance/ Quality Control Training to the Control of Iodine Deficiency Project Personnel

IGN/ICCIDD team with Mr. Abu Jamil (4th from left) and Owner and Workers of

Salt Mills in Islampur, Cox’s Bazzar

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In this Issue

Editorial Board

Chief Editor

Dr. Chandrakant S.Pandav

Managing Editor

Dr. Kapil Yadav

Editors

Dr. Harshal Salve

Ms. Rijuta Pandav

Dr. Anamika Wadhera

Editorial Advisers:

Shri L.M.Jain, IAS (retd.)

Adv. Makarand Adkar

Shri M.A. Ansari

Shri Bejon Misra

Dr. R. Lakshmy

Dr. Pradeep Saxena

Dr. Rajesh Khadgawat

Shri. Bhupesh Joshi

Patrons

Shri R.V. Pillai, IAS (retd.)

Editorial Assistants

Shri Pritam Singh

Shri Rajesh Lal

Printed & Published by:

Ms. Smita Pandav

on behalf of ICCIDD

E-mail: pandavsmita04@yahoo.co.in

Website: www.iqplusin.org

Designed & Printed at Sona Printers Pvt. Ltd.

F-86/1 Okhla Industrial Area, Ph-I

New Delhi-110020

Ph.: 41616566, 26811313

Demand & Consume Iodised Salt

for Prevention of brain damage

Healthy Children,Healthy Nations

tIGN/ICCIDD Team Visited Dhaka, Bangladesh for strengthening of USI

tIGN/ICCIDD provided Technical assistance in National Iodine Status Survey in Sri Lanka

tIGN/ICCIDD participated in 43rd Annual Conference of IAPSM at Gujarat

tIGN/ICCIDD participated in IPHA Conference at the HIMS, Dehradun

tBan sale of “salt for preservative purpose” packed in less than 2 kilograms pouches

t21st Meeting of NCSOII at AIIMS, New Delhi

tIGN/ICCIDD participated in Training of NIDDCP, Nutrition & IDD cell at NIHFW, New Delhi

tIGN/ICCIDD, successful performance under CDC Equip Certification

tJanuary Calls for International Thyroid Disease Awareness Month

tIDD related Abstracts Published from India in year 2015

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ICCIDD�Vision,�Mission�&�DedicationVision:The�vision�of�ICCIDD�is�a�world�virtually�free�from�Iodine�Deficiency�Disorders�with�national�endeavors�to�maintain�optimal�iodine�nutrition�primarily�through�consumption�of�iodised�salt,�which�should�be�made�easily�available�and�affordable�for�all�people�for�all�times.

Mission:�The�mission�of�ICCIDD�is�to�provide�a�focused�advocacy�to�governments�and�development�agencies,�for�a�continued�priority�for�iodine�nutrition,�and�providing�technical�expertise�in�a�multi�disciplinary�approach.

Dedication:�ICCIDD�dedicates�itself�to�programmes�fully�supported�at�the�national�level�for�permanent,�sustained�success�and�will�work�with�all�partners�and�national�entities�towards�that�end.

Dr.�Chandrakant�S.�Pandav

Regional Coordinator - IGN-South Asia Region

Room No 28,Centre for Community Medicine (CCM)

Old OT Block, All India Institute of Medical Sciences (AIIMS),

New Delhi 110029

Dear Colleagues,

New year 2016 provides us an opportunity to review work done in the year 2015 and plan strategies for this year to sustain IDD elimination in the region.

In this context South Asia regional office team made visit to Bangladesh to track progress of IDD elimination in the country. During this visit the team met

various stakeholders of the programme and identified gaps and challenges in the USI programme in the country. In the year 2016, IGN/ ICCIDD plans to

undertake a comprehensive USI programme review in Bangladesh in collaboration with other developmental partners. Sri Lanka is planning to undertake

National IDD Status Survey in the country. In this regard, IGN South Asia regional Office provided technical inputs in planning and execution of survey.

IGN/ICCIDD consultant attended technical meeting at Medical Research Institute, Colombo. We are covering detailed report on it in this issue.

thIGN/ICCIDD along with Micronutrient Initiative (MI) organized a session on “Celebrating Success Story of IDD Elimination in India” at 60 Annual th thConference of Indian Public Health Association in Dehradun, Uttrakhand on 4 to 6 March 2016 . In this event result of recently concluded National IDD

and Salt Intake Survey – 2015 were shared with gathering of public health professional in India. Also, experiences of National and State USI Coalitions

were shared. The session was well received by the audience attending the conference. IGN/ICCIDD also participated in Annual Conference of India th thAssociation of Preventive and Social Medicine at Gandhinagar, Gujarat on 7 to 9 January, 2016.

IGN/ICCIDD, Regional Office participated in and provided technical inputs for training workshop for State Programme Officers under National Iodine nd thDeficiency Disorders Control Program (NIDDCP) organized by Ministry of Health, Government of India from 2 to 4 March 2016 . We are including brief

report about this workshop in this issue. All partners in National USI Coalition met and reviewed progress made in last year and also discussed future

strategies for this year.

We have also covered results of an important survey done in 2015-16 regarding ban on sale of salt for preservative purpose, packed in less than 2

kilograms pouches ,by a consumer protection agency, Thiruvarur District Tamilnadu Consumer Protection Centre in the state of Tamil Nadu by MI in this

issue.

Synopsis of scientific work carried out in India regarding IDD in the year 2015 is also covered in this issue.

I hope that this issue will provide scientific and programmatic information from South Asia region to all our readers.

Dr. Chandrakant S. Pandav

Regional Coordinator, South East Asia

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Review of the activites of MI in Bangladesh:

The IGN/ICCIDD team visited Bangladesh to conduct an external review of the activities of Micronutrient Initiative (MI) and recommend future strategies for strengthening universal salt iodisation (USI) in the country. The visit took place in January, 2016.

The objectives of the visit were: (i) To critically review MI's planned USI activities for the period 2014-2017 and to identify its role for the next 3-4 years post CIDD (Control of Iodine Deficiency

Disoders) project period to maintain growth of salt iodisation. (ii) To identify gaps in terms of laboratory practices, chemical and reagent preparation, storage and handling of equipment and testing procedures for iodine content of salt.(iii) To train laboratory personnel of CIDD project in iodometric titration for estimation of salt iodine content, quality assurance (QA) and quality control (QC) protocols. (iv) To assist MI in reviewing and modifying the laboratory manual for iodometric titration in English and Bangla.

IGN/ICCIDD Team visited Dhaka, Bangladesh for strengthening of Universal Salt Iodization, January 2016

Technical and operational assistance to small and medium producers

Quality Assurance System

Policy advocacy for monitoring and law enforcement

Ÿ The MI officials embedded in the CIDD field offices were deemed highly qualified and dedicated.

