Edited by Dr. Chandrakant S. Pandav (AIIMS) Dr. M.A. Ansari ( Salt Commissioner)

transcript

Edited byDr. Chandrakant S. Pandav (AIIMS) Dr. M.A. Ansari (Salt Commissioner)

Mr. S. Sundaresan (Former Salt Commissioner)Dr. M.G. Karmarkar (ICCIDD)

Edited byDr. Chandrakant S. Pandav (AIIMS) Dr. M.A. Ansari (Salt Commissioner)

Mr. S. Sundaresan (Former Salt Commissioner)Dr. M.G. Karmarkar (ICCIDD)

Advisory CommitteeDr. Rajan Sankar (GAIN)

Dr. Victor M. Aguayo (UNICEF) Miss Melanie Galvin (MI)Dr. B.K. Tiwari (MoHFW) Dr. Kunal Bagchi (WHO)

Mr. David Haxton (ICCIDD) Dr. Peter Jooste (ICCIDD)

Dr. Michael Zimmermann (ICCIDD)

ContributorsDr. Kapil Yadav (ICCIDD)

Dr. Rahul Srivastava (AIIMS)

Dr. Rakesh kumar (ICCIDD), Ms. Rijuta Pandav (ICCIDD),

Mr. Pritam Tanwar (ICCIDD), Dr. Arijit Chakrabarty (GAIN),

Dr. Anil Kumar (ICCIDD), Dr. Denish Moorthy (ICCIDD),

Ms. Smita Pandav (ICCIDD), Dr. K. Anand (AIIMS),

Dr. M.M. Godbole (SGPGI), Dr. N. Kochupillai (AIIMS),

Mr. Suvabrata Dey (MI), Mr. Pankaj Jain (MI),

Dr. Karanveer Singh (UNICEF), Dr. Nidhi Chaudhary (WHO)

ContributorsDr. Kapil Yadav (ICCIDD)

Dr. Rahul Srivastava (AIIMS)

Dr. Rakesh kumar (ICCIDD), Ms. Rijuta Pandav (ICCIDD),

Mr. Pritam Tanwar (ICCIDD), Dr. Arijit Chakrabarty (GAIN),

Dr. Anil Kumar (ICCIDD), Dr. Denish Moorthy (ICCIDD),

Ms. Smita Pandav (ICCIDD), Dr. K. Anand (AIIMS),

Dr. M.M. Godbole (SGPGI), Dr. N. Kochupillai (AIIMS),

Mr. Suvabrata Dey (MI), Mr. Pankaj Jain (MI),

Dr. Karanveer Singh (UNICEF), Dr. Nidhi Chaudhary (WHO)

Sixth EditionJune, 2011

Fifth Edition : February, 2010Fourth Edition : September, 2008Third Edition : September, 2005Second Edition : June, 2005First Edition : January, 2005

Also available in following Indian languagesHindi, Guajarati, Kannada, Tamil, Telugu

Web linkhttp://www.iqplusin.org/Iec.htm

“With our resources and the money we spend, we could

easily accomplish three times what we do, in half the time

we normally take, if we were to operate in mission mode

with a vision for the nation”.Dr. A. P. J. Abdul Kalam

11th President of India (2002-2007)(“Ignited Minds”)

Vision for the Nation

• Iodine is an essential micronutrient, i.e.

needed in a minute quantity daily

• Total quantity present in body is

(15-20 mg) mostly in thyroid gland

• Iodine is required for production of thyroid

hormones: Tri-iodothyronine (T3) and

Thyroxine (T4)

Iodine and thyroid hormone

Functions of Thyroid hormones

Optimum mental

development

Optimum mental

development

Physical growth and

development

Physical growth and

development

Regulation of body

metabolism

Regulation of body

metabolism

Heat generation & maintenance

of body Temperature

Heat generation & maintenance

of body Temperature

Thyroid hormones act on nearly every cell in the bodyThyroid hormones act on nearly every cell in the body

Iodine Metabolism simplified

Iodine in dietIodine in diet

Absorbed throughout Gastro Intestinal tractAbsorbed throughout Gastro Intestinal tract

Circulates as Plasma Inorganic Iodide (PII) in bloodCirculates as Plasma Inorganic Iodide (PII) in blood

Thyroid GlandFor synthesis of T3/T4

Renal excretion as Urinary Iodine

<5% of Iodine<5% of Iodine 90-95% of Iodine90-95% of Iodine

Daily Iodine requirement

Age Group Iodine Requirement

0 – 59 months 90 µg/day

6 – 12 years 120 µg/day

> 12 years 150 µg/day

Pregnant & Lactating Women 250 µg/day

Source: Assessment of iodine deficiency disorders and monitoring their elimination.

