United Nations System
Standing Committee on Nutrition

Report of the Sub-Committee on Nutrition at its Twenty-Fifth Session

II.  Work in Progress:  Summary of Discussion and Conclusions

C. Reports of decisions taken in Working Groups

C.2  Iodine Deficiency Disorders -- Report of the Working Group

39. Massive implementation of universal salt iodization programmes was reported along with concrete examples of country programmes in Asia, Africa, Europe and Latin America. Progress towards achievement of the goal of IDD elimination was described as "spectacular".  The absolute need for permanent monitoring however was underscored.  It was noted that sustainability is fragile in many countries and that progress may be waning in some circumstances due to political and socio-economic factors.  Other technical issues discussed included harmonization of databases, the need for simplified measurement of iodine in salt and urine in the field, and the human right to adequate iodine. A suggestion was made to include IDD in country reporting guidelines with respect to the UN Committee on Economic, Social and Cultural Rights.
40. The Working Group felt that the elimination of IDD (still the most common cause of preventable mental impairment worldwide) needs continued prioritization  and noted that  the ACC should  maintain its commitment to this important goal. Monitoring and continued financial and technical support were also identified as key needs. The Working Group cautioned against complacency.  Hard-to-reach areas need to be identified in some countries and appropriate measures implemented.
41. The Working Group identified these issues as needing follow-up:
    

• WHO will take up salt trade issues with WTO;
  
• coordination of databases will be the responsibility of all those currently managing databases, and would be enhanced by use of the world-wide web;
  
• WHO will make copies of the "10 Key Points for Sustainability" available to members of the SCN.

Full Report of the Meeting of the Working Group on Iodine Deficiency Disorders

Saturday 28 March 1998, Oslo, Norway

Chair: Dr Graeme Clugston, WHO
Rapporteur: Dr Francois Delange, ICCIDD

Introduction

In opening the meeting, the chairman highlighted the continuing massive problem of IDD. He drew attention to the exciting progress that has been achieved, but stressed the emergence of three potential constraints:

1. In some countries IDD remains ignored.
2. In some others, following initial enthusiastic action, interest is declining and sustainability is emerging as a major concern.
3. There is the risk of a decline in the interest to IDD control by donor agencies.

Overview of the problem and status of programmes (F. Delange)

A review was presented of the current status of IDD and its control on a global basis. Massive implementation of USI programmes was reported along with concrete examples of country programmes in, Asia, Africa, Europe and the Americas. Although elimination of IDD has not yet been achieved in many countries, a spectacular trend towards the goal is obvious. Experiences in most countries, including in a few with unfavourable side effects to salt iodization, underline the absolute need for sustained and permanent monitoring. It was clear that at population level, the two main indicators of adequacy of iodine supplementation are the iodine content of salt and of urine. The need for additional data on the qualitative and quantitative improvement of the intellectual capacity of children following correction of iodine deficiency was stressed.

The discussion ended with a rapid review of key issues in the different regions. Particularly salient was the fragility of some national programmes which were previously well-established due to unexpected socio-economic and political events. Contrasting with the national successes in Peru and Bolivia, for example, recent failures in programmes were noticed in Brazil and Mexico. A similar or even more dramatic relapse of IDD has been observed in the former USSR after interruption of salt iodization programmes in 1991. Solid progress was reported from the Asian region.

Critical gaps and key issues

1. Sustainability. The ten key requirements for ensuring sustainability of country programmes were presented (see Annex 1).

In addition the discussion underlined the importance of additional points, including:

1. The movement of uniodized salt across the borders and the potential role of the World Trade Organization (WTO)
2. The need for the visibility of the commitment of national governments linked to the efforts of the international community.
3. The issue of IDD elimination as a human right and the essential role of consumer demand.

2. Databases. A review of the presently available databases was performed (WHO, UNICEF, ICCIDD, MI, IAEA). The discussion agreed that there is a need for improving the co-ordination between these different databases and for improving the access to these databases through the web.

3. Kits to measure iodine in salt. Several countries, including Indonesia, Bangladesh, Thailand, Ecuador, Sri Lanka, China, and India, have developed their own kits which have been useful for qualitative evaluation of iodine ins alt at household level. MI reported recent developments in the production of a semi-quantative, simplified, portable titration kit, testing iodine in salt in a liquid phase. This kit has been successfully tested in Ecuador, India, and Ghana. It should be rapidly available on a large scale, based on collaboration between UNICEF Copenhagen and MI.

4.. Kits to measure iodine in urine. The availability of two simplified semi-quantitative analytical methods of measure of iodine in urine samples were reported. a) Method developed by MERCK Darmstadt, Germany, and b) Method developed by ICCIDD (Dr John Dunn).

These new methods should be available quite soon and increase the availability and ease of measurement of urinary iodine in the field.

Reports from agencies

Reports were given the UN organizations, the bilateral cooperation agencies and NGOs on their own specific activities.

Conclusions and recommendations

The working group recognized that iodine deficiency continues to be the single most common cause of preventable retardation.

Major efforts have been made by governments and people of the affected countries with major international support. Major progress has been achieved in the implementation of preventive programmes by universal salt iodination.

In spite of this progress, programmes might be fragile and vulnerable due to lack of commitment and vigilance and to political and socio-economic factors.
Consequently, monitoring and quality assurance become major issues.

Recommendations:  (a = governments, b = agencies, c = ACC/SCN)

• To continue advocacy and awareness raising at consumer, national and international levels. (a,b,c)
• To improve prevalence of iodized salt consumption, especially in hard to reach areas, where if necessary iodine supplementation programmes can be temporarily implemented. (a,b)
• To ensure sustainability of the preventive programmes. (a,b)
• To develop and institutionalized monitoring systems achievable at low cost by the national authorities. This includes the availability as rapidly as possible of simplified, qualitative and semi-quantitative test kits for measuring iodine in salt and urine. (a,b,c)
• To support technical and operational research in the field of monitoring, particularly with the assistance of ICCIDD, MI, and others. (b)
• To maintain funding of ongoing by governments and international agencies. (a, b, c)
• To improve salt quality. (a, b)
• To ensure affordable supply of iodine. (a, b, c)
• To improve collaboration between the agencies for the production of joint databases easily accessible on Internet. (a, b, c)