Millions of Indians in danger of iodine deficiency disorders

By Anindita Ramaswamy Jul 1, 2005, 6:12 GMT

New Delhi - Indian children are taking salt samples from home to schools hoping the headmaster can magically make the granules change colour.

If the salt is iodized, a drop of starch solution turns it purple, and the student breathes a sigh of relief. Those whose salt plates remain obstinately white often burst into tears.

UNICEF, the U.N. children's fund, has distributed more than 40,000 salt testing kits in schools in the southern Indian state of Tamil Nadu. Children then teach their parents about the debilitating impact of a spectrum of disorders caused by a lack of iodine in their diet.

Iodine is required for the synthesis of the thyroid hormones and is essential for normal growth and development. We need just a teaspoonful of iodine in our life span, but this must be taken in small and constant quantities.

Iodine Deficiency Disorders (IDD) have enormous consequences for the sufferers, communities and nations, as millions of people will never realize their full potential. They range from goitre, characterised by a swollen thyroid gland, and cretinism, a congenital deficiency of thyroid hormone, to delayed mental and physical development.

The simplest way to ensure an adequate intake of iodine is through iodized salt, but millions in India and the rest of the developing world have no access to it.

The Indian health ministry said every single part of the country is affected by IDD, with more than 71 million people already suffering and an estimated 167 million at risk.

More than 54 million Indians have goitre, about 2.2 million are cretins and 8.8 million have mental and motor handicaps.

Children with IDD can grow up stunted, apathetic, mentally retarded and incapable of normal movement, speech or hearing. Of the 26 million children born every year, 13 million are at risk in early childhood of impaired speech and hearing, motor development and physical growth, and severely depleted levels of efficiency and output, UNICEF said.

The health ministry said children who live in areas where the soil lacks iodine and thus not available at the required levels in vegetables and pulses, have an IQ level 10-15 points lower than average.

IDD in pregnant women causes miscarriages, stillbirths and leads to the birth of mentally-retarded children. Severe cases of IDD such as cretinism are irreversible, yet completely preventable.

Doctors from the All India Institute of Medical Sciences, who documented changes after 16 years of salt iodization in the Gonda district of northern Uttar Pradesh state, were startled by the differences.

Until a few years ago, most of the schools in Gonda were empty, as there was no will to learn. Those who attended class, did so in a haze of confusion, too lethargic to imbibe much. <!--page-->

The children were suffering from hypothyroidism or the slowing of the metabolic rate due to deficiency in the production of thyroid hormones.

Today, animated groups of children rush into classrooms too small to accommodate their growing numbers. Doctors say this is the impact of salt iodization.

Fortifying salt with iodine is technically simple and inexpensive, but many traders refuse to do so because they have to pack the salt in moisture-proof bags to prevent the loss of iodine, and this packaging pushes up the price.

India is the world's largest salt producing country after the United States and China. But the consumption of iodized salt dropped from 49 per cent in 1989-1999 to 37 per cent in 2004, after the government lifted a ban on the sale of non-iodized salt in 2000 to appease the salt manufacturers' lobby.

India has among the lowest levels of iodized salt consumption in Asia while China has 93 per cent, followed by Bhutan at 95 per cent and Bangladesh at 70 per cent.

"China has done a phenomenal job, mainly because of political commitment. The Chinese government realised that a population not reaching its full potential would make it difficult to compete in the global market," said UNICEF project officer Nita Dalmiya.

"In five years, China went from 39 per cent to 95 per cent of salt being iodised. One of the areas that has flared up recently is Eastern Europe, where less than a third of salt is adequately iodized," she said.

On June 15, Indian Health Minister Anbumani Ramadoss announced the reinstatement of the ban on the sale of non-iodized salt. "At the national level, IDD is a serious public health problem. More importantly it can significantly retard socio-economic growth of the nation by vastly reducing the productive capabilities of millions of Indians."

Manufacturers have two months to comply, as the ban will be imposed from August 15.