title: Persistence of severe iodine-deficiency disorders despite universal salt iodization in an iodine-deficient area in northern India.
abstract: OBJECTIVE
  The aim of the present study was to determine the impact of universal salt iodization (USI) on the prevalence of iodine deficiency in the population of an area previously known to have severe iodine deficiency in India.
  
  
  METHODS
  In a cross-sectional survey, a total of 2860 subjects residing in fifty-three villages of four sub-districts of Gonda District were examined for goitre and urinary iodine concentration. Free thyroxine and thyroid-stimulating hormone levels were also measured. Salt samples from households were collected for estimation of iodine content.
  
  
  RESULTS
  A reduction in goitre prevalence was observed from 69 % reported in 1982 to 27.7 % assessed in 2007. However, 34 % of villages still had very high endemicity of goitre (goitre prevalence >30 %). Twenty-three per cent of households consumed a negligible amount (<5 ppm) and 56 % of households consumed an insufficient amount (5-15 ppm) of iodine from salt.
  
  
  CONCLUSIONS
  Although there was an overall improvement in iodine nutrition as revealed by decreased goitre prevalence and increased median urinary iodine levels, there were several pockets of severe deficiency that require a more targeted approach. Poor coverage, the use of unpackaged crystal salt with inadequate iodine and the washing of salt before use by 90 % of rural households are the major causes of persisting iodine-deficiency disorders. This demonstrates lapses in USI implementation, lack of monitoring and the need to identify hot spots. We advocate strengthening the USI programme with a mass education component, the supply of adequately iodized salt and the implementation of complementary strategies for vulnerable groups, particularly neonates and lactating mothers.
authors.affiliation: Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
authors.forename: Subhash
authors.initials: S
authors.lastname: Yadav
authors.forename: Sushil Kumar
authors.initials: SK
authors.lastname: Gupta
authors.forename: Madan M
authors.initials: MM
authors.lastname: Godbole
authors.forename: Manoj
authors.initials: M
authors.lastname: Jain
authors.forename: Uttam
authors.initials: U
authors.lastname: Singh
authors.forename: Praveen
authors.initials: P
authors.lastname: V Pavithran
authors.forename: Raman
authors.initials: R
authors.lastname: Boddula
authors.forename: Anand
authors.initials: A
authors.lastname: Mishra
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Shrivastava
authors.forename: Ashwani
authors.initials: A
authors.lastname: Tandon
authors.forename: Manish
authors.initials: M
authors.lastname: Ora
authors.forename: Amit
authors.initials: A
authors.lastname: Chowhan
authors.forename: Manoj
authors.initials: M
authors.lastname: Shukla
authors.forename: Narendra
authors.initials: N
authors.lastname: Yadav
authors.forename: Satish
authors.initials: S
authors.lastname: Babu
authors.forename: Manoj
authors.initials: M
authors.lastname: Dubey
authors.forename: Pradeep K
authors.initials: PK
authors.lastname: Awasthi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003296:Cooking / Q000379:methods; D003430:Cross-Sectional Studies; D005260:Female; D006043:Goiter, Endemic / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007194:India; D007223:Infant; D007455:Iodine / Q000008:administration & dosage / Q000172:deficiency* / Q000627:therapeutic use / Q000652:urine*; D008297:Male; D010353:Patient Education as Topic; D015995:Prevalence; D018571:Sentinel Surveillance; D017673:Sodium Chloride, Dietary / Q000627:therapeutic use*; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D017673:Sodium Chloride, Dietary; C034024:iodized salt; D013972:Thyrotropin; D007455:Iodine; D013974:Thyroxine