Programs and policies related to iodine deficiency disorders in Nepal.

1. PROGRAM AND POLICIES
RELATED TO IODINE
DEFICIENCY DISORDERS(IDD)
Prepared by:
Chandan Kumar Sah
Deekshya Devkota

2. IODINE
Iodine is an essential micronutrient. It is
required for the synthesis of the thyroid
hormones, thyroxine (T4) and triiodothyronine
(T3).
Iodine is essential in minute amounts for the
normal growth and development of all human
beings.
The adult human body contains about 50mg
of iodine, and the blood level is about 8-
12mcg/dl.

3. SOURCES
The sources of iodine are sea foods (e.g., sea fish, sea salt) and cod liver oil.
About 90% of iodine comes from foods eaten and rest 10% from drinking
water. The iodine content of the soil determines its presence in both water
and locally grown foods.

4. Spectrum of iodine deficiency
disorders(IDD)
• 1.Goitre
• 2.Hypothyroidism
• 3.Sub normal intelligence
• 4.Delayed motor milestones
• 5.Endemic cretinism
• 6.Intra uterine death
• 7.Neuromuscular weakness
• 8.Hearing and speech defects
• 9.Spasticity
• 10.Nystagmus
• 11.Strabismus

5. Spectrum of IDD

6. RDA:
WHO recommended that the daily intake of
iodine should be as follows:
Age mcg/day
0-59 months 90
6-12yrs 120
>12yrs 150
PW & LM 250
This amount is normally supplied by well balanced diet and drinking water
except in regions where food and water are deficient in iodine.

7. IODINE DEFICIENCY DISORDER-THE PROBLEM
• IDD is a major micronutrient deficiency in a developing country like
Nepal.
• “Himalayan goitre belt” is the world’s largest goitre belt.
• IDD is the world’s single most significant cause of preventable brain
damage and mental retardation.
• Iodine deficiency during pregnancy has also been associated with
infant mortality, miscarriage, stillbirth, and low birth weight.

8. IDD-The problem
• In some isolated
mountainous areas of
Nepal, most of the adult
women have goitre, and up
to 10% of the population
suffer from cretinism, the
severest form of IDD.

9. Epidemiological assessment of iodine
deficiency
•Indicators:
•Prevalence of goitre
•Prevalence of cretinism
•Urinary iodine excretion
•Measurement of thyroid function by determination
of serum thyroxine T4 and TSH
•Prevalence of neonatal hypothyroidism

10. PREVENTION OF IDD
Reduced
IDD
Increased
accessibility
of iodized salt
Iodization of
salt
Promote use
of iodized salt

11. PREVENTION OF IDD
• A. Iodine supplementation
• 1. Iodization of salt : Most widely used
prophylactic measure against endemic
goiter at the population level.
-salt is iodized using potassium iodide or
potassium iodate.
-current recommended level of iodine is 20-40
mg per kg of salt.
-Economical ,convenient and effective.
• 2. Iodized oil : IM injection of iodized oil or oral.
• 3. Others : Iodized bread , Iodized water, Iodized
tablets etc.

12. PREVENTION OF IDD
• B. Proper storage of iodized salt: To prevent iodine loss.
• C. Iodine monitoring : Set surveillance technique to monitor the distribution of adequately
iodized salt in the community.
• D. Increased availability of iodized salt: Increase market share of iodized packet salt and
increase its reach among the people.
• E. Health education : Create awareness about the consequences of IDD especially for high
risk groups (infants, pregnant and lactating women)
- Create awareness about the importance of iodized salt and iodine.
- By initiating school based promotion campaigns , implementing social marketing campaign.
- Training/orientation to health workers and volunteers.

