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TURKEY IODINE DEFICIENCY DISORDERS AND SALT IODISATION PROGRAMME

TURKEY IODINE DEFICIENCY DISORDERS AND SALT IODISATION PROGRAMME. SITUATION IODINE DEFICIENCY DISORDERS TURKEY. IDD SITUATION: ENDEMIC GOITRE IN TURKEY. TOTAL THYROID HYPERPLASIA % 30.5

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TURKEY IODINE DEFICIENCY DISORDERS AND SALT IODISATION PROGRAMME

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  1. TURKEY IODINE DEFICIENCY DISORDERS AND SALT IODISATION PROGRAMME

  2. SITUATION IODINE DEFICIENCY DISORDERS TURKEY

  3. IDD SITUATION: ENDEMIC GOITRE IN TURKEY TOTAL THYROID HYPERPLASIA% 30.5 (When it is evaluated with all grades)2. GRADE PREVALANCE % 4.33. GRADE PREVALANCE % 1.84. GRADE PREVALANCE % 0.5 BIG GOITRE PREVALANCE % 2.4(TOTAL OF 3. VE 4. LEVELS) THYROID NODULE PREVALANCE % 2.8  Prof. Urgancıoğlu, Hatemi and his friends 1980 - 1987 WHO indicators, 73.757 persons

  4. SCREENED REGIONS (1997-1999 )

  5. IODINE SITUATION AND GOITRE PREVALANCE OF SCHOOL AGED CHILDREN IN HIGH RISK PROVINCES 1997-1999 • RESULTS: • GOITRE PREVALENCE FOR CHILDREN IS % 31.8 • 30% AND HIGHER PROVINCES ARE; • KASTAMONU, BAYBURT, TRABZON, ERZURUM • MALATYA, SAMSUN, EDİRNE, AYDIN , KAYSERI • THROUGH THE URINARY IODINE MEASUREMENTS : 14 PROVINCES ARE MIDDLE/HIGH,6 PROVINCES HAVE LOW LEVEL OF IODINE DEFICIENCIES.

  6. IODINE DEFICIENCIES WITH SONOGRAPHIC PREVALANCE PROVINCES AT RISK 1997-1999 Bolu Çorum Burdur HIGH (9), MIDDLE (4), LOW(7) 5-19.9 % Low level 20-29.9 % Middle level 30 % + High level

  7. IODINE SITUATION AND GOITRE PREVALANCE IN 20 PROVINCES SCHOOL AGED CHILDREN RESULTS: GOITRE PREVELANCE OF SCHOOL CHILDREN IN 20 PROVINCES IS 31.8 %. WITH GOITRE PREVALANCE; THERE ARE 9 PROVINCES HIGHER THAN 30% ( KASTAMONU, BAYBURT, TRABZON, ERZURUM MALATYA, SAMSUN, EDİRNE, AYDIN VE KAYSERI)

  8. IODINE DEFICIENCIES WITH URINARY IODINE MEASUREMENTS PROVINCES AT RISK 1997-1999 Bolu Çorum Burdur HIGH (3), MIDDLE(11), LOW(6) 50-100 mcg/lt Low level 20-49 mcg/lt Middle level 0-19 mcg/lt High level

  9. LEGISLATION SITUATION TURKISH FOOD CODEX TABLE SALT CIRCULAR (09 JULY 1998 NUMBER: 23397 ) EDIBLE SALT A) Table salt (directly goes to consumers, fortified with iodine, refined or unrefined edible salt ) B) Salt used in food Industry ****INTO TABLE SALTS 50-70 mg/kg. POTASSIUM IODIDE 25-40 mg/kg. POTASSIUM IODATE MUST BE ADDED. SALT USED IN FOOD INDUSTRY NEED NOT BE FORTIFIED

  10. IODISED SALT HOUSEHOLD CONSUMPTION RATES BY REGIONS-1995 23.6 15.6 18.3 18.6 16.5 URBAN:23.6 RURAL: 9.6 AVERAGE: 18.2

  11. IODISED SALT CONSUMPTION SURVEY 2002

  12. URBAN/VILLAGE Iodised Salt Consumption -2002 ( % )

  13. %80-96 20 PROVINCE %60-78 18 PROVINCE %50-59 13 PROVINCE %35-49 13 İL %0-31 14 PROVINCE IODISED SALT CONSUMPTION IN PROVINCES- 2002 Siirt 0 Kırşehir 5.7 Hakkari 8 Batman 12

  14. IODISED SALT CONSUMPTION OF HOUSEHOLDS BY REGIONS-2002

  15. IODISED OIL CAPSULE SURVEY IN KAYSERI PROVINCE 2001-2002

  16. Urinary Iodine Level in Kapuzbaşı Village -2002(6 – 15 Years old 91 children) İyotlu tuz kullanımından önce İyotlu tuz kullanımından sonra

  17. PROBLEMS • 1-High prevalance rate of iodine deficiency disorders • -total goiter rate: 30,5% (1987) • -school children goiter rate: 31,8 % (at risk provinces, 1997-1999 ) • 2-- While consumption of iodised salt have been increasing still a sizeable segment of population is not using iodised salt due to lack of awareness of the population • 3- High number of small producers of non iodized salt (around 200) • 4- Difference between the prices of iodized and non iodized salt for food industry

