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PAKISTAN: Iodine deficiency affecting children in northwest

07 Aug 2007 05:43:38 GMT
Source: IRIN

ABBOTABAD, 6 August 2007 (IRIN) - Iodine deficiency is a major health problem in Pakistan. According to the Islamabad-based Network for Consumer Protection, around 50 million people across the country suffer from it.

Sumaira Khatoon, 35, is concerned by her youngest son's performance at school. The boy, Farhan, 10, has failed his examinations twice and teachers say he is "incapable of learning".

Sumair and her husband Farooq Ahmed, 40, who live in the small town of Thandiani, some 30km from Abbotabad, in Pakistan's North West Frontier Province (NWFP), had no idea that the problem could be linked to iodine deficiency.

"Both our other children, a daughter and a son, do well at school. We are very worried about Farhan," said Farooq.

The child shows no obvious signs of iodine deficiency. He seems active and the tell-tale swelling of the thyroid gland, known as goiter, which occurs when there is a serious iodine deficiency, is not visible.

"It is commonly believed iodine deficiency shows itself only as goiter, but actually it can lead to slow mental development, retardation, lethargy and reproductive problems, including miscarriages or still births among women," said Dr Faiza Zafar, a physician based in Abbotabad. She diagnoses iodine deficiency quite frequently among patients from all over the NWFP.

In 6.5 million people the problem of iodine deficiency is rated as "severe", while in many parts of the NWFP, where rain and rivers wash iodine and other minerals out of the soil, up to 90 percent of people outside major towns are said to suffer from some level of iodine deficiency.

On paper at least, the solution is simple. Iodised table salt was introduced in Pakistan in 1994 and currently the UN Children's Fund (UNICEF), which began importing potassium iodate into Pakistan around the same time, supplies provincial health departments.

The rate, at US$2.50 per kilogram is low, and the cost of adding it to salt ground at local mills is minimal.

Mistrust

But a quite different problem has plagued the campaign to promote and popularise iodised salt. "Many people believe that this salt is a means of preventing reproduction and is being distributed as part of a Western conspiracy to stop the growth of the Muslim population," said Dr Zafar.

Zafar said: "Some patients refused to use the widely available iodised salt because they were convinced it would reduce fertility."

This belief, which exists not only in the NWFP but also in many parts of Pakistan's populous Punjab Province, is similar to misconceptions surrounding the oral polio vaccine, and also fortified flour, the marketing of which has begun in some parts of the country.

However, Amjad Malik, a medical student who is working in Abbotabad to combat iodine deficiency, said: "Such problems have to be tackled and not allowed to stand in the way of people's health."

This may be easier said than done though - especially in conservative areas of the NWFP where campaigns conducted by the government or non-governmental organisations (NGOs), hold little weight and are often regarded with distrust.

Combating deeply rooted beliefs is hard, with many people seemingly unconvinced by factual evidence.

"Allah Almighty has given us many natural wonders, including salt. Why should we add man-made medication to it? If a child is ill or a woman suffers miscarriages, that is God's will," said cleric Abdul Hakim, based at a mosque close to Thandiani.

However, gradually, the message regarding iodine has begun to reach some families. "If this will help my son, I am willing to try it," said Sumaira Khatoon, cautiously sniffing a handful of iodised salt brought from a corner-shop.

Goiter, iodised salt statistics

According to the results of UNICEF-supported research conducted by the Peshawar-based Research Centre of the Khyber Medical College, in the Swat area of the NWFP, the findings of which were published in 2003, 52 percent of boys and 45 percent of girls aged 8-10, from a sample of 960 students, were found to suffer from goiter. While this marked a slight improvement over figures reported in past years, the incidence of the problem remained high.

According to the Network for the Sustained Elimination of Iodine Deficiency, a network of major international organisations working globally against iodine deficiency, only 17 percent of Pakistan's population uses iodised salt. This compares to over 70 percent in neighbouring India, 93 percent in Nepal and 78 percent in Bangladesh.

International agency Micro-nutrients Initiative (MI) has now taken over responsibility for promoting iodised salt in the country and is working with the Health Ministry. Attempts are being made to persuade rock-salt crushing factories to add the nutrient to its products.

Additional challenges

Wider marketing of iodised salt and indeed a battle against widespread malnutrition, which causes stunting among 38 percent of Pakistani children, according to international findings, may help solve some of the issues millions of people face.

But the struggle could be a long and difficult one, aid workers say. Many NWFP villages are cut off from major towns for months by snow and people tend to live in virtual isolation, unwilling to alter age-old beliefs.

In addition, heightened pro-militant sentiments currently prevailing in many areas of Pakistan, particularly in NWFP, are making it even harder than before for the government or NGOs to get their message across and correct the misconceptions which have consistently plagued efforts to improve health in many spheres.

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Last updated:Tue Aug 7 05:46:00 2007