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Current Iodine Deficiency Disorder Situation
Population
Population: 4.39 million
Population growth rate: 1.12%
Population < 15 years: 18.3%
Birth rate: 12.8 per 1000
Life expectancy at birth:74.13 years
Infant mortality: 7.06 per 1000
Prevalence of Goiter/ UIE
140 mcg/L. A 2002 survey of 927 schoolchildren in the four major geographical regions. Thyroid volumes by ultrasound in normal range for iodine sufficiency. Median urinary iodine excretion 140 mcg/L (range 131 to 146 mcg/L for four regions).
TSH screening of newborns (2001) show 5.2% above 5 mU/L, and an incidence of congenital hypothyroidism of 1:4244, similar to iodine sufficient neonates elsewhere.
History of goiter prevalence in the mid 20th century ranging from 80% in Slavonia and Lika to 46% in Zagreb . Cretins were found in Rude. By 1990, endemic goiter considered to be eliminated, through iodized salt, but studies in mid 90's showed goiter prevalence of 8-35% among schoolchildren, and 66-83% had urinary iodines < 100 mcg/L. 1997 data showed 22-52% of schoolchildren had urinary iodine excretion < 59 mcg/L, and 30-59% < 100 mcg/L.
Iodized salt Coverage
Household iodized salt use: 100%
Salt Situation Analysis Production
Salt is produced locally. In 2002, the mean value in Croatian salt plants was 25.9 ppm iodine. For imported salt, the value was 20.9 ppm. Salt samples from households in 1999 showed that 14% had < 20 mg ppm.
Consumption
Household consumption is 100%, and coverage includes humans, animals, and the food industry.
Iodine Procurement and Utilization
KI at 20-30ppm (standard of 25 ppm changed from 10 ppm in 10/96)
Universal Salt Iodization Program
Information, Education, Communication (IEC) Activities
Legislation
- Yes, including for animals
- Year Enacted: 1953
- Latest Revision: 1996
Program Monitoring and Evaluation
National Committee for Endemic Goiter and Iodine Deficiency Control, advisory to Minister of Health since 1992, consists of MOH representatives, thyroidologists, National Institute of Public Health, nutritionists, salt producers, and veterinarians. Stable national committee with representation from public and private sector.
Salt content is monitored at the plants, and in surveys. Nutritional surveys are conducted periodically, the most recent in 2002. Urinary iodine measurement is available, as is thyroid size by ultrasound.
Other Interventions
None
Key Lessons Learned
Challenges and Constraints
Future Plans for Sustained IDD Elimination
Sources:
IDD NL 18(4):52, 2002
IDD NL 17(4):55, 2001
IDD NL 13(1):4, 1997
IDD NL 12(4):66, 1996
IDD NL 9(1):5, 1993
[Additional information from Dr. Zvonko Kusic, ICCIDD National Representative, 2002]
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