From 1940’s onwards goiter had been identified as a common problem in Sri Lanka. There was a goiter belt across Western, Sabaragamuva, Central, Southern and Uva provinces. During this period Goiter prevalence was 40% and different actions had been taken to reduce the goiter occurrence. In spite of these actions, in 1986 goiter prevalence was at a higher level of 18%.In response to these findings and keeping in line with the goals set by the World Summit for Children in 1990, the Sri Lankan government initiated and implemented the Universal Salt Iodization programme in 1995. According to the Food Act, a minimum of 50ppm of iodine at factory level and 25ppm at the household level was essential.
After that in year 2000, 2005 and 2010, regular assessment of IDD status and quality of iodized salt were done by Department of Nutrition, Medical Research Institute. According to the WHO/ICCIDD the Criteria for monitoring progress towards sustainable elimination of IDD, Sri Lanka had achieved all the criteria by 2005.
Assessment done in 2010 included measurement of urinary iodine levels in school children and pregnant women as well as water iodine levels and iodine levels in household salt.
According to this assessment, overall goiter prevalence was 4.4% and it was higher among females than males in almost all provinces except in Central Province. The highest prevalence was seen in Northwestern, Central and southern provinces while lowest in Northern province.
Urinary iodine level is an indicator of amount of iodine taken in to the body. In a normal person this value would be 100-200µg/L and during pregnancy it is about 250µg/L. More than 300µg/L is considered as toxic levels. In 2010, among school children 37.7% had urinary iodine levels between 100µg/L - 200µg/L. The median urinary iodine level in pregnant women was 133µg/L.
Water iodine levels in 2010 in the different provinces are shown below.
Households with recommended salt iodine level should be more than 90%. In Sri Lanka it was 91% in 2005 but there was a decline in 2010 to 68.2%. None of the provinces have achieved the recommended household salt iodine levels.
In summary by 2010 Sri Lanka has fulfilled three criteria out of four in the WHO/ICCID criteria for monitoring progress for sustainable elimination of IDD as shown below. Sri Lanka is yet to achieve the usage of adequately iodized salt at household level.