TURKEYIODINE DEFICIENCY DISORDERS

AND SALT IODISATION PROGRAMME

SITUATION IODINE DEFICIENCY DISORDERS

TURKEY

TOTAL THYROID HYPERPLASIA % 30.5(When it is evaluated with all grades)

2. GRADE PREVALANCE % 4.33. GRADE PREVALANCE % 1.84. GRADE PREVALANCE % 0.5

BIG GOITRE PREVALANCE % 2.4(TOTAL OF 3. VE 4. LEVELS)

THYROID NODULE PREVALANCE % 2.8

Prof. Urgancıoğlu, Hatemi and his friends 1980 - 1987 WHO indicators, 73.757 persons

IDD SITUATION:IDD SITUATION: ENDEMIC GOITRE IN TURKEYENDEMIC GOITRE IN TURKEY

SCREENED REGIONS SCREENED REGIONS (1997-1999 )(1997-1999 )

IODINE SITUATION AND GOITRE PREVALANCE OF SCHOOL AGED

CHILDREN IN HIGH RISK PROVINCES 1997-1999

RESULTS:

• GOITRE PREVALENCE FOR CHILDREN IS % 31.8

30% AND HIGHER PROVINCES ARE;KASTAMONU, BAYBURT, TRABZON, ERZURUMMALATYA, SAMSUN, EDİRNE, AYDIN , KAYSERI

THROUGH THE URINARY IODINE MEASUREMENTS : 14 PROVINCES ARE MIDDLE/HIGH, 6 PROVINCES HAVE LOW LEVEL OF IODINE DEFICIENCIES.

Burdur

ÇorumBolu

IODINE DEFICIENCIES WITH SONOGRAPHIC PREVALANCE

PROVINCES AT RISK 1997-1999

HIGH (9), MIDDLE (4), LOW(7) 5-19.9 % Low level

20-29.9 % Middle level

30 % + High level

IODINE SITUATION AND GOITRE PREVALANCE IN 20 PROVINCES SCHOOL

AGED CHILDREN

RESULTS:

GOITRE PREVELANCE OF SCHOOL CHILDREN IN 20 PROVINCES IS 31.8 %.

WITH GOITRE PREVALANCE; THERE ARE 9 PROVINCES HIGHER THAN 30%( KASTAMONU, BAYBURT, TRABZON, ERZURUMMALATYA, SAMSUN, EDİRNE, AYDIN VE KAYSERI)

ÇorumBolu

HIGH (3), MIDDLE(11), LOW(6)

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IODINE DEFICIENCIES WITH URINARY IODINE

MEASUREMENTS PROVINCES AT RISK 1997-1999

50-100 mcg/lt Low level

20-49 mcg/lt Middle level

0-19 mcg/lt High level

LEGISLATION SITUATIONLEGISLATION SITUATION

TURKISH FOOD CODEXTURKISH FOOD CODEX

TABLE SALT CIRCULARTABLE SALT CIRCULAR

(09 JULY 1998 NUMBER: 23397 )(09 JULY 1998 NUMBER: 23397 )

EDIBLE SALTEDIBLE SALTA) Table salt A) Table salt (directly goes to consumers, fortified with (directly goes to consumers, fortified with

iodine, refined or unrefined edible salt )iodine, refined or unrefined edible salt )

B) Salt used in food Industry B) Salt used in food Industry

****INTO TABLE SALTS****INTO TABLE SALTS

50-70 mg/kg. POTASSIUM IODIDE50-70 mg/kg. POTASSIUM IODIDE

25-40 mg/kg. POTASSIUM IODATE MUST BE ADDED25-40 mg/kg. POTASSIUM IODATE MUST BE ADDED. .