Ÿ Records maintained by the MI laboratories should be linked to the regulatory action by the government officials.

Ÿ Regular periodic training and maintenance being provided to the SIP operators needs to be taken over by the CIDD project and salt

producers to ensure the sustainability of the program.

Ÿ Quarterly review meeting for millers for performance analysis and feedback for corrective measures was diligently being implemented.

Ÿ It is necessary to upgrade the quality of crude salt

Ÿ Major critical maintenance work of selected SIPs and assessment and support of small millers should be taken up by the producers

themselves.

Ÿ QA/QC system should be continued with the addition of the External Quality Assurance component

Ÿ Regular feedback should be provided to participating laboratories regarding performance of QA/QC program.

Ÿ The initiative for validation of salt samples tested at zonal labs was excellent, particularly the engagement of Institute of Public Health

Nutrition (IPHN) as the reference laboratory. Feedback on external validation should be shared with the field laboratories. Field visit by the

reference laboratory personnel to the field laboratory should be facilitated.

Ÿ The zonal laboratories visited were in excellent condition but should have a QA/QC system. MI may consider supporting small and medium

scale salt producers to establish laboratories.

Ÿ Refresher training for field staff has been regular. It could be hosted by zonal labs by rotation. The laboratory training may be expanded to

include Bangladesh Standards and Testing Institute (BSTI) as well law enforcement agency personnel.

Ÿ The support to update GSIIS and BSIIS databases and transfer to the Govt. of Bangladesh should continue. Both GSIIS and BSIIS should be

integrated with the monitoring regulatory activities being undertaken by the CIDD officials.

Ÿ Award ceremonies for best millers & exposure trips for government officials should be organized.

Ÿ Regular high level policy dialogue organized by MI in districts needs to continue and be initiated at the national level for high-level

advocacy with key policy makers in Bangladesh.

Ÿ Revision of Salt Law is necessary.

Ÿ Different iodisation standards by different agencies (CIDD, BSTI) is hampering the regulatory monitoring of salt iodisation in Bangladesh.

Ÿ Mobile courts should be leveraged optimally to strengthen the program.

Ÿ Special sensitization and advocacy meetings with the law enforcement personnel and special campaigns focusing only on iodised salt

should be organized in the salt processing zones.

Ÿ Advocacy for mainstreaming the CIDD as a government program is essential for the sustainability of the USI program.

Ÿ The National USI Coalition should be established with representation from all key stakeholders of USI Program The Coalition should expand

its current mandate from program monitoring towards high-level advocacy.

Ÿ Studies should be conducted on (i) novel techniques to improve the quality of crude salt production (ii) the salt supply chain to minimize

costs and (iii) iodised salt consumption to provide a baseline for harmonization of salt reduction and salt iodisation strategies and

monitoring trends in salt consumption in the future.

5

Field visit to salt producing areas and salt mills Cox's Bazaar and Chittagong, Bangladesh

The two membered team of ICCIDD/IGN comprising of Dr. Chandrakant S Pandav, Regional Coordinator (South Asia) and Dr Kapil Yadav, National Coordinator (India) visited the salt producing areas and salt mills in Cox's Bazaar and Chittagong districts ,the salt iodisation unit of the Bangladesh Rural Advancement Committee (BRAC) and the CIDD Zonal laboratory in Islampur and the Chittagong Zonal Office of CIDD. The team was accompanied by Mr Md Abu Jamil, Project Director, CIDD and the MI Field Monitoring officers.

The team reviewed the salt pans and the records maintained by the laboratory staff, interacted with the salt workers and the supervisors and discussed with them in detail the reasons behind the sub-optimal quality of crude salt produced as well as the difficulties faced in scaling up salt production and iodisation.

The ICCIDD/IGN team also visited the Institute of Public Health Nutrition (IPHN), the focal institution for CIDD project in Ministry of Health and Family Welfare. Dr. Pandav briefed them about the objectives of IGN team visit and requested them for greater participation of the IPHN in IDD program activities in the country. The IGN team also visited and reviewed the records of the IPHN IDD laboratory. Dr Taherul Islam Khan apprised IGN team of their participation in the recently concluded national USI Survey. MI had played a key role in revitalising the IDD laboratory at IPHN and had also facilitated the refresher training for the laboratory personnel.

Training of laboratory method for salt iodine estimation and QA/QC procedures

Two one day training programs were organised by the ICCIDD/IGN team in collaboration with the Institute of Nutrition and Food Sciences, Dhaka University on 19th and 20th January, 2016.

The objectives were (i) To provide refresher training to laboratory and field monitoring personnel of CIDD project in

salt iodine estimation methods and QA and QC methods. (ii) To review the different manuals available for iodine content estimation and develop a standardised “Laboratory and QC/QA Procedures for Universal Salt Iodization Program”

The training session was inaugurated by the Chief Guest, Mr Patit Pabon Baidya, Director (Project), BSCIC. Several distinguished guests were present -Mr Lutfor Rahman Tarofder, Joint Chief, Ministry of Industry, Dr Nazma Shaheen, Director, INFS, Mr Md Abu Jamil, Project Director, CIDD,BSCIC, Dr S M Mustafizur Rahman, Country Director, MI and Dr Cadi Praveen, INFS.

The inauguration was followed by the technical training session, which included demonstration of the iodometric titration by the INFS resource person. The topics covered were iodine metabolism and its role in the human body, epidemiology & prevention of IDD, relevant statistical issues, IDD survey methodology, IDD Monitoring/ Evaluation, salt iodine content analysis. This session was followed by a session on QA/QC protocol to be followed during iodometric titration and plotting of Levy-Jenning plot. At the end of the training, question and answer session was conducted where queries raised by the participants were addressed.

Recommendations to strengthen the Laboratory QA/QC program of CIDD supported by MI-

1. Standardisation of the laboratory method including the laboratory manual

2. Periodic review of the inventory of the participating laboratories

3. Introduction of External Quality Assurance procedures with exchange of unknown value samples by the external validation laboratory

4. Regular feedback to the participating laboratory regarding the results of QA/QC procedure

5. Establishing linkages with the salt iodine monitoring laboratories of the salt producers

6. Initiating field visits to the participating laboratory by the external validating laboratory resource personnel

Team with laboratory staff of BSCIC Zonal Office,

Chittagong

Dr Chandrakant S Pandav interacting with

Mr Jahangir Khan, owner salt mill, Islampur

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On behalf of IGN, South Asia Office, New Delhi, India, Dr. Harshal R Salve, Assistant Professor, Centre for Community Medicine,

th thAIIMS, New Delhi visited Colombo, Sri Lanka on 15 – 16 February, 2016.