A guide for programme managers. Third edition. 2007; WHO/UNICEF/ICCIDD, Geneva.

• Average daily requirement of iodine per person is 150 µg –

this fits on the tip of hair !

• Lifetime requirement for 70 years is 5 gms – one teaspoonful !

WATER, SOIL

Environmental iodine deficiency

PLANTS

Iodine poor feeds & fodders, goitrogens

HUMANS

Health & Socio – economic impact

LIVESTOCK

Clinical & Reproductive disorders, decreased

productivity

Iodine deficiency – A disease of soil

Low Foodavailability

Soil erosion

Effect on Humans Effect on Animals

Climate Change

Glaciations, Deforestation, Flooding

Gradual Leaching of Iodine

• Food is the main source of iodine

• Fish, Meat & dairy products

• Vegetables, cereals

• High amount of iodine in seaweeds & sea fish

• If soil is deficient in Iodine then the food sources are likely

to be deficient in iodine

• In India, only a small proportion of population consume

iodine rich sea foods and that too in very small quantity

Natural sources of Iodine

** Sea salt is a poor source of iodine **< 0.5 ppm of Iodine is present in Sea Salt

Earliest evidences of Goitre

• Incantation against goitre

from the period around

2000 BC are found in

Atharva Veda

• “Galaganda” was the name

given by the early Hindu

physicians Sushruta and

Charaka (500 BC)

Goitre has been known since the days of Lord Buddha and before (500 BC)

This disorder may have been present from time immemorable among

the populations of various parts of the world

Goitre

Importance of Iodine in Brain Development

• 90% of human brain development occurs

between 3rd month of pregnancy to 3rd year of life

• First 1000 days of life (conception till the age of 2

years) are considered to be the critical period for

brain development

• Diminished brain cell branching due to iodine deficiency• Diminished branching Less connections Lower IQ

Iodine sufficient brain Iodine deficient brain

• Iodine deficiency results in permanent brain damage

• Brain damage can be

prevented by correcting

iodine deficiency before &

during pregnancy• Its vital that all pregnant

& lactating mothers get

their daily requirement of

iodine (250 µg/day)

According to WHO, Iodine deficiency in foetal life and early childhood remains single most important and preventable cause of mental retardation globally

WHO (1994) Iodine and Health, WHO/NUT/94.4. WHO:Geneva

Iodine Deficiency and IQ

The Intelligence Quotient (IQ) score of children living in an iodine deficient environment is nearly 13 IQ points less than those living in iodine sufficient environments

Even mild iodine deficiency can prevent children from attaining their full intellectual potential

Mental Wellbeing

Physical Wellbeing

Social Wellbeing

Age GroupEffects

Mortality Morbidity

• Spontaneous

abortions

• Stillbirths

• ↑Perinatal mortality

• Birth defects

• Defects of speech & hearing

• Psychomotor defects

• Cretinism

Neonate• ↑Neonatal mortality • Neonatal Goitre

• Neonatal Hypothyroidism

Effect of Iodine Deficiency on Humans

Age GroupEffects

Mortality Morbidity

Children &

adolescents

• Goitre• Hypothyroidism• Retarded physical development• Impaired mental function

(13 IQ points)

Adults

• Goitre & its complications• Hypothyroidism• Impaired mental function• Iodine induced hyperthyroidism

Effect of Iodine Deficiency on Humans

Effects of iodine deficiency on Livestock

Severe Brain Damage: Tip of the Iceberg

Loss of Energy due to Hypothyroidism

Loss of IQ Mild and Moderate Brain Damage

Cretinism Goitre

Severe Brain Damage

Iodine Deficiency and Nuclear Radiation

• Iodine deficiency leads to

increased susceptibility to

nuclear radiation

• During iodine sufficiency,

the thyroid gland does not

take up radioactive iodine

Global Burden of IDD

Moderate and mild iodine deficiency (20-99μg/l)Optimal (100-199μg/l)> 200 μg/l)No data

Burden of IDD in IndiaTotal estimated population

at risk of IDDs in India: 350 millionTotal estimated population

at risk of IDDs in India: 350 millionPo

Calculated based on 71% iodised salt coverage as per Coverage Evaluation Survey -2009 and Population of India (Census – 2011)

