National Iodine Month 2023 : The Salt Trading Corporation (STC) is all set to celebrate the month of February as the ‘National Iodine month’ .Iodine is a micronutrient essential for thyroid function. Iodized salt prevents goiter, brain damage,and other health problems among children and adults. In line with food and drug regulations, household salt should be fortified with iodine to at least 15 parts per million (ppm) at the consumption level..
The primary strategy for sustainable elimination of iodine deficiency remains Universal Salt Intake. In some countries, however, implementation of salt iodization programmes may not be feasible in all areas, thus resulting in insufficient access to iodized salt for some groups within the population. In these cases, besides strengthening the USI programmes, additional complementary strategies should be considered by the country to ensure optimal iodine nutrition for these susceptible groups. As the first step, countries need to assess and categorize the level of implementation of salt iodization programmes and, based on this analysis, should revisit the strategy for the control of Iodine Deficiency Disorders (IDD), as necessary. Guidance for the categorization and planning process is presented in this statement.
Nepal once had one of the highest prevalence’s of iodine deficiency disorders in the world. Reports from British visitors to Nepal decades ago noted a high prevalence of goitre and cretinism and attributed the problems to a wide variety of causes by the local population. There were accounts of tens of thousands of cases of goitre treated in Nepal’s Terai by British medical officers in the ensuing years.
Decades passed, but the problem is still plaguing remote parts of the country. Plus, the country needs to adjust the iodine intake standard to reflect several recent developments. Hence, celebrating February as the Iodine Month is still relevant in Nepal.
Table of Contents
Policies and progress
A policy to fortify all edible salt with iodine in Nepal was adopted by the government in 1973 and iodised oil supplementation in target districts had started in 1979. The cost of iodine supplementation was much more expensive than salt iodisation, and the lack of adequate public health infrastructure required for its delivery limited the reach of the intervention.
As the access to iodised salt increased considerably in remote parts of the country, iodine supplementation was phased out in 1998, adopting salt iodisation as the sole strategy to control and eliminate IDD in the country. A social marketing campaign along with the celebration of the month of February as the Iodine Month continues to raise awareness about the government-endorsed “two‐child logo” packaged salt for consumption of adequately iodised salt at the household level. The logo includes a healthy child and was used in the communication campaign.
Because there is no salt produced in Nepal, the Universal Salt Iodisation programme leveraged the bilateral trade relationship with the government of India. Thus, by 1999, the national IDD plan recognised salt iodisation as the sole intervention for addressing IDD elimination goals.
1. Countries, or areas within countries, in which more than 90% of the households have access to iodized salt, should sustain the achievement of universal salt iodization (USI) and periodically reassess the salt iodization programme and population iodine status.
2. Countries, or areas within countries, in which 50-90% of the households have access to iodized salt should make efforts to accelerate USI based on the existing operational guidelines (1, 2). If no progress in scaling up is being made within two years, then the feasibility of increasing iodine intake in the form of a supplement or iodine fortified foods by the most susceptible groups – pregnant and lactating women and children 7-24 months of age – would need to be assessed, using the recommended strategy for countries in which 20-50% of the households have access to iodized salt.
3. Countries, or areas within countries, in which 20-50% of the households have access to iodized salt will need to assess the feasibility of increasing iodine intake in the form of a supplement or iodine fortified foods by the most susceptible groups, as described in the following programmatic steps:
- Assess population iodine nutrition status, household iodized salt coverage (preferably disaggregated) and salt iodization programmes in order to identify a national or sub-national problem. An initial rapid assessment will be needed for advocacy and for future monitoring if no assessment has yet been made. The methodology of assessments is described in the WHO/UNICEF/ICCIDD guidelines on “Assessment of Iodine Deficiency Disorders and Monitoring their Elimination” (2).
- Develop new plans to strengthen salt iodization that include increasing political commitment, advocacy, capacity-building of the salt industry for production and quality assurance, adoption and enforcement of appropriate regulations/legislation, and an effective iodized salt monitoring system at production (or importation), retail and community levels.
- If a country does not succeed in scaling up its salt iodization programme within two years, the feasibility of increasing the iodine intake of susceptible groups by means of supplements or iodine-fortified foods will need to be explored as a temporary measure while strengthening the salt iodization programme. In areas of moderate and severe iodine deficiency (median urinary iodine less than 50 ug/L or total goitre rate more than 20%), the objective should be to provide additional iodine in the form of a supplement to all pregnant and lactating women, and in the form of a supplement or complementary food fortified with iodine for children 7-24 months of age.
- Assessing the feasibility of providing additional iodine should include: (i) costing of supplementation, (ii) existing channels for distribution to reach the target groups, (iii) likely duration of supplementation, and (iv) potential compliance.
4. Countries, or areas within countries, in which less than 20% of the households have access to iodized salt should assess the current situation of its salt iodization programme to identify national or sub-national problems and to update its strategies and action plans. The most vulnerable groups, pregnant and lactating women, should be supplemented with iodine, and children 7-24 months of age should be given either a supplement or complementary food fortified with iodine until the salt iodization programme is scaled up.
Iodized Salt (Production, Sale and Distribution)Act, 2055(1998)
It is expedient to make provision for the production, import, supply, sale, distribution of iodized salt in a proper quantity and for mixing iodine with salt in order to prevent and eradicate extensive and serious effects caused to public health from iodine deficiency.
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