Around the globe there are almost two billion people that have iodine deficiency in their daily diets which is also the most prevalent yet easily preventable cause of brain damage. Iodine deficiency is the problem not only in the developing countries areas but also in many developed countries and also in those part of the world where iodine is insufficient like in Turkey, Pakistan specially northern areas. A WHO survey on iodine status worldwide lists Pakistan as having "severe iodine deficiency" with 135 million people having insufficient iodine intake. Deficiency of iodine is the single most common causes of preventable neonatal and juvenile thyroid deficiency, dwarfism, mental defects, deaf mutism, and spastic weakness and paralysis, as well as lesser degrees of loss of physical and mental function and brain damage because central nervous system development depends on the required supplying of thyroid hormones which need for the iodine biosynthesis, which loss IQ points 10 to 15 in the world which is preventable by the health diet.
Endemic cretinism is very severe manifestation of the lack of maternal and foetal thyroid hormone become from severe iodine deficiency. The hall marks of endemic cretinism include that the mental retardation and brain disorder best described as showing pyramidal signs in an upper limb distribution and extra pyramidal signs. These subjects have a diagnostic gait, which is not only related to the neurological disorder but contributed to by joint laxity and deformity. Iodine deficiency is a major public health problem in Pakistan and is a threat to the social and economic development of the country. Iodine is essential for the normal development and growth of the human brain and body after the birth of the baby as well as during pregnancy for the health of the child and mother herself. It also helps in overseeing the body efficiently also burns calories thus preventing excess calories from being stored as extra fat. Iodine has a role in maintaining the energy level of the body and in helping the skin, teeth, nails and hair to be strong and healthy.
Who is affected?
The pregnant women's and children under the age of five affected most of the time because if the pregnant women does not take enough iodine during pregnancy then it indirectly harms the baby.That is why WHO recommend increasing intake of iodine during pregnancy from 200 to 250 mg/d.
Epidemiologic criteria for assessing iodine nutrition in a population of
Pregnant women based on median urinary iodine concentrations1
Median urinary iodine intake
,150 lg/L
Insufficient
150-249 lg/L
Adequate
250-499 lg/L
More than adequate
_500 lg/L
Excessive
Iodine deficiency in pregnant women may cause miscarriage, still birth and birth defects. Iodine deficiency impairs growths and development of children. The main factor responsible for iodine deficiency is a low dietary supply of iodine. When iodine requirements are not met, thyroid hormone synthesis is impaired, resulting in hypothyroidism and a series of functional and developmental abnormalities grouped under the heading of "Iodine Deficiency Disorders (IDD)". Goitre is the most visible manifestation of IDD. However, the most damaging disorders induced by iodine deficiency are irreversible mental retardation and cretinism. If iodine deficiency occurs during the most critical period of brain development (from the foetal stage up to the third month after birth), the resulting thyroid failure will lead to irreversible alterations in brain function. While cretinism is the most extreme manifestation, of considerably greater significance are the more subtle degrees of mental impairment leading to poor school performance, reduced intellectual ability and impaired work capacity.
Iodine deficiency is a global health problem and 2.2 billion people (38 per cent of the world's population) live in areas with iodine deficiency and risk its complications, states the International Council for the Control of Iodine Deficiency Disorders (ICCIDD).
Large populations living in systems of subsistence agriculture are especially at risk of iodine deficiency as they live in an environment where the soil is deprived of iodine. The deficiency in the soil leads to iodine deficiency in all forms of plant life and cereals grown in the soil.
What is iodine deficiency
Iodine is risk factor for growth and the healthier development for the people living in iodine deficient environment in the different parts of the world.
Iodine is an element that is needed for the production of thyroid hormone. The body does not make iodine, so it is an essential part of your diet. Iodine is found in various foods. If you do not have enough iodine in your body, you cannot make enough thyroid hormone. Thus, iodine deficiency can lead to enlargement of the thyroid, hypothyroidism and to mental retardation in infants and children whose mothers were iodine deficient during pregnancy lead to hearing and speaking difficulty, & poor growth. According to WHO one billion people all over the world are at risk of IDD, 200 million people have goitre and 20 million are suffering from preventable brain damage. In Asia alone 400 million people are at risk, 30 million are suffering from goitre, 0.9 million are cretin and 36 million have some degree of mental impairment due to iodine deficiency.
However, many other parts of the world do not have enough iodine available through their diet and iodine deficiency continues to be an important public health problem globally. Approximately 40% of the world's population remains at risk for iodine deficiency.
Table . Common sources of dietary iodine
Sources
Breads
Iodized table salt
Cheese
Saltwater fish
Cow's milk
Seaweed (including kelp, dulce, nori)
Eggs
Shellfish
Frozen yogurt
Soy milk
Ice cream
Soy sauce
Iodine-containing multivitamins
Yogurt
What events can indicate a need for more high-iodine foods?
Goiter (enlargement of the thyroid gland)
Fatigue
Weakness
Depression
Weight gain
Concentrated food sources of iodine include sea vegetables, yogurt, cow's milk, eggs, strawberries and mozzarella cheese. Fish and shellfish can also be concentrated sources of iodine.
