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Correspondence

Indian Pediatr 2018;55: 1007-1008

Assessment of Iodine Deficiency Disorders among School Children in Madhya Pradesh

 

Jogender Kumar1 and Arushi Yadav2

From 1Department of Pediatrics, PGIMER, Chandigarh; and 2Departmnt of Radiodiagnosis, SMS Medical College and Hospital, Jaipur, Rajasthan; India.
Email: [email protected]


Editor’s note: We did not receive a point-by-point reply to any of these two letters from authors of the study, despite reminders.

 


We read an article by Bali, et al. [1] and would like to appreciate the authors for highlighting the current status in their district as well as irregularities of national iodine deficiency control programme (NIDCP). The study also highlights the negative implication of unmonitored universal salt iodization (USI) and emphasize the need for periodic monitoring. However, there are certain points we would like to highlight, which might bring more clarity on this issue:

1. Authors defined the cut-off for ‘inadequate iodized salt’, and ‘insufficient urinary iodine excretion (UIE)’. But further cutoffs for defining the severity as well as toxicity levels are not provided. Their description in methodology will be an ease for readers. Also, UIE <200 µg/L was considered "insufficient" by the authors, whereas WHO as well as NIDCP uses UIE <100 µg/L for defining the same [2-4]. Using a different cut-off will change the prevalence and its public health implications.

2. The median UIE level of the population was 175 µg/L, which signifies ‘adequate iodine nutrition’ in the population [2,4]. The results of individual patient/subgroup should not be used for drawing the conclusion as the results of spot sample may vary significantly among different specimens from the same individual [4].

3. As per WHO, if the median UIE levels of a population are ‘insufficient’ the level of iodization of salt, along with factors affecting the utilization of iodized salt (production level quality, packaging, and transport methods, salt intake and cooking habits) should be reassessed [4]. In this study, all households were using packed salt but there is no mention whether it was iodized or not. Also, 432 (80%) out of 540 samples were inadequately iodized at the consumer level. If these levels are despite using iodized salt, it raises serious concern at the level of iodization at production, packing, transport and storage level, and warrants urgent administrative action.

4. A majority (80%) of the population was using inadequately iodized salt, but 36% of children had UIE in toxic level. How can this finding be explained?

5. The authors used only semi-quantitative rapid test kits for iodine estimation of the salt. WHO recommends using quantitative titration method for iodine analysis in sub-sample of salt that has been analyzed by rapid kit [4].

 

References

1. Bali S, Singh AR, Nayak PK. Iodine deficiency and toxicity among school children in Damoh District, Madhya Pradesh, India. Indian Pediatr. 2018;55:579-81.

2. World Health Organization. Urinary Iodine Concentrations for Determining Iodine Status in Populations. Vitamin and Mineral Nutrition Information System. Available from:http://apps.who.int/iris/bitstream/handle/10665/85972/WHO_NMH_NHD_EPG_13.1_ eng.pdf. Accessed July 15, 2017.

3. National Health Mission. Revised Policy Guidelines on National Iodine Deficiency Disorders Control Programme. Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi; 2006. Available from: http://nhm.gov.in/images/pdf/pro grammes/ndcp/niddcp/revised_guidelines.pdf. Accessed July 15, 2018.

4. World Health Organization. Assessment of Iodine Deficiency Disorders and Monitoring Their Elimination. A Guide for Programme Managers. 3rd edition. Available from: http://apps.who.int/iris/bitstream/handle/10665/43781/9789241595827_eng.pdf. Accessed July 15, 2017.

 

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