The objectives of this visit were –

(I) To provide technical inputs to methodology and laboratory quality assurance during proposed IDD survey in Sri Lanka

(ii) Inspection of IDD laboratory at Medical Research Institute (MRI), Ministry of Health, Colombo, New Delhi

A meeting at MRI, Ministry of Health, Colombo was held to discuss the IDD survey in Sri Lanka and attended by distinguished guests such as Dr. Sumith Ananda, Director/ MRI, Dr. S. Ratnayake, Deputy Director/MRI, Dr. R. Jayatissa, Head, Health and Nutrition/UNICEF and several officials from MRI. Dr. Salve presented the methodology, results and lessons learned of the recently concluded National Iodine and Salt Intake (NISI) Survey - 2015 in India. Dr. Yasaswi presented the proposal for the national survey on iodine deficiency status in Sri Lanka 2016.

The main points made regarding the proposed National IDD Survey were:

(I) For household salt iodine estimation, 30 clusters per province and 30 samples per cluster would be taken by random sampling from samples from all the children in a selected class with. Total sample size would be-8100. (9 provinces x 30 x 30)

(ii) For urine iodine estimation, in a selected class, 20 students will be selected using systematic sampling technique with a total sample size of 5400. (9 provinces x 30 x 20)

(iii) A brief self-administered questionnaire, including information sheet on socio-demographic variables, will be used to collect above data.

(iv) Containers sufficient for 50 grams of salt would be used and 2ml small tubes would be used for urine storage.

For quality assurance (QA) of the laboratory assessments, it was recommended to establish a collaborative external quality assurance programme with IGN, South Asia regional lab in New Delhi (India), to refer to laboratory manual to for the Levy Jenning plots, for burette readings and PPM values and to arrange cross assessment at National Institute of Health Sciences (NIHS) laboratory and the Government analysts' laboratory.

A debriefing session with Director, MRI, Ministry of Health, Colombo was held on the second day. It was decided that the training and data collection of the Iodine Survey, 2016 would be

nd stcarried out during the period of 22 of April -21 of May 2016 and the salt lababoratory would be refurbished as recommended to ensure quality.

Dr. Salve also visited IDD laboratory of National Institute of Health thSciences (NIHS), Kaluthra, Sri Lanka on 16 February, 2016. The

condition of the laboratory was found to be satisfactory. The Chief Chemist also identified the need of external quality control for the IDD laboratory would discuss about an external quality control mechanism with IGN South Asia with the Director of the institute.

IGN/ICCIDD provided technical assistance in National Iodine Status survey in Sri Lanka - Dr. Harshal Salve

15th - 16th February 2016

L to R: Dr. Yasaswi Walpita – Nutrition Department, MRI, Mr. Ranbanda – Nutrition Assistant, MRI, Dr. Harshal R Salve,

Dr. Sumith Aananda – Director, MRI, Dr.Renuka Jayatissa – Nutrition Officer, Unicef, Colombo

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The 43rd Annual Conference of the Indian Association of Preventive & Social Medicine was held from 7-9th January, 2016 at the Gujarat Medical Education and Research Society Medical College and Civil Hospital, Gandhinagar, Gujarat. The theme of the conference was “Towards Sustainable Development Goal and Nutrition”. A Plenery session titled “ SDG and Nutrition – Role of Medical Colleges was held on January 8, 2016 . There were 1000 participants comprising of researchers, policy makers, academicians, public health professionals, nutritionists, and students from across the country. The session was chaired by Dr. Chandrakant S. Pandav, Professor & Head of the Department – Centre for Community Medicine at the All India Institute of Medical Sciences (AIIMS), New Delhi, and co-chaired by Dr. Vikas Desai, Technical Director, Urban Health and Climate Resilience Centre, an initiative under ACCCRN Project of Rockefeller Foundation.

The panel comprised of other eminent personalities and experts on nutrition including Dr. Purnima Menon, Dr. Alok Ranjan, Dr. Rajan Sankar and Dr. Chittaranjan Roy.

Dr. Purnima Menon is Senior Research Fellow in International Food Policy Research Institute (IFPRI) Poverty, Health and Nutrition Division and is based at IFPRI's South Asia office in New Delhi, India.

Dr. Menon's presentation dealt with Global Nutrition Targets, Sustainable Development Goals and Implications for India

Dr. Alok Ranjan is Senior Program Officer – Nutrition in India at Bill & Melinda Gates Foundation. He addressed the audience on Evidence and Status around Maternal, Infant & Young Child Nutrition: the First 1000 Days. He emphasized the need for intervening within the first 1000 days of life in order to tackle nutritional disorders like stunting .

Dr Sankar has been actively involved with iodine deficiency disorders (IDD) elimination activities in India and in the South Asia region for the past three decades. He is a Senior Advisor with the Tata Trust. Dr. Sankar's presentation talked about Evidence and Status around Micronutrient Nutrition and Fortification Interventions

Dr. Chittaranjan Roy is HOD and Professor in Darbhanga Medical College and Hospital. Dr. Roy spoke about Strengthening IYCF in Bihar: Collaborative Action by Medical Colleges of Bihar, State Health Society and UNICEF.

Dr. Vikas Desai who spoke on the need to strengthen the MIYCN component in medical institutions and integrating it in the medical curriculum. She spoke about the need to intergrate MIYCN and IMNCI. She also recommended taking a second look at traditional wisdom and practices on child feeding. She concluded the session by thanking all the participants and attendees of the session.

IGN/ICCIDD participated in 43rd Annual Conference of Indian

Association of Preventive and Social Medicine (IAPSM) at Gandhinagar, Gujarat

Dr. Chandrakant S. Pandav Chairing the IAPSM Conference

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thThe 60 Annual Conference of Indian Public Health Association

was organized at the Himalyan Institute of Medical Sciences, th thDehradun from 4 to 6 March 2016, The theme of this year's

conference is “Towards Healthy Life Styles – A Holistic Approach ”.

The conference was attended by 1500 delegates from various

national and international organizations affiliated medical

institutions. ICCIDD and All India Institute of Medical Sciences

(AIIMS), New Delhi , conducted Plenary Session on “Celebrating

the Success Story of Sustainable Elimination of Iodine Deficiency

Disorders in India with support from the Micronutrient Initiative..

Objective of the session was to provide a platform for

dissemination of information regarding IDD and USI among a

wider group of participants to accelerate up scaling and

mainstreaming of activities related to elimination of IDD and

development of sustainable partnerships and also to celebrate the

success story. Dr. Pandav shared the important key facts which

include:

· Currently 92% of population consumes iodised salt in India ,

With 78% consuming adequately iodised >=15 ppm and 14%

with iodine ( 5 – 14 ppm)

· Use of adequately iodised salt in India has increased over the

last one decade.

