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Ensuring Maximum Public Health Benefits of USI: the Role of Monitoring

Ensuring Maximum Public Health Benefits of USI: the Role of Monitoring. Prof. Gregory Gerasimov UNICEF Consultant Central and Eastern Europe, CIS and Baltic States. Global success in salt iodization. % of households that consume iodized salt Globally - 73% CEE/CIS/BS - from 5 to 90%

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Ensuring Maximum Public Health Benefits of USI: the Role of Monitoring

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  1. Ensuring Maximum Public Health Benefits of USI: the Role of Monitoring Prof. Gregory Gerasimov UNICEF Consultant Central and Eastern Europe, CIS and Baltic States

  2. Global success in salt iodization % of households that consume iodized salt Globally - 73% CEE/CIS/BS - from 5 to 90% Baltic States - up to 10% UNICEF 98 Report

  3. Definitions - MONITORING • Monitoring is the process of collecting and analysing on a regular basis information about the program for the purpose of identifying problems such as non-compliance, and taking corrective actions so as to fulfill stated objectives

  4. Definitions - INDICATOR • An indicator is used to help describe a situation that exists, and can be used to track changes in the situation over time. • Indicators are usually quantitave, but may also be qualitative. • Indicators may be direct and indirect.

  5. Indicators of IDD Control Program • Process Indicators - for monitoring of salt iodization • Impact (Outcome) Indicators - for biological monitoring

  6. Process Indicators • Is all imported salt iodized to the country’s requirement? • Is adequately iodized salt reaching the target population?

  7. Biological (Impact) Indicators • Is there a significant IDD problem? • What is the prevalence of IDD in a given population? • What impact salt iodization has on iodine status of the population? • Have IDD been eliminated as a public health problem?

  8. PROCESS INDICATORS

  9. Factors That Determine Iodine Content in Salt • Variability in the amount of added iodine • Uneven distribution of iodine in the iodized salt • The extent of iodine loss during storage and distribution • Loss of iodine due to cooking and food processing

  10. Former USSR GOST 13830-91 required: use of instable potassium IODIDE (KI) level of iodization 23+/-11 ppm shelf life 3 months UNICEF/WHO recommendations: use of stable potassium IODATE (KIO3) level of iodization 20-40 ppm shelf life more than 12 months Industry Standards for Iodized Salt

  11. MOST OF SALT PRODUCERS IN THE REGION THAT SUPPLY IODIZED SALT TO THE BALTIC STATES COMPLY WITH ABOVE RECOMMENDATIONS

  12. Determining Salt Iodine Levels • Titration method • Rapid test kits • Semi-quantitative measurement kits

  13. MONITORING SYSTEM • Government (External) Monitoring System • The Producers’ & Distributors’ (Internal) Monitoring System • Household Level Monitoring • Cross-sectional surveys • Community based monitoring

  14. IMPACT INDICATORS

  15. Biological Indicators • Goiter rate in school children (by palpation and ultrasonography) • <5% - no iodine deficiency • Urinary Iodine • >100 mcg/l - no iodine deficiency • Neonatal TSH screening • samples with TSH level > 5 mU/L - less than 3%

  16. Easy to perform Little training needed (for palpation) Reflects remote rather than present iodine status Observers’ variations Low sensitivity Expensive equipment (for ultrasonography) Goiter (Thyroid Size) Assessment

  17. Reflects current iodine status of population Samples easy to collect Sensitive and reliable indicator Trained lab staff needed External and internal quality control required Rather expensive equipment Urinary Iodine Assessment

  18. No additional investments in impact (biological) monitoring It is not recommended to set up neonatal TSH screening program solely for purpose of IDD monitoring Neonatal TSH

  19. SURVEY METHODS • School surveys • goiter rate (palpation & ultrasonography) • urinary iodine • samples of salt from households • Household surveys • goiter rate (palpation) • urinary iodine • checking of iodine in salt

  20. WHO/UNICEF/ICCIDD criteria for monitoring progress towards elimination of IDD as a public health problem

  21. Universal Salt Iodization in Baltic States • Legislation, Regulations, Standards • Implementation & Enforcement • Monitoring and Impact Assessment

  22. ACHIEVABLE GOAL: • ELIMINATION OF IDD AS A PUBLIC HEALTH PROBLEM IN THE BALTIC STATES IN THE NEXT 1-2 YEARS

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