OPTIMAL IODINE NUTRITION IN SOUTH-EAST ASIA

Iodine deficiency disorders (IDD) have long been recognisedas a public health problem in Th ailand and salt iodization eff orts have been in place since 1965. Recognizing that the international goal for the elimination of iodine defi ciency disorders is due to be achieved by the end of 2005, a request was made by the Director-General of the Department of Health of the Ministry of Health
for the Network for the Sustained Elimination of Iodine Deficiency(1) to undertake an external review of the Thai IDD programme. The Review of Progress towards Sustainable Elimination of Iodine Deficiency in Thailand took place from 18-28 April 2004. Parameters for the Review were based on internationally accepted indicators of iodine deficiency elimination programme success and sustainability
developed jointly by ICCIDD, UNICEF and WHO.2 Th ey presume that universal salt iodization (USI) will be the primary, if not the only, strategy for achieving sustainable elimination of iodine deficiency. Existing data on iodine deficiency indicate that urinary iodine levels have remained stagnant between 2000 and
2003 and that they are below acceptable levels. Goitre has also been used as an indicator of iodine defi ciency and annual school based surveys suggest it has been falling steadily. However, the low prevalence of goitre should not
be taken as an indication that Th ailand no longer has a problem of iodine defi ciency, as it is not a reliable indicator of current iodine status.
In 2003, MOPH data indicated that 51% of households consumed salt which was adequately iodized. Th is is well below the international target of at least 90% that is meant to be achieved by the end of 2005. Moreover, it suggests that over 34 million people are not consuming adequately iodized salt and approximately 375,000 newborns may not be protected from iodine defi ciency. All these indicators combine to suggest that implementation of the programme needs to be considerably accelerated and that some changes need to be made to the strategy in order to reach the goal of elimination of iodine defi ciency.
Overall, the Review team felt that political commitment to the elimination of iodine defi ciency appeared to be low and to have fallen from previous levels. Although there is definitely signifi cant dedication within the Nutrition Division of the MOH, commitment and understanding of the issues appears to be much lower at higher levels and in other departments within the MOH. Th ese low levels
of commitment may be due to the misperception that Th ailand no longer has an iodine defi ciency problem due to the low goitre rates. Th e Review team also learned that there is concern that universal salt iodization may not be a feasible strategy for Th ailand and this has led to a diversion of eff orts away from USI.
Th e International Review Team.
Although the IDD Control Project is run in theory by the National IDD Committee, in practice this Committee has not met for several years and there is minimal intersectoral collaboration for iodine defi ciency elimination or USI. In particular, at present, there is no involvement of the Ministry of Industry in working with salt producers to ensure that all salt is iodized, nor is there involvement of the Food and Drug Administration in monitoring salt iodization activities.

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