Persistence of severe iodine-deficiency disorders despite universal salt iodization in an iodine-deficient area in northern India

Abstract

Objective: The aim of the present study was to determine the impact of universal salt iodization (USI) on the prevalence of iodine deficiency in the population of an area previously known to have severe iodine deficiency in India. Design: In a cross-sectional survey, a total of 2860 subjects residing in fifty-three villages of four sub-districts of Gonda District were examined for goitre and urinary iodine concentration. Free thyroxine and thyroid-stimulating hormone levels were also measured. Salt samples from households were collected for estimation of iodine content. Results: A reduction in goitre prevalence was observed from 69 % reported in 1982 to 27?7 % assessed in 2007. However, 34 % of villages still had very high endemicity of goitre (goitre prevalence .30 %). Twenty-three per cent of households consumed a negligible amount (,5 ppm) and 56 % of households consumed an insufficient amount (5-15 ppm) of iodine from salt. Conclusions: Although there was an overall improvement in iodine nutrition as revealed by decreased goitre prevalence and increased median urinary iodine levels, there were several pockets of severe deficiency that require a more targeted approach. Poor coverage, the use of unpackaged crystal salt with inadequate iodine and the washing of salt before use by 90 % of rural households are the major causes of persisting iodine-deficiency disorders. This demonstrates lapses in USI implementation, lack of monitoring and the need to identify hot spots. We advocate strengthening the USI programme with a mass education component, the supply of adequately iodized salt and the implementation of complementary strategies for vulnerable groups, particularly neonates and lactating mothers.

Changing trends in prevalence of goitre in hilly areas

“…But with the use of iodized salt, the prevalence of goitre has decreased. 8 In our study we found around 85% of patients using iodized salt as seen in Figure 2. According to a study thyroid disorder are 8 times more common in females than males.…”

Thyroid status two decades after salt iodization: country‐wide data in school children from India

“…There was a decline of goitre prevalence from 23% to 15·5% when compared with our previous nationwide study 9 conducted a decade earlier. Other regional studies from India have also reported a residual goitre prevalence of 15·1–37·6% 10,18–21 . An impressive decline of goitre prevalence from 49·9% to 6·2% was reported from Bangladesh after one decade of iodization despite persistence of iodine deficiency in one‐third of their study population 8 and 25–6·9% from Tanzania 7 after one decades of salt iodization.…”

“…Other regional studies from India have also reported a residual goitre prevalence of 15AE1-37AE6%. 10,[18][19][20][21] An impressive decline of goitre prevalence from 49AE9% to 6AE2% was reported from Bangladesh after one decade of iodization despite persistence of iodine deficiency in one-third of their study population 8 and 25-6AE9% from Tanzania 7 after one decades of salt iodization. However, persistence of endemic goitre after salt iodization ranging from 10AE4% to 39AE6% has been reported by several authors from other countries.…”

Malignant Thyroid Lesions: A Histopathological Perspective

“…This resulted to the launching of the USI (Universal Salt Iodization) program, an exceptional cost effective community health intervention strategy [53]. This program recorded remarkable success worldwide in reducing the incidence of thyroid disease [54,55,56].…”