Eleventh Five Year Plan

146 Eleventh Five Year PlanIn 2005, a country-wide universal ban on sale of noniodizedsalt for human consumption has again beenpromulgated by the Central Government.4.1.84 Studies indicate that after a certain level, theprevalence of goitre does not decrease by iodinationalone due to role of various other factors like goitrogensin food, pollutants in water, etc. Definite identificationof the active agents and knowledge of theirbiological and physicochemical properties maypermit public health officials to develop proceduresfor eliminating these compounds at the communitylevel and eradicating goitre from endemic areas.4.1.85 Evidence also provides basis to have a freshlook about: iodine as the sole factor in causality;magnitude of the problem as a major public healthproblem universally; effectiveness of universalizationof iodized salt as a measure that leads to decreasinggoitre and other IDD by itself; and possible negativeimpacts on health like increase in hyperthyroidism andhypothyroidism, and interaction with other mineralslike iron.Vitamin A Deficiency4.1.86 VAD has been recognized as a major controllablepublic health and nutritional problem. An estimated5.7% children in India suffer from eye signs ofVAD. Recent evidence suggests that even mild VADprobably increases morbidity and mortality in children,emphasizing the public health importance ofthis disorder.4.1.87 Vitamin A is an important micronutrient formaintaining normal growth, regulating cellular proliferationand differentiation, controlling development,and maintaining visual and reproductive functions.VAD is one of the major deficiencies among lowerincome strata population in India. Human beings cannotproduce this micronutrient in the body itself. Henceit has to be externally provided. This deficiency is seengreater in preschool children and pregnant and lactatingwomen due to higher need for this micronutrient.In severe cases it can even lead to total blindness.4.1.88 Though the prevalence of severe forms ofVAD such as corneal ulcers/softening of cornea(keratomalacia) has in general become rare, Bitot spotswere present in varying magnitudes in different partsof the country (NNMB 2003). The prevalence washigher than the WHO cut-off level of 0.5%, indicatingthe public health significance of the problem of VAD.There is huge inter-State variation in the prevalence ofVAD among children. It is also a matter of concern thatonly 21% children of age 12–35 months received a vitaminA dose in last six months. Less than 10% coverageis reported in Nagaland (8.7%) and UP (7.3%).Only States such as Tamil Nadu (37.2%), Goa (37.3%),Tripura (38.0%), Kerala (38.2%), WB (41.2%), andMizoram (42.2%) have better coverage, though substantiallylow.4.1.89 In India way back in 1970 a National Programmefor Prevention of Nutritional Blindness wasinitiated to fight this deficiency. The beneficiaries ofthis programme were preschool children (1–5 years).Further, the programme was modified in 1992 to coverchildren in the age group of nine months to three yearsonly. Since Tenth Five Year Plan Vitamin A Supplementationexists as an integral component of RCHprogramme that is a part of NRHM.4.1.90 During the past few years, series of expertconsultations were held among various stakeholders.In view of disaggregated age-wise prevalence ofVAD in children (NNMB reports), all these stakeholdersrecommended extending the programme tocover children up to five years. Consequently, MoHFW,GoI, issued guidelines to the States in November2006 extending the programme to cover up to fiveyears.4.1.91 The programme focuses on:• Promoting consumption of vitamin A rich foodsby pregnant and lactating women and by childrenunder five years of age and appropriate breastfeeding.• Administering massive doses of vitamin A up tofive years.– First dose of 100000 IU with measles vaccinationat nine months.– Subsequent doses of 200000 IU each every sixmonths.