IODINE DEFICIENCY DISORDER

PROGRAM
NEETHU VINCENT
ASSISTANT PROFESSOR
KVM COLLEGE OF NURSING

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• 1962 –national Goitre Control Programme
• In August, 1992 the National Goitre Control
Programme(NGCP) was renamed as National
Iodine Deficiency Disorders Control
Programme(NIDDCP).

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 GOAL
• The government’s goal of NIDDCP is to reduce
the prevalence of iodine deficiency disorders
below 10 percent in the entire country by
2012 A.D.

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 Objective:
(i) Initial surveys to assess the magnitude of the
Iodine Deficiency Disorders.
(ii) Supply of iodated salt in place of common
salt.
(iii) Health Education & Publicity.
(iv) Resurveys to assess the impact of iodated
salt after every 5 years.
(v) Laboratory monitoring of iodated salt and
urinary iodine excretion.
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 POLICY:
• It had been established that consumption of iodated
salt is the best and simplest way to prevent and
control IDD.
• Based on the recommendation of the central council
of health in 1984, the govt. of India took a policy
decision to iodated the entire edible salt in the
country by 1992 in a phased manner. The program
started in 1986 in April.
• The central govt. has issued the notification banning
the sale of non-iodated salt for direct human
consumption in the entire country with effect from
17th may, 2006 under the prevention of food
adulteration act 1954.
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 NODAL MINISTRY:
• The ministry of health & family welfare is the
nodal ministry for policy descisions on National
Iodine Deficiency Disorder Control Program
(NIDDCP).

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 IODINE DEFICIENCY DISORDER CELL OF
DIRECTORATE GENERAL OF HEALTH SERVICES:
• The Central Nutrition and Iodine Deficiency
Disorders cell at the Directorate General of
Health Services (DGHS) is responsible for the
implementation of NIDDCP in the country. The
important activities of IDD are as follows:
• Technical guidance to the states/UTs.
• Intersectoral coordination at Central level and
maintenance close liaison with the ministry of
Industry/transport etc.

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 • Coordination of the various facets of NIDDCP in
states/ UTs.
• Undertaking independent IDD surveys and
monitoring in various states/UTs.
• Imparting training to the state health to whom
personnel, involved in NIDDCP.
• Collection, compilation and analysis of relevant data
from states/UT with a view to render more effective
and meaning advice.
• Monitoring of the quality control of iodated salt at
production level through the salt commissioner and
at the distribution & consumer level through the
state health directorate.

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• Monitoring the procurement and distribution
of iodated salt in States/UTs.
• Managing the IEC activities at apex level.\
• Managing the financing and other physical
aspects of state level IDD cells.

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 STATES/UNION TERRITORY IDD CELL:
• Each state government has an IDD control cell,
which is responsible for:
• Checking iodine levels of iodated salt with
wholesalers & retailers with in the state and
coordinating with the food & civil supplies
department.
• The distribution of iodated salt with in the state
through open market & public distribution system.
• Creating demand for iodated salt.
• Monitoring consumption iodated salt.

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• Conducting IDD surveys to identify the
magnitude of IDD in various districts.
• Conducting training.
• Dissemination of information, education and
communication.

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 Achievements:
• To ensure use of only iodated salt the sale of non-
iodated salt was banned under Prevention of Food
Adulteration Act, 1954,
• Establishment IDD Control Cell in the State Health
Directorate
• A National Reference Laboratory for monitoring of
IDD.
• Spot qualitative testing
• Setting up one district level IDD monitoring
laboratory
• Cash grants
• The standards for iodated salt have been laid down
under PFA Act, 1954.
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 INFRASTRUCTURE:
• National Iodine Deficiency Disorder controls program
at the central level is being managed by adviser
(Nutrition) of the directorate general of health services.
• An independent nutrition & IDD cell has been created
under the deputy asst. director general (IDD) with
support of research officer (IDD) assisted by a team
comprising a technical assistant, a junior investigator,
field assistants, field attendants, a computer and other
ministerial staff.
• Each state is having their own IDD cell. Till now there
now 31 IDD cells and 30 laboratories have been
established.

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 FINANCIAL ASSISTANCE:

• Financial assistance is being provided to all the

states/UTs in form of quarterlt advance
release of funds w.e.f. 2002-03 for various
components under the program.

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IDDCP IN 12TH FIVE YEAR PLAN (2012-
2017)
GOALS:
• Universal use of iodine fortified salt.
• to bring down prevalence of IDD below 5% in
the entire country by 2017 AD.
• To ensure 100% consumption of adequately
iodated salt (15 PPM) at the household level.

