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Current Iodine Deficiency Disorder Situation
Population
Population: 9.25 million
Population growth rate: 3.07%
Population < 15 years: 47.9%
Birth rate: 47.1/1000
Life expectancy at birth: 48.5years
Infant mortality: 95.7/1000
Prevalence of Goiter/ UIE
Median urinary iodine: 213 mcg/L (2003). National survey carried out at 33 sites in the 3 ecological zones, found national median UI 213.2 mcg/L, ranging from 29 to 405 mcg/L (total 333 samples). N'Djamena 369 mcg/L. Two sahelo-saharian sites were low (Biltine 29, Ouaddai 57 mcg/L). Overall 37% of samples >300 mcg/L, 16%<50 mcg/L. Goiter prevalence 5.5% (age6-12 y), and 9.5% (10-20 y). No cretins under 12 years old. 87% of urine thiocyanate >12.5 mg/L.
A national survey in 1993-1994 reported overall TGR 63%; Sahelian zone, 64%; Sudanese, 70%; Ndjamena , 25%. Cretinism was found in all areas.
In the same survey, national median UI was 29 mcg/L, and in above three zones, respectively, 37, 23, and 47 mcg/L.
In late 1996, a survey team visited Mailawo, 70 km southeast of N'Djamena and found a total goiter rate of 5.2% and a median urinary iodine of 143 mcg/L (site selected at random).
In a rural area, Mailao, median urinary iodine was 143 mcg/L and total goiter rate 5.2%.
Iodized salt Coverage
Household iodized salt use: 77% (2000)
Salt Situation Analysis Production
Likely all salt is imported. Selcam salt from Cameroon ; Dicon salt from Nigeria > 50 ppm, both sources are well iodized. Also, some salt is imported from Senegal , probably not iodized. Some also comes from Sudan , not iodized.
Consumption
- Estimated daily per capita salt consumption: no data
- Estimated % of all salt consumed by people which is adequately iodized (household level): 77%. The 2003 survey collected 1233 samples and tested by rapid test kit for iodine content. In sahelo-saharan zone, salt from 3 of 8 sites had not iodine (including Biltine and Ouaddai), others were 45%, 73%, 85%, 99%, and 99%. Overall, 24%<15ppm, 13%>100ppm, 45% 40-100ppm.
Iodine Procurement and Utilization
KIO3 but no data available (probably 100 ppm)
Universal Salt Iodization Program
Information, Education, Communication (IEC) Activities
A 1999 report (IDD NL 15(1):1, 1999) noted factors favoring sustainability included political commitment as indicated by legislation and its regular enforcement; existence of the National Nutrition Center with a chief of service in charge of micronutrient malnutrition; increased awareness from an effective education program; improved economic prospects for financing the IDD program, and a health database monitoring and reporting on IDD yearly.
Legislation
- Legislation: yes
- Legislation for Animals: yes
- Year Enacted: 1994, effective 7/95
Program Monitoring and Evaluation
A national IDD program exists, strengthening the National Nutrition Center and appointing a Chief of Service in charge of micronutrient malnutrition control. A national integrated multisectoral primary health committee coordinates activities of the National Center . Governmental orders and decrees mobilize customs officers and inspection teams to check salt at borders.
Urinary iodine was measured at the Cameroon IRLI lab in the 2003 survey. Salt is checked, extent and regularity not known.
The 2003 survey was carried out under direction of Dr. Ntambwe (ICCIDD Subregional Coordinator) with Unicef support, and the results presented to the government and many others. The government is reviewing the standards for iodine levels in salt, with a view towards lowering them, and is focusing on the area bordering Sudan , to see that salt entering from there is iodized.
Other Interventions
Iodized oil capsules were distributed extensively with the assistance of the European Union in most of the prefectures until iodized salt became readily available.
Key Lessons Learned
Challenges and Constraints
Problems were dependence on imported iodized salt, absence of facility for measuring urinary iodine; remote areas, particularly in the north.
Both cassava and millet (goitrogens) are dietary staples.
Future Plans for Sustained IDD Elimination
Sources:
T. Ntambwe, consultant's report, 9/03; D. Lantum annual report to ICCIDD for 2003
D. L. Lantum, direct communication (2/03)
IDD NL 15(1):1 (1999)
IDD NL 12(2):21 (1996)
Annual report to ICCIDD, D. Lantum, 1996.
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