Factors affecting sustainable iodine deficiency elimination in Pakistan: A global perspective

Abstract

Iodine deficiency remains a considerable challenge worldwide, even after decades of efforts to address the problem. The aim of this review is to present the current situation in historically iodine-deficient Pakistan regarding iodine nutritional status and place it in a global perspective. We collected relevant articles from online bibliographic databases and websites of concerned organizations that addressed prevalence of goiter/iodine deficiency and barriers to sustainable control. We divided the studies into pre- and post-1994, a landmark year when Pakistan formally adopted the universal salt iodization (USI) programme. Overall, 56 studies reported goiter/iodine deficiency prevalence in Pakistan. Before 1994, six studies (30%) reported a goiter prevalence ≥70%, while nine studies (45%) reported a goiter prevalence between 30% and 70%. Only five studies (25%) found a goiter prevalence less than 30%, of which only two studies reported prevalence <10%. From 1994 onwards, 15 studies (41.7%) reported a goiter/iodine deficiency (ID) prevalence ≥50%, of which seven studies reported prevalence ≥70%, while three studies (8.3%) found a goiter prevalence of 30%–49%, nine studies (25%) found a goiter prevalence of 10%–29%, and five studies (13.9%) reported prevalence of <10%. Four studies (11.1%) reported lower goiter prevalence but higher prevalence of iodine deficiency. The efforts in the past two decades resulted in up to a 50% decline in iodine deficiency disorders (IDD). Variable remaining factors and the recent results, however, indicate that this decline may be non-uniform and even over-estimated. Coordinated and regionally adopted efforts for eradication of IDD from all stakeholders should be pursued. Policy makers should take steps to protect future generations and alert concerned organizations about the importance of careful assessments and estimates of iodine nutritional status.

Iodine consumption and cognitive performance: Confirmation of adequate consumption

“…The quantity of people affected is more than the quantity of people facing the effects of severe deficiency. From the modest, this alteration extends and then noticeable neurological deviations may cause reduced learning levels and grades in school (Khattak, Khattak, Ittermann, & Völzke, 2017). By this way, ID hampers socioeconomic advancements among the population (Mtumwa, Ntwenya, Paul, Huang, & Vuai, 2017).…”

Pakistan's Journey Towards Universal Coverage of Iodised Salt: A Non-Systematic Review

“…al, revealed that prior to 1994, a small number of studies reported varied prevalences of goitre/ iodine deficiency. (14). The GoP and NI were committed to improving the iodine nutrition of the population.…”

“…The Womens' Caucus parliamentarians' focuses on nutrition and women's health, NI used this as an opportunity to sensitize them to the consequences of IDD and importance of consumption of iodized salt. Post adoption of the USI program in 1994, 36 studies in addition to the two national nutrition surveys revealed a prevalence of goitre/ iodine deficiency (14). Though the 1985 national nutrition survey did not provide data on the high goitre situation, the NNS 2001 still reported a very low percentage of households consuming iodized salt (15).…”

“…The parallel approach adopted was to capacitate the salt processors; right from appropriate iodization techniques and equipment to establishing internal quality control (QC) systems, NI's field staff has been instrumental (16, 1). The work started in Khyber Pakhtunkhwa province and gradually progressed across the country (14). NI organized regular trainings for salt processors to train them on correct techniques to iodize the salt along with the suitable equipment.…”

High Risk Profile of Pregnancy in Iodine Deficiency Areas

“…Regionally coordinated iodine deficiency prevention programs should be carried out by all stakeholders, such as policy maker and related organizations, to protect future generation through careful assessment on iodine status, legislative commitment on policy and efforts to increase collective awareness, effective monitoring on salt iodization, fortification strategy, and regional and local campaign. [16]. Moreover, knowledge on specific risk factors may help create such screening tool targeting women at higher risk to promote long-term wellbeing of mothers and babies [17].…”