Iodine Deficiency Disorders: An abandoned rural health issue

Iodine Deficiency Disorders: An abandoned rural health issue

A guest post by - Bhavnaa S – Health Psychologist and Writer

The plight of ignorance

 In a bit of a flustered open letter to Lancet, Dr.Himmatrao Saluba Bawaskar commented on the pressing health neglect that the rural populace - which constitute of over 65% of India's total population- faced, in Lancet’s published series on India healthcare in February 2011. He listed accidental snake and scorpion bites, fluorosis (disease caused by excessive consumption of fluoride-contaminated water) and hypothyroidism as some of the common causes of death and debilitation among the rural population.
Of course there any many other diseases this section of people face, yet what I really want to focus on in this article is a problem that may not lead to an immediate emergency situation but rather one that is slow to manifest.

Iodine Deficiency Disorders (IDD)

'Iodine deficiency' is sub-categorized under 'Micro-nutrient Deficiency Disorders'. As a branch of its own, Iodine Deficiency Disorders (IDD) covers a whole range of health problems out of which some are extremely common among the urban population, yet it’s the rural section that are the most affected. 
 What is Iodine deficiency, you may ask? Iodine is an important mineral nutrient needed for the normal development and functioning of the human body. Iodine is found mainly in oceans and then later the oxidized element is foundin the soil. The main problem here is that iodine, just like wealth, is unevenly distributed in natural reservoirs around the world, making it quite hard for inhabitants in iodine-deprived regions to have easy access to foods grown in iodine-rich soils (Eastmann& Zimmermann, 2009). 
 Why is iodine important for the body? Iodine helps the thyroid gland to produce thyroid hormones which are commonly known as T3 (triiodothyronine) and T4 (thyroxine) that are essential for a healthy functional body (Eastmann& Zimmermann, 2009).

 Effects of IDD:

 1.Adults suffering from iodine-deficiency end up having complications such as goitre, iodine-induced hyperthyroidism, hypothyroidism and impaired mental function.
2. Pregnant women may need to take more care as having low levels of iodine can lead to a higher rate of miscarriages, still-births, and giving birth to a baby with several abnormalities. Mental retardation among children whose mothers have iodine deficiencies are also possible manifestations. This is why maintaining a good diet during pregnancy is especially important as mother's nutrition is passed on directly to the child. Besides mental retardation, pregnant women with severe iodine deficiencies tend to have children who are deaf (which impacts the speech), who have a short stature, and have other skeletal and muscle deformities. These children are labelled as 'cretins' and this conditionis known as 'Cretinism'. In a less extreme situation, the child of a malnourished or undernourished mother having low levels of iodine could have reduced learning capacities or lower IQ levels. What is important to remember is that any nutritional deficiencies in the mother could directly affect the foetus in the womb.

3. The other sensitive group besides pregnant women are those in their adolescent stage, i.e.,those between 10 to 19 years of age. Low iodine levels in this age-group are especially harmful as this could lead to hypothyroidism. The symptoms and effects of hypothyroidism are fatigue, lethargy, weight-gain, cold-intolerance, constipation, depression, reduced muscle strength, and in severe cases (for girls/women) female infertility (Eastmann& Zimmermann, 2009).

4.The symptoms of iodine deficiency or hypothyroidism amongst elderly people can almost be overlooked as ageing problems. It is important not to overlook the hypothyroid symptoms in the older population as this could lead to further complications such as heart problems.

 To know the Iodine levels in the body, urine tests are conducted. So, if the levels iodine levels are low, it means the body is iodine-deficient. To check for hypothyroidism or hyperthyroidism (which occur due to lack or excess of iodine in the body respectively), blood tests are conducted. Patients need to ask for tests to determine their TSH, T4 and T3 levels for a complete picture (Johnson, 2008).

 Treatment solutions

Because the rural sections are the most sensitive demographic prone to suffer from malnutrition and under-nutrition, it is imperative that they understand how to pep up their iodine levels. The best way to increase iodine intake is to use salt that is 'iodized'. Salt is easily accessible to all sections of people and it is essential that the local authorities ensure that only iodized salt is being bought and distributed among the village folk.

Foods that are iodine-rich are cheese, butter, onion, spinach, carrot, garlic, lettuce, strawberries and seaweed (Bashir et al, 2011).  Also, do keep in mind that potatoes are a great source of iodine and if they are consumed with their skin, in the baked form, it is better (although this may or may not be possible in a rural environment). Seafood is also a good iodine source, although most of the Northern and centrally located villages in India follow a strict vegetarian diet. Iodine supplements and multivitamins are also available for consumption, yet it is essential that these are prescribed by doctor based on individual reports.