States TD SD EDAndhra Pradesh 23 12 11Arunachal Pradesh 16 12 12Assam 27 18 14Bihar 38 14 14Chhattisgarh 18 2 2Goa 2 2 2Gujarat 26 25 17Haryana 21 11 10

Himachal Pradesh 12 10 10Jammu & Kashmir 22 14 14Jharkhand 24 9 8Karnataka 30 21 8Kerala 14 14 12Madhya Pradesh 50 14 14Maharashtra 35 30 21Manipur 9 8 8Meghalaya 7 4 4

Iodine Deficiency Disorder Endemic States

365 Districts Surveyed and 303 were Endemic365 Districts Surveyed and 303 were Endemic

Survey by Central & state Health Directorates, ICMR and Medical Institutes

TD: Total Districts DS: Surveyed DistrictsED: Endemic districts

Endemic districts: Prevalence of Goitre ≥10%

States TD SD EDMizoram 8 4 4Nagaland 11 7 7Odisha 30 20 17Punjab 20 7 5Rajasthan 33 4 4Sikkim 4 4 4Tamil Nadu 32 29 21Tripura 4 3 3Uttar Pradesh 71 29 24

States TD SD EDUttarakhand 13 11 9West Bengal 19 8 8Andaman & Nicobar 3 2 2Chandigarh 1 1 1Daman &Diu 2 1 1Dadra & Nagar Haveli 1 1 1NCT of Delhi 9 9 9Lakshadweep 1 1 0Puducherry 4 4 2

Iodine Deficiency Disorder Endemic States (Cont…)

365 Districts Surveyed and 303 were Endemic365 Districts Surveyed and 303 were Endemic

Survey by Central & state Health Directorates, ICMR and Medical Institutes

TD: Total Districts DS: Surveyed DistrictsED: Endemic districts

Endemic districts: Prevalence of Goitre ≥10%

High Risk Population

Pregnant Women

and Children

Control of IDD among pregnant women, lactating women and early childhood would prevent

irreversible brain damage

High Risk

High Risk Population…2

Healthy ChildrenHealthy Children

Healthy MotherHealthy Mother

Healthy NationHealthy Nation

Healthy FamilyHealthy Family

Our Primary Objective

To ensure that:

Every individual should

Every mother & child must

Get their daily requirement of iodine

To ensure that:

Every individual should

Every mother & child must

Get their daily requirement of iodine

Salt: Ideal Vehicle for Iodine

• Iodisation does not impart any color, taste or smell

to the salt

• Iodisation is simple, effective, cheap and easy

process

• Production of salt is limited to few centres hence

monitoring of quality becomes relatively easy

• Delivers Iodine in physiologically adequate quantity

Universally consumed by every one

Urban/Rural Summer/Winter

Rich/PoorMales/Females

Iodised salt and vaccines

Iodised salt, can be compared to a vaccine which protects against

Vaccines are biological substance which prevent against a specific disease

Vaccine Iodised Salt

The Kangra Valley Study (1956 – 1972)

Kangra

Himachal Pradesh

Legacy of The Legend of Science & SocietyProf. V. Ramalingaswami

8th August 1921 – 28th May 2001

Legacy of The Legend of Science & SocietyProf. V. Ramalingaswami

8th August 1921 – 28th May 2001

Pioneer study conducted in Kangra District of Himachal Pradesh

Study design Community basedProspective controlled trial

Study area Kangra Valley, Himachal PradeshDivided into 3 zones –A , B , C

Study period 1956 - 1972

Study duration 16 years

Study population 1,00,000 School age children

Outcome variable Goitre prevalenceamong school age children

Zone AZone A

Zone BZone BZone CZone C

Zone A Salt + Potassium iodide Intervention

Zone B Plain salt Control

Zone C Salt + Potassium iodate Intervention

15 gms of salt/person/day to ensure 200 µg of iodine/person/day

Salt produced by Hindustan Salts Ltd. at Sambhar lake (Rajasthan)

with UNICEF assistance

Zone AZone BZone C Zone B (Salt+KIO3)40%Zone A, B, & C

40%Zone A, B, & C

15%15%

19%19%

42%42%

15%15%

Control Group

Intervention

Zone BZone A Zone C

Iodine supplementation in the form of adequately iodized salt on a regular and

continuous basis reduces Goitre prevalence

Establish a National Goitre Control Programme (NGCP)

