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Prevalence of Iodine Deficiency Disorder Iodine is an essential micro-nutrient. The normal requirement of iodine for human beings averages 150 µg per person per day. About 90 percent of this quantity comes from food, while the rest comes from soil. Some soils contain more iodine than others. Soils which are poor in iodine content are common mountainous region, adjoining plains and river basins where iodine is periodically washed away by heavy rainfall and repeated flooding. Crops grown in such soil are deficient in iodine and hence the disorder due to iodine deficiency exists in such areas. Goiter is an enlargement of the thyroid gland and is the commonest disorder caused by the environmental iodine deficiency. It is estimated that approximately 516 million people in Asia are the risk due to environmental iodine deficiency, with about 176 million actually goitrous. In Nepal, about 14 million people are at risk of which 8 million are goitrous. The Scope of the Problem Iodine deficiency is the leading preventable cause of brain damage and it can significantly lower the IQ of whole populations. The most severe impacts of iodine deficiency occur during fetal development and in the first few years of life. Globally, 38 million infants are born without the protection that iodine offers the growing brain, and a full 18 million are mentally impaired as a result. It is estimated that as many as 50 countries could prevent the loss of intellectual capacity by as much as 10 to 15 percentage points if young children, newborns, and pregnant mothers received enough iodine. Clearly, it is critical to reach women of childbearing age and young children. Given how difficult it is to target these two groups, the global strategy of choice for preventing iodine deficiency disorders (IDD) is universal salt iodization (USI). Because salt is commonly consumed, even in impoverished areas, it is an ideal vehicle to carry iodine. Adding iodine to salt provides protection from brain damage due to iodine deficiency for whole populations, helping people and countries reach their full potential. Significant progress has been made through the USI Movement. However, at least 30% of households around the world still consume inadequately iodized or non-iodized salt. We have much left to do because iodine deficiency remains the single greatest cause of preventable developmental delays in the world today. Issues inhibiting sustained USI include: •	Production level constraints •	Supply problems •	Weak enforcement of regulations and policy •	Inadequate demand on the part of consumers Eliminating iodine deficiency demands a renewed drive to iodize the salt consumed by the poorest third of the population in each nation, the third that is harder to reach and will require even more effort. The most commonly employed measure for the supplementation of iodine to the population at risk to environmental iodine deficiency is iodated salt, as the salt is universally consumed by all, everyday and it can be easily fortified with iodine. It must be pointed out that supplementation of iodine in salt is a quantitative measure and the minimum quantity which must be available at consumer’s level is 150 µg of iodine per person per day. Assuming an average daily take of 10gm of salt per person, this is equivalent to 15 parts per million (15ppm). If the Iodine content is less than 15ppm at consumption, it will not prevent Iodine deficiency disorder in the population. Iodine deficiency disorder was a most epidemic problem in Nepal, especially in the western mountains and mid-hills in 1970s. To overcome, this public health problem, government of Nepal, MoHP, adopted a policy in 1973 to fortify all edible common salt with iodine under universal salt iodization (USI) program. Later in 1998, MoHP issued a two child logo for the quality certification of iodized salt with 50 ppm iodine at production level. Since, fiscal year (2060/2061), child health division decided to celebrate February as the month to create general awareness about the use of iodized salt ‘by conducting different activities with the help of different partner agencies like UNICEF, WHO and Salt Trading Corporation Ltd. This advocacy campaign further contributed in the prevention of IDD. In order to assure the child health division is also co-coordinating with the curriculum development center under ministry of education to update the current curriculum on iodine. Micronutrient initiative (MI) in 2005, conducted the survey to track the progress towards elimination of IDD in Nepal. Two main indicators of IDD – urinary iodine excretion and salt iodine at household level were assessed in a survey. The survey also explored the knowledge attitude and behavior pattern so consumers towards procurement and consumption of iodized salt in the country. This survey has revealed 24 percent goiter rate in Nepal. Also, it has also revealed that the median, Urinary Iodine Excretion (UIE) among school-aged children increased from 144 mg/l in 1998 to 188mg/l in 2005, both of iodine intake is 100 mg/l Nepal has however yet to achieve the goal of universal salt iodization, which requires that at least 90 percent of the household should be consuming adequately iodized salt. Iodine deficiency disorder: Prevalence •	Currently only 63% of household in Nepal are using adequately iodized salt. •	The proportion of low UIE( urinary iodine excretion) values ( < 100µg /l) was 39 percent ( adult women and school aged children) •	The prevalence of low UIE is highest among terai zone women. It is still high as a public health problem in that group. •	Only 35 percent of the respondents had heard educational messages about iodized salt and very few of the respondents (19%) knew about the importance of iodized salt for health.

Fig: Prevalence of low- urinary iodine (<100 µg/l) in school aged children Iodized salt Iodine deficiency disorders ( IDD) is a public health problem in Nepal and government programs have been geared towards promoting universal salt iodization (USI) since 1998 under five year plan of Action for control of IDD|( 1998-2003) in collaboration with UNICEF and JICA (MOHP, MI and New ERA, 2005) Previously national surveys in Nepal have indicated that nearly 95 percent of the households in Nepal use salt with some iodine (MOHP, MI and New ERA, 2005).The NDHS used MBI Kits that provide an estimate of iodine content in the salt, which allows the information to be compared over time. The recent preliminary report of NDHS 2011, presents the findings on salt test carried out at the household in Nepal. Four in five households in Nepal use adequately iodized salt that rural households (94 percent and 78 percent, respectively). Household in mountain are slightly less likely to consume adequately iodized salt compared with those in the hill and terai zones (79 percent versus 80-81 percent). There has been marked improvement in household using adequately iodized salt since 2006, when only 58 percent of households consumed adequately iodized salt in Nepal (MOHP, MI and New ERA, 2005) Strategies of Government for IDD: 1.	Universal salt iodization as sole strategy to address IDD 2.	Distribution of iodized salt in remote districts at subsidized rates 3.	Implementation of Iodized salt social marketing campaign 4.	Monitoring of iodized salt at the entry points, regional and national levels 5.	Evaluation of IDD status through National survey and integrated mini surveys for Vit.A, iodized salt and deworming 6.	Iodized salt warehouse construction in various parts of country 7.	Development of Iodized salt act in 1998.
 * (This data is taken from Nutrition Policy and Strategy, 24thh Dec’2004)

Reference and further readings: 1.	Nepal Micronutrient status survey, 1998, Ministry of Health /UNICEF, WHO (MI), New ERA. 2.	Nepal Demographic and Health survey 2006. MOHP/USAID/New Era 3.	National Nutrition Policy and strategy 2004 and 2008. MOHP 4.	Tracking progress on child and Maternal Nutrition in Nepal ,2010 MOHP 5.	Nepal Nutrition Assessment and Gap analysis 2010, UNICEF 6.	Preliminary report, Nepal Demographic and Health survey 2011,MOHP