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| Report from the Working Group on Iodine Deficiency Disorders to the ACC/SCN 26th SessionPresented by the Working Chairman Dr G. Clugston, WHO IntroductionThe working group on iodine deficiency disorders did not meet this year, in accordance with last year’s decision of the SCN that the IDD Working Group would meet in the year 2000. Nevertheless much has happened over the past year. This report is presented on behalf of WHO, UNICEF and ICCIDD. Although other UN Agencies have also been involved in IDD control over the last year, these three agencies have played a leading role in coordinating IDD control. IDD is currently present in 130 countries as a public health problem and a recent review carried out by WHO in collaboration with UNICEF and ICCIDD shows that 73% of these countries have a salt iodisation programme in place. Very notable progress has been made: it is estimated that 18% of IDD affected countries have reached the goal of USI (defined as more than 90% of the households having access to iodized salt). Although it is not yet possible to estimate the impact of USI on the iodine status of the population at global or regional levels since salt iodisation programmes are still too young in most countries to be evaluated, it is clear that where salt iodisation has been introduced for more than 5 years, the reduction in goiter prevalence and the improvement in iodine status is dramatic. For example the 7 African countries surveyed as part of the multicentre study carried out by WHO, UNICEF and ICCIDD in 1996, showed substantial such improvements. The recent assessment of the IDD situation in some Latin American countries also confirms this trend. So Columbia, Peru and Venezuela are notable examples, but also China and Thailand. Activity highlightsOver the past year, activities concentrated on increasing salt iodisation coverage, assessment and monitoring, and training. Most of the work that is reported has been a collaborative effort between WHO, UNICEF and ICCIDD. UNICEFSupport to countries UNICEF continues to provide assistance to countries especially through its partnership with:
Surveillance and monitoring UNICEF is developing some guidelines for the analysis of urinary iodine levels for use in household surveys. UNICEF also provided technical support towards the development of regional quality control/salt monitoring meetings in Asia. A similar effort is underway for Latin America, Central Europe, and Africa. With regard to the monitoring of the World Summit for Children goal, a review of the process indicators related to IDD elimination is planned by UNICEF. Publications and communication UNICEF produced four USI Updates that were disseminated through UNICEF's quarterly nutrition mailing to all countries and partners. WHOSupport to countries WHO provided technical assistance to countries, especially in Africa, in the Eastern Mediterranean Region and in South East Asia to assess the magnitude of their IDD problem and the feasibility of implementing salt iodisation programmes. Inter-country workshops on micronutrient deficiencies were held in Africa, one for francophone and one for anglophone Africa. Surveillance and monitoring One of WHO’s main activities was to prepare a resolution on "Prevention and control of IDD" for the 52nd World Health Assembly together with a major report on the progress made by countries towards eliminating IDD. For this purpose a survey was carried out in collaboration with ICCIDD in all WHO’s Member States. At country level, WHO provided technical assistance to countries, especially in Africa, in America and in Eastern Mediterranean, to set up monitoring systems. For example, in South Africa, WHO provided support to develop a national system to monitor iodised salt consumption as well as the quality control of the salt. The WHO Global Database on IDD has been updated and a new version of MDIS will be published this year. In order to update the manual on "Indicators for assessing IDD and their control through iodization", a consultation is planned for May 1999. Last year, in Oslo, WHO was requested by the IDD Working Group to approach WTO to see whether an international legislative tool to regulate the trade of iodized salt among countries exists. It was discovered that WTO is not able to enforce exporting countries to export a salt whose quality, especially the level of iodine, meets the legislation of importing countries. Instead the importing countries can react by prohibiting importation of salt in order to protect its population. On the other hand, if the exporting country decides in retaliation to reduce importation of some other commodities, WTO can intervene on the pretext that trade of goods between countries is free and cannot be limited. Publications and communication Report of the Intercountry Workshop on IDD in the European Region (Munich, September, 1997) Report of the Intercountry Workshop on IDD in Anglophone Africa (Gaborone, October 1997) Report of the Intercountry Workshop on IDD in Francophone and Lusophone Africa (Bamako, May 1997) ICCIDDSupport to countries ICCIDD provided technical assistance to countries all over the world, in:
ICCIDD also provided support to the organization of the National IDD workshop in China, held in Beijing (1998). Surveillance and monitoring In the area of monitoring and surveillance, ICCIDD achieved the following:
Operational research
Publications and communication
Work in common
ConclusionsThe goal of IDD elimination is within reach. However, the road is still long and success will only be achieved with sustained and continued effort. The challenge for the forthcoming years is twofold: first to introduce salt iodisation in the 35 affected countries where it has not yet been implemented; second to sustain salt iodisation programmes - especially since a deterioration in iodine status has been seen in some industrialized countries where it had been believed that IDD was under control. In order to make programmes sustainable, it is necessary that:
We look forward to running the IDD working group next year. |
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