ConclusionsConclusions

RecommendationsRecommendations

Iodine Deficiency = GoitreNo Pain, Cosmetic problem

Cretinism: A rare event(Low Priority)

Brain Damage Lack of Energy, Hypothyroidism,

Learning Disability, ↑DeathsChild Development & Child Survival

HRD (HIGH PRIORITY)

Historic view

1962-1983

Current view

1984 onwards

The hourglass of IDD

National Iodine Deficiency Disorder Control Programme - 1992

• In June 1992, the NGCP, in recognition of the spectrum of disorders due to iodine deficiency was re-designated as;

National Iodine Deficiency Disorders Control Programme (NIDDCP)

Reduce the prevalence of Iodine Deficiency Disorders below 10 percent in the entire

country by 2012 A.D.

Total salt production in India• Total salt production in India in 2010 was

24 million tons

• India is the 3rd largest salt producing country in the

World after China & United States of America and

2nd largest iodised salt producing country

after China

• Iodised salt production in 2010 (5.8 million tons)

exceeded the target production (5.2 million tons)

Refined and unrefined iodised salt production (million tons)

Refined iodised salt production (million tons) - 2010

Gujarat Tamilnadu Rajasthan Others Total

Number of Refineries

38(56%)

24(35%)

68(100%)

(100%)

Gujarat Tamilnadu Rajasthan Others Total

Number of Iodization units

300(39%)

56(7%)

284 (38%)

125(16%)

768(100%)

Unrefined iodised salt production (million tons) - 2010

(100%)

Coverage Evaluation Survey – 2009. UNICEF and Ministry of Health and Family Welfare.

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Coverage evaluation survey – 2009. UNICEF and Ministry of Health and Family Welfare

Do we need Universal Salt Iodization?• Because iodine deficiency is a disease of soil

• IDD is a public health problem

• The serious irreversible consequences of IDD

(mental handicap) may not be visible grossly

• Prevention (including health promotion & specific

protection) is better than cure (including early

diagnosis & treatment, disability limitation &

rehabilitation)

Yes, USI is required for all times to come!Yes, USI is required for all times to come!

Universal Salt Iodisation

Elimination of Iodine Deficiency Disorders YES - A Worthwhile Investment in Health

This work was conducted as part of the INCLEN Training of Dr. Pandav at McMaster University, Canada, 1990-1991

Cost of iodine/person/year10 paisa*

Cost benefit ratio(only health benefits)

If benefits related to education (13 I.Q points) & livestock (increased productivity & yield of eggs, milk, wool, etc) included, then:Cost benefit ratio

*10 paise in 1991 has the same purchasing power as 20 paise in 2012

Community perception about iodized salt

Iodized SaltIodized Salt

Refined SaltRefined Salt

Packaged SaltPackaged Salt

Branded SaltBranded Salt

High Priced SaltHigh Priced SaltIodized SaltIodized Salt ==

The reality

Phoda salt 1.00 – 2.00 Rs./1.00 – 2.00 Rs./Kg**

Crystal salt 3.00 – 5.00/Kg*

Powdered salt 5.00 – 7.00 Rs./Kg*

Refined salt > 9.00 Rs./Kg*

IODIZATION

* Average prices at consumer level during 2007

Packaging of Iodised salt

• Pack iodated salt only in High-density polyethylene

(HDPE) or polythene- lined jute bags

• Permitted capacity, i.e. 50 Kg for bulk quantity and

polyethene pouches of 500 gms /1000 gms for retail

packing

• Following label on it

– Name of the manufacturer

– Month and year of packing

– Iodine content

– Net weight

– Batch number

IDD status of pregnant women

• Pregnant women because of greater

iodine requirement are more at risk than

general population

• Pregnant women not included in current

NIDDCP survey guidelines

• Recent studies have shown that children

are iodine replete but pregnant women

are not in same household

Scenario after lifting of the ban

• After lifting of the ban, large quantities of non-iodized salt available for human consumption in Gujarat - the major salt producing state

• Ban reinstated on 17th May, 2006

Ban remained in place 27 states & UTs

Ban partially remainedin place

Andhra Pradesh, Maharashtra

Ban lifted & then reinstated

Odisha

Ban liftedGujarat,Arunachal Pradesh

No ban Kerala

Iodine testing Methods

Salt Testing Kits

Iodometric titration(Gold Standard)

Quality Control Laboratories-Salt Commissioner’s Office

• Quality Control Laboratories: 26

• About 8000 salt samples are analysed per month while 80,000 samples are analysed annually

Gujarat 8

Rajasthan 3

Tamil Nadu 7

Andhra Pradesh 3

Orissa 2

Maharashtra 1

West Bengal 2

Source: Salt Commissioner. Annual Salt Report 2010. Department of Salt, Government of India; Jaipur, 2010.