· Adequate salt iodisation has saved 4 billion IQ points in the last

two decades.

· Success of IDD Control Programme in India is at par with Small

Pox Eradication, Guinea Worm Eradication and Polio

Eradication.

Dr Kapil Yadav , presented the key findings of NISI survey

mentioning significant progress in iodised salt coverage over last

decade at national and zonal level, Wide differentials in iodised

salt coverage across zones needs to be addressed .

Mr Ranjan Jha, National Programme Officer at Food Fortification

from Micronutrient Initiative presented on District USI Coalition-

Experience from 12 districts in India.

Dr Harshal R Salve shared an experience of coverage and

sustaining USI Coalitions at National and State Level,

Mr Soloman Prakash made the presentation on Role of NGO the

in Universal Salt Iodisation.

IGN/ICCIDD participated in Indian Public Health Association (IPHA) Conference at the Himalyan Institute of Medical Sciences, Dehradun

4th to 6th March 2016

Left to Right: Dr. Kapil Yadav, Dr. Aditi Yadav, Dr. Anamika Wadhera, Ms. Rijuta Pandav, Dr. C.S. Pandav, Dr. Harshal R. Salve

Left to Right: Mr. Ranjan Jha, Dr. Harshal R. Salve, Dr. C. S. Pandav, Dr. Surekha Kishore, Dr. Kapil Yadav, Mr. Solomon Prakash

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Need of the hour: Ban sale of “salt for preservative purpose” packed in less than 2 kilograms pouches

By S. Syed Ahmed, Project Manager - TN and Ranjan Kumar Jha, NPO - Food Fortification

A survey done in 2015-16 by a consumer protection agency,

Thiruvarur District Tamilnadu Consumer Protection Centre in the

state of Tamil Nadu revealed that a significant number of salt

packets stocked by retailers were “salt for preservative

purposes”such as preparation of pickles, curing of fish, tannery,

ice making and is a special category of salt exempted from

iodization under the Food Safety and Standard Act (FSSA 2006);

hence it is devoid of iodine and not to be used for cooking

purposes or as table salt. The Consumer Protection Agency,

supported by the Micronutrient Initiative (MI),surveyed the edible

salt market, collecting 20 salt samples each from all the 32 districts

of the state, from the retailers, on a quarterly basis,over a period of

one year. Analysis of the data revealed that 82 of over 400 brands

collected from retail shops were “salt for preservative

purposes”.The surveyrevealed that this exception was being widely

misused to sell non-iodized salt to the consumer and evade

persecution by the Food and Drugs Control Authority (FDCA).

The most recent District Level Household Survey (DFHS-4) for the

state highlights that 21% of the salt samples did not have any

iodine, 43% had some iodine, and only 26% of the salt samples

had adequate iodine (15 parts per million). The worst performing

districts were Virudhunagar with 47%, Sivagangai with 44% and

Thirunelveli with 40% of salt samples with no iodine.

The problem is further aggravated as the majority of consumers

cannot differentiate between regular household salt/edible salt

and “salt for preservative purpose”,The reason being that pouches

of both types of salt look similar, except for one obscure line printed

on the pouch which says “salt for preservative or agriculture or

industrial or other non-edible purposes”. Further, both types of salt

are found packed in 1 kilogram and 500 grams pouches and are

available to customers at the same retail outlet. Since non-iodized

salt is cheaper, consumers often buy it without understanding the

risks involved. This practice is harmful to the consumers who

unknowingly purchase and consume “salt for preservative

purpose” which deprives them of iodine, thereby exposing the

population to mental retardation, still births, cretinism and

goitre collectively called Iodine Deficiency Disorders(IDD).

It has been observed that industries such as fishing, tanning and

ice manufacturing who are the major buyers of “salt for

preservative purposes”,do not buy these pouches as they

purchase salt in bulk quantities which is far more

economical.This defeats the purpose of packaging “salt for

preservative purposes” in small pouches. The fact that non-

iodised salt is available in smaller packs, contributes to an

unfortunate lucrative business in the state to sell non-iodised

salt through common retail outlets. As non-iodised salt is

available at lower price than edible iodized salt, processors of

edible salt are compelled to lower the price of iodized salt to

remain competitive in the market inducing them to produce

inadequately iodized salt. This perpetuates a vicious cycle of

production and sale of non iodized or inadequately iodized

salt. Dr. Pirai Arivazhagan, Chairperson of the Thiruvarur

District Tamil Nadu Consumer Protection Centreh as called for

a ban on sale of “salt for preservative purpose” in 1kilogram

and 500 grams pouches. He says the Centre, with other

network partners, working towards protecting consumers'

rights, will continue to intensively monitor edible salt available

at retail shops. The Centre has taken up the issue of banning the

sale of “salt for preservative purposes”for human consumption

with relevant authorities both independently during their

meeting with District Collectors, State Food Commissioner,

Commissioner of Labour and through forums such as state and

district level USI committee meetings. He suggests that the

Directorate of Public Health, which is the nodal agency for

implementation of National Iodine Deficiency Disorders

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Control Program (NIDDCP) in the State, and,Food Safety

Commission which implements the FSSA, should ensure that food

business operators adhere to the Act, and that they and the Legal

Metrology wing of the Labour Department, which implements

the Legal Metrology (Packaged Commodities) Rules, 2011,

need to work together to ensure that the salt produced and

sold for human consumption contains adequate iodine. This

advocacy effort has resulted in initial success with the

Commissioner of Labour issuing a state order for the

Inspector of Labour to ensure that “salt for preservative

purpose” is packed only in pouches of two kilograms or more.

Similar has been the case in Andhra Pradesh, wherein non-

iodized salt, with declaration“for preservative purposes”, is

being consumed at household level. Advocacy efforts of

Consumer Guidance Society, another consumer protection

agency supported by MI, has resulted in Commissioner of Food

Safety, issuing state order to the Food Safety Officer to consider

all salt available in 1 kilogram packet in the market only for

human consumption,under Food Safety And Standards

(Prohibition And Restrictions On Sales) Regulations, 2011.

Salt pouch with declaration “for preservative purpose only" printed at the bottom of the pouch

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st21 meeting of National Coaltion for Sustained Optimal Iodine thIntake(NCSOII) was organised on 28 January 2016 at Center for

Community Medicine , All India Institute of Medical Sciences,

New Delhi .The meeting was chaired by Dr. Chandrakant S.

Pandav, CCM, AIIMS, New Delhi/ Regional Coordinator-South

Asia, IGN/ICCIDD, Dr Pradeep Saxena, , Additional DDG IDD

and Nutrition Cell, DGHS, MOHFW, Dr. Angela Padmini D Silva,

WHO Regional Advisor Nutrition & Food Safety, World Health

Organization – SEARO were the special guests . Ms. P. N.

