Transcript Sustainable Elimination of Iodine Deficiency: Perspectives for Lithuania ARNOLD TIMMER, UNICEF REGIONAL OFFICE 17 December 2003

Sustainable Elimination of
Iodine Deficiency:
Perspectives for
Lithuania
ARNOLD TIMMER,
UNICEF REGIONAL OFFICE
17 December 2003
Overview
• Central Eastern Europe & Central Asia
• Examples relevant to Lithuania
• Indicators used:
– Households consuming iodized salt (table salt)
– Iodine status: urinary iodine (table salt, other salt)
– TSH
– Newborn children protected from brain damage
due to iodine deficiency
Iodine Deficiency: The Problem
Cretinism
Goiter
At risk of
mental
Impairment
10-15% IQ loss
Worldwide: 41 million newborns still
unprotected:
113.000 per day!
Middle East/
North Africa
Latin America/
Caribbean
2 million
3 million
South Asia
17 million
CEE/CIS
4 million
East Asia/
Pacific
7 million
Sub-Saharan
Africa
8 million
Lithuania
• + 32,000 newborns per year
• This means 28,800 newborns not protected
• With decreasing population, future generation
needs to be protected!
• Investment in USI = better intelligence among
newborn = better learning and earning =
benefiting economy of the country
In 31 countries, > 90%
households consume iodized
salt
UNICEF 2000
In 36 countries, 50-89%
households consume iodized
salt
UNICEF 2000
In 38 countries, <50%
households consume iodized
salt
UNICEF 2000
Production of Iodized Salt
(unofficial data)
100
90
80
70
60
50
40
30
20
10
Uk
ra
in
e
Ru
Uz ssia
be
ki
sta
n
Be
lar
us
M
ol
Ka dova
za
kh
sta
n
Ar
m
en
i
Ge a
or
gia
Ta
jik
ist
ur
km an
en
ist
an
0
IS production in 1999
or 2000, % of total
IS production in 2001
or 2002, % of total
Considerations
• Mandatory legislation
– The minimum to eliminate iodine deficiency:
• All table salt iodized
• Food grade salt iodized: staple foods bread, bakery products,
and others if possible
• Expectations from communication activities:
– Without mandatory law: no behaviour change of all people
achievable, cost is high, not sustainable
– Lithuania: 20% households used iodized salt after the
campaign in 2000, then dropped to 10%
– With mandatory law: raise awareness, inform public and
main actors, use logo and slogan
• WHO guidelines
– Iodization levels: minimum 20-40 ppm iodine
– Iodized salt is safe - 1994
Salt Iodization in other countries
• Switzerland:
– voluntary law since 1922
– 94% use of iodized salt after 60 years of public
awareness raising; food producers use iodized salt
• Netherlands:
– Iodization of “all” table and bread/pasta salt (through
voluntary system)
– 65% use iodized salt
• Austria:
– Mandatory iodization for all salt
– Respected by EU regulatory system
Salt Iodization in other countries
• Denmark:
–
–
–
–
1920: voluntary iodization of table salt
1982: iodization prohibited
1998: voluntary iodization of all salt
2000: mandatory iodization of all table (retail) salt
and salt for bread
– 100% use iodized salt today!
• Turkey:
–
–
–
–
Mandatory law for table salt being implemented
64% use iodized salt in 2002
Iodine status not sufficient: median = 53 mcg/L
None of food grade salt is iodized
mcg/L
120
UIE in Lithuania, 1995
100
80
Median 75
60
40
20
0
Median Urinary Iodine levels in 28 schools
Lithuania
• + 32,000 newborns per year
• This means 28,800 newborns not protected
• With decreasing population, future generation
needs to be protected!
• Investment in USI = better intelligence among
newborn = better learning and earning =
benefiting economy of the country