14. PROGRAMS AND POLICIES
SPECIFIC OBJECTIVES STRATEGY ACTIVITY RESPONSIBILITY INDICATOR
To ensure all
edible salt is
iodized
Strengthen the
implementation of
Iodized Salt
Act,1998.
-Implement Iodized salt
regulations.
-Develop operational
guidelines for iodized salt
trading.
-strengthen monitoring
bodies of iodized salt
trading
NS/CHD
DFTQC
IDD Committee
-Prepared guidelines
-iodine level at entry
,dealer, and household
levels.
-% of households
consuming adequately
iodized salt.(>15 ppm)
Encourage better
storage practices to
prevent iodine loss.
Advocacy for
importer/trader, dealer,
retailer and community
people
MoH ,STC
Ensure systematic
monitoring of
iodized salt.
-Internal monitoring .
-External monitoring at the
entry sites and depot sites.
-monitoring at community
level.
STC
Salt traders
NS/CHD
DFTQC
DHO/DPHO

15. PROGRAMS AND POLICIES
SPECIFIC OBJECTIVES STRATEGY ACTIVITY RESPONSIBILITY INDICATOR
To increase the
accessibility of iodized
packet salt with” two
child “ logo.
Increase the
market share
of the iodized
packet salt
• Advocate among
traders/dealers.
• Monitor the market share
of iodized packet salt with
quality assurance logo in
salt business
• Distribution of iodized salt
in inaccessible districts at
subsidized costs
• Coordinate with different
government bodies to
restrict infiltration of non
iodized salts.
NS/CHD Coverage of the market share
of iodized packet salt

16. PROGRAMS AND POLICIES
SPECIFIC OBJECTIVES STRATEGY ACTIVITY RESPONSIBILITY INDICATIONS
To increase the use of
iodized packet salt
Create awareness of
the importance of
iodized salt.
• Implement social
marketing campaign
• Initiate school based
promotion
campaign
• Training/orientation
of health workers
and volunteers
• NS/CHD
• DHO/DPHO
• NGOs/INGOs
Coverage of use of
iodized packet salt
To monitor IDD
prevalence at national
level.
Develop IDD
monitoring system and
implement the
monitoring survey at
national level.
• Collaborations with
external and
internal partners to
practice.
• NS
• IOM
Prevalence of IDD
based on UIE
examination and
coverage of iodized
salt.

18. PROGRAMS AND POLICIES
• UNIVERSAL SALT IODIZATION(USI)
-In 1994 the joint UNICEF-WHO Committee on health policy agreed to
recommend Universal Salt Iodization(USI) as the main strategy in countries
where IDD was a public health problem.
-After implementation of USI to control IDD, Nepal is heading towards iodine
sufficiency but the prevalence of clinical and sub clinical hypothyroidism is
still high.
• IODIZED SALT (production , sale and distribution)ACT, 2055
-An act made to provide iodized salt.

19. PROGRAMS
• Distribution of iodized salt in remote districts at subsidized rates/free of cost.

20. PROGRAMS AND POLICIES
• February: National Iodine Month
-The government of Nepal is observing February as national iodine
month with an aim of creating awareness among people about
consumption of iodized salt.
• The Five Year Plan of Action to achieve optimal Iodine Nutrition In Nepal:
2015-2019 prioritized USI as the primary intervention to improve iodine
status.

21. IODINE STATUS IN NEPAL
• Population iodine status is based on the median urinary iodine
concentration(mUIC).
• If mUIC is greater or equal to 100 ug/l , the population is said to be iodine
sufficient.
• According to Nepal National Micronutrient Status Survey 2016, the overall
mUIC of children 6-9 years was 314.1 ug/l.
By location, the mUIC among children in urban area was 341.8ug/l and in
rural area it was 313.7 ug/l.
• The mUIC among non pregnant women 15-49 years was 286.2 ug/l.(Urban-
307.7 ug/l ,Rural-279.4 ug/l)
• The mUIC among pregnant women was 241.3 ug/l.(Urban-273.2 ug/l ,Rural-
239.7 ug/l.)

22. REFERENCES
• Nepal National Micronutrient Status Survey , 2016
• Nutrition Policy and Strategy , 2004
• Five Year National Plan of Action to Achieve Optimal Iodine Nutrition
in Nepal , 2013-2017
• www.lawcommission.gov.np
• www.ncbi.nlm.nih.gov
• www.sciencedirect.com
• www.gainhealth.org
• www.cochranelibrary.com
• www.google.com
• Park’s Textbook of Preventive and Social Medicine, K.Park , 24th
edition

23. THANK YOU
THANK YOU