Padmini, RO (IDD), IDD and Nutrition Cell, DGHS, MOHFW,

Ms.Preetu Mishra, UNICEF, Mr Ranjan Jha, Micronutrient

Initiative, Mr. Suvabrata Dey, Micronutrient Initiative , Dr Arijit

Chakarboarty, GAIN, Ms. Ruchita Gupta, WHO, Dr Kapil Yadav,

AIIMS, New Delhi, Dr. Harshal R. Salve, Assistant Professor, AIIMS,

New Delhi, Dr. Anamika Wadhera, Programme Officer,

IGN/ICCIDD South Asiaalso participated .

Dr. Pandav Welcomed and felicitated Dr. Pradeep Saxena and

Dr. Angela Padmini D Silva.

Following action points were outlined in the meeting and focused

on this year theme for wide scale dissemination of success story of

USI and IDD Elimination In India.

1. Technical dissemination of key findings of National Iodine

and Salt Intake Survey and sharing the report of NISI Survey.

2. Advocacy for priority to refined iodised salt in Public

Distribution System.

3. Inviting Bill and Melinda Gates Foundation (BMGF) Tata

Trusts and Indian Council for Medical Research (ICMR) to be

part of the National Coalition.

4. Revising the IEC Material and disseminating the same.

21st Meeting of National Coalition for Sustained Optimal

Iodine Intake (NCSOII)

28th January 2016, CCM, AIIMS

Left to Right (Sitting): Dr P.N Padmini, Dr. Chandrakant S Pandav, Dr. Pradeep Saxena, Dr. Angela Padmini de Silva, Mr. Suvabrata Dey

Left to Right (Back): Dr. Kapil Yadav, Ms. Preetu Mishra, Mr. Ranjan Jha, Dr. Arijit Chakrabarty, Dr. Rachita Gupta,Dr. Harshal R. Salve, Dr. Anamika Wadhera

12

IGN/ICCIDD participated in Training on Management of NIDDCPorganized by Nutrition & IDD cell, MOHFW at NIHFW

2nd to 4th March 2016

Three day training workshop was organised on Management of

National Iodine Deficiency Disorders Control Programme for nd thState Programme Officers from 2 to 4 March 2016 at NIHFW,

Munirka New Delhi. Inaugration was done by DrJagdishPrasad,

DGHS,MOHFW , Dr. ChandrakantS Pandav, Dr. Pradeep Saxena

, Add DGHS, Nutrition & IDD cell.There was a participation from

state programme officers , Salt commissioner office.

Prof.Jagdish Prasad laid emphasis on equitable distribution of

subsidized salt through public distribution system to be taken to

highest level, making goiter free country, requesting the

government for subsidizing iodised salt ,Dr.Pandav highlighted on

IDD National priorities and Technical Priority, Strengthening of

PDS. Success story of IDD Elimination and USI was also shared .

Representation from Chhattisgarh state IDD cell shared about the

distribution of Amrut Salt by PDS. Dr Pradeep Saxena focused on

national iodine deficiency disorder control programme .and

shared the data with audience , showing the no of districts found to

be endemic in goiter.Dr. Saxena also shared the new initiatives

Lamp lightening Ceremony

Left to Right - Dr. Pradeep Saxena, Dr. Jagdish Prasad, Dr. Chandrakant S. Pandav, Dr. J.K. Das, Ms. Padmini N.

13

taken by MOHFW, regarding the restarting of national level

trainings of state programme officers . New audio, video

spotsand radio jingles for awareness in community on Iodine

deficiency disorders. Dr Kapil Yadav presented the

epidemiological aspects of iodine deficiency disorders and

shared the important findings of NISI Survey. Dr Kapi lmentioned

that one point increase in nation average IQ, there is 0.11%

increase in GDP. Lastely Dr RN Kashyap, Deputy Salt

Commissioner , GOI shared the production and distribution of

iodised salt in the country. Dr. Kashyap shared the important

findings regarding the production of iodised salt in India i.e

5163.9 million tons. He also shared that there are 700

iodisation units and 120 salt refineries procuring iodised salt

capacity of about 100%. Dr. Kashyap added that estimated

refined iodised salt production was 3249.50 million tons and

non refined iodised salt production was1919.84 million tons in

the year 2015-2016, with West Bengal having the highest

supply.

Dr. C.S. Pandav and Dr. Pradeep Saxena addressing the Audience Dr. Kapil Yadav sharing the presentation

Participants of the training programme State officers working in camps

14

IGN/ICCIDD, South Asia Regional Labortory got successful certificate of performance under Center for Disease Control and Prevention for Ensuring the

Quality of Urinary Iodine Procedure (EQUIP)

CDC Equip Certification

Mr. Rajesh Lal Senior Laboratory Technician, ICCIDD Laboratory

15

Thyroid Awareness Month Celebrated by Nutrition Society of India Nagpur, Maharastra in January 2016

January calls for International Thyroid Disease Awareness Month!Excerpts: Source The Times of India, dated January 25, 2016

Common thyroid related diseases and conditions include hypothyroidism(causing fatigue, depression, memory loss and weight gain) and hypothyroidism(leading to muscle weakness, weight loss, sleep disorders and vision problems) and goiter, (enlargement of the thyroid glad). Hypothyroidism increases the risk of insulin resistance due to polycystic ovary syndrome (PCOS), which increases the risk of obesity, infertility, metabolic syndromes. Being insulin resistant increases the risk of cardiovascular disease as well as diabetes. Hypothyroidism as well has been shown to contribute to insulin resistance.

During this month, the Nutrition Society of India Meeting focused on the importance of micronutrients such as iodine, required for adequate thyroid functioning.

The absence of certain important micronutrients in the food results in “hidden hunger”, which remains unfulfilled despite having a rich meal.Various aspects of this hidden hunger were discussed during the annual scientific session of the city chapter of Nutrition Society of India (NSI) in Nagpur, Maharashtra in January, 2016. The event was attended by senior scientists from NIN, Hyderabad, K. Madhavan Nair, G.M. Subba Rao and B. Dinesh Kumar and diabetologist Dr. Sunil Gupta and numerous young researchers, nutritionists, students, medical agriculturists and other such professionals.

Discussions were held on national policy for spreading awareness on junk food and promote healthy food. Officials from NIN declared that the same tools used by corporates to sell junk food should instead be used to promote healthy food i.e. social marketing. At present, several products advertised as health food, especially drinks and powders, have contents that may inadvertently be harming the consumer. A.N. Radha, convener of NSI, Nagpur, said that supplements, often called nutraceuticals, need to be governed by strict rules.

