IDD in Kyrgyz Republic: country situation and prevention programmes

1. IDD in Kyrgyz Republic: country situation and prevention programmes Chinara Aidyralieva

2. Extent of the problem Goiter rate in Kyrgyzstan (1995-2000) 1993: Osh, Bishkek and Naryn oblasts TGR: 49.1% THS >5mU/l 60% 1994: Bishkek and Osh city TGR: 26-79% THS >5mU/l 60,1%

3. Urinary excretion of iodine: • 5 oblasts of the republic out of 6 in 1995-1998 • School children 10-12 years 100 boys/100 girls in each oblast (sample size 1000 ) • TGR %(19-31% average, with 64% in Jalal-Abad) on the basis of ultrasound goiter evaluation • Median urinary iodine (20-50 g/L average, at the Jalal-abad oblast <20) • Household consumption of iodised salt: • 27% (DHS 1997)

4. Sources of salt 25% -local production (4 enterprises, 2 of them equipped by UNICEF + 350 kg of Potassium Iodate for start-up) 75% -import from Kazakhstan, Tajikistan, Uzbekistan, Russia, China Kazakhstan TERMINAL «AK JOL» Russia, Кazakhstan TERMINAL «CHALDOVAR» BISHKEK КARAKOL TALAS NARYN J.-ABAD TERMINALS «SAVAI», «BEGABAD»; «DOSTLIK» (Andijan oblast) Uzbekistan, Kazakhstan Osh TERMINAL «TORUGART» China Tajikistan Salt production sites

5. Support to the development of Law on the prevention of IDD • Law wasadopted early in 2000. It states that all salt for human and animal consumption should be iodised. • Provisions of the law in general are adequate, but … • It lacks a mechanism for the law implementation (with regard to the fine for those violating the law and control of import of technical salt, which is often then being sold as non-iodised). • Introduction of amendments will require simultaneous changes at the Administrative and Customs Codes as well as the Law on Licensing. • Inter-sectoral mechanism of collaboration is not in place

6. Support to the IDD monitoring • Laboratories for iodine determination in urine and salt and set of reagents were supplied, installed, staff trained • Programme of IDD monitoring at all levels was developed with participation of SES, Manas Health Reform project, WHO Health Policy Analysis project • -at the production site • -at the wholesale/retail level • -at the school (knowledge of children and iodine content in salt) • 60 schools targeted at all oblasts of the republic • ¤ 91 % knew about IDD, mostly linking it to goiter (89%), 6% to mental retardation and tiredness • ¤ 93 % of children were positive about possibility of IDD prevention

7. ¤ 84% of urban and 77% of rural children suggested iodised salt as primary method of prevention (70% of urban children in Chui oblast preferred drugs for prevention and 24% of Batken children were not aware of prevention methods) ¤ Source of knowledge in 42% were medical workers, 26% - TV, 14% newspapers, 11% -relatives ¤ 67.7% are consuming only iodised salt, 29.6% - any, 2.8%- only non-iodised salt ¤ Only 35% of salt was adequately iodised, 34% had low levels of iodine, 31% was non-iodised (in Talas - 55% and in Osh - 43%) ¤ 23% of urban and 35% of rural citizens purchase non-iodised salt as iodised

8. IDD communication campaign • First workshop was conducted in 2000 (facilitated by Fatima Jatdoeva) • Two videospots, three audiospots were developed and broadcast for 3 months • Three types of posters (for schools, health facilities and public places) and pocket calendar were developed, printed and distributed • Teachers of biology will be trained • to basic IDD messages through • the cascade type of training • Under the ADB/UNICEF project- • national communication w/shop ? • NGO engagement • Swiss Red Cross project

9. Challenges • Poor quality and limited availability of iodised salt down to the village level • IDD activities are mainly led by health people and lacking of inter-agency coordination • Introduction of changes into the law and establishment of mechanism of law implementation is time-consuming • Licensing procedure needs to be established for all salt, including technical • Communications strategies are not developed /partners are not engaged • Procurement of potassium iodate by local producers is too complicated