Friday, April 24, 2009

War Against Iodine Deficiency Disorder

There is a big problem at the moment in Nigeria and the consequence of that problem could be catastrophic because it is a health problem. The bad news however is that Nigeria is still lagging behind in tackling the problem head-on and according to experts the shock this problem would leave on the nation could be double compared to that of HIV and AIDS.

The problem is called the Iodine Deficiency Disorders (IDD) and even though Nigeria is very susceptible to these especially in areas where the soil is deficient in iodine it seems not to have been doing enough to nip this problem on the bud.

The target to eliminate the problem by 100% in the shortest possible time is still eluding Nigeria and the situation has led to the widespread of Iodine Deficiency Disorders especially goitre, cretinism, reproductive failures and hypothyroidism in the four most endemic states of Ebonyi, Taraba, Nasarawa and Benue.

Apparently because of the calamitous situation, the National Agency for Food and Drug Administration and Control (NAFDAC), launched a media sensitisation campaign to enlighten both the media and the public on the dangers of using non-iodized salt as well as the negative health implication of overusing and under using the substance.

Iodine deficiency is often characterised by neurological changes which amongst other things can also cause permanent damage to the cognitive development in children, severe mental retardation and impaired mental function in adults while the severest form manifests as goitre. However the most frightening aspect of iodine deficiency in babies and children is inability of the brain to be fully developed for maximum Intelligent Quotient (IQ).

For instance, a recent survey revealed that children born in iodine deficient areas are more likely to have a low IQ. A similar survey conducted in Nigeria in 1993 concurred with this finding and also indicated a 20 percent prevalence for IDD with an estimated 25 to 35 million Nigerians at risk. At the time of the survey, less than 40 percent of table salts sold in Nigerian markets were iodised.

Following the bolt from the blue of this finding, the Nigerian Government in 1993 demonstrated its commitment to eliminate the IDD through salt iodization by promulgating legislation that made iodisation of edible salt mandatory in the country. It also set clear iodine fortification levels in the salt.

Obviously accepting that the idea is not sinking into the bone marrow of the major players in the iodisation sector, the Federal Ministry of Health teamed up with the National Agency for Food and Drug Administration and Control, the United Nations Childrens Fund and Standard Organisation of Nigeria on an aggressive Universal Salt Iodisation campaign as a vehicle to ensure that people are not only aware of the need to use iodised salt but also to patronise only iodised ones.

As a show of commitment the Nigerian Government recently passed an Act mandating the iodisation of all edible table salt and to provide a legal backing for more effective regulation, NAFDAC formulated and got the Government to sign into law the Food Grade (Table or Cooking) Salt Regulation No. 14 of 1996, which stipulates that table salt shall be iodised and have a minimum level of iodine ex-factory/at port of entry of 50mg iodine/kg and at retail or household end of 30mg iodine/kg.

According to the Nigerian Industrial Standard for Food Grade Salt, NIS: 168/1992, Potassium Iodine which is a more stable compound than the cheaper iodised form is also recommended for use as a fortificant and it is against this backdrop that the NAFDAC underscored the importance of media involvement and assistance in the efforts to control IDD and enlist Nigeria as USI compliant.

Iodine Deficiency Disorders constitutes the single greatest cause of preventable brain damage in infant and of retarded development in young children. It is also a threat to both health and development worldwide. IDD as noted at outset results in goitre, stillbirth, miscarriage, mental retardation and impaired capability, amongst other consequences.

Bearing this in mind, one cannot over emphasise the urgent need for all hands to be on deck to nip this problem on the bud. It requires our collective commitment and pressure on the government of the day to do more to ensure that all households in Nigeria consume iodised salt. This calls for a team work and more than what one agency of the government can achieve within a short time hence my revisiting this issue five years after I wrote on the issue for the first time.

Iodine is very important to the body just like the air or water. On daily basis, at least 150 microgram (ug) is needed for healthy development of the body. The recommended daily intake of iodine is at least 150 micrograms (ug). Ingested iodine which the body does not utilise is normally passed out of the body through urine. This makes the urinary iodine level a reliable index of the iodine status of an individual.

A urinary iodine level less than 50 ug per day indicates iodine deficiency. A mean daily urinary iodine excretion in a given population which is less than 25mg indicates severe deficiency of iodine in the area. Though the initial proposal of the Nigerian Government was to embark on iodine supplementation through the distribution of Lipipodol capsules to all women of childbearing age living in the IDD endemic areas, the strategy of enriching salt, water and flour with iodine was also considered.

However the option of salt iodisation was chosen by the World Health Organisation (WHO), due to its feasibility and cost-effectiveness, in addition to its universal acceptance and affordability. The wisdom behind this choice was that since salt is a condition sine qua non in homes in Nigeria, the option of using that which is common to them becomes not only wise but also viable and handy.

It should also be noted that risks are also associated with this method if it is not used with moderation. The excessive intake of salt is a major factor in High Blood Pressure otherwise called the hypertension while the low intake could result in cretinism also known as stunted growth, low IQ in growing children, poor brain development and similar problems.

Since the early 1990s, Nigeria has been implementing the national programme on the eradication of IDD through the USI. The result obtained so far indicates that Nigerians are very comfortable with this method. Part of the reason as I mentioned earlier includes its availability, cost effectiveness and a very simple fortification process. If the present trend continues, Nigeria would soon be enlisted as USI compliant nation.

An impact evaluation of some previously IDD endemic sentinel sites indicated drastic reductions in total goitre rate and more significantly increased urinary iodine excretion rates. Goitre rate which was 20 percent in 1993 was found to have dropped to 11 percent in 1999.

In the same trend collated reports of the December 2002 IDD task force survey indicated the following iodine level;
• 97.3 percent at Household level
• 98 percent at Retail level
• 100 percent at Distributor level
• 100 percent at Factory level compared to 40 percent in 1993.

Though this may sound a good news but bearing in mind how long it took the government to get this far and the fact that the battle is yet to be over in eliminating the problem at household and retail level by 100% in the shortest possible time, we need to ask the Nigerian Government to show more dedication and seriousness in fighting this problem.

1 comment:

  1. The original of this article was titled 'NAFDAC, others renew fight against iodine deficiency disorders' and was first published by the Guardian Newspapers of Nigeria on Thursday September 16, 2004.