The Department of Health and Family Welfare, Government of Andhra Pradesh (AP), with technical support from Nutrition International, in 2020-21, conducted a first of its kind state level IDD survey across 13 districts, to assess the iodine nutrition status of the population. The survey indicated that while the iodine nutrition status of the school aged children (6-12 years), taken as proxy for the population was adequate, only 71.9% of the households were consuming adequately iodized salt or uppu as it is called in the state. Iodized salt is the primary source of Iodine in our daily diet. The prevalence of goitre was 1.8% amongst the school aged children (6-12 years), an indicator for long-term deficiency of iodine in diet.
Iodine is a micronutrient required in very small quantity in our daily diet, for optimal mental and physical development. In order to address Iodine Deficiency Disorders, a term used to denote a range of disability and disorders from goitre, cretinism, stillbirth to suboptimal mental development and poor cognitive function, government of India had launched the National Goitre Control Program in 1962, later renamed as National Iodine Deficiency Disorders Control Program in 1992. In the state, based on the findings of the previous surveys, six districts viz Srikakulam, Visakhapatnam, East Godavari, West Godavari, Krishna and Nellore were found to be goitre endemic and the program was implemented in these districts, later extended to all the districts.
Andhra Pradesh is close to winning the battle against IDDs, with the achievement of 71.9% coverage of adequately iodized salt in the population, an improvement from 63.9% reported in India Iodine Survey 2018-19. Some of the districts such as Vizianagaram, Kurnool and Chittoor have reported high coverage of 82.4%, 78.5% and 78.1% respectively. But the battle is still on and the last mile of achieving universal salt iodization (USI) is ahead. This would require integrated efforts across the state. One of the areas that need extensive efforts is iodization of locally produced salt consumed in the form of crystal salt. Only 37% of such crystal salt is adequately iodized and is traditionally being consumed by rural and tribal populations. The goitre prevalence amongst population consuming crystal salt increases to 3.1% against the state average of 1.8%. This significantly increases in Krishna, Kadapa and Nellore districts to 8.1%, 7.2% and 6.2% respectively.
Over the last few years, the state government has put considerable efforts to improve the coverage of adequately iodized salt in the state, which include strengthening regulatory monitoring to improve availability of iodized salt and carrying out public awareness generation initiatives such as testing of salt samples during Village Health, Sanitation and Nutrition Day to counsel the beneficiaries coming to the facilities and discussion of benefit of consuming iodized salt during Gram Sabha and passing of resolution. In addition, the retailers and wholesalers are sensitized on dealing in only adequately iodized salt.
Of late, there has been increased consumer preference for “traditional salt” under the impression that it contains multiple micronutrients and trace minerals and is beneficial for people with high blood pressure and other heart ailments. This is pushing sale of organic salt / rock salt / himalayan salt which is mostly non iodized and make the population vulnerable to Iodine deficiency disorders.
Consolidating the gains, the insights of the survey may be used by the state to develop a contextual and district specific strategy, to include consolidating the local salt farmers and traders to set up facilities to iodize and retail locally produced salt. Food Safety Officers may be asked to collect statutory samples from remote rural and tribal locations; implement the recent amendment banning sale of non-iodized salt declared as “preservative salt”, for direct human consumption.
Further existing programs and platforms such as Poshan Abhiyan need to be leveraged to educate consumers on the benefit of consuming iodized salt. It should equally focus on removing such myths as trace minerals in “traditional salt” are not sufficient to meet a portion of their recommended daily allowance. On the contrary, consuming such “traditional salt” would expose them to Iodine Deficiency. Further, the sodium content of both traditional salt and iodized salt is same, hence reducing salt intake would be a better choice rather than changing type of salt.