"A Review of Iodine Nutrition Situation in Bhutan; Historical Milestones"

Abstract

Iodine is a micronutrient required for production of thyroid hormones which plays a critical role in metabolism. Iodine deficiency can lead to many severe effects throughout the human life cycle and is collectively termed as iodine deficiency disorders. Salt fortification is an effective intervention to improve iodine nutrition in the population. In Bhutan, iodine deficiency disorders (IDD) were universally present with the first nationwide survey conducted in 1983, reporting a total goiter rate of 64.5%. This lead to establishment of ‘Nutrition Section’ in the Directorate of Health and the Iodine Deficiency Disorders Control Program (IDDCP) in planning commission in 1985. Several public health interventions were undertaken to address this public health burden; salt iodization and distribution, iodized oil injections, establishment of the Bhutan Salt Enterprise in Phuntsholing and program evaluation. Since then, many assessments were conducted to evaluate the program all of which reported significant improvements. In 2003 an external monitoring team confirmed that Bhutan was the first country in WHO SEARO to have eliminated IDD as a public health problem. An assessment conducted in 2010 reported that Bhutan was sustaining the IDD elimination status achieved in 2003. Constant program improvements and investments are required to sustain this achievement. Iodine content of various salt brands needs to be analyzed from time to time to regulate import control and surveys must be conducted periodically for program evaluation.