New Delhi: Global Iodine Deficiency Disorders (IDD) Prevention Day is observed on 21st October to draw attention to sustaining the success of universal salt iodization (USI) which has eliminated afflictions due to iodine deficiency. The National Family Health Survey 2015-16 and the Comprehensive National Nutrition Survey (CNNS) 2019, reveal that over 95% population consume salt fortified with iodine providing iodine adequacy. No child in India is reported to be born crein suffering from preventable brain damage drop 10-15 IQ points or perform poorly at school due to iodine deficiency. The success of salt fortification is a great example of addressing a public health problem of micronutrient deficiency through strong public-private partnership of food industry and the entire trade chain including wholesalers and retailers.
The positive lessons emerging from the USI experience pave the way for addressing hidden hunger or micronutrient deficiency. As per the CNNS, besides iron, deficiencies of folic acid, vitamins B12, A and D are high even in school children aged 5-9 years and adolescents aged 10-19 years. Almost a fifth suffer from vitamin A and D deficiencies while 3-4 out of 10 adolescents suffer B12 and folate deficiencies. These are important causes of mortality, morbidity, reduced immunity, impaired cognitive development, poor physical growth, poor mental concentration, and decreased work productivity.
Folic acid deficiency in fact, contributes to preventable neurological disorders in newborns while deficiency of folate along with iron and B12 leads to anaemia. Anaemia problem is grave in our country. Every second woman and child and every third man are anaemic. These micronutrients are not produced in the body and need to be obtained through regular consumption of pharmaceutical supplements or through ensuring adequate daily consumption of vegetables and fruits. In India, every second person consumes less than half the recommended dietary allowance (RDA) of these micronutrients, which is the primary reason for such deficiencies.
The long-term solution to this ‘hidden hunger’ problem, is being intensified under the POSHAN Abhiyaan. Establishment of ‘saag-sabjee bagichaas’ (kitchen gardens) is being promoted at home level, schools and ICDS. The National Agri-Food Biotechnology Institute scientists are also working on biofortification measures for enhancing the micronutrient content of selected food items such as bananas. Food fortification is the other doable diet-based cost-effective solution to reach the unreached, as demonstrated by the success of USI.
Food fortification, a measure complementary to diet diversification and supplementation, is gaining increased attention in India. The Food Safety and Standards Authority of India (FSSAI), issued guidelines on fortifying wheat flour and rice with iron, vitamin B12 and folate, fortifying edible oil and milk with vitamins A and D and double fortification of salt with both iron and iodine. The fortification technology ensures fortificant levels are safe and free from any toxicity, with minimum cost escalation and no change in colour, taste, or texture.
Recognizing the urgency to eliminate micronutrient deficiencies in vulnerable population reached through ICDS and MDM, the Ministry of Women and Child Development and the Ministry of Human Resource Development issued instructions in mid-2017 for mandatory use of fortified wheat flour, rice, oil and double fortified salt in the social safety net feeding programmes. Additionally, the Ministry of Consumer Affairs, Food and Public Distribution issued guidelines to state governments in December 2016 to consider supplying fortified wheat flour under PDS.
Besides government programmes, taking into consideration its immense benefits, the scope of using only fortified food staples in institutional set-ups such as large canteens of industries need to be explored. Interestingly, some tea industries that make partial payment as food rations have shifted to supplying fortified foods since the value-addition of micronutrient adequacy in reducing anaemia, absenteeism, lethargy and enhancing overall productivity is well-recognized.
Elimination of micronutrient deficiencies through food fortification would be achieved only when industry and government are treated as equal partners and voluntary sale of fortified food items through open market is enhanced with the full support of food industries and their national and regional associations, wholesalers, and retailers. Moreover, mainstreaming the unorganized sector in the food fortification efforts remains a challenge. Lessons can be learnt from salt industry to involve them since about one-third of wheat flour is marketed by organized producers. Such a production scenario also does not support the policy of making fortification mandatory, except in the case of oil since the unorganized sector has only 3-5% edible oil. The policy of mandating oil fortification therefore needs serious consideration.. Along with these, demand creating strategy for consumers is imperative..
To facilitate wise food choices and purchase of fortified wheat, rice, oils and milk, FSSAI has issued ‘+F’ logo, denoting fortification. The logo needs to accompany information on fortification benefits such as enhanced mental concentration, school performance, immunity, productivity, work output and earning capacity. Wide dissemination of this information can create consumer demand. The success of iodized salt’s ‘Smiling Sun’ logo testifies the significance of such a strategy. Moreover, for sustaining quality of fortified food items, higher attention needs to be directed to establishing an appropriate government-controlled monitoring system for traders and consumers at state level. Introduction of a simple consumer-friendly micronutrient testing kit, as in the case of India developed and manufactured rapid iodized salt testing kit (MBI Kits, Chennai), is essential not only for protecting consumer interest but also for building confidence among consumers for investing in the purchase and consumption of adequately fortified food for building human capital.
(The author is Dr Sheila C. Vir, Founder Director, Public Health Nutrition and Development Centre. Views expressed are personal)
NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.
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