Preventing Iodine Deficiency Disease in Nepal

19th November 2018

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For over 10 years, David Brodie from Jordans and District Rotary Club and Nirmal Baral from the Dharan Ghopoa Club in Nepal have been working together with other members of their clubs to reduce the incidence of iodine deficiency disease (IDD) in Nepal. 

A Rotary Foundation global grant was awarded in late 2013 for the continuation and development of this project. 10,000USD raised by Jordans and District Club was matched by District 1090 and the Rotary Foundation World Fund. The 35,000USD project and reporting was recently completed. The funding was used to buy educational materials and books, iodised salt, computing equipment and to cover costs such as laboratory analysis, plus travel and accommodation for Nepal-based team members and for experts for evaluation and training. The project delivered both iodised salt for children and education of children, teachers and community leaders.

Read David's personal account of the project below and see how successful long-term sustainable projects can be.

“IDD is considered by the World Health Organisation as the most prevalent, preventable mental disease. It is caused by insufficient iodine in the soil meaning that iodine fails to get into the food chain. The outcome, apart from mental retardation, is goitre (a swelling of the neck resulting from enlargement of the thyroid gland), premature births, stillbirths and cretinism (congenital iodine deficiency syndrome). Prevention is based on including iodine in common salt and all the earlier work was to explore this approach.  For many years Nirmal and I travelled to remote parts of Nepal  with our team to establish the incidence of IDD in schoolchildren and to supply iodised salt. In one landmark study we found a 30% incidence of the disease, but by using iodised salt over just six months, we reduced the disease to zero.  The measurement of iodine was based on analysing samples of urine back at the university biochemistry laboratories at the BP Koirala Institute of Health Sciences, based in Dharan, in the East of Nepal.  At the same time we checked to see if any households were currently using iodised salt.
 
“Grants to undertake this important work were received from many sources, including the Rotary Foundation, the Coronary Prevention Group and the Mother and Child Foundation .

“To get to remote and mountainous areas to undertake this work took many days of trekking, carrying collection equipment and delivering the salt.  When you think of the road network in the UK, to walk for up to eight days away from one is very different!

“More recently, a global grant enabled us to change the perspective from delivery to sustainability. We organised a full educational programme, based primarily in the East of the country, to inform communities of the merits of iodised salt, its correct storage and usage. This involved writing a full-length book on the topic, publishing pamphlets, educational material and other resources to disseminate the programme.  We met with community leaders, schoolteachers, children, parents and policy makers. We touched the lives of many thousands of children and whole communities are now fully informed over the benefits of iodine in their diet. It has been a huge success, with our evaluations indicating that iodine deficiency is no longer the problem it was in the past. 

“Nepal is one of the poorest countries in the world and it is gratifying to know that the impact of our work means that the devastating disease of IDD is now controllable.”

This project was funded under two of the Rotary Foundation’s Areas of Focus: disease prevention and treatment, and basic education and literacy. Prior to the Global Grant, the clubs had used smaller grants awarded by the District Grants Committee, again matching funds raised by Jordans and District Club. It was therefore easy to demonstrate that the clubs involved understood the needs of the communities with whom they wanted to work.

David Brodie, DSc, is an Emeritus Professor of Cardiovascular Health at the University of Liverpool and Bucks New University. He is also author of "Treacherous Games" and "Beggar on a Bicycle"