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IDD Elimination & Universal Salt Iodization Policy in Georgia Current Trends and Challenges

IDD Elimination & Universal Salt Iodization Policy in Georgia Current Trends and Challenges. Ms. Mariam Jashi APO Health – UNICEF Georgia Mr. Zurab Sekhniashvili Director, National Center for Nutrition. National Conference “Enhancing Partnership for IDD Elimination in Georgia”

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IDD Elimination & Universal Salt Iodization Policy in Georgia Current Trends and Challenges

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  1. IDD Elimination & Universal Salt Iodization Policy in GeorgiaCurrent Trends and Challenges Ms. Mariam Jashi APO Health – UNICEF Georgia Mr. Zurab Sekhniashvili Director, National Center for Nutrition National Conference “Enhancing Partnership for IDD Elimination in Georgia” 25-28 June 2004 - Tbilisi Georgia PARTNERSHIP FOR IDD ELIMINATION IN GEORGIA

  2. Iodine Deficiency in Georgia Traditional Concern • 1745 • First source describing Goiter problem - writings by Vakhushti Bagrationi • 1921 • Establishing Universal System for Combating Endemic Goiter - USSR • 1935 • Republican Dispensary for Goiter Prevention in Tbilisi, Adjara & Kutaisi • 1939 • Iodized Salt Manufacturing in Kutaisi supplying Racha-Letchkhumi, Imereti, Svaneti and other High-Land areas • 1938-1944 • Goiter prevalence in the High-Land regions reduced from 42.7% to 14% PARTNERSHIP FOR IDD/USI IN GEORGIA

  3. Lost Opportunity • 1970s • IDD Virtually Eliminated in Georgia • 1980s • Reducing efforts to sustain achievements - Illusion of IDD Liquidation • 1990s • Social-Economic Crisis, Disruption of Iodized Salt Import & Distribution • Mid-1990s • Alarming Trend of IDD and Goiter Prevalence throughout the Country PARTNERSHIP FOR IDD/USI IN GEORGIA

  4. Per cent 5.0 - 25.0 25.1 - 50.0 50.1 - 70.0 > 70.1 Missing Data No Single District in Georgia Free of Goiter Age group >15 years old - 2003 PARTNERSHIP FOR IDD/USI IN GEORGIA

  5. Per cent < 25.0 25.1 - 50.0 50.1 – 70.0 > 70.1 Missing Data No Single District in Georgia Free of Goiter - PARTNERSHIP FOR IDD/USI IN GEORGIA

  6. National Efforts to Combat IDD since 1990s • 1996 • Presidential Decrees on State IDD Programme & National Council on IDD • 1997 • VAT (20%) Exception Policy for Iodized Salt Import (0.15%) and Sale • Establishing district IDD committees in 71 administrative units • 1998 • State Standard for Iodized Salt • Special Coding for Import of Iodized Salt vs. Non-iodized • IDD Centres in Tbilisi, Kutaisi, Batumi, Telavi & Zugdidi • Lab & Ultrasound Equipment provided by UNICEF • Continuous Disease Surveillance and Database Formation PARTNERSHIP FOR IDD/USI IN GEORGIA

  7. National Efforts to Combat IDD since 1990s • 1997-2004 • Free consultation provided to 500,000 patients • Medication (Levoxile) provided by ACTS Georgia for treatment of Goiter • 2000-2001 • Distribution of Iodized Oil Capsule to 300,000 children, pregnant & lactating women in 35 districts of 10 regions (UNICEF) - Emergency Interventions • 1998-2001 • Information-Communication Campaign (TV/Radio, Printed Materials) PARTNERSHIP FOR IDD/USI IN GEORGIA

  8. National Efforts to Combat IDD since 1990s • 2002 • Presidential Decree overriding 1996 Decrees • Renewing membership of National Council • Drafting Law on Universal Salt Iodization • 2003 • Draft Law Submitted to Parliament - Banning Import of Non-iodized salt except for Industry, Medical Purposes & Re-Iodization PARTNERSHIP FOR IDD/USI IN GEORGIA

