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A Reminder:

Sustainable Elimination of Iodine Deficiency through Universal Salt Iodization Regional Overview & Keys to Success for CARK Nune Mangasaryan, Arnold Timmer, John Egbuta UNICEF REGIONAL OFFICE CEE/CIS & HEADQUARTERS 23 Sep 2005. A Reminder:. Iodine Deficiency Affects:

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A Reminder:

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  1. Sustainable Elimination of Iodine Deficiency through Universal Salt Iodization Regional Overview &Keys to Success for CARKNune Mangasaryan, Arnold Timmer, John EgbutaUNICEF REGIONAL OFFICE CEE/CIS & HEADQUARTERS23 Sep 2005

  2. A Reminder: • Iodine Deficiency Affects: • All aspects of brain development • During first 3 months of pregnancy • Reduces the intellectual capacity forever by 10-15% IQ • Affects the whole population

  3. The network of connections are less dense Iodine Sufficient Brain Iodine Deficient Brain Source: From Legrand, 1967.

  4. All Central Asian Countries agreed to eliminate IDD- a few examples - • CIS agreement 2001 on Prevention of IDD in CIS member states • UN Special Session on Children - 2002: Sustainable elimination of IDD through USI by 2005 • World Health Assembly 2005: resolution adopted on sustaining elimination of IDD through regular reporting by MoH

  5. Universal Salt Iodization: A Global Success Story most effective public health interventions known!

  6. Household use of iodized salt in 2004 (by region) 52%

  7. Percent of households using adequately iodized salt in CEE/CIS (survey based) > 90% : 6 50-90% : 12 <50% : 5

  8. Percent of households using adequately iodized salt in CARK (survey based) >90 : 1 50-90 : 2 <50 : 2

  9. % Households using adequately iodized salt in CARK: Average (survey based) 90% 2004 : 67% 2001: 30%

  10. Remaining new borns unprotected 514,000 222,000 125,000 108,000 100,000 72% 59% 37% 33% 14% 0%

  11. CHILDREN BORN WITH DECREASEDBRAIN CAPACITY: 1015 PER DAY! 1,015 521 247 162 85 0

  12. IDD Elimination in CARK: • 1 Country has eliminated IDD: • Confirmed by expert team: Turkmenistan - 2004 • 1 Country expected to eliminate IDD by 2005:Kazakhstan • 3 countries will eliminate IDD by 2006-7(Kyrgyzstan, Uzbekistan, Tajikistan) 2005

  13. Progress in CARK • Political will! • Goal achieved in Turkmenistan • Good increase of % use of iodized salt in Kyrgyzstan and Kazakhstan • Increase in Uzbekistan, but can only sustained with USI legislation • Tajikistan increased production of iodized salt • Responsibility for iodine premix slowly being shifted to salt producers

  14. Challenges for CARK • Adopt and implement USI legislation in Uzbekistan • Increase use of iodized salt in Tajikistan through: • Focus on districts with low use of iodized salt • Reduce counterfeiting salt through better enforcement • Tackling sale of industrial salt as retail salt • Enforce salt iodization with small salt producers in Khatlon: find a solution for them e.g. set up a cooperative

  15. Challenges for CARK • Address sustainability in Turkmenistan: monitoring and oversight, communication • Address sustainability in Kazakhstan through consistent monitoring and increased awareness creation • Work out a means of centrally harvesting the salt from 53 small scale salt producers in Khatlon oblast in Tajikistan • Adoption of USI legislation and enforcement in Uzbekistan • Establishment of CARK regional/area association of salt producers

  16. Challenges for CARK • Increase use of iodized salt in Kyrgyzstan through: • Vigorous advocacy to policy makers in Kazakhstan (90% of salt used in Kyrgyzstan comes from Kazakhstan) • Establishment of strong and independent salt producers association in Kyrgyzstan • Include food grade salt as part of USI: consumption of salt from processed foods (bread, cheese, meat) will increase: therefore, iodize food grade salt!

  17. Challenges for CARK • Sustainability of the programme (1): • Programme efforts maintained without external support: government, salt producers and other partners • Carry over responsibility for iodine premix procurement to salt producers • Establish functioning IDD committee and salt producers association with regular exchange of information • Re-advocate for USI and strengthen link with other national priorities such as child survival, universal primary education and poverty reduction

  18. Challenges for CARK • Sustainability of the programme (2): • Monitoring embedded in ongoing activities: • Monitoring data reported to IDD committee and discussed for necessary changes • Periodic monitoring of iodine in salt and iodine status at household level • Address districts with low use of iodized salt • Government maintains monitoring

  19. Challenges for CARK • Sustainability of the programme (3): • Communication embedded in ongoing activities: • Curriculum of primary and secondary schools, for medical doctors and health care providers • Remind the public through salt package (logo and slogan), • Target future mothers and pregnant women through health care providers • Target districts where use of iodized salt is low • Involve community groups for word-to-mouth encouragement

  20. Investment in USI = Cost • A solution that reaches all people and affordable to everyone • Adding iodine to salt costs about 2% of total production cost of salt • The price increase is minimal and not a concern in most countries (Kazakhstan, Uzbekistan, Kyrgyzstan, etc) • Initially support is required but eventually should be self-sustaining

  21. Investment in USI = Benefit • Better intelligence among ALL newborns • Better learning and earning in their future • Lower cost for diagnosis and treatment of thyroid diseases (Germany spends 1 billion Euros per year! How much do you spend?) • Equitable solution as iodized salt reaches the poor. • USI is investment in education and improved school performance • USI improves future learning and earning and therefore should be seen as poverty reduction mechanism

  22. Conclusion • The problem is known • The solution is available • Countries can act now or react later • CARK can do better: from 67% to 90% (100%!) • UNICEF is ready to support and overcome the challenges

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