Dr. Nair remarked that we often fail to fulfill our body's need for micronutrients such as iron, magnesium, vitamins and iodine because we often club together foods that inhibit the body's ability to absorb the micronutrients.He added that fat, which is avoided by a big majority these days, is good as it helps in bioabsorption of micronutrients.

In a related article, nutritionist Rujuta Diwekar cautioned that foods such as peanuts, cauliflower and soya can interfere with iodine absorption but only if they are consumed raw.

She further added that while we are on diets, we often restrict our calories to such an extent that even if our thyroid gland is functioning properly, it begins to slow down, trying to match the reduced metabolism as a result of the low-calorie diet. Thus, the thyroid gland needs support from increased nutritional intake, which includes essential amino acids, good quality carbs (unprocessed), iodine, and vitamins B, C and E, for higher metabolism.The key here is to increase the nutrition-to-calorie ratio, not merely increase the amount of food intake and calorie consumption at the cost of greater salt and processed food consumption.

Participants attending the NSI meeting

Mother and Child BondBlue Paisley ribbon , symbol of Thyroid Disease awareness

16

1. Ramesh BG, Bhargav PR , Rajesh BG , Vimala Devi N , Vijayaraghavan R , Aparna Varma B . Genomics and

phenomics of Hashimoto's thyroiditis in children and adolescents: a prospective study from Southern India. Ann T r a n s M e d . 2 0 1 5 N o v ; 3 ( 1 9 ) : 2 8 0 . d o i : 10.3978/j.issn.2305-5839.2015.10.46.

Abstract

BACKGROUND:Hashimoto's thyroiditis (HT) is the commonest cause of acquired hypothyroidism in children and adolescents in iodine non-endemic areas. The genetic analysis in HT shows two types of susceptibility genes-immune regulatory and thyroid specific genes. The exact genotype-phenotypic correlations and risk categorization of hypothyroid phenotypes resulting from these known mutations are largely speculative. The genetic studies in pediatric HT are very sparse from Indian sub-continent. In this context, we analysed the prevalence of TPO, NIS and DUOX2 gene mutations along with genotype-phenotype correlations in hypothyroid children with HT.

METHODS:This is inter-disciplinary study conducted by collaboration between a tertiary care endocrinology hospital, biochemistry department of a teaching medical institute and genetics lab. In this prospective study, we employed 8 sets of primers and screened for 142 known single nucleotide polymorphisms in TPO, NIS, DUOX2 genes. The subjects were children and adolescents with hypothyroidism due to HT. Congenital hypothyroidism, iodine deficiency and dyshormonogenetic hypothyroidism cases were excluded.

RESULTS:We detected 8 mutations in 7/20 (35%) children in the entire cohort (6 in NIS and 2 in TPO genes. No mutations were observed in DUOX2 gene. All our mutations were localized in introns and we found none in exons. Except for bi-allelic, synonymous polymorphism of TPO gene in child No. 18, all other mutations were heterozygous in nature. Genotype-phenotype correlations show that our mutations significantly expressed the presence of associated autoimmune manifestations and existence of family history. Clinical phenotypes of painful thyroiditis, severity of hypothyroidism and absence of goiter were statistically significant in the presence of these mutations. But, they could not reach significance on multivariate analysis.

CONCLUSIONS:NIS gene followed by TPO mutations appears to be most prevalent mutations in HT amongst South Indian children and these mutations significantly influenced phenotypic expressions such as severity of hypothyroidism, goiter, auto-immune manifestations and family history.

2. Lohiya A, Yadav K, Kant S, Kumar R, Pandav CS. Prevalence of iodine deficiency among adult population residing in Rural Ballabgarh, district Faridabad, Haryana. Indian J Public Health. 2015 Oct-Dec;59(4):314-7. doi: 10.4103/0019-557X.169668.

Abstract

Community-based surveys are essential to monitor iodine deficiency disorders (IDD) program at both the state and national levels. There is paucity of information on population iodine nutrition status in Haryana state using standard methods. A cross-sectional study was conducted in villages of Comprehensive Rural Health Services Project (CRHSP), Ballabgarh, Haryana, India. A total of 465 randomly selected individuals were assessed for urinary iodine concentration (UIC) by microplate method and household salt iodine content using iodometric titration. Of the interviewed households, 73% were using adequately iodized salt (≥15 ppm). Iodine nutrition was deficient in 17% respondents (UIC <100 μg/L); 20.2% among males and 13.9% among females. Iodine intake of the study population as measured by UIC was adequate but nearly one-fourth of households in the study population were consuming inadequately iodized salt. The availability and access to adequately iodized salt in the study population should be improved by strengthening regulatory monitoring.

3. Kapil U, Sareen N, S Nambiar V, Khenduja P, Sofi NY. Iodine Nutritional Status among Adolescent Girls in Uttarakhand, India. J Trop Pediatr. 2015 Oct 17. pii: fmv069

Abstract

INTRODUCTION:Uttarakhand (UK) state is a known endemic region for Iodine deficiency.

OBJECTIVE:To assess iodine nutritional status among adolescent girls in districts: Udham Singh Nagar (USN), Nainital (N) and Pauri (P) of UK state.

METHODS:In each district, 30 clusters (schools) were identified by using population proportionate to size cluster sampling. In each school, 60 girls (12-18 years) attending the schools were included. Total of 5430 girls from USN (1823), N (1811) and P (1796) were studied. Clinical examination of thyroid of each girl was conducted. From each cluster, spot urine and salt samples were collected.

RESULTS:Total goiter rate was found to be 6.8% (USN), 8.2% (N) and 5.6% (P). Median urinary iodine concentration levels were 250 μg/l (USN), 200 μg/l (N) and 183 μg/l (P).

Abstracts

17

CONCLUSION:Findings of the study documented that adolescent girls had adequate iodine nutritional status in the three districts of UK.

4. Kapil U, Pandey RM, Sareen N, Khenduja P, Bhadoria AS. Iodine nutritional status in Himachal Pradesh state, India.Indian J Endocrinol Metab. 2015 Sep-Oct;19(5):602-7. doi: 10.4103/2230-8210.163173. Abstract

INTRODUCTION:Iodine deficiency (ID) is the preventable causes of mental retardation worldwide. Himachal Pradesh (HP) state is a known endemic region to ID.

OBJECTIVE:The objective was to assess the current status of iodine nutrition in a population of HP, India.

METHODOLOGY:There are three regions in HP namely: Kangra, Mandi, and Shimla. In each region, one district was selected namely: Kangra, Kullu, and Solan. In each district, 30 clusters were identified by utilizing population proportional-to-size cluster sampling methodology. A total of 5748 school-age children (SAC) (Kangra; 1864, Kullu; 1986, Solan: 1898), 1711 pregnant mothers (PMs) (Kangra; 647, Kullu; 551, Solan: 513), and 1934 neonates (Kangra; 613, Kullu; 638, Solan: 683), were included in study. Clinical examination of thyroid of each child and PM was conducted. Casual urine samples were collected from children and PMs. Cord blood samples were collected for estimation of thyroid stimulating hormone (TSH) among neonates.

