THE Directorate of Health Services, Government of Maharashtra, has been surveying Iodine Deficiency Disorders (IDD) since 1998. The data was collated recently in a report. The survey "was conducted in three districts each year covering 1 per cent of the population and 5 per cent of schoolchildren."
It emerges that goitre cases were present in every surveyed district of the State. Significantly, in no district does the number of goitre cases exceed 20 people per 1,000 surveyed. Given this, it is valid to question whether compulsory iodisation needs to be imposed on the rest of the population. This is especially so since there is a separate report of the State government linking goitre to malnutrition.
It seems that the government is rushing into the iodisation programme. Iodisation is not just a matter of making and distributing iodised salt. It requires support from an efficient infrastructure that includes advocacy efforts to create awareness about iodine among the population and quality assurance procedures. Ironically, as the Maharashtra report itself states, it also requires "a strategy to verify the extent and nature of the IDD problem." This tells of the blindness with which States are following the Centre's diktat. The Centre in turn seems to be blindly following the World Health Organisation (WHO).
Without being dismissive of the WHO's research on iodised salt, Dr. S.M. Sadikot, consulting endocrinologist at Mumbai's Jaslok Hospital, recalls the time in 1998 when the WHO declared India the diabetes capital of the world. In 1999, when the criteria for diagnosing diabetes patients were declared, he said "they were such that nobody in India was at risk".
Unfortunately, the safety procedure advocated by the WHO to monitor the health of the population taking iodised salt is too random and also impractical at the field level. Iodine levels in the blood are best tested by a urine test. The sample has to be collected at the village level and then sent for analysis at one of the four regional public health laboratories of the department. Given the demands of a high population and an already burdened health care system, the impossibility of the process needs no elaboration. Despite declaring that there are no side effects to iodised salt, the WHO still recommends urine testing.
Opposing the ban is Mumbai-based Susheel Somani who has felt the ill effects of iodised salt. Somani, who got the report under the Right to Information Act, said that it "makes gross errors of calculation... and draws inferences [from this]."
For example, figures are shown as per 1,000 population rather than as per 100 population, with the result that 112.03 persons out of 100 persons were shown to be suffering from goitre in Osmanabad district. For Somani, this is just "another instance of the casualness with which the government works".
Lyla Bavadam
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