National Iodine Deficiency Disorders Control Programme (NIDDCP)

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Introduction

The National Iodine Deficiency Disorders Control Programme (NIDDCP) — a program crucial for addressing one of the most preventable causes of brain damage and mental retardation: iodine deficiency.

Iodine is a trace element essential for the synthesis of thyroid hormones, which regulate metabolism, growth, and development. Although the daily requirement is small (150 µg/day for adults), iodine deficiency can lead to a spectrum of disorders collectively known as Iodine Deficiency Disorders (IDDs).

Iodine is an essential trace element required for the synthesis of thyroid hormones — thyroxine (T4) and triiodothyronine (T3) — which regulate metabolism, growth, and neurological development.

Natural Sources of Iodine:

Seafood – Fish (e.g., cod, tuna), shellfish (e.g., shrimp), and seaweed (e.g., kelp, nori) are naturally rich in iodine due to the high iodine content in seawater.
Dairy products – Milk, cheese, and yogurt contain iodine, partly due to iodine-fortified cattle feed and iodine-based disinfectants used in dairy farming.
Eggs – Especially the yolk contains moderate iodine levels.
Meat and poultry – Contain small amounts of iodine.
Vegetables and grains – Grown in iodine-rich soils may contain iodine, but levels vary widely.

Section 1: Epidemiology and Public Health Significance

What is IDD?

The term Iodine Deficiency Disorders (IDD) encompasses more than just goitre. It includes:

Goitre
Cretinism (neurological & myxedematous)
Hypothyroidism
Impaired mental function
Delayed physical development
Increased perinatal mortality
Stillbirths and spontaneous abortions

This shift in terminology—from “endemic goitre” to IDD—was made to reflect the full burden of iodine deficiency.

Global and Indian Burden

As per WHO, around 9 billion people globally are at risk of IDDs.
In India, IDD is endemic in almost all states and union territories. In 1960 roughly around 9 million persons were affected . Out of 325 districts (as per recent estimates), approximately 263 districts have been surveyed and found to be endemic with 10 % of prevalence overall amounting to roughly 71 million people suffering from iodine deficiency disorder.
Himalaya goitre belt.

Iodine deficiency affects people across all ages, but its most devastating effects are on:

Foetus (mental retardation, stillbirth)
Neonates (cretinism)
Children (goitre, learning disabilities)

🧠 Even mild iodine deficiency in children leads to reduced IQ, attention deficits, and poor school performance.

Section 2: Evolution of the Programme

Timeline

1962: National Goitre Control Programme (NGCP) launched in endemic areas.
1992: Renamed as National Iodine Deficiency Disorders Control Programme (NIDDCP) to include broader consequences beyond goitre.
1997: Universal Salt Iodization (USI) made mandatory under the Prevention of Food Adulteration Act.

Rationale for Programme Evolution

The shift from NGCP to NIDDCP was based on:

Better understanding of iodine’s role.
Evidence of brain damage even in absence of goitre.
Expanded focus from treatment to prevention and monitoring.

Section 3: Objectives and Strategy of NIDDCP

Objectives of NIDDCP

Survey the magnitude of IDD in districts.
Supply iodized salt to all.
Resurvey every 5 years to assess the magnitude.
Laboratory monitoring of iodized salt and urinary iodine levels.
Health education to create awareness.

📌 The ultimate goal: Eliminate IDDs as a public health problem.

Strategic Components

Universal Salt Iodization (USI):

Salt must contain ≥30 ppm iodine at production and ≥15 ppm at household level.
Packaging and fortification are regulated under Food Safety and Standards Act (FSSA), 2006.

Monitoring and Evaluation:

Conducted by IDD control cells and food safety officers.
Includes:
- Salt iodine monitoring (qualitative & quantitative)
- Urinary iodine estimation (median value ≥100 µg/L)

Health Education:

Mass media, interpersonal communication, school health programs.
Aim: Promote iodized salt use and demystify myths.

Inter-sectoral coordination:

Involves departments of health, industry, civil supplies, railways, education.

Section 4: Salt Iodization – The Cornerstone

Why Salt?

Universally consumed
Consumption is stable
Ideal carrier for iodine

Types of Salt Used

Crystalline (common salt)
Refined iodized salt
Spray-dried salt
Double Fortified Salt (DFS): fortified with iodine and iron (pilot-tested in some states)

Section 5: Monitoring Indicators

Monitoring is essential to ensure effectiveness. Key indicators include:

Indicator	Target
Household iodized salt coverage	≥90%
Median urinary iodine excretion (UIE)	≥100 µg/L
Goitre prevalence in school children (6–12 yrs)	<5%

In addition:

No cases of cretinism should be reported.
Surveillance must include salt testing kits, spot testing, and lab testing.

Section 6: Achievements and Challenges

Achievements

Household coverage of adequately iodized salt has increased significantly (NFHS-5 data: approx. 88%).
Goitre prevalence has reduced in many areas.
Awareness levels have improved.

Challenges

Quality control at production and distribution level.
Smuggling of non-iodized salt from unregulated sources.
Storage issues leading to iodine loss.
Limited lab capacity for urinary iodine testing in rural areas.
Sustainability in backward or tribal districts.

Section 7: Recent Updates (28th Edition & Policy Integration)

IDD has been integrated into broader nutrition programs like POSHAN Abhiyaan.
Double fortified salt is promoted under Mid-Day Meal (MDM) and Integrated Child Development Services (ICDS).
Real-time digital monitoring tools are being piloted in some districts.
FSSAI launched the Eat Right Movement, which includes promotion of iodized salt.

Section 8: Role of Health Personnel

For Medical Officers:

Diagnose and report IDD cases.
Ensure health education in OPDs and schools.
Coordinate salt testing campaigns.

For ANMs and ASHAs:

Use spot testing kits in households.
Educate mothers and women of reproductive age.
Link children with goitre to PHCs for referral.

Section 9: Summary

To summarize, NIDDCP represents one of India’s earliest and most effective nutrition interventions, with a strong preventive focus. Iodine deficiency is entirely preventable, and with sustained effort in monitoring, enforcement, and public education, the goal of IDD elimination can be realized.