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 STRATEGIES:
• IDD survey
• Establishment of IDD Contrrol cells
• Establishment of IDD Monitoring labs.
• Training program
• Production and distribution of iodated salt.
• Health education and publicity.
• Community level iodated salh testing.
• Incentive to ASHA for community level awareness of
iodated salt.
• Strengthening of central IDD control cell.
• Health education and publicity by the state/UTs.
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 IEC Activities
• To intensify the IEC activities a communication
package by way of video films
posters/danglers and radio/TV spots have
been finalized. IDD spot has been telecast on
Doordarshan (National Network)

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 COMMUNITY NUTRITION
PROGRAMME
NEETHU VINCENT
ASSISTANT PROFESSOR
KVM COLLEGE OF NURSING

4/4/2020 19
• Large scale supplementary nutrition
programmes.
 Main aim is to improve nutritional status in
targeted groups.
 And overcome specific diseases to combat
malnutrition.

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 LIST OF PROGRAMMES
1. Vitamin A prophylaxis programme
2. Prophylaxis against nutritional anaemia
3. Control of iodine deficiency disorders
4. Special nutrition programme
5. Balwadi nutrition programme
6. ICDS programme
7. Mid-day meal programme
8. Mid-day meal scheme

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CNP and Ministry
 Vitamin A prophylaxis
programme
• Initiated in 1970,launched by ministry of
health & family welfare
• Beneficiary: age group 6mo - 5year
Objective:
 Prevent blindness due to VAD
• Implemented by: PHC and subcenter
• A single massive dose of Vitamin-A 2 lac IU
(retinol palmitate 110mg) orally every 6
months above 1 year through peripheral
health workers

