Legislation on IDD Control as a Part of Effective Preventive Strategies in Bulgaria

1
Legislation on IDD Control as a Part of
Effective Preventive Strategies in Bulgaria

• L. Ivanova, Tz. Timtcheva
• National Center of Hygiene, Medical Ecology and
  Nutrition Ministry of Health
• Sofia, Bulgaria

2
Bulgaria is a country with 1/3 of the territory
being endemic

• For the first time a Regulation on IDD
  Prevention was introduced in 1958.
• The strategies were focused on endemic regions
  only.
• Salt iodization and iodine supplementation of
  target groups (children, pregnant women) was
  implemented
• The outcome was reduction of goitre from 55.9 to
  12.1 in the following 15 years.

3
In 1994 the new Legislation was introduced based
on

• Lessons learned by the previous National
  Regulation
• IDD situation in Bulgaria
• International Recommendations (ICCIDD/UNICEF/WHO)

4
National Legislation on IDD Control

• Government Decree 96/17.05.1994 of the Council of
  Ministers (State Gazette 43/27.05.1994)
• Order N RD-09-244/14.06.1994. of the Chief State
  Sanitary Inspector of the Republic of Bulgaria
  (State Gazette 52/26.06.1994)
• Amendment N 7/01.07.1996 to Bulgarian State
  Standard 628-77 Table salt
• Ordinance for Requirements to the composition and
  characteristics of food grade salt (State Gazette
  11/06.02.12001)

5
Government Decree 96/17.05.1994 was developed
to set the foundational of the IDD Elimination
Program Main Principles/Activities

• Universal salt iodization covering all salt for
  human consumption, food industry and cattle
  breeding
• Additional prophylaxis of risk groups in the
  endemic regions with iodine tablets
• Trade policy stimulating the import of iodized
  table salt
• Creation of national IDD monitoring system.

6
Government Decree 96/17.05.1994 of the IDD
Elimination Program Main Principles/Activities

• Implementation of a program for public education
  and social mobilization on the importance of IDD
  and the consumption of iodized salt
• Establishment of an effective functional
  Interagency IDD Council of Ministers, under the
  Minister of Health (with representatives of
  Ministry of Industry, Trade, Finances,
  Agriculture, Committee of Standardization)

7
Order N RD-09-244/14.06.1994. of the Chief State
Sanitary Inspector of the Republic of Bulgaria

• Prohibition of placing non-iodized table salt at
  the market
• Definition of a system and methods for control of
  the quality of iodized salt
• Creation of a database for recording results of
  iodized salt at the market through the Ministry
  of Health

8
Amendment N 7/01.07.1996 to Bulgarian State
Standard 628-77 Table salt

• Salt iodization with potassium iodate at level
  28-55 ppm (19.6-32 ppm I).

9
Ordinance for Requirements to the composition
and characteristics of food grade salt (State
Gazette 11/06.02.2001)

• Sets requirements to the composition and
  characteristics of food grade salt for direct
  consumption, catering and food manufacture.

10
Ordinance for Requirements to the composition and
characteristics of food grade salt (State
Gazette 11/06.02.12001)

• Definition For food purposes only salt iodized
  with KJO3 at level 28-55 ppm must be used
• Expiry time, not longer than 12 months after
  iodization
• Specification of storage condition (clean, closed
  and dry rooms)
• Specification of Package material
• Labeling (Ordinance for food labeling, Decree
  136/2000(SG, 62/2000)

11
Ordinance for Requirements to the composition
and characteristics of food grade salt (State
Gazette 11/06.02.2001)

• Laboratory control Sampling procedure (Ordinance
  2/1997, SG 10/97) Methods-Bulgarian State
  Standard methods-8840-71, BSS 2/92),

12
As a result of effective implementation of
enacted legislationNational Survey on IDD
Situation in Bulgaria - Spring 2003
13
National Survey on IDD Situation in Bulgaria
-Spring 2003

• Urinary iodine
• Median (mg/L) 198.0
• Proportion below 100 mg/L 6.9
• Proportion below 50 mg/L 0.8

14
National Survey on IDD Situation in Bulgaria
-Spring 2003

• Goitre grade (ultrasonography)
• Proportion above P97 (WHO, 1997) 4.3

15
Percentile distribution (P25, P50,P75) of ioduria
from schoolchildren for the period 1994-2003
16
(No Transcript)