SALT USED IN FOOD INDUSTRY NEED NOT BE FORTIFIEDSALT USED IN FOOD INDUSTRY NEED NOT BE FORTIFIED

IODISED SALT HOUSEHOLD CONSUMPTION RATES BY REGIONS-1995

18.6

16.5

18.3

23.6

15.6

URBAN:23.6

RURAL: 9.6AVERAGE: 18.2AVERAGE: 18.2

33,6%

0,5%

63,9%

2,0%

iodised salt noniodised saltconsumption no salt at home

IODISED SALT CONSUMPTION SURVEY2002

URBAN/VILLAGE Iodised Salt Consumption -2002

( % )70

34

0

10

20

30

40

50

60

70

URBAN VILLAGE

   

  %80-96 20 PROVINCE   

  %60-78 18 PROVINCE   

  %50-59 13 PROVINCE   

  %35-49 13 İL   

  %0-31 14 PROVINCE

 

IODISED SALT CONSUMPTION IN PROVINCES- 2002

Siirt 0Kırşehir 5.7Hakkari 8Batman 12

IODISED SALT CONSUMPTION OF HOUSEHOLDS BY REGIONS-2002

7775

7261

58 48

37

0

10

20

30

40

50

60

70

80

MARMARA AGEAN BLACKSEA

MEDITERANIAN MIDANATOLIA EAST

SOUTHEAST

Urinary Iodine Level in Kapuzbaşı Village -2002

(6 – 15 Years old 91 children)

87

3 0 10

20

40

60

80

100

< 2 2 - 5 5 - 10 > 10

iyot (mcg/ dl)

vaka

say

ısı

27

1512

10

0

5

10

15

20

25

30

< 2 2 - 5 5 - 10 > 10

iyot (mcg/dl) 3. haftava

ka s

ayısı

İyotlu tuz kullanımından önceİyotlu tuz kullanımından sonra

PROBLEMSPROBLEMS 1-High prevalance rate of iodine deficiency 1-High prevalance rate of iodine deficiency

disordersdisorders -total goiter rate: 30,5% (1987) -total goiter rate: 30,5% (1987) -school children goiter rate: 31,8 % -school children goiter rate: 31,8 %

(at risk provinces, 1997-1999 ) (at risk provinces, 1997-1999 ) 2-- While consumption of iodised salt have been 2-- While consumption of iodised salt have been

increasing still a sizeable segment of population is increasing still a sizeable segment of population is not using iodised salt due to lack of awareness of not using iodised salt due to lack of awareness of the populationthe population

3- High number of small producers of non iodized 3- High number of small producers of non iodized salt (around 200)salt (around 200)

4- Difference between the prices of iodized and 4- Difference between the prices of iodized and non iodized salt for food industry non iodized salt for food industry

TURKEYIODINE DEFICIENCY DISORDERS

AND SALT IODISATION PROGRAMME

ELIMINATION OF IDD IN TURKEYELIMINATION OF IDD IN TURKEY

GOAL OF THE PROGRAMME

MPO OBJECTIVES Elimination of IDD of children until 2005

Reduction of IDD of adults 1/3 until 2005

To iodise 100% of table salt in the country

Raise3 awareness of all related organizations, salt producersand the community on the importance of iodisied salt

To establish effective monitoring and evaluation system for the whole programme in Turkey

IMPLEMENTATION ON 1994-2002

1. TRAINING

2. ON LEGISLATION

3.WITH SALT PRODUCERS ON HOW TO IODISE THE SALT

4.DEVELOPMENT OF MATERIALS

5-MONITORING AND EVALUATION

FOR HEALTH PERSONNEL ( 81 PROVINCES) FOR MINISTRY OF AGRICULTURE PERSONNELFOR MINISTRY OF AGRICULTURE PERSONNEL (81 PROVINCES)

SALT PRODUCERS (220 FACTORIES)

MARKET REPRESENTATIVES

NGOS MUNICIPALITIES PROVINCIAL DIRECTORS

UNIVERSITIES

1. TRAINING ACTIVITIES

Providing iodisation machines and on the job training for usage,

Providing Potasium Iodate to the producers,

Training of salt producers on how to produce iodised salt ,

19941994 4 Firma4 Firma

20012001 15 Firma (KI)15 Firma (KI)

7 Firma (KIO3)7 Firma (KIO3)

3. ACTIVITIES WITH SALT PRODUCERS FOR SALT

IODISATION IMPLEMENTATION

4. DEVELOPMENT OF MATERIALS

For health personnel and

community

Audio and visual materials

training materials developed

A. MONITORING OF IODISATION LEVEL IN SALT

B. MONITORING IODISATION IN URINARY LEVEL OF THE PEOPLE

C. CHECKINGS AT THE FIELD LEVEL

NATIONAL MONITORING LEVELS OF THE PROGRAMME

A ) MONITORING OF IODISATION LEVEL IN THE SALT

1.QUALITATIVE (WITH TEST KITS (KIO3 and KI))

2.QUANTITATIVE ANALYSIS (IN THE LABAROTORIES

PRODUCTION STAGE

•81 PROVINCIAL PUBLIC HEALTH LABORATORIES

•1 REFİK SAYDAM GENERAL HYGIENE CENTRAL ADMIN.•7 REGION R.S.•8 REGION R.S.

