SALT SOLUTION: Salt is an ideal vehicle for iodine fortification as it is cheap and is one of the items that is universally consumed. — Photo: S. Thanthoni

ONE OF the long pending demands by doctors and others interested in the welfare of children has been finally met — the Central Government intends to re-impose the ban on the sale of non-iodised salt effective August 15.

It may be recalled that the then Central Government had revoked the ban in 2000, the target year set by the World Health Organisation (WHO) to eliminate iodine deficiency as a public health problem around the world.

What in the first place makes iodine so important that an organisation like the WHO has taken up the issue? Iodine is a micronutrient like vitamin A and iron. Iodine that comes from natural food is used by the thyroid gland to produce thyroid hormones. These hormones in turn are essential for normal growth and development of the brain and the body.

Deficiency in iodine in daily food intake leads to a host of problems, such as development of goitre, mental retardation, stunted growth, deafness and dumbness, to name a few. These are collectively called the iodine deficiency disorders (IDD).

Children highly vulnerable

Since brain development and physical growth are at a maximum during childhood, any deficiency in iodine level has a direct impact on children. The daily requirement of iodine does not start after the baby is born but much before.

Even as a foetus, any deficiency in iodine can affect its normal brain development and body growth. Hence it is imperative for pregnant women and lactating mothers to have iodised salt and ensure that they never suffer from iodine deficiency.

The first three years of a child, right after conception, are very critical for the child's brain development. Any deficiency in iodine level during this period will result in irreversible damages.

Even an adult requires only 15 mg of iodine daily. Pregnant women and lactating mothers need more (20 mg). This works out to just a teaspoon of iodine for a person over a 70-year period. Unfortunately, the body has no mechanism to store iodine if taken in one dose; it needs a daily intake of iodine.

Daily intake imperative

This is where the daily intake of iodine gains special significance. Though daily iodine requirement can be met by eating normal food items, the soil in many regions either lacks iodine or is completely devoid of it. The crops grown in such soils are in turn deficient in iodine.

Hence the compelling need to fortify food items with iodine arises. Since salt is a cheap product and is one of the items that is universally consumed, it becomes the best vehicle for iodine fortification. Imposing a ban on the sale of non-iodised salt thus gains special significance.

It has been proved that unless a ban is in place, universal consumption of iodised salt is never achieved. Studies undertaken in several States have shown that the consumption of iodised salt has dropped to varying levels since 2000.

Though the Central Government abolished the ban, all State governments, except Gujarat and Kerala, came up with their own legislations to ban the sale of non-iodised salt. While Gujarat was quick to follow the Central Government's footsteps in revoking the ban, Kerala never imposed the ban.

The implications are there for all to see — a study undertaken in Kerala recently has revealed that iodine deficiency disorders are prevalent in 11 of the 14 districts surveyed. Goitre prevalence rate is nearly 17 per cent. This despite the fact that the consumption of fish, which is rich in iodine, is high in the State.

But even in a State like Tamil Nadu where a ban on non-iodised salt exists, the prevalence of IDD is common. Nearly 13 per cent of the 1230 children studied were suffering from goitre.

The most important revelation was that though Kerala had no ban in place, almost 100 per cent of households consumed iodised salt.

Adequate consumption

However, the number of households that consumed adequately iodised salt (more than 15 mg of iodine per kg of salt) was only about 50 per cent. Similar trends were seen in other States where such studies were undertaken.

Consumption of adequately iodised salt is important to keep IDD at bay.

There are many reasons why households consume inadequately iodised salt. Salt not being sufficiently iodised by the manufacturers is one of the most important factors.

Salt loses iodine when not properly transported and stored. Studies have shown that many households in most States do not store salt in airtight containers. Cooking leads to further loss of iodine. Manufacturers compensate for this by adding more than the required level of iodine.

Sensitising the retailers on the need to store iodised salt, particularly crystal salt in air-tight containers is a must.

A study undertaken in Madhya Pradesh revealed that nearly 98 per cent of retail shops catering to households sold only iodised salt and a large proportion of the salt was adequately iodised. By far one of the most important factors that has withheld universal consumption of iodised salt is the price.

The price of iodised salt is nearly double that of ordinary salt. And consumers are not willing to buy the `expensive' iodised salt. And they pay a huge price for this.

Lack of awareness

The unwillingness to buy the `expensive' iodised salt goes beyond financial capability. Lack of understanding and awareness of iodine deficiency disorders and the merits of consuming iodised salt to prevent these disorders have been found to be prevalent in many States. Misconceptions — about the disorders and consumption of iodised salt — are not uncommon either.

The survey undertaken in Kerala shows that though people are price conscious, a majority of respondents are willing to spend more to buy iodised salt. The only factor that holds them back from doing so is the lack of awareness of the advantages of iodised salt.

Building awareness and ensuring that the price is not beyond the purchasing power of even the most disadvantaged sections of the populace should be the goal.

Crystal salt

The Government has to ensure that crystal salt, which is largely consumed by the rural population, is also iodised.

The Madhya Pradesh study has one more surprise — nearly 40 per cent of the rural population that consumed crystal salt were adequately iodised.

Making it available is only part of the solution. Finally, a ban sans strict enforcement will do little good as revealed in the States where the ban on the sale of non-iodised salt still exists.

R. Prasad
in Chennai

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