High national and sub-national coverage of iodised salt in India: evidence from the first National Iodine and Salt Intake Survey (NISI) 2014-2015.

OBJECTIVE: The National Iodine and Salt Intake Survey (NISI) 2014-2015 was undertaken to estimate household iodised salt coverage at national and sub-national levels in India. DESIGN: Cross-sectional survey with multistage stratified random sampling. SETTING: India was divided into six geographic zones (South, West, Central, North, East and North-East) and each zone was further stratified into rural and urban areas to yield twelve distinct survey strata. SUBJECTS: The target respondent from each household was selected as per predefined priority; wife of the household head, followed by women of reproductive age, followed by any adult available during the visit. RESULTS: Households (n 5717) were surveyed and salt samples (n 5682) were analysed. Household coverage of iodised salt (iodine≥5 ppm) was 91·7 (95 % CI 91·0, 92·7) %. Adequately iodised salt (iodine≥15 ppm) was consumed in 77·5 (95 % CI 76·4, 78·6) % of households. Significant differences in coverage were seen across six geographic regions, with North and North-East zones on the verge of achieving the universal salt iodisation target of >90 % coverage. Coverage of households with adequately iodised salt (adjusted OR; 95 % CI) was significantly less in rural households (0·55; 0·47, 0·64), lower/backward castes (0·84; 0·72, 0·98), deprived households (0·72; 0·61, 0·85) as assessed by multidimensional poverty index, households with non-diverse diet (0·73; 0·62, 0·86) and households using non-packaged salt (0·48; 0·39, 0·59) and non-refined salt (0·17; 0·15, 0·20). CONCLUSIONS: India is within striking reach of achieving universal salt iodisation. However, significant differentials by rural/urban, zonal and socio-economic indicators exist, warranting accelerated efforts and targeted interventions for high-risk groups.

Towards universal salt iodisation in India: achievements, challenges and future actions.

India is one of the first countries to introduce salt iodisation, but the national programme has experienced major setbacks. The purpose of this paper is to review the national efforts towards universal salt iodisation (USI) in India and highlight key challenges in programme implementation. A brief historical overview of the salt iodisation programme is provided and the current status of the household usage of iodised salt and population iodine status is described. The present status of the USI programme together with the challenges being faced towards achieving USI are classified in five categories, which represent the five guiding principles crucial to sustained USI programme success: ensuring political commitment, forming partnerships and coalition, ensuring availability of adequately iodised salt, strengthening the monitoring system and maintaining continuous advocacy, education and communication. A future agenda towards the achievement of USI is also proposed.

A reliable and accurate portable device for rapid quantitative estimation of iodine content in different types of edible salt.

BACKGROUND: Continuous monitoring of salt iodization to ensure the success of the Universal Salt Iodization (USI) program can be significantly strengthened by the use of a simple, safe, and rapid method of salt iodine estimation. This study assessed the validity of a new portable device, iCheck Iodine developed by the BioAnalyt GmbH to estimate the iodine content in salt. MATERIALS AND METHODS: Validation of the device was conducted in the laboratory of the South Asia regional office of the International Council for Control of Iodine Deficiency Disorders (ICCIDD). The validity of the device was assessed using device specific indicators, comparison of iCheck Iodine device with the iodometric titration, and comparison between iodine estimation using 1 g and 10 g salt by iCheck Iodine using 116 salt samples procured from various small-, medium-, and large-scale salt processors across India. RESULTS: The intra- and interassay imprecision for 10 parts per million (ppm), 30 ppm, and 50 ppm concentrations of iodized salt were 2.8%, 6.1%, and 3.1%, and 2.4%, 2.2%, and 2.1%, respectively. Interoperator imprecision was 6.2%, 6.3%, and 4.6% for the salt with iodine concentrations of 10 ppm, 30 ppm, and 50 ppm respectively. The correlation coefficient between measurements by the two methods was 0.934 and the correlation coefficient between measurements using 1 g of iodized salt and 10 g of iodized salt by the iCheck Iodine device was 0.983. CONCLUSIONS: The iCheck Iodine device is reliable and provides a valid method for the quantitative estimation of the iodine content of iodized salt fortified with potassium iodate in the field setting and in different types of salt.

Prevalence of paratuberculosis in organized and unorganized dairy cattle herds in West Bengal, India.

AIM: The aim of this study was to determine the prevalence pattern of Mycobacterium avium subsp. paratuberculosis, the causative agent of paratuberculosis or Johne's disease, in unorganized as well as organized cattle herds in West Bengal. MATERIALS AND METHODS: Four organized cattle farms with identical management practice in Nadia (n=3) and South 24 Parganas (n=1) districts and three unorganized cattle herds, one each from three districts, namely, Burdwan, North 24 Parganas, and Purba Midnapur, were selected randomly and screened for paratuberculosis by delayed-type hypersensitivity (DTH) and enzyme-linked immunosorbent assay (ELISA). RESULTS: Of 191 animals tested by DTH, 57 (29.8%) were found to be positive in comparison to 72 (37.7%) by ELISA. In organized farms, seropositivity varied from 13.3% to 53.1%, whereas in unorganized sector, it ranged from 5% to 6.7% with one area having exceptionally high prevalence, i.e. 53.3%. The range of positivity detected by DTH both in organized farms and backyard sectors varied from 0% to 46.7%. By employing both DTH and ELISA together, the positivity of animals in organized and unorganized herds was 19.9% and 8%, respectively. CONCLUSION: The results indicate that animals in organized farms are much more prone to paratuberculosis than others. For screening the herd, both DTH and ELISA should be used simultaneously to increase the test sensitivity in order to minimize its further spread adopting control programs.

The National Coalition for Sustained Optimal Iodine intake (NSOI): a case study of a successful experience from India.

Iodine deficiency disorders (IDD) constitute the single most important preventable cause of mental handicap at global level. Recognizing the importance of coordination and synergy of the activities of wide range of universal salt iodisation (USI) stakeholders, WHO/ Unicef/ ICCIDD has prescribed a national multi-sectoral coalition as one of the ten indicators essential for attaining sustainable elimination of IDD at national level. Challenge for coordination among different stakeholders of IDD/USI is even greater in democratic and diverse country like India. In the present article we present successful experience from India regarding formation of a national coalition and contributions made by the coalition towards promoting USI in India. The activities of the national coalition in India are classified into three phases; 1) Phase 1- year 2006 to 2009- the inception; 2) Phase 2- year 2009 to 2012- consolidation; 3) Phase 3- year 2013 and ongoing- expansion. The National coalition for Sustained Optimal Iodine Intake (NSOI) has been instrumental in ensuring greater coordination and synergy amongst IDD and USI stakeholders in India and partially responsible for the current 71 percentage household level coverage of adequately iodised salt. The most significant contribution of the national coalition has been to act as a high level advocacy channel and provide a platform for regular dialogue for all partners of the coalition. With "mission" approach and allocation of optimal resource, India can achieve and should achieve USI by 2015, an apt culmination of a decade of existence of the national coalition.