Iodine-deficiency disorders (IDDs) are a major public health problem in India; about 150 million people are at risk, of whom 54 million have goitre, 2.2 million are cretins, and 6.6 million have milder neurological deficits . Irrespective of whether the cause of IDDs is environmental deficiency or the presence of goitrogens in the diet, the easiest way of eliminating the problem is to fortify dietary salt with iodine .
The National Iodine Deficiency Disorders Control Programme, which is organized by the Ministry of Health and Family Welfare, has the following important components:
- carrying out initial surveys to identify areas
where goitre is endemic; - production and supply of iodinated salt; and - carrying out resurveys after 5 years of continuous
supply of iodinated salt to assess its impact.
The Salt Commissioner's Office at Jaipur (Rajasthan State) is responsible for ensuring the supply of iodinated salt.
The iodination of salt is a simple process that can be carried out by salt manufacturers and smallscale entrepreneurs. The manufacturers control the level of iodination by adjusting a nozzle, which sprays a solution of potassium iodate, and the amount of salt travelling on a conveyor belt below it. Government regulations require salt to be iodinated to a level of at least 50 mg of iodine per kg of salt (50 ppm) so that, after making allowance for losses of iodine during storage and distribution, the salt contains not less than 15 mg/kg of iodine . In India the average per capita consumption of salt is 10 g per day and salt with an iodine content of 15 mg/kg would therefore satisfy the recommended daily requirement of 150 [micro]g of iodine.
Consistent monitoring of the iodine content of salt at the production, storage, sale and consumption levels, and prevention of the sale of uniodinated salt, are vital components of salt iodination programmes, which should be adjusted to meet local conditions and requirements. The information generated by the monitoring mechanism should be directly linked to decision-making, and there should be a feedback system allowing necessary changes to be made.
In India, salt iodination is primarily carried out in approximately 350 production centres, over 90% of which are in Gujarat, Rajasthan, and Maharashtra in the west of the country, and in Tamil Nadu and Andhra Pradesh in the south. Iodinated salt is largely transported by rail to the areas where IDDs are endemic, mainly in northern, north-eastern, and central India.
At present the Salt Commissioner's Office periodically checks the iodine content of salt at the production level. At the consumer level the Prevention of Food Adulteration Act is applicable to salt intended for human consumption in, districts where IDDs are endemic, i.e., where the prevalence of goitre exceeds 10%; however, the monitoring system at this level still requires to be streamlined. The Act prohibits the sale of uniodinated salt in areas where IDDs are endemic.
Since there is no effective implementation mechanism and because uniodinated salt, which is cheaper than the iodinated product, is available for animals, consumer awareness about IDDs is important at the household level. It is also important for nongovernmental organizations (NGOs) to be actively involved in the monitoring process.
The objectives of the present study were as follows:
- to assess the iodine content of salt at the household
and retail levels in selected districts in the
Dehradun, Gorakhpur and Varanasi regions of
Uttar Pradesh, where IDDs are endemic; and - to study the feasibility of using NGOs in selected
districts to monitor the iodine content of salt at
the household and retail levels.
The feasibility of using NGOs to monitor the iodine content of salt was studied in five districts in Gorakhpur, five in Varanasi, and six in Dehradun regions. …