IYOT

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TURKEY IODINE DEFICIENCY DISORDERS AND SALT
IODISATION PROGRAMME
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SITUATION IODINE
DEFICIENCY DISORDERS TURKEY
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IDD SITUATION ENDEMIC GOITRE IN TURKEY
TOTAL THYROID HYPERPLASIA
30.5 (When it is evaluated with all grades)2.
GRADE PREVALANCE 4.33. GRADE
PREVALANCE 1.84. GRADE PREVALANCE
0.5 BIG GOITRE PREVALANCE
2.4(TOTAL OF 3. VE 4. LEVELS) THYROID NODULE
PREVALANCE 2.8
? Prof. Urgancioglu, Hatemi and his friends 1980
- 1987 WHO indicators, 73.757 persons
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SCREENED REGIONS (1997-1999 )
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IODINE SITUATION AND GOITRE PREVALANCE OF SCHOOL
AGED CHILDREN IN HIGH RISK PROVINCES 1997-1999

• RESULTS
• GOITRE PREVALENCE FOR CHILDREN IS 31.8
• 30 AND HIGHER PROVINCES ARE
• KASTAMONU, BAYBURT, TRABZON, ERZURUM
• MALATYA, SAMSUN, EDIRNE, AYDIN , KAYSERI
• THROUGH THE URINARY IODINE MEASUREMENTS 14
  PROVINCES ARE MIDDLE/HIGH, 6 PROVINCES HAVE LOW
  LEVEL OF IODINE DEFICIENCIES.

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IODINE DEFICIENCIES WITH SONOGRAPHIC
PREVALANCE PROVINCES AT RISK 1997-1999
Çorum
Bolu
Burdur
HIGH (9), MIDDLE (4), LOW(7)
5-19.9 Low level 20-29.9 Middle level 30
High level
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IODINE SITUATION AND GOITRE PREVALANCE IN 20
PROVINCES SCHOOL AGED CHILDREN
RESULTS GOITRE PREVELANCE OF SCHOOL CHILDREN IN
20 PROVINCES IS 31.8 . WITH GOITRE PREVALANCE
THERE ARE 9 PROVINCES HIGHER THAN 30 (
KASTAMONU, BAYBURT, TRABZON, ERZURUM MALATYA,
SAMSUN, EDIRNE, AYDIN VE KAYSERI)
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IODINE DEFICIENCIES WITH URINARY IODINE
MEASUREMENTS PROVINCES AT RISK 1997-1999
Çorum
Bolu
Burdur
HIGH (3), MIDDLE(11), LOW(6)
50-100 mcg/lt Low level 20-49 mcg/lt Middle
level 0-19 mcg/lt High level
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• LEGISLATION SITUATION
• TURKISH FOOD CODEX
• TABLE SALT CIRCULAR
• (09 JULY 1998 NUMBER 23397 )
• EDIBLE SALT
• A) Table salt (directly goes to consumers,
  fortified with iodine, refined or unrefined
  edible salt )
• B) Salt used in food Industry
• INTO TABLE SALTS
• 50-70 mg/kg. POTASSIUM IODIDE
• 25-40 mg/kg. POTASSIUM IODATE MUST BE ADDED.
• SALT USED IN FOOD INDUSTRY NEED NOT BE FORTIFIED

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IODISED SALT HOUSEHOLD CONSUMPTION RATES BY
REGIONS-1995
23.6
15.6
18.3
18.6
16.5
URBAN23.6 RURAL 9.6
AVERAGE 18.2
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IODISED SALT CONSUMPTION SURVEY 2002
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URBAN/VILLAGE Iodised Salt Consumption -2002 (
)
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IODISED SALT CONSUMPTION IN PROVINCES- 2002
 
 
 
Siirt 0 Kirsehir 5.7 Hakkari 8 Batman 12
 
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IODISED SALT CONSUMPTION OF HOUSEHOLDS BY
REGIONS-2002
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IODISED OIL CAPSULE SURVEY IN KAYSERI
PROVINCE 2001-2002
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(No Transcript)
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Urinary Iodine Level in Kapuzbasi Village
-2002(6 15 Years old 91 children)
Iyotlu tuz kullanimindan önce
Iyotlu tuz kullanimindan sonra
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PROBLEMS

• 1-High prevalance rate of iodine deficiency
  disorders
• -total goiter rate 30,5 (1987)
• -school children goiter rate 31,8
  (at risk provinces,
  1997-1999 )
• 2-- While consumption of iodised salt have been
  increasing still a sizeable segment of population
  is not using iodised salt due to lack of
  awareness of the population
• 3- High number of small producers of non
  iodized salt (around 200)
• 4- Difference between the prices of iodized and
  non iodized salt for food industry

