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Sustainable Elimination of Iodine Deficiency
through Universal Salt Iodization
Regional Overview &Keys to Success for CARK
Nune Mangasaryan, Arnold Timmer, John EgbutaUNICEF REGIONAL OFFICE CEE/CIS & HEADQUARTERS
23 Sep 2005
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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
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The network of connections are less dense
The network of connections are less dense
Iodine Sufficient Brain
Iodine Deficient Brain
Source: From Legrand, 1967.Source: From Legrand, 1967.
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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
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Universal Salt Iodization: A Global Success Story
0
20
40
60
80
100
%
1990 - 2000
Iodized SaltHousehold Consumption
0
20
40
60
80
100
%
1990 - 2000
Iodized SaltHousehold Consumption
most effecti
ve
most effecti
ve
public health
public health
interv
entions
interv
entions
known!
known!
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Household use of iodized salt in 2004 (by region)
0 10 20 30 40 50 60 70 80 90 100
E/S Africa
W/C Africa
M East/N Africa
S Asia
E Asia/Pacific
C/S America
E Europe/CIS/B
Other supply data
Percent
52%
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Percent of households using adequately iodized salt in CEE/CIS
(survey based)
0
20
40
60
80
100
1999-2000 2005
> 90% : 6
50-90% : 12
<50% : 5
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Percent of households using adequately iodized salt in CARK (survey based)
0%
20%
40%
60%
80%
100%1999-2000 2004
>90 : 1
50-90 : 2
<50 : 2
10
% Households using adequately iodized salt in CARK: Average (survey based)
0%
20%
40%
60%
80%
100%2001 2004
2001: 30%
2004 : 67%
90%
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Remaining new borns unprotected
Turkm
enis
tan
Kazakhst
an
Kyrgyz
Rep.
Tajik
ista
n
Uzbek
ista
n
CARK aver
age
new borns peryear% notprotected
72%59%
33%37%
14%0%
514,000
125,000100,000
222,000
108,000
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CHILDREN BORN WITH DECREASEDBRAIN CAPACITY:
1015 PER DAY!
Turkm
enis
tan
Kazak
hstan
Kyrgyz
Rep
.
Tajikis
tan
Uzbek
ista
n
CARK tota
l
521
247162
850
1,015
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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
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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
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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
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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
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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!
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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
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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
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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
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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
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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
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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
