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Write 5 marks answer from park on topic prevention of IDD

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Prevention of Iodine Deficiency Disorders (IDD)

(Park's Textbook of Preventive and Social Medicine)
Adequate technology exists for the successful prevention of iodine deficiency disorders. IDD encompasses the full spectrum of conditions caused by iodine deficiency - goitre, hypothyroidism, cretinism, mental retardation, deaf-mutism, spontaneous abortion, and stillbirth. Prevention is addressed at multiple levels:

1. Iodization of Salt (Primary Strategy)

The most effective and widely used method is salt iodization (Universal Salt Iodization - USI). Common salt is fortified with potassium iodate (KIO₃) because:
  • Salt is universally consumed across all socioeconomic groups
  • No special delivery system is required
  • It is cost-effective and technically feasible
In India, under the National Iodine Deficiency Disorders Control Programme (NIDDCP), nation-wide use of iodized salt in place of common salt is promoted. The sale of non-iodized salt for human consumption is banned under the Food Safety and Standards Act 2006 and Regulations 2011.
Level of iodine in salt: 30 ppm (mg/kg) at the production level; at least 15 ppm at the consumer level.

2. Iodized Oil (For High-Risk and Inaccessible Areas)

Where salt iodization is not feasible (remote or inaccessible areas), iodized oil (e.g., Lipiodol) is used. It can be given:
  • Intramuscularly (IM): Single injection protects for 3-5 years
  • Orally: Cheaper, easier to administer; protects for about 1 year
It is especially recommended for pregnant women and children in severely deficient endemic areas.

3. Iodization of Water

In some areas, iodine is added to the drinking water supply. This is a supplementary strategy used where other methods are not practical.

4. Dietary Diversification and Avoidance of Goitrogens

  • Encouraging consumption of iodine-rich foods: sea fish, seafood, sea salt, cod liver oil, milk, and eggs.
  • Goitrogens (substances that block iodine utilization, e.g., cassava/cyanoglycosides, thiocyanates, brassica vegetables like cabbage and cauliflower) should be avoided or minimized in severely deficient areas.
  • Diet should be well-balanced to meet the daily iodine requirement:
    • Adults: 150 mcg/day
    • Pregnant women: 250 mcg/day (WHO recommendation)

5. Monitoring and Surveillance

Prevention programs require ongoing monitoring through:
  • Urinary iodine excretion (key surveillance indicator; median UIE ≥ 100 mcg/L = adequate intake)
  • Prevalence of goitre (clinical grading)
  • Prevalence of cretinism
  • Serum T4 and TSH levels
  • Neonatal hypothyroidism rates (sensitive indicator of environmental iodine deficiency)
Resurveys to assess impact of iodized salt are conducted every 5 years.

6. National IDD Control Programme (NIDDCP) - India

The four essential components are:
  1. Iodized salt - use in place of common salt
  2. Monitoring and surveillance - of salt iodine content and urinary iodine
  3. Manpower training - at all levels
  4. Mass communication / IEC - to educate people about the importance of iodized salt
IDD Control Cells have been established in 34 States/UTs. ASHAs test salt with salt testing kits at the community level.

7. Health Education

Community education is essential to:
  • Promote consumption of iodized salt
  • Discourage use of raw/unprocessed salt
  • Create awareness about the spectrum of IDD and its consequences
Source: Park's Textbook of Preventive and Social Medicine, Chapter on Nutrition and Nutritional Disorders (IDD section, pp. 720-721, 739-740) and National Health Programmes chapter (pp. 494, 499).
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