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Iodine deficiency and its effects
A small village with a big number of goiter patients awaits the attention of the health department
By Dr Arif Azad
Nothian is a small village on the outskirts of Islamabad. The village, composed of 400-500 households, is undistinguished from the surrounding villages in all respects expect one: wide spread prevalence of goiter among mainly female participation. The first thing that comes forcefully into view when you enter the village is the ugly sight of young girls carrying visible protuberance on their necks. You get a sense of all village womenfolk suffering from goiter as you get into the heart of the village.
From old to young, the common thread of having goiter in common binds them in a single woe. On some women the size of goiter is as small as apricot while on other as big as a melon. School teachers of the village tell of low school achievement among children. Nothian illustrates all milestones in the spectrum of maladies that has come to be known as Iodine deficnciey disorder. There is widespread prevalence of both visible and invisible signs of iodine deficiency: goiter and low IQ among children.
More importantly, Nothian also belies the generally-held belief of iodine defincicy being primarily the problem of hilly areas like Chitral and Gilgit. Nothian shows that problem of iodine deficiency knows no geographical boundaries. It affects all regions (villages next to Nothian are also known to show up IDD cases). One also comes across one of the biggest reasons of Iodine deficiency disorder -- non-use of iodized salt. Neither of the shops in village sells iodized salt nor a majority of village folk aware of the advantages of using iodized salt. More alarmingly, those who used iodized salt in the past were dissuaded from using it on the ground of iodized salt promoted as part of imported agenda of family planning.
In a nutshell, Nothain is a microcosm of what ails IDD policy and perceptions. And Nothian is hardly an exception. The same picture obtains all across Pakistan.
Iodine is one of the micronutrients that are needed by human body over a period of time to perform its most vital functions. All we need in terms of intake of iodine is a spoon of Iodine. But this spoonful of iodine is spread over our life cycle, with small amount ingested on a daily basis. One of the tested ways to improve idoine's sustained intake is through salt. This has proven to be a success in the rest of the world, yet in Pakistan iodized salt use has been decreasing over the years.
This is evidenced in the dismal figure of only 17 percent of people using iodized salt despite 52 percent of the population being aware of the health benefits of its use. While the iodized salt intake has been going up in the rest of the world and in South Asia, Pakistan has registered a downward trend. This has serious implications for public health in Pakistan. According to nutritional survey 2001-2002, the prevalence of goiter among women stood at 21 percent and among school children 6.7 percent. The urinary iodine test revealed a more worrying figure of about 36.5 percent of mothers and 23 percent of pre-school children suffering from iodine deficiency.
Though goiter is the most visible manifestation of iodine deficiency, mental impairment is the most invisible result of iodine deficiency which consigns a whole generation to a life of mental retardation. In Pakistan, an estimated 2.1 million children are born each year with severe intellectual impairment caused by iodine deficiency in pregnancy. This is compounded by the prevalence of goiter among 4.3 percent of children in urban and 8, 2 in rural areas.
This poses an enormous public health challenge. The most common way to prevent this alarmingly widespread problem is the promotion of universal salt iodization and legislation to ensure mandatory iodization of salt. In countries where USI was adopted and implemented the iodized salt uptake has shot up. China, India, and Iran have seen the use of iodized salt intake going up to 95 percent, 70 percent, and 95 percent respectively. This shows Pakistan in poor light as compared to its neighbours like Bangladesh where iodized salt uptake is 78 percent. In Pakistan, the ministry of health is leading the charge on USI in Pakistan.
USI campaign worldwide has been fortified with an array of legislative measures to ensure mandatory use of iodized salt. In African subcontinent, 32 out of 43 countries have legislation to ensure mandatory use of iodized salt. In Pakistan the Ministry of health drafted bill called Iodine deficiency control disorder bill 2009 is toeing and froing in a ping pong game between different bureaucratic departments, with the Cabinet division withholding its assent to the passage of the bill on an absurd technicality.
This delay is aggravating an already worsening public health emergency which consigns more than 2 million children to a life of mental retardation in a single year. Beyond these bureaucratic tangles, there are encouraging stirrings from across the board parliamentarians on IDD legislation issue. Lately a sizeable number of parliamentarians are evincing great interest in the issue. Political ownership of IDD legislation was initiated by mohtarma Benazir Bhutto when she gave full backing to USI. Sherry Rehman gave her full support to IDD legislation.
These are encouraging signs for public health professionals, policy makers and consumers alike. Only by joined up action of government, civil society, parliamentarian and ministry of health and UN bodies and media can we get any closer to the goal of making Pakistan a model country where the scourge of IDD is removed for ever. Whereas the rest of the world has achieved its salt iodization goals, Pakistan still lags behind despite massive investment poured into salt iodization programmers. We need to act quickly. Luxury of time is something we cannot afford given the urgency of the situation.
The writer is Chief Executive of the Network for Consumer Protection
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