  9. 1996 State Chancellery - Chair of NCIDD Ministry of Health Ministry of Food and Agriculture Ministry of Justice Ministry of Trade & Foreign Econ. Relations Ministry of Education Ministry of Economy Ministry of Finance State Customs Department State Dept. for Standardization, Metrology & Certification 2002 State Chancellery - Chair of NCIDD Ministry of Labour, Health & SA Ministry of Food and Agriculture Ministry of Justice Ministry of Economy, Trade & Industry Ministry of Education Ministry of Finance Ministry of Transport & Communication State Dept. for Standardization, Metrology & Certification Ministry of Interior affairs Ministry of State Security Ministry of ENVR/Natural Resources Membership of National IDD Council Roles & Responsibilities too General Private Sector not officially included PARTNERSHIP FOR IDD/USI IN GEORGIA

  10. Policy and Strategic Framework Guiding National Programmes • Government Commitment • World Summit For Children - 1990 • World Fit For Children - 2002 • Millennium Development Goals - 2000 • National Health Policy & Strategy • What is the Goal? • Sustainable Elimination of IDD by 2005 Universal Salt Iodization (USI) by 2005 All Salt for Human and Animal Consumption to be Iodized What Indicators? Household Consumption of Iodized Salt >90% Goiter Prevalence < 5% of the population Adequate Iodine Status - Urine Iodine Excretion > 100 mcg/dl PARTNERSHIP FOR IDD/USI IN GEORGIA

  11. How to Verify Progress & What are Achievement? • Salt Situation Analysis in Georgia - 1999 & 2003 • Household Survey on Consumption of Iodized Salt - 1999 & 2003 • Iodine Status among Children - 2000-2002 • Goiter Prevalence among Children and Adults - 1997-2002 • Communication Assessment -2003 John Hopkins University PARTNERSHIP FOR IDD/USI IN GEORGIA

  12. Progress and Status • Findings from • Salt Situation Analysis in Georgia • 2003 • Institute for Polling and Marketing PARTNERSHIP FOR IDD/USI IN GEORGIA

  13. Salt Import in TonsGeorgia 1999-2002 Source: Salt Situation Analysis 2003 - IPM/UNICEF Customs Data - 2002 PARTNERSHIP FOR IDD/USI IN GEORGIA

  14. Key Findings from 2003 Salt Situation Analysis • 2002 - Iodized Salt mainly imported from Ukraine (96%), also from Greece, Germany, Armenia, Azerbaijan, Turkey & Italy • Iodine content not tested at customs level – customs-clearance & registration based on manufacturer’s certificate or State Department of Standardization • Wholesale/Retail Quality Control – State Sanitary Inspection • No clear articulation of administrative regulations & sanctions for violating packaging, sorting, labeling, transportation & storage standards for iodized salt PARTNERSHIP FOR IDD/USI IN GEORGIA

  15. Key Findings from 2003 Salt Situation Analysis • Some violation of State Standards for Storage of Iodized Salt observed at various distribution points. Salt Expiry Dates almost always followed. • Quality Control systems at Import, Wholesale/Retail Sale needs refinement • Lab equipment for salt titration at State Sanitary Department outdated • Despite all efforts for legislative framework, no comprehensiveness achieved. Inadequacy of Legislative basis & endorsement; PARTNERSHIP FOR IDD/USI IN GEORGIA

  16. Communication on IDD/Iodized Salt • IEC campaigns in 1998-2001 - NCN, Public Health Department, UNICEF • No coordinated professional marketing & communication efforts taken. • Communication by salt importers not considered profitable given that salt import is no “Big Business”. • Communication efforts needed at all levels - decision makers, importers, distributors, Households PARTNERSHIP FOR IDD/USI IN GEORGIA

  17. Iodized Salt Prices Range 0.25 to 7.57 GEL Affordability issue is a lesser concern PARTNERSHIP FOR IDD/USI IN GEORGIA