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 PROPHYLAXIS AGAINST
NUTRITIONAL ANAEMIA
• Initiated in 1970
• Centrally sponsored
• Over 50%pregnant woman suffer from anemia
• CausesL B W and perinatal mortality, maternal
death
• Objectives:Assessprevalence, Givetreatment,
Giveprophylaxis, Monitoring, Education
• Beneficiaries:
– Children aged 1 to 5 years
– Pregnant and nursing mother
– Female acceptor of terminal method of
family planning and IUDS
• Implemented by: PHC and subcenters
• Dosageof tablets:
– Pregnant women: 100 mg Fe& 0.5mg folic acid
– Children 6 to 60 months : 20mg Fe& 0.1 mg folic acid
– Should be given 100 days
– Adolescent girls: 100 mg Fe& 0.5mg folicacid
• Children between 1 to 5years
– Screeningtest for anemia done at 6 mo, 1, 2years
• Iron fortification of salt
 IODINE DEFICIENCY DISORDER
CONTROL PROGRAMME
• National goiter control programme in1962
• IDDControl Programme
• Replacethe entire edible salt by iodide salt
• Fortification of salt with iodine
 SPECIAL NUTRITIONAL
PROGRAMME
• Started in 1970 in urban slums, tribal areas and
backward rural areas
• Supplementary food
-300 kcal &10 -12 gm of protein child per day
- 500 kcal & 25 gm of protein per mother
• Main aim is to improve nutritional status in
– children <6years
– pregnant and lactating women
• Gradually being merged into ICDS
 APPLIED NUTRITIONAL
PROGRAMME
• This project was started in Orissa on1963
• Later extended to TN and UP
• Objectives:
– Promoting production and of protective food
such vegetables and fruits
– Ensure their consumption by pregnant
&lactating women and children.
• In 1973 extended to all states in INDIA
• Major components
– Nutritional Services
– Health services
– Communication
– Monitoring and evaluation
• Later converted into ICDS
BALWADI NUTRITION PROGRAMME
• This was started in 1970 by the department of
social welfare
• Beneficiary:
– Preschool children 3-6 years of age
• Activities
– 300 kcal and 10 g protein
– Preschool education
• Phased out because universalization of ICDS
INTEGRATED CHILD DEVELOPMENT
SERVICES (ICDS)SCHEME
• Launched on 2nd October1975
• • One of the world’s largest and most unique
programmes for early childhood development
• India’s response to the challenge of
– Providing pre-school education on one hand and
– Breaking the vicious cycle of malnutrition,
morbidity, reduced learning capacity and mortality,
on the other
• Foremost symbol of India’s commitment to her
children
MID DAY MEALPROGRAMME 1961
• School Lunch Programme
• Objectives
– Improve school attendance
– Improve child nutrition
• Principles
– Supplement, not substitute to home diet
– 1/3rd of energy and ½ of protein requirement/day – low cost,
easily prepared at schools
– locally available food
– change menu frequently
–prepared easily in schools
–locally available foods ,reduce the cost of the meal
 MID-DAY MEAL SCHEME 1995
• National Programme of Nutritional Support to
Primary Education
Centraly sponsered programme and revised in
2004
• Objectives:
– Universalization of primary education by
increasing enrollment (class 1 to 5)and
– Improve nutritional status of children (class1-5)
– 300 kcal and 8-12 g protein
 Challenges of mid-day meal scheme
• Good for improving nutrition of the
underprivileged children
• But it requires sustainability
• Repeated incidence of food poisoning in the
mid day meal causing serious threat
Universal IMMUNIZATION
PROGRAMME IN INDIA
NEETHU VINCENT
ASSISTANT PROFESSOR
KVM COLLEGE OF NURSING
VACCINE PREVENTABLE DISEASES
8 TARGETED VPDS
1. Diphtheria
2. Hepatitis B
3. Measles
4. Pertussis
5. Poliomyelitis
6. Tetanus
7. Tuberculosis
8. JE
•Under Global Smallpox Eradication Program,
it was experienced that immunization is the
most powerful and cost effective weapon for
the prevention and control and even
eradication of a disease.
•In 1974, WHO officially launched a global
immunization program, known as Expanded
Program of Immunization for the prevention
and control of six killer diseases of children,
namely tuberculosis, diphtheria, pertussis,
tetanus, poliomyelitis and measles, all over the
world.
It was called Expanded because:
 •Adding more disease controlling antigens of
vaccination schedules.
 •Extending coverage to all corners of a country.
•Spreading services to reach the less privileged sectors
of the society
•The primary health care concept as enunciated in the
1978 Alma-Ata Declaration included immunization as
one of the strategies for reaching the goal of “Health For
All” by the year 2000.
•The Government of India launched EPI in1978 with
objective of reducing mortality and morbidity resulting
from vaccine-preventable diseases of childhood and to
achieve self sufficiency in the production of vaccines.
•In October 1985, UNICEF emphasized the goal of
achieving universal immunization by 1990 so the global
program was renamed as ‘Universal Child Immunization’.
•On 19 November 1985, GOI renamed EPI program,
modifying the schedule as ‘Universal Immunization
Program’ dedicated to the memory of Late Prime Minister
Mrs Indira Gandhi.
•UIP has two vital components: immunization of
pregnant women against tetanus, and immunization of
children in their first year of life against the six EPI target
diseases.
•The aim was to achieve 100 per cent coverage of
pregnant women with 2 doses of tetanus toxoid (or a
booster dose), and at least 85 per cent coverage of infants
with 3 doses each of DPT, OPV, one dose of BCG and one
dose of measles vaccine by 1990.
•Universal immunization was first taken up in 30 selected districts
and catchment areas of 50 Medical Colleges in November 1985.
•A “Technology Mission on Vaccination and Immunization of
Vulnerable Population, specially Children” was set up to cover all
aspects of the immunization activity from research and
development to actual delivery of services to the target
population.
•The immunization services are being provided through the
existing health care delivery system (i.e., MCH centres, primary
health centres and subcentres, hospitals, dispensaries and ICD
units).
•During 1992, immunization program become a component of
Child Survival and Safe Motherhood (CSSM) program. It was
recommended to cover 100% among infant also.
•In 1995, Pulse Polio Immunization Program was launched as a
strategy to eradicate poliomyelitis.
In 1997, immunization activities have been an important
component of National Reproductive and Child Health
Program.
• In 2005, immunization schedule was revised incorporating
hepatitis vaccine, 2 doses of JE vaccine in selected endemic
districts , 1st during 912 months and 2nd during 16-24
months and 2 doses of measles vaccine, 1st dose during 9-12
months and 2nd dose during 16-24 months, under National
Rural Health Mission (NRHM).
• In 2012, GOI declared 2012 as the “Year of Intensification
of Routine Immunization”.
• In 2013, GOI along with other S-E Asia regions, declared
commitment towards measles elimination and congenital
rubella syndrome control by 2020.
• In 2014, India was certified as “Polio free country”.
• Although the target was “universal” immunization by
1990, in practice, no country, even in the industrialized
world, has ever achieved 100 per cent immunization in
children.
• ‘Universal’ immunization is, therefore, best interpreted as
implying the ideal that no child should be denied
immunization against tuberculosis, diphtheria, whooping
cough, tetanus, polio and measles.
• It is, however, generally agreed that when immunization
coverage reaches a figure of 80 per cent or more, then
disease transmission patterns are so severely disrupted as to
provide a degree of protection even for the remaining
children who have not been immunized, because of “herd
immunity”.
• It is also important that children are immunized during the
first year of life and that levels of immunization are
sustained so that each new generation is protected.
• Significant achievements have been made in India.

