'Pain in the neck' is a thing of the past in Xinjiang

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Last updated at: (Beijing Time) Thursday, February 12, 2004

'Pain in the neck' is a thing of the past in Xinjiang

Tusunhan Oxwy at Titi Village of Yarkant (Shache) County in Kashgar, the Xinjiang Uygur Autonomous Region, still recalls the scenes of "big-necked patients'' in the far northwest of China.

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Tusunhan Oxwy at Titi Village of Yarkant (Shache) County in Kashgar, the Xinjiang Uygur Autonomous Region, still recalls the scenes of "big-necked patients'' in the far northwest of China.

"They used to be ubiquitous here," says the 55-year-old who has been serving as the village medic for 38 years. "Now you seldom see a kid or an adult with goitre. It's mainly because of the campaign to help local people increase consumption of iodized salt."

Goitre free

The 850 farmers and their children at Titi Village in southern Xinjiang are all goitre free, says Tusunhan. "So far only one boy of 15 was found to have an enlargement in thyroid gland, but not serious."

The main source of water in land-locked Xinjiang is glaciers. With very low iodine content in the soil and water, the region, especially southern Xinjiang, used to be plagued by the "big-necked disease" or cretin, caused by iodine deficiency disorder (IDD). Of a population of 19 million in the 1980s, 1.28 million suffered goiter, with an accumulative 12,000 victims of cretin, most in the Tarim Basin, according to Wang Shaohua, deputy director of the regional health bureau.

By 1995, goiter occurrence among children aged 8-10 in Xinjiang was 43.29 per cent as the coverage of iodized salt was only 41.7 per cent. "That is to say IDD, the second killer after tuberculosis in the region, had caused a goiter endemic," says Wang.

Nurala Yusup, a 50-year-old mother of six at Yengisar County of Kashgar, is illiterate and has only a vague idea of what caused her goitre when the regional government launched a campaign against IDD in collaboration with UNICEF-China in 2000. But she is determined not to let her baby granddaughter to grow up into a dwarf.

Now she knows that IDD could hinder children's main brain cells development, thus leading to intellectual disability or mental retardation. "Taking iodized salt can prevent the big-neck goitre disease and kids won't get retarded," says Nurala, sounding very knowledgeable about IDD.

The Uygur woman, however, consumed no iodine-added salt before, simply because "we could not afford it. One kilo of iodized salt costs 1.5 yuan (less than 20 US cents)," she says.

Living on a small plot of barren land growing wheat and corn, her family earns no more than 2,000 (US$240) yuan a year, which barely keeps them off starvation, and makes things like iodized salt a luxury for them.

This deficiency in her diet has resulted in an egg-sized lump on Nurala's neck -- a goitre. "Ugly," she mumbles, trying to cover it up with her scarf.

Fortunately, she says, her one-year-old granddaughter is fine, thanks to the IDD elimination programme. "Doctors gave us an iodine-release device, which could increase iodine content in the salty water we use." In a corner of her yard is a crock full of feculent water in which salt cubes are melted. That's the salty water Nurala uses for cooking every day.

Iodine-release device

Jiang Jiyong, director of the Xinjiang Endemic and Diseases Control Centre, says the device is their "indigenous innovation" with regard to local farmers' poverty.

"The salt cubes they use contain almost no iodine, but the price-sensitive farmers consume it because it's very cheap," he says. "So we had to come up with something to make iodine salt accessible and affordable to them so as to guarantee their health."

Dr Jiang has visited almost all the iodine deficiency-affected villages in southern Xinjiang. He says even the farmers have become aware of the danger of IDD and the importance of iodine, although "they continue to purchase non-iodized salt cubes so long as iodized salt is not that cheap."

The iodine-release device conveniently solves the problem. "When dropped into a crock, the one-inch long device, containing 2 grams of iodate, would release iodine to iodize the water of raw salt," says Wang Shaohua, who has 20 years of experience in public health.

In poverty-stricken areas like southern Xinjiang, he notes, "you can never promote iodized salt by force or administrative power. Even the few households who bought a bag of iodized salt never actually consumed it but only showed it when public health inspectors came."

With regard to this situation, Wang says, "we have to figure out a way for local victims to increase their intake of iodine. And the iodine-release device, so far, is most effective. For a family of five, it costs 3 yuan a year, only 8 to 10 per cent that of iodized salt, which gives sufficient iodine salt while is affordable to them."

Since 2000, the regional government of Xinjiang has spent 1.2 million yuan (US$144,600) in getting 600,000 devices for 300,000 households, benefiting 1.5 million people in the southern areas, according to Wang.

Wang says Xinjiang began its efforts to eliminate IDD years before its collaboration with UNICEF-China was launched in 2000. In fact, he says, "we started to address the problem in the mid-1990s after the State Council issued the Regulations on Iodized Salt Control for IDD in 1994. We set up government-controlled sales network in 10 prefectures and 83 cities and rural communities throughout Xinjiang."

For newly-wed women, the government provides iodine oil shots to prevent newborn cretin and other IDD-related diseases. One injection can satisfy a woman's iodine demand for three or five years. Out of the 300,000 women at childbearing age, 270,000 have injections each year.

The tremendous effort eventually paid off. The coverage of iodized salt intake in the population is greatly improved, jumping from 62.7 per cent in 1996 to 87.8 per cent in 2002, he says.

"The goitre rate among children aged between 8-10 dropped below 15 per cent in 2003," says Wang Shaohua, adding, "we still have a long way to go though, in comparison with other provinces and regions." Nationwide, goitre occurrence among Chinese kids aged between 8-10 dropped from 20.4 per cent in 1995 to 5.8 per cent in 2002.

One of the beneficiaries is Kuwanhan Sit, 36. She and her three kids are lucky compared to her mother-in-law, 60, whose tubercular goitre is so big and hard that looks like rock hanging underneath her chin.

Though illiterate, Kuwanhan believes a quality life is very important for her kids. "In the past we could not consistently use iodized salt because of the cost," she says. "Now we are using the iodine-release device, which is very convenient to use. The village medic and leaders from the region told us raw salt is no good for kids. Kids could lose their learning ability if there is no iodine in their food."

Kuwanhan's 13-year-old daughter at junior high school says innocently, "I don't want to have a big neck like my grandma. I want go to Urumqi (the regional capital). I'll study hard and well to attend college there."

The latest figures from the Ministry of Health indicate that Xinjiang is one of the seven provinces and regions, mostly in the west, still struggling to reach the Universal Salt Iodination (90 per cent households consume iodized salt) -- the goal the United Nations set at the Summit for Children in 1990. The rest of the country had realized the goal by 2000. In Xinjiang, 35 out of 96 counties are yet to reach the Universal Salt Iodination.

IDD has a subversive effect on the public health and social-economic development, so eliminating IDD requires political commitment. "Any politician with a big vision shouldn't ever ignore or neglect the problem, because to protect children today is for the well-being of the future generation," Wang says.

Source: China Daily

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