Transcript ดาวน์โหลดเอกสาร ภาษาอังกฤษ

Sustaining the Prevention and Control of
Iodine Deficiency in the Southeast Asia and
Pacific Region
Karen Codling
Regional Coordinator South East Asia and the Pacific
Meeting: Iodine Villages Across Thailand to Honor Her Royal Highness
Princess Maha Chakri Sirindhorn, Nutritional Princess: Overcoming the
Challenges to Sustainability
25 June 2015, Bangkok
1993
Severe
Moderate
Mild
Adequate
No data
Ref: IGN
110 countries iodine
deficient
2014
Severe
Moderate
Mild
Adequate
No data
Ref: IGN
30 countries remain
iodine deficient
HH use of adequately iodized
salt globally and by region
UNICEF SOWC 2015
Household use of iodised salt
in the EAP Region
Ref: National surveys such as DHS, MICS, Living Standards, National Nutrition or IDD. Surveys assessing
adequately of iodine with a quantitative methodology, such as titration, shown with an asterix *
Lessons learnt in increasing
coverage with iodised salt and
sustaining IDD elimination
achievements
The importance of mandatory
legislation
 Equalizes costs for producers
 Provides more equitable access to fortified
foods  public health impact
 Can be more easily monitored than
voluntary fortification
 Does not require consumer behavior
change
 Sets appropriate fortification standards
Reasons for mandatory
legislation
Analysis of salt iodisation
programmes has found that in
one decade, countries with
mandatory legislation had a
greater increase in household
coverage (from 49% to 72%,
compared with the increases
in countries with voluntary
iodisation (from 40% to 49%)
Ref: Horton, Mannar & Wesley. Micronutrient Fortification (Iron and Salt Iodisation)
Copenhagen Best Practice Paper 2008
Decline in coverage of adequately
iodized salt in Viet Nam following
the end of mandatory legislation
End of mandatory legislation
Ref: National IDD Surveys and Multiple Cluster Indicator Survey in 2011
Malaysia
 Legislation 1999
 Peninsular Malaysia – Voluntary
 Sarawak – Mandatory in some districts
 Sabah – Mandatory
 2010 survey - UIC and HHIS
Salt iodisation in Malaysia
Ref: Selamat et al. Iodine deficiency status and iodised salt consumption in Malaysia: findings
from a national iodine deficiency disorders survey. Asia Pac J Clin Nutr. 2010
The importance of
enforcement
 Weak point of most fortification programmes
 Enforcement of food fortification should be
integrated into routine food control systems
 Industry/enterprises must fortify
 Government must create safe, fair
environment
 Best way govt can support mandatory salt
iodisation is ensure all enterprises comply
with law – create an even playing field
The importance of use of iodised
salt in processed foods & animal
feed
 WHO recommendations for
scope of salt iodization
 “universal salt iodization calls
for fortification with iodine of
all food-grade salt for human
and animal consumption,
including salt for food
processing”
Ref: WHO, 2014 and WHO, UNICEF, ICCIDD, 2007
Iodised salt for food
processing and animals
 Why iodised salt for food processing?
– A significant amount of salt is consumed through
processed foods
– As countries develop, proportion of salt consumed
through processed foods increases
 Why iodised salt for animal?
– Animals also suffer from iodine deficiency; iodised salt
improves health and increases productivity
 If salt for food processing and animal feed is
iodised, there can be no leakage of non-iodised
to the market
Estimates of proportion of salt
consumed as household salt or
through processed food
 WHO: “in many countries, about 80% of salt in the diet comes
from processed foods”
Country
Processed
Food
United Kingdom
77
United States
75
South Africa
60
Philippines
57
Indonesia
46
China
45
Ref: WHO, 2014 and various country references (see notes)
Sources of sodium intake in
Thanh Oai district of Hanoi
Ref: National Institute of Nutrition. Investigation of dietary sodium intake and sources in adults, aged 25-64
years. 2010
The importance of monitoring
and evaluating the impact
 Coverage sub-nationally to identify unreached
populations
 Urinary iodine status of different population
groups to ensure adequate iodine for whole
population (school age children, pregnant
women, reproductive age women)
 Urinary iodine status to adjust iodization levels
 Use of iodized salt in processed foods
 Salt intake from household salt and processed
foods
2014
 Iodized salt has a large effect on reducing the
risk of goitre, cretinism, low cognitive function,
and iodine deficiency.
 Robust monitoring of salt iodization
programmes is important to ensure safe and
effective levels of iodine consumption, especially
as countries implement programmes to reduce
population salt intake
For more information:
Web: http://www.ign.org
Twitter: @ign_iccidd
Email: [email protected]