Network E-Bulletin
Volume 2 Issue 1, January 2006

Welcome to the Electronic Bulletin from the Network for Sustained Elimination of Iodine Deficiency.

The current Bulletin includes:

1. Are the MDGs well known outside the development community?

The MDGs are familiar to those working in international development, but little-known among the public. A survey conducted for the European Commission found that 88 percent of respondents in 25 European countries had never heard of the MDGs.  In addition, a 2004 OECD study concluded that, despite high-level discussions, "debate and awareness about the MDGs has not trickled down to public opinion.without the pressure which comes from public accountability, these commitments are less likely to be achieved." 

The World Bank's Data Group and National Geographic have undertaken a partnership to raise awareness of the  Millennium Development Goals  (MDGs) by producing and disseminating a large-format, full-color wall map highlighting progress toward the goals. The map, entitled A Global Agenda to End Poverty , is an informative tool to increase understanding of the MDGs among all audiences. It has a special focus on educating secondary school students about the substance of the MDGs and what is needed to meet them. Features of the map help to raise awareness of the MDGs. For more information about the map please visits http://www.worldbankinfoshop.org .

2. Nune Mangasaryan : New Senior Advisor for Nutrition and Child Growth & Development, Nutrition Unit, UNICEF NY

UNICEF recently announced the appointment of Dr. Nune Mangasaryan as a Senior Advisor for Child Nutrition and Growth & Development, in the Nutrition Section of UNICEF Headquarters in New York (effective February 2006). Her field of work will include Complementary Feeding, Growth Monitoring and Promotion, Food Fortification, and other nutrition issues contributing to Child Growth and Development.

Prior to this appointment, Dr Mangasaryan served as a Fortification Officer in the Nutrition Section at NYHQ, as well as Child Survival and Development Officer and Health/Nutrition Officer in the CEE/CIS Region. Nune Mangasaryan is a medical doctor and a public health professional. She has started her public health career with the position at the World Bank programme, and held several leadership positions in the Armenian Ministry of Health and National Institute of Health, including the position of Deputy Minister of Health.

Her contact information at the UNICEF Nutrition Section is
+ 1 212 326 71 59, E-mail: nmangasaryan@unicef.org

3. Update from Micronutrient Initiative: Rehabilitation of Salt Plants to accelerate salt iodization in Sri Lanka.

As part of the post-tsunami initiatives, the MI Asia just signed a memorandum of understanding with the government of Sri Lanka for a project amount of CAD 779,000.00. The project was initiated in collaboration with the local ICCIDD representative.

During the project launching, the Healthcare and Nutrition Minister Nimal Siripala de Silva on Friday said that he was disappointed over the consuming of non-iodized salt by a large percentage of people in the country due to lack of understanding on the risk of brain damages and other related disorders. In an interview with the local newspaper, Sunday Observer, Minister de Silva said that from the huge bulk of salt, currently produced by large and small scale salt manufacturers in Sri Lanka , only 30 per cent accurately maintains the accepted iodization standards. The Minister is also of the view that some salt manufacturers are in the habit of mixing colours in their manufactured salt and deceive consumers, saying that they are properly manufactured according to the accepted standards.

Referring to a recently conducted program by the Health care and Nutrition Ministry in Colombo to provide assistance to countrywide salt producers to iodise the salt they manufacture, Minister Silva thanked the International Council for Control of Iodine Deficiency (ICCIDD) and the Micronutrient Initiative (Asia) for granting a sum of Rs. 80 million to modernize the Hambantota and Puttalam salterns. It is reported that under this novel program, these two organizations are expected to provide technical assistance and the know-how to these two major salt manufacturers in order to produce at least 75,000 metric tons of iodized salt which is the national requirement of the country.

Minister Silva further said that as the country was not self-sufficient in salt, around 10,000 metric tonnes were being imported from India annually and the health authorities had already been directed to make a thorough investigation into the iodization standards of such imported salt.

Source: Micronutrient Initiative Asia Branch and Sunday Observer February 5, 2006 . Please visit http://www.sundayobserver.lk/2006/02/05/new24.html for more information about the initiative.

4. Update from ICCIDD

The ICCIDD Regional Coordinator for Africa , Prof. D. Lantum recently assessed the urinary iodine laboratory of the Tanzania Food and Nutrition Centre (TFNC) as part of monitoring and evaluation of the national Universal Salt Iodization and Iodine Deficiency Disorders Programmes ( USI /IDD). The findings are as follow:

•  TFNC has the necessary technical equipment and capacity to analyze 500-750 samples per day and therefore it can accelerate the urinary iodine assessment for the National Surveys.

•  The urinary iodine assessed by TFNC meets international standards and it inter-calibrated with CDC Atlanta and other world laboratories.

