Sustainable Elimination of Iodine Deficiency through Universal Salt Iodization Regional Overview

1
Sustainable Elimination of Iodine Deficiency
through Universal Salt Iodization Regional
Overview Keys to Success for CARKNune
Mangasaryan, Arnold Timmer, John EgbutaUNICEF
REGIONAL OFFICE CEE/CIS HEADQUARTERS23 Sep 2005
2
A Reminder

• Iodine Deficiency Affects
• All aspects of brain development
• During first 3 months of pregnancy
• Reduces the intellectual capacity forever by
  10-15 IQ
• Affects the whole population

3
The network of connections are less dense
Iodine Sufficient Brain
Iodine Deficient Brain
Source From Legrand, 1967.
4
All Central Asian Countries agreed to eliminate
IDD- a few examples -

• CIS agreement 2001 on Prevention of IDD in CIS
  member states
• UN Special Session on Children - 2002
  Sustainable elimination of IDD through USI by
  2005
• World Health Assembly 2005 resolution adopted on
  sustaining elimination of IDD through regular
  reporting by MoH

5
Universal Salt Iodization A Global Success Story
most effective public health interventions known!
6
Household use of iodized salt in 2004 (by region)
52
7
(No Transcript)
8
Percent of households using adequately iodized
salt in CEE/CIS (survey based)
gt 90 6
50-90 12
lt50 5
9
Percent of households using adequately iodized
salt in CARK (survey based)
gt90 1
50-90 2
lt50 2
10
Households using adequately iodized salt in
CARK Average (survey based)
90
2004 67
2001 30
11
Remaining new borns unprotected
514,000
222,000
125,000
108,000
100,000
72
59
37
33
14
0
12
CHILDREN BORN WITH DECREASEDBRAIN CAPACITY
1015 PER DAY!
1,015
521
247
162
85
0
13
IDD Elimination in CARK

• 1 Country has eliminated IDD
• Confirmed by expert team Turkmenistan - 2004
• 1 Country expected to eliminate IDD by 2005
  Kazakhstan
• 3 countries will eliminate IDD by 2006-7
  (Kyrgyzstan, Uzbekistan, Tajikistan)

2005
14
Progress in CARK

• Political will!
• Goal achieved in Turkmenistan
• Good increase of use of iodized salt in
  Kyrgyzstan and Kazakhstan
• Increase in Uzbekistan, but can only sustained
  with USI legislation
• Tajikistan increased production of iodized salt
• Responsibility for iodine premix slowly being
  shifted to salt producers

15
Challenges for CARK

• Adopt and implement USI legislation in Uzbekistan
• Increase use of iodized salt in Tajikistan
  through
• Focus on districts with low use of iodized salt
• Reduce counterfeiting salt through better
  enforcement
• Tackling sale of industrial salt as retail salt
• Enforce salt iodization with small salt producers
  in Khatlon find a solution for them e.g. set up
  a cooperative

16
Challenges for CARK

• Address sustainability in Turkmenistan
  monitoring and oversight, communication
• Address sustainability in Kazakhstan through
  consistent monitoring and increased awareness
  creation
• Work out a means of centrally harvesting the salt
  from 53 small scale salt producers in Khatlon
  oblast in Tajikistan
• Adoption of USI legislation and enforcement in
  Uzbekistan
• Establishment of CARK regional/area association
  of salt producers

17
Challenges for CARK

• Increase use of iodized salt in Kyrgyzstan
  through
• Vigorous advocacy to policy makers in Kazakhstan
  (90 of salt used in Kyrgyzstan comes from
  Kazakhstan)
• Establishment of strong and independent salt
  producers association in Kyrgyzstan
• Include food grade salt as part of USI
  consumption of salt from processed foods (bread,
  cheese, meat) will increase therefore, iodize
  food grade salt!

18
Challenges for CARK

• Sustainability of the programme (1)
• Programme efforts maintained without external
  support government, salt producers and other
  partners
• Carry over responsibility for iodine premix
  procurement to salt producers
• Establish functioning IDD committee and salt
  producers association with regular exchange of
  information
• Re-advocate for USI and strengthen link with
  other national priorities such as child survival,
  universal primary education and poverty reduction

19
Challenges for CARK

• Sustainability of the programme (2)
• Monitoring embedded in ongoing activities
• Monitoring data reported to IDD committee and
  discussed for necessary changes
• Periodic monitoring of iodine in salt and iodine
  status at household level
• Address districts with low use of iodized salt
• Government maintains monitoring

20
Challenges for CARK

• Sustainability of the programme (3)
• Communication embedded in ongoing activities
• Curriculum of primary and secondary schools, for
  medical doctors and health care providers
• Remind the public through salt package (logo and
  slogan),
• Target future mothers and pregnant women through
  health care providers
• Target districts where use of iodized salt is low
• Involve community groups for word-to-mouth
  encouragement

21
Investment in USI Cost

• A solution that reaches all people and affordable
  to everyone
• Adding iodine to salt costs about 2 of total
  production cost of salt
• The price increase is minimal and not a concern
  in most countries (Kazakhstan, Uzbekistan,
  Kyrgyzstan, etc)
• Initially support is required but eventually
  should be self-sustaining

22
Investment in USI Benefit

• Better intelligence among ALL newborns
• Better learning and earning in their future
• Lower cost for diagnosis and treatment of thyroid
  diseases (Germany spends 1 billion Euros per
  year! How much do you spend?)
• Equitable solution as iodized salt reaches the
  poor.
• USI is investment in education and improved
  school performance
• USI improves future learning and earning and
  therefore should be seen as poverty reduction
  mechanism

23
Conclusion

• The problem is known
• The solution is available
• Countries can act now or react later
• CARK can do better from 67 to 90 (100!)
• UNICEF is ready to support and overcome the
  challenges