• At the beginning of the programme in 1985-

86,vaccine coverage ranged between 29 % for BCG and
41 % for DPT.
• By the end of 2014, coverage levels had gone up
significantly to about
 • 87 % for tetanus toxoid for pregnant women
 • About 91 % for BCG
 • 83 % for DPT 3 doses
 • 83 % for measles
 • 82% for OPV 3 doses and
 • 70 % for HepB3 and
 • 20 % for Hib3.
• To strengthen routine immunization, Government of India has
planned the State Programme Implementation Plan (PIP) part C.
• It consists of:
(a) Support for alternate vaccine delivery from PHC to sub-centre
and outreach sessions;
(b) Deploying retired manpower to carry out immunization
activities in urban slums and underserved areas, where services
are deficient;
(c) Mobility support to district immunization officer as per state
plan for monitoring and supportive supervision;
(d) Review meeting at the state level with the districts at 6 monthly
intervals;
(e) Training of ANM, cold chain handlers, mid-level managers,
refrigerator mechanics etc.;
(f) Support for mobilization of children to immunization session
sites by ASHA, women self-help groups etc.;
(g) Printing of immunization cards, monitoring sheet, cold chain
chart vaccine inventory charts etc.
• In addition, central government is supporting
in supplies of auto-disposable syringes,
downsizing the BCG vial from 20 doses to 10
doses to ensure that BCG vaccine is available in
all immunization session sites, strengthening
and maintenance of the cold chain system in the
states, and supply of vaccines and vaccine van.
 PULSE POLIO IMMUNIZATION
PROGRAMME
Pulse Polio Immunization Programme was launched in the
country in the year 1995.
• In this programme children under five years of age are given
additional oral polio drops in December and January every year
on fixed days.
• From 1999-2000, house to house vaccination of missed
children was also introduced. The NIDs rounds cover
approximately 172 million children and SNIDs rounds cover
40-80 million children. In addition, large scale multidistrict
mop-ups have been conducted.
• As a result only one case of polio was reported in 2011 in the
month of January.
• As on 25th Feb 2012, India was removed from the list of
polio endemic countries, and on 27th March 2014, India was
certified as polio-free country.
 INTRODUCTION OF HEPATITIS-B
VACCINE
• In 2010-2011, Government of India
universalized hepatitis B vaccination to all
States/UTs in the country.
• Monovalent hepatitis B vaccine is given as
intramuscular injection to the infant at 6th,
10th and 14th week along with primary series of
DPT and polio vaccines.
• In addition one dose of hepatitis B is given at
birth for institutional deliveries within 24 hours
of birth.
 INTRODUCTION OF JE VACCINE
• The programme was introduced in 2006 to
cover 104 endemic districts in phased manner,
using SA 14-14-2 vaccine, imported from China.
• Single dose of JE vaccine was given to all
children between 1 to 15 years of age through
campaigns.
• The JE vaccine is being integrated into routine
immunization in the districts where campaign had
already been conducted to immunize the new
cohort of children by vaccinating with two doses
at 9-12 months and 16-24 months.
 INTRODUCTION OF MEASLES
VACCINE SECOND OPPORTUNITY
•In order to accelerate the reduction of measles related
morbidity and mortality, second opportunity for
measles vaccination is being implemented.
•The National Technical Advisory Group on
immunization recommended introduction of 2nd dose
of measles vaccine to children between 9 months and
10 years of age through supplementary immunization
activity (SIA) for states where evaluated coverage of
first dose of measles vaccination is less than 80 per cent.
•In states, with coverage of measles vaccination more
than 80 per cent, the second dose of vaccine was given
through routine immunization at 16-24 months.
INTRODUCTION OF PENTAVALENT
VACCINE (DPT + Hep-B + Hib)
•India introduced pentavalent vaccine containing DPT, hepatitis B and Hib vaccines
in two states viz. Kerala and Tamil Nadu under routine immunization programme
from December 2011.

•DPT and hepatitis B vaccination require 6 injections to deliver primary doses.

