Myanmar Vitamin A

Nepal

Iodine

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EPIDEMIOLOGICAL DATA
   
Goiter  
Most Recent Goiter Survey  
Date: Dec 1997-July 1998
Groups Surveyed: Pre-school children and women
Sample Size: Women: 15,540
Pre-school children: 15,542
  Sampling Method: Two-stage cluster survey.
  The Nepal Micronutrient Status Survey was completed in 1998.  It was a national survey that assessed goiter prevalence along with data on other indicators of micronutrient deficiency.  The survey included sub-national data and the resulting sample was weighted to account for differences among eco-development zones.  The country was divided into 13 eco- development zones of which 1,200 mothers and school-aged children were randomly selected for goiter assessment by palpitation.  Also a randomly selected sub- sample of school-aged children were assessed for deficiency using ultrasonography, in order to compare results with the goiter method.
Estimated Goiter Prevalence:

Note:  The prevalence in the sample was assessed for grades, 1, 2, as well as TGR (total goiter rate)

Group

Sample Size
Indicator

Prevalence in Sample

Population Affected*

G1

G2

TGR

Women

15,540

Visible or palpable goiter (grades 1 and 2)

48.1

1.3

50.0

2,887,515

Children 6-11 yrs  (school aged children)

15,542

Visible or palpable goiter (grades 1 and 2)

40.5

0.0

40.5

1,328,648

 

*The estimate of the population affected is based on the US Census Bureau’s 2000 population profile for Nepal.  The number of women affected is based on the number of women aged 15-49.  The number of school children affected is based on the estimated population of children between the ages of 5-10
 
Urinary Iodine
Most Recent Urinary Iodine Survey
    The most recent survey of urinary iodine levels was included in the survey described about.  However, the sample sizes varied as urine samples were taken from a sub-sample of school aged children (6-11 years) and of women.
 
Estimated Prevalence of IDD:  Indicator urinary iodine level < 100 mcg/L)

Group

Sample Size

Mean Urinary Iodine

Prevalence in Sample

Population Affected

Women

1,449

114.1

43.6

2,517,913

Children 6-11 yrs (school- aged)

1,314

143.8

35.1

1,165,888

 

* Population Affected calculated as described previously
     
     
 

POLICY AND LEGISLATION
 

Legislation on IDD
    

Currently, there is legislation concerning the status of IDD in Nepal.  It was enacted in 1999 and makes the iodization of salt manditory at a level of 50 PPM of iodine at the production level.  The legislation has not been significantly revised since, although there are no published government documents concerning IDD.
 
Government Agency to Address IDD
    

There is legislation governing IDD in Nepal.  It was passed in 1955 and has been revised since.  Salt iodization is mandatory at the level of 20-60 ppm.
    

The agency that is responsible for addressing IDD is the Nutrition Section, Child Health Division, of the Department of Health Services under the MOH.  It is responsible for coordinating and funding IDD activities, but does not monitor them.
    

Contact:  Mrs. Sharanda Pandey, Chief, Nutrition Section, Teku, Kathmandu P: +977-1-261660
   
     

PROGRAM DATA
Supplementation

Program Description
     There is currently no program operating that provides supplementation with iodized oil capsules.
     However, supplementation was used in the past via iodized oil injections from the years 1979/80- 1993/94.  Injections were given every five years in 40 remote rural districts.
     Iodized oil capsules were distributed from 1994/95- 1997/98 in 15 of the most inaccessible Himalayan districts.
     The program targeted women of reproductive age, and children up to 15 years of age.
     Data is not available on the number of people supplemented, but based on the findings in the Nepal Micronutrient Status Survey 1998, coverage was thought to be poor, only around 20% of target groups were reached.
Fortification
Production and Importation of Salt
    

No iodized salt is produced, but is imported from India
    

The intended level of iodization is 50 ppm of Iodine or 85ppm of Potassium Iodate
    

The level of salt iodization is assured through The Salt Department of the government of Indian.  This department issues “Iodine Test Certificates” to suppliers.  Certificates are mandatory for sale to Nepal and The Salt Departement usually collects samples from each salt consignment from railway platforms prior to loading into railway wagons.
    

About 5% of salt is imported unofficially from India and Tibet.  All salt from Tibet is uniodized and that from India generally has a lower iodine content.
Retail
   

*  The average retail cost of iodized salt is $0.07-0.15/kilogram in places accessible by road.  The price ranges from $0.30-0.70/Kilogram in remote regions without any subsidy.  The retail price of uniodized salt is similar, but is mainly found in border areas.
   

*  There are many differences in prices depending upon geographical and ecological conditions.
 
Household Consumption
     The average daily consumption of salt is as follows
     - Women :  8.76 grams
     - School-aged Children (6-11 yrs): 5.95 grams
     - Pre-school Children (6m- 59m):   2.54 grams
     (Sourced from the Fortification Feasibility Study 2000, MI)
     The estimated percent of households consuming salt with some iodine is 91%.  The estimate of households consuming adequately iodized salt (15ppm or above) is 63%.  Sourced from the Between Census Household Information, Monitoring and Evaluation System 2000- BCHIMES.