assessment and perspectives of the iodized salt program in lao pdr universal iodized salt program in...
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Assessment and perspectives of the iodized salt program in
Lao PDRUniversal Iodized salt program in Lao PDR:
current situation, development and perspectives
25 – 26 JUNE 2015
Bounthom PHENGDYDirector of Nutrition Center, Department of Hygiene and Health PromotionMinistry of Health
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Outline of the presentation
Background of the IDD in Lao PDR : Evidence based data of IDD and salt consumption by HH
National Health Survey, 2000 School Survey, 2005 MICs III, 2006 School Survey, 2014
Indicators for program achievement
Some recommendations for future direction on IDD eradication
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Background
IDD was identified as main public health problem since 1993 Evidence showed:
Œ 95% of school age children 6- to 12 years old had urine iodine excretion < 100 mcg/l
Œ 65% had urine iodine excretion < 60mcg/l
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Background
In 1995, then the Universal Salt iodization (USI) program was announced and implemented under the PM decree number 42
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After five year of USI was implemented, the NHS2000 showed
Mean urine iodine excretion among school children was 155.30mcg/l and
only 27% had urine iodine excretion < 100mcg/l (68%drop from 1993)
Coverage of adequate Iodized salt at household level was 76%
9% of school children were identified as goiter grade 1-+2
Progress of USI
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In 2005, the school based survey was conducted nation wide And MICS survey also provided data on its coverage, 2006
Can IDD eradicate in LAO PDR?
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National coverage of iodized salt at household level: School based survey
2005
Borikhamxay
Xiengkhoang
Sayaboury Saysomboun
OudomxayBokeo
Luangnamtha
Luangprabang
Phongsaly
Saravan
ChampasackAttapeu
Sekong
Houaphan
Savannakhet
Khammouane
Vientiane M.
Vientiane P.
Average coverage 85% iodized salt consumption nation wide
Vietnam
Thailand
Myanmar
China
CambodiaSource: Recently School Based Survey 2005 by MOH, MOEH
< 70%
70 – 90%
> 90%
Missing data
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Salt iodization (MICS 2006)
0102030405060708090
100
Consume iodized salt Consume adequatelyiodized salt
Adequate urinaryiodine
83.8%
58.3%
87.2%
Mics and Nutrition survey 2006
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Since 2005, Eradication of IDD from this country was discussed and planned
…However,
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Survey in the target 5 provinces in 2008
0 %
10 %
20 %
30 %
40 %
50 %
60 %
70 %
80 %
90 %
100 %
Series1 59 % 52 % 52 % 64 % 97 % 55 %
Phongsaly Houaphanh XiengkhuangKmammouan
eAttapeu 5 provinces
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In the year 2008: In the year 2008:
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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Xiengkhouang province Xiengkhouang province
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Houaphanh Province 2008
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
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Sources of salt (XiengKuang province, 2008)
Lao salt producer
Import salt
Others
37%
62.7%
0.3%
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Sources of salt (Huaphanh province , 2008)
Lao salt Producer
Vietnam
Others
53.5% 42%4.5%
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Sources of salt Phongsaly province, 2008
Lao salt producer
Small salt factory
Import salt
40.8%
40.8%
18.4%
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Sources of salt Khammouane province, 2008
Lao salt Producer
Small factory (Thagnam)
Import salt
Others
60.7%33.3%4.1%1.6%
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Soures of salt Attapeu province, 2008
Lao salt producer
Import salt
Others
92.4%
6.7%0.8%
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Salt producer, 2008
Veunkham
Ban Bo
Khoksa ath
Nataeu
kengkok
Songkhone
Boten
Small factory
Thai
China
Vietnam
Others
48%
23.5%
7.7%
4.1%
4.4%
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Quality of salt testing by WYD test 2008
0 ppm
< 20 ppm
20-40 ppm
>40-60 ppm
42.2%
55.2%
2.2% 0.4%
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Getting to Zero of the IDD: Challenges for Lao PDR
School Survey 2013-2014
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2013-2014 School survey
The median urinary iodine concentration (UIC) =103 µg/L(95% CI 96-114)
89.1% of the salt was “iodized” based on RTK tests (compared to 85% in 2005 and 79.5% in 2011-12),
Only 37% of the salt samples had actually a measured iodine level >15 mg/kg (compared to 68.3% in 2005).
Compared to the results of the 2006 NNS (median UIC was 205.4 µg/L), the median UIC nationwide has decreased by almost 2 times from optimal to borderline due to suspension of iodized salt production.
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The underlying causes for the failing, or poorly executed, salt iodization strategy in Lao PDR were the lack or temporary shortage of essential supplies (potassium iodate and/or WYD solutions)
This was combined with temporary weakened official enforcement and oversight and led to failures in the salt factory’s commitments to continually adhere to the national USI mandate.
Challenges, and Why?
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To secure the potassium iodate supply, consolidate all the required supplies for USI though a newly established Lao USI Secretariat/PIRF,
Efforts to ensure QA measurements and required reporting in all salt factories
Creation of a central QA data analysis and information capacity.
What to do next?
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10 Indicators to measure Progress for USI program achievement
1. Iodized salt coverage > 90% Urine iodine excretion
Œ < 50% Urine iodine excretion <100 mcg/lŒ < 20% Urine iodine excretion < 50 mcg/l É
Quality of salt with adequate iodine (90%):Œ HH level 20Œ40 ppm, Œ Factory level 40Œ60 ppm
2. Existing of National Committee from multi-sectors for IDD eradication
3. Existing clear policy and strategy for USI and IDD eradication
4. Existing Committee secretariat for IDD eradication5. Existing regulations on control and management of IDD,
Existing regular monitoring system for the progress of the USI with good laboratory for testing iodine in salt and urinary iodine excretion
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10 Indicators to measure Progress for USI program achievement
(continue)
6. Existing IEC program for the community on IDD and iodized salt consumption
7. Existing regular data on iodine at factory level, household level, and retail shop
8. Existing data from laboratory regularly on urinary iodine excretion for school children with focus on high risk areas
9. Existing good collaboration among salt producers in management and quality control
10. Existing data collection and record system with regular monitoring
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Some recommendations for future direction on IDD eradication to
Concerned bodies
Control measurement/enforcement to monitor factory salt production and imported salt from neighboring countries
Salt for human and animal consumption should fortified with iodine
Control check point at the border for imported salt and allow only salt with adequate iodine levelTest kit should be available at Control check
point
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Some recommendations for future direction on IDD
eradication
To salt factory Quality Control at factory level on salt
production with adequate iodine Regular improvement internal and external
production system To Community
Educating community to understand the importance of IDD and the use of salt iodization for IDD prevention
Educated community on how to store and use iodine salt properly
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There is a need for multi-sectoral collaboration to work
together
MOH, MOIC, MOE, Mass organization
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Conclusion Iodized salt Status in Lao PDR
8479
89
58
37
percent
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Where we are in the Region?
Unicef: Sustainable Elimination of Iodine Deficiency
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Kor
ea
Phi
lippi
ne Thai
Mya
nmar
Nep
al
Cam
bodi
a
Indo
nesi
a
Lao
PD
R
Chi
na
Vie
tnam
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Where we are in the Region?
Unicef: Sustainable Elimination of Iodine Deficiency
korea Phillipine Myanma Nepal CambodiaIndonesia Lao PDR China Thailand Vietnam
New data 2012 for Thailand
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Thank you for your kind attention