MINISTRY OF HEALTH

MINISTRY OF AGRICULTURE

38 PROVINCIAL AGRICULTURE LABORATORIES

FROM PRODCUTION TO CONSUMPTION

WHO IS RESPONSIBLE FROM WHICH MONITORING ?

RANDOM ANALYSIS IN 3. MONTHRANDOM ANALYSIS IN 3. MONTH

B) IODINE CONSUMPTION LEVEL IN URINARY LEVEL OF PERSONS

WITH SURVEYS;

1. A) Goitre prevelance surveys,

B) Iodine level in urinary,

C) Neonatal – TSH,

2. HOUSEHOLD IODISED SALT CONSUMPTION

( Cluster survey )

PRODUCTION OF IODISED AND NON-IODISED SALT SITUATION

( Kg.)

-171.000.0002001

-85.128.0002000

35.943.19862.104.8931999

73.872.43223.751.7021998

83.970.86120.773.5271997

NON-IODISED

IODISED SALT YEARS

22 ÜRETİCİDEN ALINAN VERİLER

OBJECTIVES OBJECTIVES

To encourge and support the small salt producers in all regions to produce iodised salt in order to expand the consumption of iodised table salt in rural areas;

To ensure the use of potassium iodate instead of iodide in iodised salts at the national level in order to introduce a standard in quality as well as monitoring;

To establish quality control laboratories, fully equipped with the necessary tools and trained personnel, that can conduct iodine analysis in the 22 centres identified for the purposes of monitoring-assessment activities on the national scale by the end of 2001;

To promote nationwide use of iodised salt through community leaders, mass media, schools, the military, community groups etc;

To ensure that the consumption of iodised salt reaches 95% by the year 2005. To conduct cross-sectional surveys within the framework of monitoring

activities with the aim of providing guidance for the programme activities.

STRATEGİESSTRATEGİES

Increase demand for iodized salt in the Increase demand for iodized salt in the community through innovative community through innovative approaches in advocacy and social approaches in advocacy and social marketingmarketing

Strengthen collaboration with the school Strengthen collaboration with the school system as channel for promotion of system as channel for promotion of iodized salt iodized salt

Intensify support to salt producersIntensify support to salt producers

THE PROGRAMMETHE PROGRAMMEACTIVITIESACTIVITIES

TRAINING:TRAINING:– Health Personnel (Health Managers of 81 Provinces )Health Personnel (Health Managers of 81 Provinces )– Representatives of Provincial Agriculture DirectorsRepresentatives of Provincial Agriculture Directors– Salt ProducersSalt Producers– Market representatives, teachersMarket representatives, teachers– Production of training materialsProduction of training materials

ADVOCACY AND SOCIAL MOBILIZATIONADVOCACY AND SOCIAL MOBILIZATION : :Through the school system:Through the school system:- - Training of teacher trainers, studentsTraining of teacher trainers, students-Development and production of education material-Development and production of education material-Training of Community leaders, military, media etc. -Training of Community leaders, military, media etc.

THE PROGRAMMETHE PROGRAMMEACTIVITIESACTIVITIES

IODISATION OF SALT:IODISATION OF SALT:– On the job training of salt producersOn the job training of salt producers– Legislation changeLegislation change– Ttechnical material supportTtechnical material support– Potassium iodate supportPotassium iodate support

MONITORING AND EVALUATION:MONITORING AND EVALUATION:

– Situation Analysis, Household consumption and School based Situation Analysis, Household consumption and School based surveys surveys

– Establishment of monitoring systemEstablishment of monitoring system

– Annual Evaluation meetingsAnnual Evaluation meetings