NATIONS UNIES
UNITED NATIONS
NATIONS UNIES
ADMINISTRATIVE COMMITTEE ON COORDINATION/SUBCOMMITTEE ON NUTRITION
ACC/SCN STATE-OF-THE-ART SERIES
NUTRITION POLICY DISCUSSION PAPER NO. 3
by
Basil S. Hetzel, MD, FRCP, FRACP, FFCM, FTS
CSIRO Division of Human Nutrition
Adelaide, Australia
Executive Director, International Council for Control
of
Iodine Deficiency Disorders (ICCIDD)
c/o Health Development Foundation, 8th Floor,
Samuol Way Building, Women's and Children's
Hospital,
72 King William Road, North Adelaide. 5006,
Australia
with discussion by F. Delange, J. B. Stanbury and F. E.
Viteri
and an introduction by M. Lotfi and J. B. Mason
March 1988
reprinted June 1993 with assistance of the Government of the
Netherlands
ACC/SCN documents may be reproduced without prior permission, but please attribute to ACC/SCN.
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The designations employed and the presentation of material in
this publication do not imply the expression of any opinion whatsoever on the
part of the ACC/SCN or its UN member agencies concerning the legal status of any
country, territory, city or area or of its authorities, or concerning the
delimitation of its frontiers or boundaries. |
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Dr John B. Mason |
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Technical Secretary, ACC/SCN c/o World Health
Organization |
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20, Avenue Appia |
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CH-1211 Geneva 27 |
Facsimile No: (41-22) 798 88 91 |
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Switzerland |
Telex No: 415416 |
UNITED NATIONS
ADMINISTRATIVE COMMITTEE ON COORDINATION -- SUBCOMMITTEE ON NUTRITION (ACC/SCN)
The ACC/SCN is the focal point for harmonizing the policies and activities in nutrition of the United Nations system. The Administrative Committee on Coordination (ACC), which is comprised of the heads of the UN Agencies, recommended the establishment of the Sub-Committee on Nutrition in 1977, following the World Food Conference (with particular reference to Resolution V on food and nutrition). This was approved by the Economic and Social Council of the UN (ECOSOC). The role of the SCN is to serve as a coordinating mechanism, for exchange of information and technical guidance, and to act dynamically to help the UN respond to nutritional problems.
The UN members of the SCN are FAO, IAEA, IFAD, ILO, UN, UNDP, UNEP, UNESCO, UNFPA, UNHCR, UNICEF, UNRISD, UNU, WFC, WFP, WHO and the World Bank. From the outset, representatives of bilateral donor agencies have participated actively in SCN activities. The SCN is assisted by the Advisory Group on Nutrition (AGN), with six to eight experienced individuals drawn from relevant disciplines and with wide geographical representation. The Secretariat is hosted by WHO in Geneva.
The SCN undertakes a range of activities to meet its mandate. Annual meetings have representation from the concerned UN agencies, from 10 to 20 donor agencies, the AGN, as well as invitees on specific topics; these meetings begin with symposia on subjects of current importance for policy. The SCN brings certain such matters to the attention of the ACC. The SCN sponsors working groups on inter-sectoral and sector-specific topics.
The SCN compiles and disseminates information on nutrition, reflecting the shared views of the agencies concerned. Regular reports on the world nutrition situation are issued, and flows of external resources to address nutrition problems are assessed. State-of-the-Art papers are produced to summarize current knowledge on selected topics. SCN News is normally published twice per year. As decided by the Sub-Committee, initiatives are taken to promote coordinated activities - inter-agency programmes, meetings, publications - aimed at reducing malnutrition, primarily in developing countries.
INTRODUCTION AND POLICY IMPLICATIONS
1.1 WHAT IODINE DEFICIENCY DISORDERS ARE
1.2 THE MECHANISM OF IODINE DEFICIENCY
1.3 NATIONAL AND INTERNATIONAL PROGRAMMES TO CONTROL IODINE DEFICIENCY DISORDERS (IDD)
2. IDD IN HUMANS AT FOUR STAGES OF DEVELOPMENT AND IN ANIMAL MODELS
2.1 IODINE DEFICIENCY IN THE FOETUS
2.2 IODINE DEFICIENCY IN THE NEONATE
2.3 IODINE DEFICIENCY IN CHILDREN AND ADOLESCENTS
2.4 IODINE DEFICIENCY IN ADULTS
2.5 ANIMAL MODELS2.5.1 IODINE DEFICIENCY IN SHEEP
2.5.2. IODINE DEFICIENCY IN MARMOSETS
2.5.3 IODINE DEFICIENCY IN RATS
3. PREVALENCE OF IODINE DEFICIENCY DISORDERS (IDD)
3.1 EUROPEAN REGION
3.2 AMERICAN REGION
3.3 AFRICAN REGION
3.4 SOUTHEAST ASIAN REGION
3.5 WESTERN PACIFIC REGION
3.6 GENERAL CONCLUSIONS
4. METHODS TO CORRECT IODINE DEFICIENCY
4.1 IODIZED SALT
4.2 IODIZED OIL BY INJECTION
4.3 IODIZED OIL BY MOUTH
4.4 IODIZED BREAD
4.5 WATER IODIZATION
4.6 OTHER METHODS
4.7 GENERAL COMMENTS
4.8 CONCLUSIONS ON CHOICE OF METHODS
6. RECENT IODIZATION PROGRAMMES
6.1 FINLAND (SALT)
6.2 PAPUA NEW GUINEA (OIL THEN SALT)
6.3 COUNTRIES OF CENTRAL AND SOUTH AMERICA (SALT THEN OIL)
6.4 ZAIRE (OIL)
6.5 INDONESIA (SALT AND OIL)
6.6 CHINA (SALT AND OIL)
6.7 INDIA (SALT)
7. ASSESSING IODINE DEFICIENCY DISORDERS FOR PUBLIC HEALTH PROGRAMMES
7.1 DEFINITION OF GOITRE STAGES
7.2 DEFINITION OF ENDEMIC GOITRE AS A PUBLIC HEALTH PROBLEM
7.3 ENDEMIC CRETINISM AND ADDITIONAL DEVELOPMENTAL ABNORMALITIES
8. ELEMENTS OF NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAMMES
8.1 ASSESSMENT
8.2 COMMUNICATION
8.3 PLANNING
8.4 POLITICAL DECISION
8.5 IMPLEMENTATION
8.6 MONITORING AND EVALUATION
9. RECENT DEVELOPMENTS IN CREATING A GLOBAL STRATEGY
9.1 ACC/SCN's DEVELOPMENT OF A GLOBAL STRATEGY
9.2 THE WORLD HEALTH ASSEMBLY RESOLUTION
9.3 THE INTERNATIONAL COUNCIL FOR CONTROL OF IODINE DEFICIENCY DISORDERS (ICCIDD)
10. SUGGESTIONS FOR FURTHER RESEARCH AND INVESTIGATION
PHYSIOPATHALOGICAL ASPECTS OF ENDEMIC GOITRE AND CRETINISM
COMMENTARY ON DR. HETZEL'S REVIEW OF THE GLOBAL PROBLEM OF IODINE DEFICIENCY DISORDERS
RELATIVE ADVANTAGES AND DISADVANTAGES OF PRESCRIPTIVE VERSUS POPULATION BASED PROPHYLAXIC MEASURES