Based on these findings, ICCIDD recommends that TFNC can be utilized by other countries in East, Central and Southern Africa Region to accelerate USI /IDD monitoring and reporting.

5. Second Regional Meeting of Salt Producers in Central Asia and Mongolia: 22-24 November 2005, Tashkent, Uzbekistan

Representatives from salt production companies and Salt Producer Associations of Kazakhstan, Kyrgyz Republic , Mongolia , Tajikistan and Uzbekistan , met in Tashkent , on November 22-24 to discuss progress and the remaining urgency to reach sustainable quality salt iodization in Central Asia and Mongolia ( Network E-Bulletin, November 2005 ). The meeting was organized by Asian Development Bank, United Nations Children Fund and Kazakhstan Academy of Nutrition as part of the Sustainable Food Fortification in Central Asia and Mongolia project.

The participants of the meeting confirmed their supports to the goal of universal salt iodization ( USI ) in order to protect newborns from brain damage and reduce national economic loss, and agreed on the following actions:

a. Upholding the principle that salt production companies are responsible for achieving USI by ensuring:
•  ongoing improvements in quality iodized salt production;
•  promotion of iodized salt to the customers and the public;
•  un-interrupted adequate potassium iodate supplies, requesting UNICEF assistance where appropriate.

b. Strengthen the authority of the Salt Producer Associations in their collaboration as full partner in national salt iodization programs in each country by:
•  promoting membership by all salt production companies in the country;
•  membership of the Chairpersons in national Food Fortification Alliances;
•  engagement by the Associations as a full participant in the processes of regulation/legislation.

c. Strengthen the collaboration of Salt Producer Associations with the Governments and other national partners by:
•  facilitation of cross-border trade and reduction of transport costs, tariffs and value-add taxes;
•  improving border control against illegal imports and exports of non-iodized salt;
•  continuous improvements of quality monitoring systems;
•  regular reporting to the Food Fortification Alliance about the status of iodized salt supplies and submit proposals on how to improve the supply.

A report of the meeting is now available at http://www.iodinenetwork.net . For more information about the project please visit http://caffproject.net/index.html .

6. Global Report on Birth Defects: The Hidden Toll of Dying and Disabled Children.

Every year about 8 million children are born with a serious birth defect of genetic or partially genetic origin, according to a new report from the March of Dimes Global Report on Birth Defects. The report reveals that at least 3.3 million children less than 5 years of age die annually because of serious birth defects, defined as any serious abnormality of structure or function. An estimated 3.2 million of those who survive may be mentally and physically disabled for life. Birth defects are a global problem, but their impact is particularly severe in middle- and low-income countries where more than 94 percent of births with serious defects and 95 percent of the deaths of these children occur, the report finds. Both high prevalence rates and larger numbers of births contribute to the differences between low- and middle-income countries and those with higher incomes.

The database prepared for the report details the prevalence rates and the numbers of affected births in 193 countries. The data provide broad comparison of specific birth defects across regions and among countries of different income level. Worldwide, the birth prevalence of all genetic birth defects combined range from a high of 82 per 1,000 live births in low-income regions to a low of 39.7 per 1,000 live births in high-income regions. The data provided in the report are considered an essential addition to the extensive worldwide effort to reduce infant and child mortality to meet one of the United Nations Millennium Development Goals for 2015. By the beginning of 2004, efforts to meet this goal fell far below U.N. projections. Data in the March of Dimes report make a strong argument for recognizing and addressing the significant contribution of birth defects to infant and childhood mortality if the U.N. goal is to be achieved.

For more information, visit the March of Dimes Web site at http://www.marchofdimes.com/globalprograms

7. Goitre and iodine deficiency in Afghanistan: a case-control study.
O Oberlin, E Plantin-Carrenard, O Rigal, and C Wilkinson

Br J Nutr, January 1, 2006 ; 95(1): 196-203.   Iodine deficiency is the leading cause of preventable mental retardation. A number of surveys in Afghanistan show goitre prevalence rates more than 20% amongst children and women. Access to iodized salt remains low, with disparate coverage by region, despite the recent implementation of a national salt iodization programme. The objectives were to identify whether the presence of goitre is a satisfactory marker of I deficiency and to examine the relationship between goitre and thyroid function. A case-control study was carried out in children and women of childbearing age, stratified on the presence of goitre. Adequate levels of urinary I were observed in 6.8 % of all the subjects, and amongst the subjects without goitre, this figure was only 9%. The presence of goitre was significantly associated with severe urinary I deficiency; however, the difference between the cases and controls was not as great as expected. An association between the presence of goitre and elevated thyroid-stimulating hormone ( TSH ) levels was observed, but 14% of the children without palpable goitre also showed abnormal TSH levels.Given that the majority of subjects showed some degree of I deficiency and that children without goitre may have elevated TSH levels, the absence of goitre is an insufficient indicator to determine adequate I status. The risk of subsequent development of goitre, in the currently non-goitre population, is elevated. This suggests that short-term I supplementation should be considered independently of the presence of goitre or urinary I level, until the access to and consumption of iodized salt is generalized.  

