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HEALTH HEED
 

Iodine Deficiency Disorders

Iodine deficiency is the world's leading cause of preventable mental retardation and loss in learning ability in children. In its most extreme form, iodine deficiency causes cretinism. It also significantly raises the risks of stillbirth and miscarriage for pregnant women.

Most commonly and visibly associated with goiter, iodine deficiency takes its greatest toll in impaired mental growth and development, contributing in turn to poor school performance, reduced intellectual ability, and impaired work performance.

Pakistan is one of the very few make or break countries in the world where the burden of disease due to deficiency of Iodine is enormous and is directly effecting the health, education, economics and social well being of a very large proportion of the population.

Pakistan is directly and/or indirectly responsible for almost 50% of all under 5 deaths in the country. The larger part of malnutrition is ‘Hidden Hunger’ or malnutrition of micronutrients like Iodine, Vit-A, iron and Zinc, which has been a serious concern.

Iodine is a natural element which may leach out of soil making the food ingredients deficient in its content. It is a micronutrient with a daily requirement in trace amounts. Iodine Deficiency Disorders (IDD) is one of the major micronutrient problems affecting about 1.5 billion people worldwide; 655 millions with goiter and 11 millions with cretinism. Visible goiter represents only “the tip of the iceberg" and about 90% of IDD incidence is unexposed.

A basic element, it is antiseptic, water soluble, tasteless and white in color. “It makes a very important hormone in the body for which a very small amount, that is, 150 micro grams is required per person per day. One teaspoon of iodine is enough for entire life,” informs Dr. Mohammad Rafique, known for his successful Swat Model, which achieved 100% iodization at the processing units and about 96% consumption at the household level. Regular consumption of iodized salt can eliminate iodine deficiency with in a short period of time.

According to the National Nutrition Survey, one of the main reasons for not using iodized salt other than the high price (35%) and non-availability (17%) were rumors about contraceptive effect (13%). However, according to Dr Rafique, “on the contrary, the truth is even a low level of iodine deficiency can result in several negative health consequences leading to suboptimal development and growth of an adult with a diminished physical and socio-economic potential.” He supports by the following examples:

  • Effects on the mother/ fetus: - Abortions, Still births, Congenital Abnormalities, Neurological Cretinism, Myxoedema, Cretinism, Psychomotor defects, Increase neonatal mortality
  • Effect on the child and adolescent:-             Goiter, and its complications, Hypothyroidism, loss of energy, impaired mental function, lowering of IQ by upto 15 points, retarded mental and physical development, diminished school performance
  • Effect on the adult:- Goitre and its complications, Hypothyroidism, impaired mental function, reduced socio economic acumen.

 Some of the reasons for the misconception was that the television commercial advocating the message of use of iodized salt stared the popular mini screen actress Atiqa Odho. During that time, Ms Odho was also doing a public service announcement (PSA) for family planning. The two commercials were aired on Pakistan Television one after the other, with Ms Odho in the same get-up. This created a misunderstanding amongst the public, Dr Yaqoob Qureshi, Media Advisor, Nutrition Wing, Ministry of Health, clarifies the misconception. Had the Ministry known about the severity of the campaign, it would have taken measures to clear it immediately, adds Dr Qureshi.

“The new communication strategy also aims to "reposition" iodine deficiency from "goiter" to a wide spectrum of disorders (especially mental retardation) that causes prenatal deaths, mental retardation, reduced school performance, lower labor productivity, as well as ongoing human suffering and will dispel the misconception and myth of relationship between iodized salt contraceptive measures.

Global evidence thus suggests that control of IDD through Universal Salt Iodization (USI), is the cheapest, most cost-effective and one of the easiest way to tackle the problem. The general consensus is to make USI mandatory for every country. Over the last several decades the Government of Pakistan has shown continued interest in eliminating Iodine Deficiency from the country, however concerted effort still lacks. As such, IDD remains to be a significant and pressing public health problem in Pakistan.

Pakistan is one of the very few make or break countries in the world where the burden of disease due to deficiency of Iodine is enormous and is directly effecting the health, education, economics and social well being of a very large proportion of the population.

Over the last several decades the Government of Pakistan has shown continued interest in eliminating Iodine Deficiency from the country. For Dr Zahid Larik, Deputy Director Health (Nutrition) Salt iodisation and availability and use of iodised salt is not yet a reality in Pakistan. Salt iodization coverage trends in many countries, including Pakistan, severely affected by iodine deficiency have been flat or even declining. The group of Children and women not yet reached is the more marginalized section of the world’s population and in greatest need for protection against IDD. Compliance by small and some medium-scale salt producers continues to pose the main challenge.

It will thus be impossible to achieve the health MDG targets without addressing malnutrition and hunger. The investment in the reduction of iodine deficiency is in line with more than one MDGs.

  • Reduce child mortality: Reduce ID will ensure reduce incidents of miscarriages still births and other pregnancy related complications, as well as early neonatal deaths.
  • Improve maternal health: Elimination iodine deficiency in women will reduce the rate of miscarriages, incidents of thyroid diseases and other associated clinical and sub clinical outcomes of ID, and hence would improve the health status of women in the reproductive age.

With iodization the main gain to the society is the increase in productivity of the human resources, better health of the mothers, decrease in the proportion of disabled and mentally retarded, who are less productive, increase in average Intelligence Quotient (IQ) of school going children and decreased school dropout rate, decrease in the cost of private and public expenditure on healthcare.

Despite more than ten years of various programs, campaigns and promotional activities, investment and support, the low demand for iodized salt is evident from low coverage 17% of population. Unless there is an effective and persistent consumer demand the suppliers will continue to process and market un iodized salt. The processors would only produce/ supply iodized salt if the consumers send a signal to the producers that only iodized salt is acceptable. Syed Husaini Jagirdar, Development Economist.

 

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