Successful implementation of a laboratory iodization quality assurance system in small-scale salt production facilities in India.

OBJECTIVE: To establish a laboratory iodization quality assurance system to support small-scale salt production facilities in India and to assess the level of agreement for the internal quality assurance (IQA) and external quality assurance (EQA) protocols. DESIGN: Operational research. The IQA and EQA programme was established in the year 2008. Agreement between field laboratories and the reference laboratory for estimation of iodine content of salt from 2008 to 2011 was assessed. Agreement was assessed using the χ 2 test, kappa statistics and the Bland-Altman plot. SETTING: Small-scale salt producers in the states of Andhra Pradesh, Gujarat, Rajasthan, Tamil Nadu, Odisha and Karnataka; 'field laboratories' supporting the small-scale salt producers; and the 'reference laboratory' of the Regional Office (South Asia) of the International Council for the Control of Iodine Deficiency Disorders. SUBJECTS: Three hundred small-scale salt producers in the states of Andhra Pradesh, Gujarat, Rajasthan, Tamil Nadu, Odisha and Karnataka and seventeen 'field laboratories'. RESULTS: A total of 6573 salt samples for IQA and 347 salt samples for EQA were exchanged between field and reference laboratories during 2008-2012. Out of the total salt sample exchanges, 527 were from Andhra Pradesh and Odisha, 2343 from Gujarat, 2016 from Rajasthan and 1677 from Tamil Nadu and Karnataka. The overall between-laboratory agreement was for 61·6 % for IQA and 64·8 % for EQA. The mean difference between iodine content estimation of field laboratories and the reference laboratory was 0·3 ppm (sd 8·2 ppm) for IQA and -0·3 ppm (sd 3·5 ppm) for EQA. CONCLUSIONS: Our study successfully documents implementation of a laboratory iodization quality assurance protocol in laboratories supporting small-scale salt production facilities in India.

Community monitoring of the National Iodine Deficiency Disorders Control Programme in the National Capital Region of Delhi.

OBJECTIVE: The present study was conducted to assess the current status of iodine-deficiency disorders (IDD) in the National Capital Region of Delhi (NCR Delhi) and evaluate the implementation and impact of the National Iodine Deficiency Disorders Control Programme (NIDDCP). DESIGN: Cross-sectional study. SETTING: School-going children (n 1230) in the age group of 6-12 years were enrolled from thirty primary schools in the Municipal Corporation of Delhi. Thirty schools were selected using the probability-proportional-to-size cluster sampling methodology. In each identified school forty-one children were surveyed. Urine and salt samples were collected and studied for iodine concentration. A total of sixty salt samples from retail level were also collected. SUBJECTS: Schoolchildren aged 6-12 years. RESULTS: The median urinary iodine excretion (UIE) was found to be 198·4 µg/l. The percentage of children with UIE levels of <20·0, 20·0-49·9, 50·0-99·9 and ≥100·0 µg/l was 1·9, 4·3, 9·5 and 84·2%, respectively. The proportion of households consuming adequately iodized salt (salt with iodine levels of at least 15 ppm at consumption level) was 88·8%. The assessment of iodine content of salt revealed that only 6·1% of the families were consuming salt with iodine content less than 7 ppm. At retail level 88·3% of salt samples had >15 ppm iodine. CONCLUSIONS: Significant progress has been achieved towards elimination of IDD from NCR Delhi. There is a need for further strengthening of the system to monitor the quality of iodized salt provided to the beneficiaries under the universal salt iodization programme and so eliminate IDD from NCR Delhi.