RESULTS:In SAC, total goiter rate (TGR) was 15.8% (Kangra), 23.4% (Kullu), and 15.4% (Solan). Median urinary iodine concentration (UIC) level was 200 μg/l (Kangra), 175 μg/l (Kullu), and 62.5 μg/l (Solan). In PMs, TGR was 42.2% (Kangra), 42.0% (Kullu), and 19.9% (Solan). Median UIC level was 200 μg/l (Kangra), 149 μg/l (Kullu), and 130 μg/l (Solan). In Neonates, TSH levels of > 5 mIU/L were found in 73.4 (Kangra), 79.8 (Kullu), and 63.2 (Solan) percent of neonates.

CONCLUSION:As per, UIC level (<100 μg/l) in SAC, ID was found in district Solan. In Kullu and Solan districts, there were ID (UIC level < 150 μg/l) among PMs. TSH levels indicated ID in all districts surveyed.

5. Yadav K, Kumar R, Chakrabarty A, Pandav CS. A reliable and accurate portable device for rapid quantitative estimation of iodine content in different types of edible salt. Indian J Public Health. 2015 Jul-Sep;59(3):204-9. doi: 10.4103/0019-557X.164658.

Abstract

BACKGROUND:Continuous monitoring of salt iodization to ensure the success of the Universal Salt Iodization (USI) program can be significantly strengthened by the use of a simple, safe, and rapid method of salt iodine estimation. This study assessed the validity of a new portable device, iCheck Iodine developed by the BioAnalyt GmbH to estimate the iodine content in salt.

MATERIALS AND METHODS:Validation of the device was conducted in the laboratory of the South Asia regional office of the International Council for Control of Iodine Deficiency Disorders (ICCIDD). The validity of the device was assessed using device specific indicators, comparison of iCheck Iodine device with the iodometric titration, and comparison between iodine estimation using 1 g and 10 g salt by iCheck Iodine using 116 salt samples procured from various small-, medium-, and large-scale salt processors across India.

RESULTS:The intra- and interassay imprecision for 10 parts per million (ppm), 30 ppm, and 50 ppm concentrations of iodized salt were 2.8%, 6.1%, and 3.1%, and 2.4%, 2.2%, and 2.1%, respectively. Interoperator imprecision was 6.2%, 6.3%, and 4.6% for the salt with iodine concentrations of 10 ppm, 30 ppm, and 50 ppm respectively. The correlation coefficient between measurements by the two methods was 0.934 and the correlation coefficient between measurements using 1 g of iodized salt and 10 g of iodized salt by the iCheck Iodine device was 0.983.

CONCLUSIONS:The iCheck Iodine device is reliable and provides a valid method for the quantitative estimation of the iodine content of iodized salt fortified with potassium iodate in the field setting and in different types of salt.

6. Kotwal A, Kotwal J, Prakash R, Kotwal N. Does iodine excess lead to hypothyroidism? Evidence from a case-control study in India. Arch Med Res. 2015 Aug;46(6):490-4. doi: 10.1016/j.arcmed.2015.07.005. Epub 2015 Aug 4.

Abstract

BACKGROUND:Iodine deficiency disorders have been known to mankind since antiquity and various researchers elucidated the role of iodine in its causation. However, recent evidence shows that the entire control program ignored multi-causality and association of increased iodine intake with hypothyroidism. This study was conducted to assess differences of iodine intake as measured by urinary iodine excretion (UIE) between cases of hypothyroidism and healthy controls.

METHODS:A case-control study was conducted with three groups (cases, hospital controls and community controls) in two cities of India. Patients with overt hypothyroidism were cases (n = 150) and were compared with age, sex and socioeconomic status-matched

18

hospital (n = 154) and community (n = 488) controls. Thyroid function tests (T3, T4, TSH) were used as diagnostic and inclusion criteria. TPOAb and UIE estimation were carried out for all study participants.

RESULTS:Mean values of TPOAb and UIE were higher in cases as compared to hospital controls as well as community controls (p <0.05). With a cut off of 34 IU/mL for TPOAb, more cases had an anti-TPO level >34 as compared to hospital controls (p <0.001) as well as community controls (p <0.001); OR, 0.06 (95% CI, 0.03, 0.12) and 0.08 (0.05, 0.12), respectively. For UIE cut-off of 300 μg/L, more cases than hospital controls (p = 0.090) and community controls (p = 0.001) had higher levels; OR, 0.671, (0.422, 1.066) and 0.509, (0.348, 0.744), respectively.

CONCLUSION:The study has clearly shown that cases of hypothyroidism are associated with excess iodine intake. Cohort studies to generate further evidence and an eco-social epidemiological approach have been suggested as the way forward.

7. Manjunath B, Suman G, Hemanth T, Shivaraj NS, Murthy NS. Prevalence and Factors Associated with Goitre among 6-12-year-old Children in a Rural Area of Karnataka in South India. Biol Trace Elem Res. 2016 Jan;169(1):22-6. doi: 10.1007/s12011-015-0398-0. Epub 2015 Jun 13.

Abstract

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.

8. Nazeri P, Mirmiran P, Shiva N, Mehrabi Y, Mojarrad M, Azizi F. Iodine nutrition status in lactating mothers residing in countries with mandatory and voluntary iodine fortification programs: an updated systematic review. T h y r o i d . 2 0 1 5 J u n ; 2 5 ( 6 ) : 6 1 1 - 2 0 . d o i : 10.1089/thy.2014.0491. Epub 2015 May 14.

Abstract

BACKGROUND:The aim of this review is to assess data available on iodine nutrition status in lactating mothers residing in countries with mandatory and voluntary iodine fortification programs and/or iodine supplementation.

