12 IDD NEWSLETTER MAY 2010 NEPAL Background Nepal is land locked country situated between India and China (see map on p.14). It covers 147,181 km 2 , divided into three ecological (Mountain, Hill and Terai) regions and five developmental (Eastern, Central, Western, Mid-Western and Far- Western) regions, 14 zones and 75 districts. The Terai region is adjacent to India and Mountain region to China, with the Hill region between them. In the past, IDD was rampant in Nepal as reflected by a 55% total goiter rate (TGR) in 1965, during the first IDD survey in Nepal. The Government of Nepal has taken the initiative since 1973, after recognizing the importance of iodine to prevent IDD. There were two projects established by Ministry of Health in 1973; the Goiter Control Program and the Goiter and Cretinism Control Project. These consisted of a combination of activities including Universal Salt Iodization (USI) and iodine supplementation through injections and/or oral iodine capsules given to the target populations. The iodized oil injection program (1979-1994) covered 40 districts located in the hill/mountain regions, while iodized oil capsules (1995-1998) were pro- vided to women and children in 45 remote mountain districts. However, since late 1990s, USI became the sole policy to con- trol IDD in this country. The Government established the Salt Trading Corporation Limited (STC) in 1973 to import iodized salt from India and to distribute it throug- hout the country. In the Mountain region, a small amount of salt is imported from Tibet. Assessment of iodine status The Government of Nepal in collaboration with national and international organiza- tions began the assessment of iodine status in 1965 and it has been continuous since that date. National and sub-national sur- veys were conducted in Nepal by different organizations, including three consecutive national surveys in 1998, 2005 and 2007. In these surveys school aged children were studied and urinary iodine excretion (UIE), TGR and salt iodine content were taken as study parameters. The prevalence of TGR was reduced from 55% in 1965 to 0.40% in 2007 (Figure 1). Median UIE of the Nepalese population was significantly increased from 144 μg/L in 1998 to 203 μg/L in 2007 (Figure 2), indicating adequate iodine intake and optimal iodine nutrition of the populati- on. There was 19.4% of the population with UIE<100μg/L in 2007, which was decreased from 35.1% in 1998 and 27.4% in 2005. The proportion of households consuming adequately iodized salt (at least 15 ppm at the household level) was incre- ased from 55.2% in 1998 to 77.0% in 2007 (Table 1), showing the positive impact of USI in Nepal. Moving toward the sustainable elimination of IDD in Nepal Basanta Gelal and Nirmal Baral B. P. Koirala Institute of Health Sciences, Dharan, Nepal Himalayan salt is sold worldwide; its pink color is due to its mineral content, but it is usually low in iodine