title: Factors affecting sustainable iodine deficiency elimination in Pakistan: A global perspective.
abstract: Iodine deficiency remains a considerable challenge worldwide, even after decades of efforts to address the problem. The aim of this review is to present the current situation in historically iodine-deficient Pakistan regarding iodine nutritional status and place it in a global perspective. We collected relevant articles from online bibliographic databases and websites of concerned organizations that addressed prevalence of goiter/iodine deficiency and barriers to sustainable control. We divided the studies into pre- and post-1994, a landmark year when Pakistan formally adopted the universal salt iodization (USI) programme. Overall, 56 studies reported goiter/iodine deficiency prevalence in Pakistan. Before 1994, six studies (30%) reported a goiter prevalence ≥70%, while nine studies (45%) reported a goiter prevalence between 30% and 70%. Only five studies (25%) found a goiter prevalence less than 30%, of which only two studies reported prevalence <10%. From 1994 onwards, 15 studies (41.7%) reported a goiter/iodine deficiency (ID) prevalence ≥50%, of which seven studies reported prevalence ≥70%, while three studies (8.3%) found a goiter prevalence of 30%-49%, nine studies (25%) found a goiter prevalence of 10%-29%, and five studies (13.9%) reported prevalence of <10%. Four studies (11.1%) reported lower goiter prevalence but higher prevalence of iodine deficiency. The efforts in the past two decades resulted in up to a 50% decline in iodine deficiency disorders (IDD). Variable remaining factors and the recent results, however, indicate that this decline may be non-uniform and even over-estimated. Coordinated and regionally adopted efforts for eradication of IDD from all stakeholders should be pursued. Policy makers should take steps to protect future generations and alert concerned organizations about the importance of careful assessments and estimates of iodine nutritional status.
authors.affiliation: Institute for Community Medicine, Walther-Rathenau, Greifswald, Germany; Department of Zoology, Islamia College Peshawar (CU), Pakistan. Electronic address: rehmanmehmood.khattak@uni-greifswald.de.
authors.forename: Rehman Mehmood
authors.initials: RM
authors.lastname: Khattak
authors.affiliation: Department of Zoology, Hazara University, Mansehra, Pakistan.
authors.forename: Muhammad Nasir Khan
authors.initials: MNK
authors.lastname: Khattak
authors.affiliation: Institute for Community Medicine, Walther-Rathenau, Greifswald, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Ittermann
authors.affiliation: Institute for Community Medicine, Walther-Rathenau, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, University Greifswald, Germany.
authors.forename: Henry
authors.initials: H
authors.lastname: Völzke
mesh_terms: D060740:Disease Eradication; D014943:Global Health; D006042:Goiter / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007455:Iodine / Q000172:deficiency*; D009752:Nutritional Status; D010154:Pakistan / Q000453:epidemiology
chemical_list: D007455:Iodine
keywords: Goiter prevalence; Iodine deficiency disorder; Iodine nutritional status; Pakistan; Salt iodization