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Davydova L. N. , Chief of the Department for the State Sanitary and Epidemiological Control

Salt Iodization in the Kyrgyz Republic. Davydova L. N. , Chief of the Department for the State Sanitary and Epidemiological Control. Ashgabat, November 2002. Iodine D eficiency Disorders. Iodin e D eficiency Disorders (IDD) are among the most common non- communicable diseases:

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Davydova L. N. , Chief of the Department for the State Sanitary and Epidemiological Control

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  1. Salt Iodization in the Kyrgyz Republic Davydova L. N. , Chief of the Department for the State Sanitary and Epidemiological Control Ashgabat, November 2002

  2. Iodine Deficiency Disorders • Iodine Deficiency Disorders (IDD) are among the most common non-communicable diseases: • More than 1,5 million people in the world are affected by Iodine Deficiency Disoders (IDD); • 900 million people in 118 countries suffer from large thyroid mass (endemic goiter); • 40 million people have mental retardation due to the lack of iodine in their nutrition; • Global causes of IDD: • Lack of iodine in soil (endemic regions); • Consumption of products grown in endemic regions

  3. Pyramid of Iodine Deficiency

  4. In accordance with the WHO recommendations, Kyrgyz Republic is one of the countries in need of urgent measures on IDD elimination

  5. IDD Morbidity, Kyrgyz Republic, 1995-2001

  6. IDD Morbidity by Oblast , Kyrgyz Republic, 2001 (per 100.000 )

  7. Reasons , aggravating deterioration of IDD situation in Kyrgyz Republic • Nutrition pattern has changed – consumption of sea products, rich in iodine, as well as meat and dairy products (also containing iodine) has considerably decreased – by 2-3 times. In addition, rural residents tend to consume local products grown in their households, and under the conditions of nature iodine deficiency, these products virtually do not contain iodine; • Lack of local salt production industry; • A complete dependence on salt imports, up to 50% of which does not meet the iodine contents standards; • Not-controlled turnover of technical salt; • Out of Control imports of salt in large quantities by individuals; • Population consumes salt from local deposits, requiring additional industry processing and iodizing; • Low level of awareness of population of IDD issues and necessity to consume iodized salt; • Traditional practice of buying food salt in large quantities and storing it for 2-5 years.

  8. Findings of IDD Issues Survey in Schoolchildren (2001-2002) • Total of 3127 schoolchildren from 60 schools all over the country were interviewed; • Both interview and express-test of salt samples, delivered by respondents from households, were conducted; • Findings of the Survey: • Level of awareness of the ID problem – 91%; • Level of consumption of Iodized salt – 35%; • Level of awareness of IDD issues does not differs considerably in rural and urban populations; • The most important information sources – health workers and TV; • More than 30% of the population do not have adequate quality salt, due to purchasing it in the places of spontaneous sale or consuming the salt from local salt deposits;

  9. Legislative framework for Control and Provision of quality and fortification of products Legal provisions of the Kyrgyz Republic: • Decree of the KR President «On enforcement of State Regulation and Control of Production, Storageand Sale of Salt»(11 July 2002; №184); • «On Standartization»; • «On Certification of Products and Services»; • «On Sanitary-Epidemiological Welfare of Population»; • «On Prevention of Iodine Deficiency Disorders»; • «On Protection of Consumers Rights»; • Code «On Administrative Responsibility»

  10. Legislative framework for Control and Provision of quality and fortification of products (contin.) • Decree of the KG Government №778 as of 10.12.2001 “On Implementation of the KR Law “On Sanitary Epidemiological Welfare of the Population" • Decree of the KG Government №6 as of 09.01.2001«On Implementationof the KR Law « On IDD Prevention» • Decree of the KG Government №760 as of 28.12.2000«On the List of Products requiring Mandatory Certification by Safety Indicators» • Decree of the KG Government №229 as of 14.05.2001 «On Evaluation of Conformity ofImported Products with the requirements, set by Technical Standards Valid for KR» • Decree of the KG Government №260as of 31.05.2001 «On Licensing of Certain Types of Productions» • Decree of the KG Government №834 as of 31.12.2001 «On Approval of Consensus to Use Technical, Medical, Pharmaceutical, Sanitary, Veterinary and Phyto-Sanitary Norms, Regulations and Requirements related toGoods, Imported into the NIS countries»

  11. Legislative framework for Control and Provision of quality and fortification of products (contin.) • Decree of the KG Government №194as of 04.04.2002 «Regulations for Inspection ofBusiness/Entrepreneurship Subjects by State Control Bodies». • Decree of the KG Government №242 as of 23.04.2002 «On Approval of the Documents, confirming safety of products, subject to obligatory control upon imports into the KR». • Decree of the KG Government №667 as of 12.10.1998 «On Measures to Implement the KR Law «On Protection of Consumers Rights». • Decree of the KG Government №407 as of 09.07.1997 «Regulations on Disposal (reprocessing) of Products (goods), declared as ineligible for sale». • Decree of the KG Government №289-p; • Decree of the Chief State Sanitary Doctor №3 as of 29.01.2000«On Introduction of Hygienic Conclusion», registered on 10.02.2000 in the Ministry of Justice under the Reg. Number №16. • SanPin 2.3.2.560-96 «Hygienic Requirements to Quality and Safety of Food Stuffs and Food Products».