State IDD Cells 31

State IDD laboratories

Quality Control Laboratories-Ministry of Health and Family Welfare

Revised Policy Guidelines On National Iodine Deficiency Disorders Control Programme. October, 2006

NIDDCPNIDDCP

Benefits & Risks of Iodine Supplementation

• Prevention of Goitre• Prevention of Cretinism

• Prevention of IIH• Prevention of Brain damage

• Improvement in Fetal & Neonatal Health• Improvement in Productivity of Population

• IIH• Thyroid Cancer• Autoimmune

Thyroiditis

IDD Control Programme: IDD Control Programme: A Multi-pronged StrategyA Multi-pronged Strategy

Promotion of Consumption of Adequately Iodized Sat ForeverPromotion of Consumption of

Adequately Iodized Sat Forever

Supply PUSH Demand PULL

Regular, Reliable, & Representative

State-level Scientific Data

Regular, Reliable, & Representative

State-level Scientific Data

Sustained Political Commitment

Data For Decision Makers

Supply (Push)Supply (Push)

Salt producersSalt producers

EconomicincentivesEconomicincentives

TechnicalSupport

Socialincentives

Rail transportCheaper than road

Category B:High priority

Exemption fromduty & tax

Rail transportCheaper than road

Category B:High priority

Exemption fromduty & tax

Social profit:Welfare of childrenWelfare of society

Qualityassurance

Betteriodizationtechniques

Increasedyield of

quality salt

Increasedyield of

quality salt

Demand (PULL)

CommunityPerceptionCommunityPerception

MediaMedia EducationEducation Legislation(PFA Act, 1954)

Legislation(PFA Act, 1954)

SchoolsSchools PhysiciansPhysicians

ProfessionalOrganizationsProfessional

OrganizationsAgriculture &

livestockAgriculture &

livestock

TradersTraders

ConsumerOrganizations

DisabilityGroups

Regular, reliable, representative National/State level Scientific Data

• No national/state level representative data

on IDD available

• Only USI surveys done and not IDD surveys

(include UI)

• NIDDCP guidelines there but-– Not adhered to, surveys not carried out

– Outdated, needs to be revised

• Iodised Salt Coverage surveys carried out

but with Salt Testing Kits

Tracking progress towards sustainable elimination of IDD

• Need for regular 3 year National/State

level surveys as per the guidelines of

WHO/Unicef/ICCDD

• Surveys to include-

– Household iodised salt coverage

(Only iodometric titration should be used)

– Urinary Iodine in Pregnant women/children

• NIDDCP should be a priority National

Health Program of the Govt. of India

• Strategy for IDD elimination is universal

salt iodization

• Increase & sustain 100% coverage of

adequately iodized salt

Various departments working together for IDD

Ministry of Finance

1. Ministry of Health & Family Welfare

2. Salt Commissioner

3. Ministry of Railways

1. Ministry of Health & Family Welfare

2. Salt Commissioner

3. Ministry of Railways

Ministry of Road Transport and

Highways

Ministry of Panchayati raj

Ministry of Law and Justice

Ministry of Information and

Broadcasting

Ministry of Human Resources and Development

Planning Commission

Ministry of Women and Child

Development

NGOsIDD Experts

Salt Industry

SaltRegulators

Government

Policy MakersCommunicators

Educators

Consumers

Agriculturalist

Consumers

HealthCare

Various stakeholders: IDD

Time Line of Organization & Agencies involved in IDD in India

UNICEF

ICCIDD

Iodine Network

1945 1960 1961 1980 1981 2000 2001 2020

1945 WHO

1946 UNICEF

1958 NIN

1985 ICCIDD

1962 1992(NGCP) (NIDDCP) GOI

2002 Iodine Network

2006 GAIN

2006 WFP

1956 AIIMS

Establishing PartnershipNational Coalition for Sustained Iodine

Intake (NCSII)

• National Coalition established in 2006• 2009 Secretariat of NCSII set up at ICCIDD, New Delhi