•With the introduction of pentavalent vaccine, a new antigen, i.e., Hib has been
added which protects against haemophilus influenzae type B (associated with
pneumonia and meningitis) and the number of injections are reduced to 3.

•The vaccine has been expanded to 6 more states, i.e., Haryana, Jammu and
Kashmir, Gujarat, Karnataka, Goa and Puducherry in 2012-13. Now pentavalent
vaccine is being given in all states.
 MISSION INDRADHANUSH
•The Government of India launched Mission Indradhanush
on 25th December 2014, to cover children who are either
unvaccinated or partially vaccinated against seven vaccine
preventable diseases, i.e., diphtheria, whooping cough,
tetanus, polio, tuberculosis, measles and hepatitis B.

•The goal is to vaccinate all under-fives by the year 2020.

•201 high focus districts were covered in the first phase. Of

these 82 districts are from Uttar Pradesh, Bihar, Madhya
Pradesh and Rajasthan. These 201 districts have nearly 50 per
cent of all unvaccinated children of the country. The drive
was through a “catch-up” campaign mode. The mission was
technically supported by WHO, UNICEF, Rotary
International and other donor partners.
•Government of India introduced “Intensified
Mission Indradhanush (IMI)” in select districts and
urban areas of the country to achieve the target of
more than 90%coverage.
•IMI focus on children up to 2 years of age and
pregnant women who have missed out on routine
immunization. However, vaccination on demand to
children up to 5 years of age will be provided during
IMI rounds.
•Intensified Mission Indra dhanush Immunization
drive will be spread over 7 working days starting from
7th ofevery month.These 7 days do not include
holidays,Sundays and the routine immunization days
planned in that week.
• In April 2016, India introduced the use of fractional
dose IPV (fIPV) into the routine immunization
programme in eight states (Odisha, Andhra Pradesh,
Telangana, Karnataka, Tamil Nadu, Punducherry and
Maharashtra).
• Since March 2017 has been scaled up nationwide in all
36 states. Two fractional doses of IPV 0.1ml, are being
given intradermally at 6 and 14 weeks.
• On 5 Feb 2017, The Ministry of Health and Family
Welfare launched Measles Rubella (MR) vaccination
campaign in the country, following the campaign,
Measles-Rubella vaccine will be introduced in routine
immunization, replacing the currently given two doses
of measles vaccine, at 9-12 months and 16-24 months
of age in five States/UTs (Karnataka, Tamil Nadu,
Pondicherry, Goa and Lakshadweep).
 In March 2016, the Rotavirus vaccine was first
introduced in four states namely Haryana, Himachal
Pradesh, Andhra Pradesh and Odisha. On 18 Feb
2017, Union Minister for Health and Family Welfare
announced the expansion of the Rotavirus vaccine
under its UIP in five additional states of Assam,
Tripura, Madhya Pradesh, Rajasthan and Tamil Nadu.
• On 13 May 2017, Union Minister for Health and
Family Welfare, announced the introduction of
pneumococcal conjugate vaccine (PCV) in the UIP.
Currently, the vaccine is being rolled out to
approximately 21 lakh children in Himachal Pradesh
and parts of Bihar and Uttar Pradesh in the first phase.
This will be followed by introduction in Madhya
Pradesh and Rajasthan next year, and eventually be
expanded to the country in a phased manner.
 Implementation of Routine
Immunization
• RI targets to vaccinate 26 million new born each year with all
primary doses and ~100 million children of 1-5 year age with
booster doses of UIP vaccines. In addition, 30 million pregnant
mothers are targeted for TT vaccination each year.
• To vaccinate this cohort of 156 million beneficiaries, ~9 million
immunization sessions are conducted, majority of these are at village
level.
• ASHA and AWW support ANM by mobilizing eligible children to
session site thus try to ensure that no child is missed. ASHA is also
provided an incentive of Rs. 150/session for this activity.
• To ensure potent and safe vaccines are delivered to children, a
network of ~27,000 cold chain points have been created across the
country where vaccines are stored at recommended temperatures.
• To ensure safe injection practices, Government of India endeavors
to ensure continuous supply of injection safety equipments (AD
syringes, reconstitution syringes, hub cutters and waste disposal
bags).
 Achievements:
•The biggest achievement of the
immunization program is the eradication of
small pox.
•One more significant milestone is that India is
free of Poliomyelitis caused by Wild Polio
Virus (WPV) .
•Vaccination has contributed significantly to
the decline in the cases and deaths due to the
Vaccine Preventable Diseases (VPDs).