  18. Household Consumption of Iodized Salt >90%? • Findings from • Household Survey • 2003 • State Department for Statistics PARTNERSHIP FOR IDD/USI IN GEORGIA

  19. Availability of Iodized Salt at Household LevelGeorgia (except Abkhazia and South Ossetia)1999 – 2003 Source: MICS 1999 2003 HH Survey/ UNICEF - SDS 1117 Households PARTNERSHIP FOR IDD/USI IN GEORGIA

  20. Availability of the Iodized Salt at the Household Level Georgia (except Abkhazia and South Ossetia)1999 - 2003 Source: MICS 1999 2003 HH Survey UNICEF - SDS PARTNERSHIP FOR IDD/USI IN GEORGIA

  21. Awareness of Households on Iodine Deficiency Republic of Georgia (except Abkhazia and South Ossetia)2003 From 67% in 1998 Source: 2003 HH Survey UNICEF - SDS Georgia PARTNERSHIP FOR IDD/USI IN GEORGIA

  22. Main Source of Information on Iodine DeficiencyRepublic of Georgia (except Abkhazia and South Ossetia)2003 PARTNERSHIP FOR IDD/USI IN GEORGIA

  23. Some Other Findings • What do you do to prevent Iodine Deficiency? 67.9% who knows about Iodized Salt can buy it in areas where they live 61.2% households are buying iodized salt monthly Each household spends 10-11GEL/year for purchasing salt. PARTNERSHIP FOR IDD/USI IN GEORGIA

  24. If you have a choice which salt would you buy? PARTNERSHIP FOR IDD/USI IN GEORGIA

  25. Motivation for choosing iodized vs. Non-IS PARTNERSHIP FOR IDD/USI IN GEORGIA

  26. IDD Prevalence Data • Findings from National Center of Nutrition • 1. Urine Iodine Excretion data among children • 2001 • 2. Goiter Prevalence among children and adults • 1997-2003 PARTNERSHIP FOR IDD/USI IN GEORGIA

  27. Urine Iodine Excretion Children Aged 1-15 UIE Median Children 67 mcg/dl Tbilisi Data 2003 Source: NCN, 2001 PARTNERSHIP FOR IDD/USI IN GEORGIA

  28. Goiter Prevalence – Adult Population 1997-2003 Source: National Center for Nutrition, Georgia * 2003 Data - Referral PARTNERSHIP FOR IDD/USI IN GEORGIA

  29. Goiter Prevalence – Child Population 1997-2003 Source: National Center for Nutrition, Georgia 2003* - Referral Data PARTNERSHIP FOR IDD/USI IN GEORGIA

  30. IDD Impact on Mental Development IDD PROBLEM PYRAMID IQ Reduction by 10-15% 13.5 IQ Points in Average PARTNERSHIP FOR IDD/USI IN GEORGIA

  31. Future Challenges Summary of Recommendations Political CommitmentRe-establishment of Effective Coordination Council/Committee/Task Force Clear delineation of roles/responsibilities & mandates Commitment from local governments - sub-national level advocacy Legislation Endorsement by Parliament Banning Import of Non-Iodized Salt Articulating clearly administrative & sanction regulations PARTNERSHIP FOR IDD/USI IN GEORGIA

  32. Future Challenges Summary of Recommendations Establishment of a strong monitoring system for Quality Control of Iodized Saltat all levels From Import to Household Level Continuation of Communication & Awareness raising on IDD/USI Research-Based Strategy with Experts - Refer to SitAn, HH Survey Intersectoral Partnership – Health, Education, Private, Youth, NGOs Increase networking with main Salt Importers Exploring school based IEC and monitoring activities Identification & Focus on Pockets with high IDD prevalence PARTNERSHIP FOR IDD/USI IN GEORGIA

  33. Eliminating IDD in Georgia by 2005? Reaching 38% of Children & AdultsAffected by IDD 24% of PopulationNot Aware on IDD 33% of FamiliesNot Using Iodized Salt STILL PARTNERSHIP FOR IDD/USI IN GEORGIA

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