Assessment and perspectives of the iodized salt program in Lao PDR Universal Iodized salt program in Lao PDR: current situation, development and perspectives 25 – 26 JUNE 2015 Bounthom PHENGDY Director of Nutrition Center, Department of Hygiene and Health Promot Ministry of Health
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Assessment and perspectives of the iodized salt program in Lao PDR Universal Iodized salt program in Lao PDR: current situation, development and perspectives.
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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
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
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
Background
In 1995, then the Universal Salt iodization (USI) program was announced and implemented under the PM decree number 42
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
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?
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
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
Since 2005, Eradication of IDD from this country was discussed and planned
Getting to Zero of the IDD: Challenges for Lao PDR
School Survey 2013-2014
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.
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?
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?
10 Indicators to measure Progress for USI program achievement
1. Iodized salt coverage > 90% Urine iodine excretion