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Current Iodine Deficiency Disorder Situation
Population
Population: 7.6 million
Population growth rate: -1.1%
Population < 15 years: 14.6%
Birth rate: 8.1 per 1000
Life expectancy at birth: 71.5 years
Infant mortality: 14.2 per 1000
Prevalence of Goiter/ UIE
Schoolchildren - 111.4 mcg/L (1996 national survey), 145 mcg/L (Sofia City, 2001) Report of 89.4% of samples < 100 mcg/L (F. Delange, 1991, small scale study; 86% of samples < 100 mcg/L, 43% < 50 mcg/L, 10% < 20 mcg/L (L. Ivanova, spring 1994, two endemic regions; 42.9% of samples < 100 mcg/L, 0.8% < 20 mcg/L (L. Ivanova, 1996, national survey); 23.3% of samples < 100 mcg/L, 0.6% < 20 mcg/L (L. Ivanova, 2001 Sofia City).
TSH neonatal screening 1993-2000 - neonatal hypothyroidism - 1:4000; neonatal TSH > 5 mU/L -9.2% (I. Stoeva, 2000).
In 1956, a first national survey of one million schoolchildren, aged 7-18 years revealed a goiter prevalence of 55.9% that was substantially reduced to 12% in the year 1974 after implementation of salt iodization and iodine supplementation in endemic areas. A 1988 national survey found 23% goiter in endemic areas. In 1994, a strategy of USI was implemented nationwide and supplementation with tablets of KJ of schoolchildren and pregnant women in endemic regions was started again. In 1998, a national survey of 8,444 schoolchildren, aged 7-11 years, revealed a TGR between 5% and 18% in some regions in South and West Bulgaria . In most areas the TGR decreased to 5%. In 2001 a survey on school-aged children in Sofia-city revealed a TGR per palpation - 14.8% and by ultrasonography above P97 - 2.8% (B. Lozanov, 2001).
Iodized salt Coverage
Household iodized salt use: > 90% (2001)
Salt Situation Analysis Production
- Percent Iodized Salt Available: Over 90%
- Percent of Salt Which is Imported: 60% (table salt)
- Salt Imported from: Belarus , Ukraine , Israel , Egypt
The country is sea salt producer and once improving the salt refining process the country will be able not only to satisfy local needs but also to export iodized salt.
Consumption
- Estimated daily per capita salt consumption: 10 g
- Estimated % of all salt consumed by people which is adequately iodized (household level): Over 60% (1999)
Iodine Procurement and Utilization
KI since 1958; KIO3 since 1994, 32 ppm KIO3 (28-55 ppm) = 20 ppm I
Universal Salt Iodization Program
Information, Education, Communication (IEC) Activities
Legislation
- Legislation: Yes, USI became mandatory for the whole country in 1994.
- Legislation for Animals: Yes, in progress
- Year Enacted: 1958
- Latest Revision: 1994
Program Monitoring and Evaluation
National Expert Committee for Control of IDD to Ministry of Health since 1991. Inter-sector coordination between Ministry of Health, Ministry of Industry, Committee of Standardization, Ministry of Trade.
Iodine nutrition by urinary iodine and thyroid size, palpation and ultrasonography.
Salt: Strict monitoring by government under the MOH, monthly activities on market level.
Other Interventions None
Key Lessons Learned
Challenges and Constraints
Future Plans for Sustained IDD Elimination National representative survey is needed in order to evaluate the iodine status. Planned for spring 2003.
Sources:
IDD NL 18(4):52, 2002
L. Ivanova, Report of the National Centre of Hygiene, Medical Ecology and Nutrition, 2001
B. Lozanov, I. Ivanova, et al. VII National Symposium on IDD, 2001, Endocrinologia, 3, 2001.
I. Stoeva, National Symposium on IDD, 2001, Endocrinologia, 3, 2001
Zv. Timcheva, Reports of the Ministry of Health, Bulgaria
IDD NL 9(1):5, February 1993
IDD NL 13(1):4, February 1997
E. McLoughney, UNICEF consultant report, 8/96. |