  12. Interaction between Ministries and Agencies on the Issues of Fortification of Nutrition Products Office of Prime-Minister of KG Legislative Chamber of “Jogorku Kenesh” (Parliament) Ministry of Finances Ministry of Justice Ministry of Health, Implementing Agency Ministry of External Trade and Industry State Custom Inspection Kyrgyz Standart 1 State TV-Radio Corporation Ministry of Education and Culture Ministry of Internal Affairs Ministry of Agrc M of Labor and Social Protection NGOs

  13. State Control of Quality of Iodized Products Manufacturer State Inspection on Standartization andMetrology under the Kyrgyz Government Conditions of Production Safety of Production, Iodine contents Production Certification of Raw Materials, Products, and Inspection Control of it* State Sanitary-Epidemiological Service, Ministry of Health of the Kyrgyz Republic Transportation conditions Tradenetwork Storage conditions Accredited Bodies for Certification Inspection control of Certified Production Terms of sale Safety of the production on sale, iodine contents Consumer

  14. Years Region 1996г. 1996 1997г. 1997 1998г. 1998 1999г. 1999 2000г. 2000 2001г. 2001 REPUBLIC 510 825 kg # test % dev 97 282 kg # test % dev-s 85 906 kg # test % dev-s 290631 kg # test % dev-s 162015 kg # test % dev-s 50403 kg # test % dev-s Bishkek 222 86,6 216 69,0 199 54,3 234 62,0 186 42,5 87 62,0 Chui Oblast 276 54,7 532 50,0 520 31,7 252 59,5 1517 56,7 1943 78,5 Talas Oblast 107 56,0 126 42,0 192 47,3 156 31,0 197 64,9 292 31,5 Naryn Oblast 223 66,8 234 62,3 280 63,5 471 40,1 380 55,1 356 55,8 Osh Oblast 1218 38,3 1506 44,2 1960 46,1 460 54,1 1589 42,8 1615 29,4 J-Abad Oblast 740 48,3 1092 47,9 1015 49,4 804 32,0 800 30,7 802 35,8 I-Kul Oblast 232 42,2 402 52,7 630 37,9 615 29,3 651 40,1 683 41,4 Batken Oblast 756 58,4 719 32,4 REPUBLIC 3018 46,5 4102 49,0 4789 45,0 2992 44,3 6076 54,3 6497 48,5 Measures, taken by SES of the Kyrgyz Republic Number and Quality of Tested Samples of Food Salt Rejected Salt (In kg)

  15. Assistance, provided to KR by International Organizations to control and liquidate IDD UNICEF– the cost of aid since 1997 comprised $122,000– 2 technological salt iodizing lines and 200 kg of Iodate Potassiumwere provided; Social Mobilization Campaign and other activities were conducted. ADB - JFPR9005-Kyrgyzstan Project with support of Japanese Fund of Poverty Alleviation«Improvement of Nutrition of Low-Income Mothers and Children in Asian Countries in Transition» - $ 700,000 have been allocated.

  16. Solution of Problems with Partners, representing different layers of society • Political– people, identifying the policy; • Bureaucratic and technocratic –state employees and technical specialists; • Professional, civil, public- NGOs, including religious, commercial, professional, industrial and special interests groups; • Community Based Organizations –different local associations, schools, high schools, etc.; • Families and Individuals – family members, incl. mothers, fathers, grandparents, who can make decisions related to purchase and consumption of food products.

  17. Barriers in Solution of IDD Problems • Enterprises lack salt enriching supplement, so they have to buy it at a high price, and this increases the cost and market price of the productby 2-3 times compared to normal salt; • For a long time the issue of modifying current legislation – Law «On IDD Prevention», Code «On Administrative Responsibility» has not been solved yet; • The issue of control of turnover of technical salt is pending solution; • In spite of existing 20 salt deposits in KG, the issue of establishment of local production of salt is not solved either.

  18. Activities Implemented in KG • Inter-State GOST «Food Salt» has been approved (contents of Iodine is fixed at the level of 40 mg.kg) • The National Program to decrease the level of IDD has been drafted, approved by Ministries, is pending the Govt approval; • Law «On Modifications and Addenda to some Legislative Acts of the KR» (Law «On IDD Prevention» - Section related to State guarantees and control of technical salt; Code «On Administrative Responsibility» - section onadministrative responsibility for imports, production, sale of low quality salt, including non-iodized salt needs to be added; • The issue of establishment of a specialized enterprise «Kyrgyz Тuz» as a state bodyto be in charge of salt turnover in the republic; • Education work is being carried out for the population in IDD prevention towards changes of nutrition habits.

  19. Ways to Solve Problems • To fill the consumer market with Iodized food products, first of all food salt; • To conduct active communication with population on ID problems; • To build wide political support for IDD Control and Liquidation, including Social mobilization, with wide involvement of mass media; • To coordinate interaction of all governmental and non-governmental organizations, international organizations, aimed at control of the above problem; • To speed up the process of approval of Law «On Modifications and Addenda to some Legislative Acts of the KR»; • To speed up approval of the National Program for the years 2003-2007on Decrease of IDD level; • To speed up the establishment of a specialized enterprise «Kyrgyz Tuz»; • To organize Association of Salt Manufacturers; • To interact with Central Asian Region countries in the area of enhancement of control of salt quality,including information/feedback on imports of low-quality salt; • To develop infrastructure of local enterprises, producing enriched food products, including salt.

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