Health and Nutrition

Health and Nutrition Ministry of Health of Azerbaijan Republic and UNICEF

Problems Addressed of 1999 • No National policy: • No Law/Legislation on Food Codex/Food Production/Quality Control • No Law on Salt Iodization • No National program on IDD elimination/Nutrition, Micronutrient Deficiencies • No intersectoral or sectoral activities on IDD/USI • Domestic salt production of iodized salt - 0% • Household consumption of iodized salt - 0% • Lack of public awareness on IDD/Salt Iodization • Low professional commitment to elimination of IDD • High prevalence of goiter among children in endemic districts, including IDP/Refugee Concentrated districts (up to 90%)

IDD Prevalence by Districts (per 100 population), Azerbaijan, 1998

Health and NutritionProgram 2000-2004

Progress in Azerbaijan • Production and import of iodized salt were limited till 1998 year, • As a result of active work of all partners and UNICEF’s assistance 41% of households consumed iodized salt in 2000 (MICS, 2000), • The law “On prevention of iodine deficiency disorders,” which establishes universal salt iodization beginning from January 2003 year.

Iodized Salt Consumption (percentage), Azerbaijan, 2000 Source: MICS 2000

Situation in Azerbaijan • Nowadays there is a lack of national normative of requirement for marking and shelf life of iodized salt. • Not adequate metod is being used in quantitative determination of iodine in salt, • Little number of investigation of iodine in salt (15 in 2001), limited to one laboratory in Baki.

Sub-legal and normative acts of government are necessary • Decree of Cabinet of Ministers that regulates coming into force of law on prevention of iodine deficiency, • Orders, regulations and normative acts of Ministries and Departments, detailing the legislation and determining the ways of it’s implementation, • Regulations of monitoring aspects of the program is to a considerable extent within the authority of the Ministry of Health.

STANDARD 1991 Iodine content 23+/-11mg/kg of salt Unstable potassium-iodide (KI) was used Excessive packing reguirements Shelf-life is 3 months STANDARD 2000 Iodine content 40+/-15 mg/kg of salt Stable potassium-iodate (KIO3) is being used Reasonable packing requirements Shelf-life is up to 12 months Sample of Russia, Ukraine, and Belarus: the quality of iodized salt was sharply increased after accepance of new normatives

Azerbaijan Law“On prevention of iodine deficiency disorders” Article 5.11. -To carry out evaluation of dynamics of iodine deficiency disorders for monitoring purposes and efficiency of prevention measures and to report the results to concerned organs Article 7.1. - Iodine content in salt is determined by the correspondent organs of executive power.

Monitoring of iodized salt in Azerbaijan should be implemented in all the levels on the regular bases • Personal (domestic) system of quality central of to salt producers (quantitative method), • State quality control on production (import) and salt trade (quantitative method) levels, • Monitoring of iodinezed salt in household level(qualitative method)

RECOMMENDATIONS (1) To establish by the order of state head sanitary doctor the followings: • the rate of iodine content in salt within the level of 40+/-15 mg/kg • the use of only potassium-iodate for saltconcentration, • Shelf-life of iodized salt - 12 months, and it’s utilization order after the expiry date.

RECOMMENDATIONS (2) • marking requirements (production date, iodine content rate, shelf-lives, information about prophylactic properties), • laboratory methods on quantitative and qualitative iodine content in salt and required reporting forms, • the group of authorized persons and organizations responsible for monitoring of iodized salt, and the order of implementation of controlling measures.

RECOMMENDATIONS (3) To hold investigations on consumption of iodized salt by households (with qualitative methods) periodically (not rarely than once in two years): • to include iodized, salt investigation to planned demographic and medical researches, • to attract consumer societies, women and youth organizations to investigations, • to attract teachers and pupils to iodized salt researches.

RECOMMENDATIONS (4) • Creation of a laboratory for determination of iodine in urine (acquiring of equipment and reagents, training of staff), • Carrying out pilot investigations in different regions in 2002-2003. • Planning of nation wide investigation within the program of iodine deficiency elimination for 2003 - 2004 years, • Achieving of liquidation of iodine deficiency in Azerbaijan till 2005 year.

Criterions of elimination of Iodine Deficiency Disorders, proposed by WHO, UNICEF and ICCIDD (1999) • Salt iodizations > 90%(persentage of households consuming iodized salt) • Goiter cases (frequency) < 5%(persentage of pupils with thyroid increase) • Iodine content in urine 100 - 300 mkg/l(indicates real iodine intake by organism) • Compliance of minimum 8 from 10 criterions of sustainability of iodine deficiency elimination.

Effective indicatorsare necessary for monitoring of the program • Indicatorsare used for evaluation of current situation and also are applied for monitoring of the change in situation in the course of time • Indicators should be quantitative and qualitative • Indicators can be direct and indirect

EVALUATION/STUDIESMOH-UNICEF AZERBAIJAN2000-2002

Vitamin A status of the children under 5 years in Azerbaijan % (laboratory survey) Source: «Vitamin A status among the children» survey, 2002. (Department of Nutrition of the Azerbaijan Medical University)

Consumption of Iodized Salt among the population in Azerbaijan Source: «Iodized salt the status of consumption among the population» (Independent Consumers’ Union)

Lessons Learned

Future plans

Future Plans

Thank you very much!

Health and Nutrition