8. The effectiveness of a 40-year long iodine prophylaxis in endemic goitre region of Grobnik, Croatia.

Z Crncevic-Orlic, A Ruzic, K Rajkovic, and M Kapovic Coll Antropol, December 1, 2005 ; 29(2): 509-13.   The region of Grobnik, in the north west of Croatia , 15 km away from the Adriatic coast and 400 meters above the sea level, used to be known as a centre of endemic goitre. Iodine prophylaxis of 10 mg KJ added per kilo salt started in Croatia during the year 1953 and it was increased to 25 mg KJ per kilo in 1996. During 1961, the prevalence of goitre among Grobnik school children was 63%, while in the adult population it was 34%. In 1981, 18% of goitrous school children and 11% of goitrous adults were found in the same region, which shows the fall in goitre prevalence in the twenty-year period, from a severe to a mild one. The aim of this study was to estimate the effectiveness of iodine prophylaxis in goitre eradication and to compare the obtained results to those found in the same region 20 and 40 years ago, namely, in 1961 and 1981. The research was conducted in 2001. We examined 472 Grobnik inhabitants, 378 children (196 girls and 182 boys, aged 7-15 years) and 94 adults. Regarding their size thyroid glands were graded according to WHO and PAHO classification. Data regarding lifestyles and health conditions were collected by individual and family questionnaires. The prevalence of goitre in 2001 was 6.6% in school children and 6.4% in adults. In relation to 1981, we found a statistically significant fall of goitre in school children at the level of p < 0.01 (chi2 = 23.65), but the prevalence change was not statistically significant in adults (p > 0.01, chi2 = 1.419). The frequency of thyroid gland hereditary diseases in native inhabitants was high, 11.7%. There were no statistically significant differences in the prevalence of goitre or thyroid hereditary diseases between groups of native and newcomers' children. According to our results, in the year 2001 the area of Grobnik was still was a region of a mildly expressed endemic goitre. This study presents final results of a 40-year long follow up of endemic goitre eradication, demonstrating the long-term effectiveness of iodine prophylaxis.    




9. Iodine supplementation improves cognition in iodine-deficient schoolchildren in Albania : a randomized, controlled, double-blind study.
Zimmermann MB , Connolly K , Bozo M , Bridson J , Rohner F , Grimci L .

Am J Clin Nutr. 2006 Jan;83(1):108-14.
BACKGROUND: Iodine is required for the production of thyroid hormones, which are necessary for normal brain development and cognition. Although several randomized trials examined the effect of iodine supplementation on cognitive performance in schoolchildren, the results were equivocal. OBJECTIVE: We aimed to ascertain whether providing iodized oil to iodine-deficient children would affect their cognitive and motor performance. DESIGN: In a double-blind intervention trial, 10-12-y-old children (n = 310) in primary schools in rural southeastern Albania were randomly assigned to receive 400 mg I (as oral iodized oil) or placebo. We measured urinary iodine (UI), thyroid-stimulating hormone (TSH), and total thyroxine (TT4) concentrations and thyroid gland volume (by ultrasound). The children were given a battery of 7 cognitive and motor tests, which included measures of information processing, working memory, visual problem solving, visual search, and fine motor skills. Thyroid ultrasound and the biochemical and psychological tests were repeated after 24 wk. RESULTS: At baseline, the children's median UI concentration was 43 microg/L; 87% were goitrous, and nearly one-third had low concentrations of circulating TT4. Treatment with iodine markedly improved iodine and thyroid status: at 24 wk, median UI in the treated group was 172 microg/L, mean TT4 was approximately 40% higher, and the prevalence of hypothyroxinemia was < 1%. In the placebo group after the intervention, these variables did not differ significantly from baseline. Compared with placebo, iodine treatment significantly improved performance on 4 of 7 tests: rapid target marking, symbol search, rapid object naming, and Raven's Coloured Progressive Matrices (P < 0.0001). CONCLUSION: Information processing, fine motor skills, and visual problem solving are improved by iodine repletion in moderately iodine-deficient schoolchildren.

The Iodine Network Bulletin  is prepared by the Network for Sustained Elimination of Iodine Deficiency and posted on its website, www.IodineNetwork.net.  If you have any information to share or queries please contact Dr. Juliawati Untoro, IDD Network Secretary at Info@IodineNetwork.net