Copenhagen Consensus - 10 Challenges and IDD

Conflicts

Diseases Diseases

EducationEducation

Global Warming

Malnutrition and Hunger

Sanitation and Water

Subsidies and Trade Barriers

Terrorism

Women and DevelopmentWomen and

Development

Air Pollution

4 out of 10 challenges are partially related to IDD

Copenhagen: Challenges and solutions

10 Challenges 10 Challenges

30 Solutions 30 Solutions

Ranking list

4 solutions related to Malnutrition & 1 to IDD in first 10 priorities

1. Micronutrient supplements for children (vitamin A and zinc)

3. Micronutrient fortification (iron and salt iodization)

5. Bio-fortification

9. Community-based nutrition promotion

Millennium Developmental Goals

Daily consumption of Iodised salt is a healthy habit

1. Eradicate

extreme

poverty

& hunger

6. Develop a global partnership for development

5.Improve maternal

health

4.Reduce child

mortality

3. Promote gender equality &

empower women

2.Achieve

universal primary education

Criteria for tracking progresstowards elimination of IDD

Indicator Goal

Salt iodisationProportion of Households consuming adequately iodised salt

Urinary Iodine Median in the general populationMedian in pregnant

100-199ug/L150-249ug/L

Programmatic IndicatorsAttainment of indicators

At least 8 of 10

The Government’s goal of NIDDCP is to reduce the prevalence of

iodine deficiency disorders below 10 percent in

the entire country by 2012

In summary…1. Iodine and its importance2. Consequences of Iodine deficiency3. Burden of Iodine deficiency4. Methods to control IDD5. The Kangra Valley study6. New evidence: From Goitre to IDD7. Iodised salt production8. Iodised salt coverage9. Key Issues in IDD10. The Way forward

Consumption of adequately iodized salt for all times to come

“Never before so much can be done

For so many, For all times to come

For so little, in such a short time”

How Simple is Simple?

The Story of Iodine Deficiency&

Preventable Brain Damage

Sustainable Elimination ofIodine Deficiency Disorders in India

“Simple Goitre is the easiest of all known diseases to prevent…It may be excluded from the list of human diseases

as soon as the society determines to make the effort.”- Dr. David Marine, 1920

(Pioneer in mass prophylaxis of endemic Goitre)

Thus, The Story of iodine deficiency continues…

How Simple is Simple?How Simple is Simple?

Even man finds it difficult to be human !Even man finds it difficult to be human !

Mirza GhalibMirza Ghalib

18th Century Poet18th Century Poet

" We ourselves sometimes feel that what we dois just a drop in the ocean,

But the ocean would be lessbecause of that missing drop.“

- Mother Teresa

" We ourselves sometimes feel that what we dois just a drop in the ocean,

But the ocean would be lessbecause of that missing drop.“

- Mother Teresa

“In the field of nutrition, as in politics the task is to do what is possible without

forgetting to make possible what is necessary”

G. H. Beaton, J. M. Bengoa“Nutrition and Health in Perspective”

In Nutrition in Preventive MedicineWorld Health Organization, 1976

Acknowledgement - 1

To the Global PartnershipDedicated to the Sustainable Elimination of

Iodine Deficiency DisordersAn Ancient Scourge of Mankind

The People of the affected countriesThe Governments of the affected countries

The Salt Producers of each country

Acknowledgement - 2• National Coalition for Sustained Iodine Intake (NCSII) partners:

– Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS)

– Global Alliance for Improved Nutrition (GAIN)– Indian Coalition for Control of Iodine Deficiency Disorders– Nutrition cell, Ministry of Health and Family Welfare,

Government of India (GoI)– Micronutrient Initiative (MI)

Acknowledgement – 2 (cont..)• National Coalition for Sustained Iodine Intake (NCSII) partners:

– Salt Department, Government of India (GoI)– United Nations Children’s Fund (UNICEF)– World Food Program – India Office– World Health Organisation – India Office– International Council for Control of Iodine Deficiency

Disorders (ICCIDD)

Acknowledgement -3

The International Development Agencies–

Australian Agency for International Development

Canadian International Development Agency

Kiwanis International

Netherlands Ministry for Development Cooperation

Swedish International Development Agency

United States Agency for International Development

Global Network for Sustained Elimination of Iodine Deficiency

World Bank

Daily consumption of adequately iodized salt is a healthy habit

Towards Sustainable Elimination of IDD

Edited by Dr. Chandrakant S. Pandav (AIIMS) Dr. M.A. Ansari ( Salt Commissioner)

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