Times of India
23 August 2010
By Jayashree Nandi & Senthalir S
Bangalore, India

Study Finds Sharp Dip In Iodine Content In Salt; Deficiency Affects Karnataka,
What was a severe problem a decade or two ago in Maharashtra is now affecting Karnataka and Tamil Nadu. Iodine deficiency in salt is taking a serious turn in the two southern states, with the former showing sharp dips and the latter not having adequate records to capture the percentage of iodine in salt.

Maharashtra, where salt is produced in significant quantity, has lessons for Karnataka and Tamil Nadu in containing iodine deficiency (ID), with the kind of measures it has taken over the past two decades to address the problem.

A minimum of 15 ppm of iodine should be present in every gram of salt to avoid ID, but studies show that in Karnataka, it has reduced drastically over the years. Not just in rural areas, instances of iodine deficiency are found to be high even in urban areas.

In Karnataka, the condition has been stark. When TOI accessed reports from the state lab for iodine deficiency, run by the state health department in 2009–10, the department had received 1,119 samples, of which 613 had severe ID.

"We are seeing a surge in iodine deficiency in urine samples from across the state. Over the years, health officers have been apathetic in the implementation of local health programmes and this is evident with the increase in the number of severe iodine–deficient cases even in areas in and around Bangalore," said M Chikkaramaiah, technologist at the iodine deficiency laboratory.

Health Dept Ignorant
Surprisingly, the health and family welfare department is not even aware of the increase in cases. "The number of samples coming to the lab doesn’t mean incidence is high. Last year, for around six months the government did not provide us with salt testing kits, so there were problems with testing. However, now they are being regularly tested and we have been penalizing the manufacturers who have flouted iodine levels," state health department officials explained.

The official said iodine deficiency is often ignored in urban areas. "People are not aware of the repercussions of iodine deficiency. It can be linked to neurological defects, stunted growth, stillbirths, spontaneous abortions and cretinism."

He added that the government has to take steps to ensure that people get sufficient iodine. "We write to the salt commissioner regularly with batch numbers and name of the salt company, for action. But they are often ignored," the officials said.

However, the salt commissioner’s office has washed its hands of the issue. "If iodine deficiency is detected at the manufacturing level, we can screen it, but once it is in the market, it is the state government’s job to inspect," said an officer from the deputy salt commissioner’s office in Mumbai.

NO RECORDS IN TN
In Tamil Nadu, there is no record of ID cases in people. But instances of low iodine content in salt are high. In 2009–10, samples collected by health inspectors showed that out of around 1.45 lakh samples, 11,571 (7.9%) had no iodine, 41,817 (28.7%) samples had less than 15 ppm of iodine, around 92,000 (63%) had above 15 ppm of iodine. "We don’t record ID cases, neither do we have urine testing. Our inspectors collect salt samples regularly to check on iodine levels," said director, public health, Dr Porkai Pandyan.

Maharashtra government officials said iodine deficiency is not considered a big problem in Mumbai or the rest of the state. "It is a problem only in high–altitude areas and not urban areas,’’ said a senior health officer from the Maharashtra directorate of health services.

Considering that salt is manufactured mainly in the Maharashtra–Gujarat belt, it is not surprising that iodine deficiency is not as big a problem now as it was two decades ago. The mandatory iodine deficiency cells also helped here.

But it is also true that pockets of endemic iodine deficiency remain to this day. A survey by the Indian Council for Medical Research found that 29 of Maharashtra’s 35 districts surveyed five years ago, iodine deficiency was endemic in 21 districts. The problem was much worse decades ago: according to a research paper in 1993 by SNDT Women’s University, Santa Cruz (W), which studied 866 adolescents – 416 girls and 450 boys – from the slums of Mumbai, found the prevalence of goitre to be 56% in both boys and girls.

Impact On Health
According to Jyoti Prasad, chief dietitian, Manipal Hospital, goitre (swelling in the thyroid gland which can lead to swelling of the neck or larynx) is not the only issue. In fact, it is a small percentage of patients with severe deficiency who get goitre.

"The other serious health impacts are mental retardation in children or cretinism, lower IQ, pregnancy–related problems like sudden miscarriages, stillbirths and congenital abnormalities," she said. Though these conditions have hardly been associated with the probable lack of iodine in diet, the figures of the state lab show the real story.

Salt Samples

• Results of salt samples sent to the lab by medical colleges or other health institutions: Devanahalli: 52 samples – 40 had severe deficiency
• Hassan: 524 samples – 522 had severe deficiency
• Tumkur: 499 samples sent, 377 with severe deficiency
• Shimoga: 546 samples, 322 had severe, many had moderate deficiency
• The status of urine samples is also grim. Of 275 samples, 141 had severe deficiency:
• Bangalore Urban: 12 samples – 8 had severe deficiency
• Hassan: 269 samples – 130 severely deficient, 161 had moderate deficiency