IDD Status in Bulgaria

1. IDD Status in Bulgaria Ivanova, L*. B. Lozanov**, Zv.Timcheva*** *National Center of Hygiene, Medical Ecology and Nutrition, Sofia ** Clinical Center of Endocrinology, *** Ministry of Health

2. National Program for Control of IDD - Multisectoral Efforts • Legislation: Since 1958; Updated 1994 • Decree 96/94 of Council of Ministers; Ordinance RD-09-244/94 of the Chief Sanitary Inspector; Amendment of the Bulgarian State Salt Standard • Institutional support / Intersectoral Co-ordination • National Coordinating Committee for IDD Control (MOH,- Industry, -Trade, Salt Producers, Thyroidologists, Nutritionists, NGO,s) • Expert Council on IDD at Ministry of Health

3. Salt production/iodination • Local production - 40% ; import - 60% • Local production - 6000 t/last year iodized salt - 20 % of iodized salt required for humans • Iodine compound: KIO3 • Level of iodination: 19-32 ppm I2 (28-55 ppm KIO3) • Availability of iodized salt : general

4. Assessment/Monitoring/Evaluation • Monitoring plan of IDD status Indicators  Proportion of adequately iodized salt at the market  Urinary Iodine Excretion  Total Goiter Rate: palpation; ultrasound  Neonatal TSH

5. IDD STATUS • Total Goiter Rate:18 % (5-26%) (National survey, 1996) 14.8% -palpation; 2.7% ultrasound (Sofia-city, 2001) • Urinary Iodine Excretion: 111.4 mcg/L (1996); 145.0 mcg/L(2001) • Incidence of Congenital Hypothyroidism: 1: 4000 live births • Incidence of Transient Hypothyroidism in newborn:8.8% • Neonatal TSH > 5 U/mL: 9.2%

7. Percentile Distribution of ioduria from representative surveys of schoolchildren 1994-2001

8. Conclusions • The legislation and capacity building of the IDD Program was completed. • The iodine intake of Bulgarian population was substantially improved after the implementation of universal salt iodination in 1994. • Our country is already achieving the final goal - eradication of IDD at population level

9. Thank you