  18. TURKEY IODINE DEFICIENCY DISORDERS AND SALT IODISATION PROGRAMME

  19. GOAL OF THE PROGRAMME ELIMINATION OF IDD IN TURKEY

  20. MPO OBJECTIVES • Elimination of IDD of children until 2005 • Reduction of IDD of adults 1/3 until 2005 • To iodise 100% of table salt in the country • Raise3 awareness of all related organizations, salt producersand the community on the importance of iodisied salt • To establish effective monitoring and evaluation system for the whole programme in Turkey

  21. IMPLEMENTATION ON 1994-2002 1. TRAINING 2. ON LEGISLATION 3.WITH SALT PRODUCERS ON HOW TO IODISE THE SALT 4.DEVELOPMENT OF MATERIALS 5-MONITORING AND EVALUATION

  22. 1. TRAINING ACTIVITIES • FOR HEALTH PERSONNEL ( 81 PROVINCES) • FOR MINISTRY OF AGRICULTURE PERSONNEL(81 PROVINCES) • SALT PRODUCERS (220 FACTORIES) • MARKET REPRESENTATIVES • NGOS • MUNICIPALITIES • PROVINCIAL DIRECTORS • UNIVERSITIES

  23. 3. ACTIVITIES WITH SALT PRODUCERS FOR SALT IODISATION IMPLEMENTATION • Providing iodisation machines and on the job training for usage, • Providing Potasium Iodate to the producers, • Training of salt producers on how to produce iodised salt , • 4 Firma • 15 Firma (KI) • 7 Firma (KIO3)

  24. 4. DEVELOPMENT OF MATERIALS • For health personnel and community • Audio and visual materials training materials developed

  25. NATIONAL MONITORING LEVELS OF THE PROGRAMME A. MONITORING OF IODISATION LEVEL IN SALT B. MONITORING IODISATION IN URINARY LEVEL OF THE PEOPLE C. CHECKINGS AT THE FIELD LEVEL

  26. WHO IS RESPONSIBLE FROM WHICH MONITORING ? A ) MONITORING OF IODISATION LEVEL IN THE SALT 1.QUALITATIVE (WITH TEST KITS (KIO3 and KI)) 2.QUANTITATIVE ANALYSIS (IN THE LABAROTORIES RANDOM ANALYSIS IN 3. MONTH 38 PROVINCIAL AGRICULTURE LABORATORIES MINISTRY OF AGRICULTURE PRODUCTION STAGE • 81 PROVINCIAL PUBLIC HEALTH LABORATORIES • 1 REFİK SAYDAM • GENERAL HYGIENE CENTRAL ADMIN. • 7 REGION R.S. • 8 REGION R.S. FROM PRODCUTION TO CONSUMPTION MINISTRY OF HEALTH

  27. B) IODINE CONSUMPTION LEVEL IN URINARY LEVEL OF PERSONS • WITH SURVEYS; • A) Goitre prevelance surveys, • B) Iodine level in urinary, • C) Neonatal – TSH, • 2. HOUSEHOLD IODISED SALT CONSUMPTION • ( Cluster survey )

  28. YEARS IODISED SALT NON-IODISED 1997 20.773.527 83.970.861 1998 23.751.702 73.872.432 1999 62.104.893 35.943.198 2000 85.128.000 - 2001 171.000.000 - PRODUCTION OF IODISED AND NON-IODISED SALT SITUATION ( Kg.) 22 ÜRETİCİDEN ALINAN VERİLER

  29. OBJECTIVES • To encourge and support the small salt producers in all regions to produce iodised salt in order to expand the consumption of iodised table salt in rural areas; • To ensure the use of potassium iodate instead of iodide in iodised salts at the national level in order to introduce a standard in quality as well as monitoring; • To establish quality control laboratories, fully equipped with the necessary tools and trained personnel, that can conduct iodine analysis in the 22 centres identified for the purposes of monitoring-assessment activities on the national scale by the end of 2001; • To promote nationwide use of iodised salt through community leaders, mass media, schools, the military, community groups etc; • To ensure that the consumption of iodised salt reaches 95% by the year 2005. • To conduct cross-sectional surveys within the framework of monitoring activities with the aim of providing guidance for the programme activities.

  30. STRATEGİES • Increase demand for iodized salt in the community through innovative approaches in advocacy and social marketing • Strengthen collaboration with the school system as channel for promotion of iodized salt • Intensify support to salt producers

  31. THE PROGRAMMEACTIVITIES TRAINING: • Health Personnel (Health Managers of 81 Provinces ) • Representatives of Provincial Agriculture Directors • Salt Producers • Market representatives, teachers • Production of training materials ADVOCACY AND SOCIAL MOBILIZATION : Through the school system: - Training of teacher trainers, students -Development and production of education material -Training of Community leaders, military, media etc.

  32. THE PROGRAMMEACTIVITIES IODISATION OF SALT: • On the job training of salt producers • Legislation change • Ttechnical material support • Potassium iodate support MONITORING AND EVALUATION: • Situation Analysis, Household consumption and School based surveys • Establishment of monitoring system • Annual Evaluation meetings

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