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INTRODUCTION:

An important public health aim is to Eliminate Iodine Deficiency (ID). ID causes diminished growth that results in decreased mental function, especially in critical stages of pregnancy and early childhood. Iodine is required for normal growth and women who reside in regions of severe iodine deficiency, experience miscarriages, stillbirths, and difficulties with reproduction than women in an iodine-sufficient region. These miscarriages decrease the fertility and endanger the well-being of women and affects children as their defence mechanism against infections are reduced. Assumed with ambiguity and fluctuations in iodine status, it is crucial to develop an evaluation of iodine status for a national strategy to mandate iodine fortification.

THE EFFECTS OF IODINE DEFICIENCY:

Iodine deficiency is the utmost cause of mental retardation and avertible brain damage. Its severity can range from intellectual dulling to cretinism, a disorder resulting in mental retardation, etc. Most individuals are at risk of some level of impairment that affects all the stages of life, from foetus to adults, due to the spectrum of symptoms resulting from iodine deficiency in affected regions. When it’s left untreated, foetal growth is retarded where they either perish in the womb or die within a week of birth.

SIDE-EFFECTS OF IODINE DEFICIENCY:

• Swelling in the neck
• Unexpected weight gain
• Hair loss
• Dry and Flaky skin
• Trouble learning and remembering

THE SCOPE OF THE PROBLEM:

“12% of the world’s population are iodine deficient and appropriate supplementation will prevent these consequences. The US does not mandate fortification of salt with iodine. The Salt Institute guesses that approximately 79% of the salt sold in the US is iodized”. But this method of mass supplementing is no longer adequate. But 70% of the salt in the diet comes from food eaten outside which is not iodized. One of the most common way to reduce iodine deficiency is by salt iodization, where potassium iodate is added to salts consumed by humans. Since, the addition of salt to food is prone to vary, exposure cannot be assessed by gauging the type of food being consumed. Adequate dietary iodine is mandatory for normal thyroid hormone synthesis since pregnancy results in increased production of hormone, thereby foetal iodine requirements are increased. That is why dietary iodine requirements are higher in prenatal and lactating women.

IODINE FORTIFICATION AND SUPPLEMENTATION:

Pregnant women in the US are encouraged to take prenatal supplement. “A brief report of NHANES data collected between 2001 and 2006, about 70% of women who are pregnant in the US reported supplement use”. Iodine content differs among foods and only few prenatal vitamins have iodine listed on the label and few do not list the labelled quantity of iodine, making exposure measurement difficult.

While supplementation must go through the sequence of policy development, it appears to be a feasible intervention that can be used when salt iodisation is unsuccessful. Targeting is the vital step that needs a clear strategy because some groups are more vulnerable than others, along with the fortification of salt. When pregnant women are targeted, a strong implementation of public health strategies is required since, reaching pregnant women at times might be challenging. Hence, supplementation of iodine is recommended to women of reproductive age.

Sustainability planning is an essential contributor of health. Low cost and high efficiency of the programme improves sustainability. Cost must be considered in setting national policies, but an important prerequisite must be delivering iodine supplementation to the exposed group in a sustainable approach. Support from Government, strong policy and advocacy combined with a strong community partnership is essential for a programme to be efficient.

CONSIDERATIONS:

1. Strong implementation of pre-conception programs and Public health strategies.
2. Adequate training, effective communication, motivated health-care workers and Increased awareness.
3. Low cost, High effectiveness
4. Secure political commitment
5. Strengthen Monitoring systems
6. Targeting supplementation

A CALL TO ACTION:

Salt iodisation is the most effective way for eradication of iodine deficiency. Iodine supplementation and fortification must be considered in regions of extreme iodine deficiency and where salt iodisation cannot be executed.

To achieve ideal Iodine level for both Mother and Child through Iodization of salt, we require support from Government officials through various policies and administrative measures. There is a clear evidence to mandate iodine supplementation, but the main concern is that the iodine content of foods is not always listed on food packaging labels in the US, making it hard to recognize good iodine sources, or even monitor consumption. Eradication of iodine deficiency is attainable only through an intensive effort by the government funding bodies, salt industries along with sustained education of consumers to motivate them to utilize iodised salts.

1. Identifying further trends among the vulnerable population in the US, here being mothers and infants, by monitoring iodine levels.
2. The Use of biomarkers to evaluate exposure and effect.
3. Mandate the fortification of preconception supplements and salt with iodine.
4. Conducting extensive research on the efficiency of iodine supplementation and the resulting health effects on children.

REFERENCES:

• “Shao J Zhou, Amanda J Anderson, Robert A Gibson, Maria Makrides, Effect of iodine supplementation in pregnancy on child development and other clinical outcomes: a systematic review of randomized controlled trials, The American Journal of Clinical Nutrition, Volume 98, Issue 5, November 2013, Pages 1241–1254, https://doi.org/10.3945/ajcn.113.065854”
• “UNICEF. (2008, May). SUSTAINABLE ELIMINATION OF IODINE DEFICIENCY. Retrieved November 7, 2019, from https://www.unicef.org/publications/files/Sustainable_Elimination_of_Iodine_Deficiency.pdf”
• “Pearce, E. N., Lazarus, J. H., Moreno-Reyes, R., & Zimmermann, M. B. (2016). Consequences of iodine deficiency and excess in pregnant women: an overview of current knowns and unknowns. The American journal of clinical nutrition, 104 Suppl 3(Suppl 3), 918S–23S. doi:10.3945/ajcn.115.110429 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5004501/”
• “Renner R. (2010). Dietary iodine: why are so many mothers not getting enough?. Environmental health perspectives, 118(10), A438–A442. doi:10.1289/ehp.118-a438 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957951/”
• “American Thyroid Association. (2019, June 20). Iodine Deficiency. Retrieved November 8, 2019, from https://www.thyroid.org/iodine-deficiency/”