According to the World Health Organization (WHO), iodine deficiency is the single major cause of preventable mental impairment in the world. In the case of Pakistan, the recent National Nutrition Survey (NSS) 2017-18 shows that iodine deficiency afflicts one out of every six children of ages six to 12 years. In addition, 18% of women in the reproductive age bracket are also iodine deficient, more so in the rural areas. Even mild to moderate maternal iodine deficiency in early pregnancy is associated with suboptimal cognitive development in the offspring. For a country striving to create a place for itself in the global knowledge economy, the survey figures do not augur well.
Unfortunately, the linkage between iodine deficiency and mental handicap has not been adequately emphasised and therefore this issue escapes the priority list of policymakers and planners. The general public is also not well informed about how this deficiency can be prevented or the risks associated with it, especially for young children and women of reproductive age.
The easiest approach for addressing iodine deficiency is through ensuring universal access to iodised salt. In this regard, there are two sets of interventions that the government needs to introduce in the short and long term. The long-term intervention should aim at enhancing the current proportion of households consuming iodised salt from around 80% to over 90%, which is the level recommended by WHO to protect fetal and child brain development. This will require a reinvigorated iodine deficiency control programme that has legislative, administrative, technical and most importantly, financial support of the federal and provincial governments. A crucial element that would determine the programme’s success is sustained political commitment and resolve. The fact that the Prime Minister, during his maiden address to the nation, recognised intellectual stunting as a major challenge is already a step in the right direction. He now needs to champion this cause and monitor the country’s progress in achieving our national goal.
Following the example of the Sindh province, the other provinces and regions need to introduce legislation for making universal salt iodisation mandatory with mechanisms in place to ensure that the law is stringently implemented to curtail the sale of non-iodised salt. Concurrently, a nationwide public awareness campaign through mass media, with sustained advocacy should highlight the importance of preventing iodine deficiency, particularly among women and to remove any myths and misconceptions associated with its consumption. At the same time, the capacity of salt producers to effectively iodise salt needs to be built. The government should provide salt producers with the fortifying and iodisation equipment, and have trained inspectors to periodically monitor the salt quality through rapid testing at sale points and production facilities.
For the short term, till the time iodised salt is universally available, the newly launched social protection Ehsaas Programme could more explicitly include tackling iodine deficiency as part of its planned nutritional interventions. It could provide WHO recommended iodine supplements to women of reproductive age, especially pregnant and lactating women, and foods fortified with iodine to children of ages six months to two years, particularly among the far-flung and vulnerable populations where the deficiency is more pronounced.
Research evidence shows that repeated pregnancies can deplete the woman’s iodine stores. In Pakistan, where nearly 37% pregnancies occur in an interval of fewer than two years, healthcare providers must counsel all women in the reproductive age bracket on the benefits of birth spacing and provide the requisite family planning services to mitigate this risk.
Iodine deficiency is a major public health issue that must be tackled without further delay to prevent compromising the intellectual capacity of our future generations.
Published in The Express Tribune, August 29th, 2019.