The world's healthiest food
Causes of iodine deficiency
Causes of iodine deficiency are could be medically or insufficient intake of iodine.
Medically Goitre, (An enlargement of the thyroid gland) Multinodular goitre, thyroid gland, myxedema, iodine supplementation.
Non medical Non medical is simply iodine deficiency which is insufficient take of iodine in diet.
How do you diagnose iodine deficiency
To diagnose the iodine deficiency in the hospital setting patients normally doctor first of all palpate the thyroid gland and then they further investigate depend upon the symptoms or simple test is patient have to take iodine tablets if the iodine is sufficient in the body of the patient the excess iodine is excreted in the urine within the next 24 hours and if the iodine is insufficient in the body it retains most of the iodine with a little iodine appearing in the urine. Almost everyone who is associated with iodine deficiency tested positive for iodine lack. Therefore, it often is sensible to assume iodine lack and proceed to treat with iodine. However, some patient takes iodine for several months and has shown no improvement this test can be used to exclude a problem with absorption of iodine. Iodine lack is known to be a factor in the development of breast and prostate cancer.....
Also some other tests like blood test for the function of thyroid gland which is very help full for the diagnostic purpose and biopsy in case of nodules for differential diagnosis also taken and ultrasound.
Previous Level of IDD in Pakistan
According to UNICEF (1998), 70% of the total population in Pakistan is at risk of IDD.
Northern areas of Pakistan (Dir, Swat, Chitrral and Gilgit) are highly endemic for IDD5-6. Iodine deficiency is also reported from other parts of the country like Azad Jammu and Kashmir, Peshawar, Swabi, Islamabad, Karachi and Quetta.
IDD can only be eliminated by addition of iodine through any mean in the food items. Pakistan among the nations of the world raised the slogan to eliminate IDD by the year 2000. In 1983, Government of Pakistan in collaboration of UNICEF started a crash programme of oil iodization and its administration in the population of northern areas of the country, but due to high cost the program could be sustained for 10 years. District Swat being one of the highly endemic area for IDD Sustained and dedicated efforts could raise the iodized salt consumption to 20% in the families by 1997.
Current Situation in Pakistan
According to the National Nutrition Survey (2001-2002) more than half of Pakistanis total population was at the risk of iodine deficiency among pregnant women could also cause miscarriages, stillbirths and other complications. Children with IDD grow up stunted, apathetic, mentally retarded and incapable of normal movements, speech or hearing, Dr Noor Ahmad said. He added that it was only with longer and severe deficiency of iodine, that goiter formation took place. If not addressed this iodine deficiency can alone result in mental impairment of 2.1 million Pakistani children, he warned. The Nutrition Wing, Ministry of Health (MoH) with the assistance of the Micronutrient Initiative (MI) revitalised the Universal Salt Iodisation Programme (USIP) in Pakistan, during 2005-06. (Azam 2009)
According to the independent statistics in Pakistan, around 50 million people are suffering from iodine deficiency, 6.5 million of which are facing severe type of deficiency and at least one million show some degree of mental retardation.
Up to 90% of the population of hilly areas of NWFP, AJK and Northern Areas and numerous pockets of population in Punjab is iodine deficient. Ironically, only 17 per cent of the overall population use iodised salt in our country.
How is iodine deficiency prevented?
As with many diseases, it is better to prevent the problem rather than have to treat it. Over the last 80 years, world-wide efforts have been made to eliminate iodine deficiency. Indeed, elimination of iodine deficiency has been a major goal of the World Health Organization. Iodized salt has been the mainstay of treatment for iodine deficiency worldwide, including in the United States as well as in Pakistan.
Some vitamins are also containing iodine so people could full fill their requirement of iodine by using vitamins during the year. However if people use iodised salt then they do not need to use take extra iodine supplements. Injections of iodized oil are occasionally used in regions of the world where widespread iodized salt use is not possible. Iodination of water supplies also has been effective in some places.
The Institute of Medicine has set the Recommended Dietary Allowance (RDA) for iodine in adult men and women at 150 μg per day. Individuals who add table salt to their food regularly should use iodized salt. One teaspoon of iodized salt contains approximately 400 μg iodine. Most iodine-containing multivitamins have at least 150 μg iodine, but only about half of the types of multivitamins contain iodine.
The RDA is 220 μg iodine per day for pregnant women and 290 μg iodine per day for breastfeeding women. Because the effects of iodine deficiency are most severe in pregnant women and their babies, the American Thyroid Association has recommended that all pregnant and breastfeeding women should take a prenatal multivitamin containing 150 μg iodine per day.
Intervention
Country Profiles >Pakistan
Population 1
Population: 153.578 millions
Population annual growth rate: 2.5%
Population < 18 years: 73,711 thousands; <5 yrs: 23,528 thousands
Crude birth rate: 36 per 1000
Life expectancy at birth: 61 years
Current Iodine Nutrition Situation
Total goiter rate in 1993 was 84.9%.
Median urinary iodine concentration (1993) was 16 µg/l with 90.4% of population had UIC<100 µg/L .