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TURKEY IODINE DEFICIENCY DISORDERS AND SALT
IODISATION PROGRAMME

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GOAL OF THE PROGRAMME

• ELIMINATION OF IDD IN TURKEY

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MPO OBJECTIVES

• Elimination of IDD of children until 2005
• Reduction of IDD of adults 1/3 until 2005
• To iodise 100 of table salt in the country
• Raise3 awareness of all related organizations,
  salt producersand the community on the importance
  of iodisied salt
• To establish effective monitoring and
  evaluation system for the whole programme in
  Turkey

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IMPLEMENTATION ON 1994-2002

• 1. TRAINING
• 2. ON LEGISLATION
• 3.WITH SALT PRODUCERS ON HOW TO IODISE THE SALT
• 4.DEVELOPMENT OF MATERIALS
• 5-MONITORING AND EVALUATION

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1. TRAINING ACTIVITIES

• FOR HEALTH PERSONNEL ( 81 PROVINCES)
• FOR MINISTRY OF AGRICULTURE PERSONNEL (81
  PROVINCES)
• SALT PRODUCERS (220 FACTORIES)
• MARKET REPRESENTATIVES
• NGOS
• MUNICIPALITIES
• PROVINCIAL DIRECTORS
• UNIVERSITIES

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3. ACTIVITIES WITH SALT PRODUCERS FOR SALT
IODISATION IMPLEMENTATION

• Providing iodisation machines and on the job
  training for usage,
• Providing Potasium Iodate to the producers,
• Training of salt producers on how to produce
  iodised salt ,

• 4 Firma
• 15 Firma (KI)
• 7 Firma (KIO3)

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4. DEVELOPMENT OF MATERIALS

• For health personnel and community
• Audio and visual materials training materials
  developed

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NATIONAL MONITORING LEVELS OF THE PROGRAMME

A. MONITORING OF IODISATION LEVEL IN SALT B.
MONITORING IODISATION IN URINARY LEVEL OF THE
PEOPLE C. CHECKINGS AT THE FIELD LEVEL
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WHO IS RESPONSIBLE FROM WHICH MONITORING ?
A ) MONITORING OF IODISATION LEVEL IN THE SALT
1.QUALITATIVE (WITH TEST KITS (KIO3 and
KI)) 2.QUANTITATIVE ANALYSIS (IN THE LABAROTORIES
RANDOM ANALYSIS IN 3. MONTH
38 PROVINCIAL AGRICULTURE LABORATORIES
MINISTRY OF AGRICULTURE
PRODUCTION STAGE

• 81 PROVINCIAL PUBLIC HEALTH LABORATORIES
• 1 REFIK SAYDAM
• GENERAL HYGIENE CENTRAL ADMIN.
• 7 REGION R.S.
• 8 REGION R.S.

FROM PRODCUTION TO CONSUMPTION
MINISTRY OF HEALTH
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• B) IODINE CONSUMPTION LEVEL IN URINARY LEVEL OF
  PERSONS
• WITH SURVEYS
• A) Goitre prevelance surveys,
• B) Iodine level in urinary,
• C) Neonatal TSH,
• 2. HOUSEHOLD IODISED SALT CONSUMPTION
• ( Cluster survey )

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(No Transcript)
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PRODUCTION OF IODISED AND NON-IODISED SALT
SITUATION ( Kg.)
22 ÜRETICIDEN ALINAN VERILER
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OBJECTIVES

• To encourge and support the small salt producers
  in all regions to produce iodised salt in order
  to expand the consumption of iodised table salt
  in rural areas
• To ensure the use of potassium iodate instead of
  iodide in iodised salts at the national level in
  order to introduce a standard in quality as well
  as monitoring
• To establish quality control laboratories, fully
  equipped with the necessary tools and trained
  personnel, that can conduct iodine analysis in
  the 22 centres identified for the purposes of
  monitoring-assessment activities on the national
  scale by the end of 2001
• To promote nationwide use of iodised salt through
  community leaders, mass media, schools, the
  military, community groups etc
• To ensure that the consumption of iodised salt
  reaches 95 by the year 2005.
• To conduct cross-sectional surveys within the
  framework of monitoring activities with the aim
  of providing guidance for the programme
  activities.

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STRATEGIES

• Increase demand for iodized salt in the community
  through innovative approaches in advocacy and
  social marketing
• Strengthen collaboration with the school system
  as channel for promotion of iodized salt
• Intensify support to salt producers

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THE PROGRAMMEACTIVITIES

• TRAINING
• Health Personnel (Health Managers of 81
  Provinces )
• Representatives of Provincial Agriculture
  Directors
• Salt Producers
• Market representatives, teachers
• Production of training materials
• ADVOCACY AND SOCIAL MOBILIZATION
• Through the school system
• - Training of teacher trainers, students
• -Development and production of education material
• -Training of Community leaders, military, media
  etc.

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THE PROGRAMMEACTIVITIES

• IODISATION OF SALT
• On the job training of salt producers
• Legislation change
• Ttechnical material support
• Potassium iodate support
• MONITORING AND EVALUATION
• Situation Analysis, Household consumption and
  School based surveys
• Establishment of monitoring system
• Annual Evaluation meetings