Lastly, iodized oil is also used as a form of treatment (Eastmann and Zimmermann, 2009). This can be given in the oral form or in injection form, but again this too depends on the doctor's advice and whether they prescribe it or not. Hence, it is important for doctors at health care facilities located at village in India to do regular checks and not overlook this issue.

The ripple effect of malnutrition
Malnutrition is linked to poverty, not insufficient food production. In rural areas, due to low family wages, fluctuating food/vegetable prices, droughts, soil erosion, flooding and several other reasons, villagers are unable to have a steady supply of vegetables, crop, pulses, and other foods. If they are not malnourished, then they tend to be under-nourished which is still not good. Rather malnutrition is a main cause of vitamin deficiencies, anaemia, and of course iodine deficiency among the rural population. This impacts the body, the brain and consequently impacts their quality of life too.

 One study carried out in a rural area (Mandya district) in South Karnataka (Devendrappa, 2009) concluded that hypothyroidism - a manifestation of low iodine levels - is a common problem amongthe rural population and those who were prescribed medication complied to it better than the urban population. This study is important because besides the fact that it points out the high prevalence of hypothyroidismbeing linked to low iodine levels, it also makes a point about compliance.
The malleability of compliance

In rural parts of India, it is important to note that lots of close-knit groups or people living in villages maintain certain beliefs, such as: a person could be ill because of spirits, or due to the breaking of a rule, or because of doing something that is usually considered taboo. Interestingly, herbal medical practitioners and those offering their 'religious and magical' services/medications are also seen in plenty in these areas and usually these are undocumented or non-scientific medicine systems that they follow (Patil et al, 2002). Because such 'quacks' know that the compliance levels of the villagers or tribal population tend to be high, they are drawn to set base in these areas and continue with their practices. Hence, one would find 'doctors', rather quacks, having their non-scientific medical centressituated in these areas in abundance. Most of the times, these non-qualified ‘specialists’ allow villagers to maintain their illogical ideologies so as to capitalize on their naive thought processes.

In such areas, there is a dire need for qualified doctors. Licensed MBBS-qualified doctors or licensed Homeopaths and Ayurvedic specialists need to come into the forefront here.

It is in fact shocking to know that according to a recent unpublished study by the Rural Medical College in India, 80% of the medical practitioners who practice 'allopathy' or Western/Orthodox medicine in rural villages do so without actual and proper training. Also, 73% of these 'doctors' first think of the actual cost of the drug and whether it will be affordable by their patients or not, and only then consider the pharmaceutical properties of the drug.
It’s interesting to note how ‘compliance' is often taken for granted. This makes it all the more important for rural sections of the population to be educated and to understand how important it is toknow about their own health and to understand that they are equipped with the right to ask as well as choose between what they are offered and what they decide to get treated with.

The need for altruistic and authentic leadership

 The underlying cause of frustration is the lack of a solid and workable government health policy which is making people of the rural sector seek out more health facilities offered by the private sector. This in turn leads them to take more loans and get further burdened with debt. The consequences can be several. It hence becomes essentially important that waiting for the government to act may not be the solution in the short-run, which is why individuals and doctors from the private sector, or the common, educated individual may need to initiate medical programs, camps or health-awareness programs that constitute of a group of medical professionals, who are able to use this platform less for seeking out personal benefits but rather for the genuine general welfare of the rural population. This in turn will help get rid of negative elements still prevalent in modern India, which in turn will empower and educate the most important section of our country. 

Note :For references please see  bottom of the post


Bashir, H., Farooq, R., Bhat, M., and Majid, S. (2011).Increased prevalence of subclinical hypothyroidism in females in mountainous valley of Kashmir – a signal for advocating iodine sufficient diet intake, Unpublished. Government Medical College Srinagar.

Devendrappa, G. (2009). Clinical Profile of Hypothyroidism Patients in a Rural Area of South Karnataka.Journal of Association of Physicians of India. Available from:

Eastman, C and Zimmermann, M.(2009).The Iodine Deficiency Disorders.Thyroid Disease Manager. Available at:
Johnson, L.(2008).Disorders of Nutrition, The Merck Manual Home Health Handbook Online Version. Last revised: August 2008.Available at:

MalathyIyer (2011) ‘Lancet neglects neglected diseases of India’, The Times of India, 7 May [Online]
Patil, A., Somasundaram, K., and Goyal, R. (2002). Current Health Scenario in Rural India, Australian Journal of Rural Health, 10, 129-135.










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