Household consumed adequately iodized salt 1 : 17 % (1995)
Salt Situation Analysis
Production 3
1
Rock Salt (tons/year)
360,000
2
Lake, sea and subsoil salt(tons/year)
90,000
Imported salt
-
3
Export of salt to other countries(tons/year)
Afghanistan, 25,000 Tonnes/year
4
Salt produced by small scale industry/processor
65%
Total salt production (tons/year) 6
800,000
There are close to 600 primarily small-scale, private sector salt processors in Pakistan who crush and grind rock salt using manual labor and technology that has changed little for centuries.
Universal Salt Iodization Program
Information, Education, C ommunication (IE C ) Activities
UNICEF assisted designing a social marketing program in the highly endemic northern regions of Pakistan. Based on the success of this intervention, UNICEF subsequently expanded the project by contracting a local NGO partner, Social Marketing Pakistan (SMP), to implement the project on a national scale. In consultation with the Government of Pakistan and with continuing support and funding from UNICEF and the Canadian International Development Agency (CIDA), the Pakistan Iodized Salt Project works with the salt industry to ensure a sustainable supply of iodized salt while simultaneously creating demand among consumers.
As the supply of iodized salt hits the market, the demand creation campaign ensures that consumers choose iodized salt instead of non-iodized salt. Central to the marketing campaign was the development of the "Hand & Pot" logo, which has become the universal symbol for iodized salt in Pakistan. The demand creation campaign makes intensive use of mass media such as television and radio. The campaign has made the "Hand & Pot" logo a positive image, emphasizing the healthy family, rather than the negative aspects of IDD. In addition to mass media, a range of other communications channels are used to reach a variety of target audiences: salt retailers, doctors, teachers and volunteers in remote villages.
Logo for Iodized Salt in Pakistan
Challenges
Most of the salt processors, especially the small scale producers lack equipment, technical know-how and means for purchasing KIO3 and recovering the cost from consumers due to their market size.
In two of most populous provinces of Pakistan (75 % of country population), salt iodisation legislation is not in place.
Integration of IDD control & USI program is not being properly & adequately treated as priority subject within the health services delivery.
Consumer awareness and demand for iodised salt is still not up to the mark which is somehow or the other backed by rumours and fallacies.
Plans for the future
A national strategic Plan has been developed and approved by the Government of Pakistan early this year. A five year phased out national action plan, 2005-10 was prepared in three phases. Ministry of Health, UNICEF, MI and Salt sector have been in closed coordination and some progresses have been made:
• UNICEF continues providing KIO3 (until arrangements of importation - which is currently being developed - is established)
• Private sector involvement in importation of KIO3, its distribution and proper utilization will be entrusted to some motivated and interested party such as HUB PAK salt industry.
Provincial Health Department especially those of Punjab and Sindh have been involved in promulgation of USI legislation and quality control.
• A good move in North-West Frontier Province (NWFP) is the establishment of Association of Salt Industry has been established in NWFP and they will be involved in the storage and distribution of KIO3 and regulation of salt processing units.
• A National Coalition on IDD control and USI is currently being formalized.
Are there problems with taking too much iodine?
Taking too much iodine can also cause problems. This is especially true in individuals that already have thyroid problems, such as nodules, hyperthyroidism and autoimmune thyroid disease. Administration of large amounts of iodine through medications (ie Amiodarone), radiology procedures (iodinated intravenous dye) and dietary excess (Dulce, kelp) can cause or worsen hyperthyroidism and hypothyroidism.
In addition, individuals who move from an iodine-deficient region (for example, parts of Asia and Africa) to a region with adequate iodine intake (for example, the United States) may also develop thyroid problems since their thyroids have become very good at taking up and using small amounts of iodine. In particular, these patients may develop iodine-induced hyperthyroidism
Treatment
In an adult, 150 mcg/d is sufficient for normal thyroid function. Using highly concentrated pharmaceutical agents, such as a saturated solution of potassium iodide (SSKI), ie, 35,000-50,000 mcg/drop, is impractical and potentially dangerous.
Adult multiple vitamins that contain iodine typically contain 150 mcg of iodine per tablet.
Other alternative food sources include milk, egg yolks, and saltwater fish.
In developing countries, eradication of iodine deficiency has been accomplished by adding iodine drops to well water or by injecting people with iodized oil.
Recommendation
Govt should advertise with the help of mass media campaign and educate people via advertisements or educational programs because a large percentage of people in Pakistan don't know why they should eat iodised salt and what are the importance of iodine in everyday life. To encourage people to take some vitamins during the year as in most of vitamins are contains iodine which should be provided on cheap rates as it is not possible to buy vitamins for everyone, and more awareness by education like people don't know how much and what to take in daily diet and there so many thing to remember but I think first of all people at least should know when they found one of these symptoms which are mention in this easy they should contact with their family doctor or GP like in some part of the world iodine is naturally in sufficient so people have to take additionally iodine with their diet and normally they do but if someone migrate to that country then it is hard to guess for them but if they have some knowledge of iodine deficiency they will recognise the problem and will seek the medical assistance, also people who have hypersensitivity, tiredness, heart beat difficulty in breath while sleeping and lump or observe growth in neck need to seek medical assistance.
