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Persistence of severe iodine-deficiency disorders despite universal salt iodization in an iodine-deficient area in northern India

  • Subhash Yadav (a1), Sushil Kumar Gupta (a1), Madan M Godbole (a1), Manoj Jain (a2), Uttam Singh (a3), Praveen V Pavithran (a1), Raman Boddula (a1), Anand Mishra (a4), Ashutosh Shrivastava (a1), Ashwani Tandon (a1), Manish Ora (a5), Amit Chowhan (a2), Manoj Shukla (a1), Narendra Yadav (a1), Satish Babu (a4), Manoj Dubey (a1) and Pradeep K Awasthi (a1)...

Abstract

Objective

The aim of the present study was to determine the impact of universal salt iodization (USI) on the prevalence of iodine deficiency in the population of an area previously known to have severe iodine deficiency in India.

Design

In a cross-sectional survey, a total of 2860 subjects residing in fifty-three villages of four sub-districts of Gonda District were examined for goitre and urinary iodine concentration. Free thyroxine and thyroid-stimulating hormone levels were also measured. Salt samples from households were collected for estimation of iodine content.

Results

A reduction in goitre prevalence was observed from 69 % reported in 1982 to 27·7 % assessed in 2007. However, 34 % of villages still had very high endemicity of goitre (goitre prevalence >30 %). Twenty-three per cent of households consumed a negligible amount (<5 ppm) and 56 % of households consumed an insufficient amount (5–15 ppm) of iodine from salt.

Conclusions

Although there was an overall improvement in iodine nutrition as revealed by decreased goitre prevalence and increased median urinary iodine levels, there were several pockets of severe deficiency that require a more targeted approach. Poor coverage, the use of unpackaged crystal salt with inadequate iodine and the washing of salt before use by 90 % of rural households are the major causes of persisting iodine-deficiency disorders. This demonstrates lapses in USI implementation, lack of monitoring and the need to identify hot spots. We advocate strengthening the USI programme with a mass education component, the supply of adequately iodized salt and the implementation of complementary strategies for vulnerable groups, particularly neonates and lactating mothers.

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Copyright

Corresponding author

*Corresponding author: Email madangodbole@yahoo.co.in

References

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