SUMMARY:A systematic review was conducted by searching articles published between 1964 and 2013 in Pub Med, ISI Web, and Cochrane Library using iodine nutrition, lactation, iodine supplementation, and iodine fortification as keywords for titles and/or abstracts. Relevant articles were included if they reported urinary iodine concentration (UIC) in lactating mothers and, if determined, the type of iodine fortification program and/or iodine supplementation. Forty-two studies met the inclusion criteria. Among these, 21 studies assessed lactating mothers in countries with a mandatory iodine fortification program, 17 studies were from countries with voluntary and/or without iodine fortification programs, and four studies assessed iodine nutrition status in lactating mothers undergoing iodine supplementation. Among countries with mandatory iodine fortification programs, the range of salt iodization level in lactating mothers with a UIC <100 μg/L was between 8 and 40 ppm, whereas among lactating mothers with UIC >100 μg/L, it was between 15 and 60 ppm. Levels of UIC <100 μg/L were observed among lactating women in India, Denmark, Mali, New Zealand, Australia, Slovakia, Sudan, and Turkey, whereas in countries such as Chile, Iran, Mongolia, New Guinea, and Nigeria, the median or mean of UIC was >100 μg/L. There was a median or mean UIC <100 μg/L in nearly all lactating mothers residing in countries where implementation of universal salt iodization program was voluntary, including Switzerland, Australia, New Zealand, Ireland, and Germany. However, in some countries with voluntary iodine fortification programs, such as the United States, Spain, and Japan, a mean or median UIC of >100 μg/L has been reported.

CONCLUSIONS:Although universal salt iodization is still the most feasible and cost-effective approach for iodine deficiency control in pregnant and lactating mothers, UIC in lactating mothers of most countries with voluntary programs and in areas with mandatory iodine fortification is still within the iodine deficiency range, indicating that iodine supplementation in daily prenatal vitamin/mineral

19

supplements in lactating mothers is warranted. However, further investigations are still recommended in this regard.

9. Sareen N, Pradhan R. Need for neonatal screening program in India: A national priority. Indian J Endocrinol Metab. 2015 Mar-Apr;19(2):204-20. doi: 10.4103/2230-8210.149315.

AbstractIn India, out of 342 districts surveyed, 286 have been identified as endemic to iodine deficiency (ID). Research studies conducted in school age children (SAC), Adolescent girls, Pregnant Mothers (PMs) and Neonates have documented poor iodine nutritional status. As observed by total goiter rate of more than 5% and median urinary iodine concentration level of <100 μg/l in SAC and <150 μg/l in PMs as prescribed cutoff of World Health Organization. And higher thyroid stimulating hormone levels among neonates. ID leads to compromised mental development and hence which remain hidden and not visible to family, program managers and administrator. The present review describes the current status of ID in different parts of the country. With a view to strongly recommend the implementation of Neonatal screening program for ID so that the optimal mental development of children can be achieved.

10. Kapil U, Sareen N, Nambiar VS, Khenduja P, Pande S. Status of iodine nutrition among pregnant mothers in selected districts of Uttarakhand, India. Indian J Endocrinol Metab. 2015 Jan-Feb;19(1):106-9. doi: 10.4103/2230-8210.131764.

Abstract

BACKGROUND:Uttarakhand state is a known endemic area for iodine deficiency.

OBJECTIVE:The present study was conducted with an objective to assess the iodine nutritional status amongst pregnant mothers (PMs) in districts: Pauri (P), Nainital (N) and Udham Singh Nagar (USN) of Uttarakhand state.

MATERIALS AND METHODS:Thirty clusters from each district were selected by utilizing the population proportionate to size cluster sampling methodology. A total of 1727 PMs from P (481), N (614) and USN (632) were included. The clinical examination of the thyroid of each PM was conducted. Urine and salt samples were collected from a sub samples of PMs enlisted for thyroid clinical examination.

RESULTS:The total Goiter rate was found to be 24.9 (P), 20.2 (N) and 16.1 (USN)%. The median urinary iodine concentration (UIC) levels were found to be 110 μg/L (P), 117.5 μg/L (N) and 124 μg/L (USN). The percentage of PMs consuming salt with iodine content of 15 ppm and more was found to be 57.9 (P), 67.0 (N) and 50.3 (USN).

CONCLUSION:The findings of the present study revealed that the PMs in all three districts had low iodine nutritional status as revealed by UIC levels of less than 150 μg/L.

11. Jaiswal N, Melse-Boonstra A, Sharma SK, Srinivasan K, Zimmermann MB. The iodized salt programme in Bangalore, India provides adequate iodine intakes in pregnant women and more-than-adequate iodine intakes in their children. Public Health Nutr. 2015 Feb;18(3):403-13. doi: 10.1017/S136898001400055X. Epub 2014 Apr 24.

Abstract

OBJECTIVE:To compare the iodine status of pregnant women and their children who were sharing all meals in Bangalore, India.

DESIGN:A cross-sectional study evaluating demographic characteristics, household salt iodine concentration and salt usage patterns, urinary iodine concentrations (UIC) in women and children, and maternal thyroid volume (ultrasound).

SETTING:Antenatal clinic of an urban tertiary-care hospital, which serves a low-income population.

SUBJECTS:Healthy pregnant women in all trimesters, aged 18-35 years, who had healthy children aged 3-15 years.

RESULTS:Median (range) iodine concentrations of household powdered and crystal salt were 55·9 (17·2-65·9) ppm and 18·9 (2·2-68·2) ppm, respectively. The contribution of iodine-containing supplements and multi-micronutrient powders to iodine intake in the families was negligible. Adequately iodized salt, together with small amounts of iodine in local foods, were providing adequate iodine during pregnancy: (i) the overall median (range) UIC in women was 172 (5-1024) µg/l; (ii) the median UIC was >150 µg/l in all trimesters; and (iii) thyroid size was not significantly different across trimesters. At the same time, the median (range) UIC in children was 220 (10-782) µg/l, indicating more-than-adequate iodine intake at this age. Median UIC was significantly higher in children than in their mothers (P=0·008).

CONCLUSIONS:In this selected urban population of southern India, the iodized salt programme provides adequate iodine to women throughout pregnancy, at the expense of higher iodine intake in their children. Thus we suggest that the current cut-off for median UIC in children indicating more-than-adequate intake, recommended by the WHO/UNICEF/International Council for the Control of Iodine Deficiency Disorders may, need to be reconsidered.

Publishing any material in IQ+ Jagriti does not necessarily mean ICCIDD's endorsement of the views expressed therein or the results quoted.

Materials for publication, subscription request, comments may be sent to: Dr. Chandrakant S Pandav, Room No 28, CCM Building,Old OT Block, All India Institute of Medical Sciences, New Delhi 110029 E-mail: cpandav@iqplusin.org

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Daily consumption of iodized salt

is a healthy habit

In preparing this issue we gratefully acknowledge the support from:

Let There be work, bread and water and salt for “All”

- Nelson Mandela

7 out of 17 SDGs are related to IDD

1. End Poverty

Strengthen the means of

implementationand revitalize the

global partnership

6.Reduce inequalities

within and among countries

5.Achieve gender

equality

4. Ensure inclusive

and equiatble qualityeducation

3.Ensure healthy

lives and promote well-being

SIDDG

7.

2. End hunger, achieve food

security & improved nutrition

SUSTAINABLE

DEVELOPMENT

GOALS

IODINE

DEFICIENCY

DISORDERS