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Current Iodine Deficiency Disorder Situation
Population
Population: 2.05 million
Population growth rate: 0.41%
Population < 15 years: 22.4%
Birth rate: 13.35 per 1000
Life expectancy at birth: 74.26 years
Infant mortality: 12.54 per 1000
Prevalence of Goiter/ UIE
<198 mcg/L. Survey 2002 (n=1216) found median UI 198.5 mcg/L, 2.4% <50, 12%>300mcg/L.
Neonatal screening woth TSH initiated in 4/02, covers 30% of newborns, so far no excess of transient neonatal TSH elevations.
Ultrasound 2002 of 535 children, medians slightly enlarged, compatible with recently corrected iodine deficiency
Survey in September/October 2001 of 929 schoolchildren showed national median of 164.5 mcg/L.
In September 2000, median urinary iodine 154 mcg/L (range 96 (Debar)-207 (Negotino)). National median 117 mcg/L; 8 of 30 communities below 100 in 1996; follow-up in 1999 was also 117. Goiter prevalence was 18.7% by palpation, also increased prevalence by US (range 7.8-29%) in 1995-96 national survey of schoolchildren.
Study in 2001 of 382 pregnant women and 109 lactating women showed median urinary iodine of 140.4 mcg/L but 26% were below 100 mcg/L.
Iodized salt Coverage
Household iodized salt use: >80%
Salt Situation Analysis Production
100% of Salt Imported from Bulgaria , Greece , Bosnia , Egypt , Austria
In 2002 about 16400 tons for human consumption, some later exported.
Over 50 importers. About 60% is imported already iodized, checked at borders. Most of the remainder is iodized at one of two plants (Izvor in Skopje , Solbit in Bitola ).
Consumption
Roughly 10000 tons consumed in Macedonia , e stimated daily per capita salt consumption: 8.6 g. Survey in 2002 of 418 household samples brought by schoolchildren from 30 schools in 16 regions, found 65.5% were 20-30 ppm, 15% above 30 ppm, 19.5% below 20 ppm. Most of the 20% outside the required range were close.
Iodine Procurement and Utilization
Salt iodized with KIO3 at 20-30 ppm as iodine
Universal Salt Iodization Program
Information, Education, Communication (IEC) Activities
A team of external experts visited in May, 2003, at the request of the government and with the support of the Network for Sustained Elimination of Iodine Deficiency, including ICCIDD, WHO, and Unicef. The team concluded the country is currently iodine sufficient, and commended the vigorous work of the National Committee. Recommendations included continued monitoring of iodine nutrition and iodized salt, further education, and extension of neonatal screening.
Legislation
- Legislation: Yes, for human and food industry use
- Legislation for Animals: Yes
- Year Enacted: 1999
Program Monitoring and Evaluation
A strong and active national coordinating committee for IDD control has existed since 1997, containing representatives of the Ministries of Health, Education, Agriculture, thyroidologists, nutritionists, salt producers, journalists, consumers groups, and representatives of local WHO and UNICEF offices. Members appointed by Ministry of Health. Has own constitution, president, meets often. Active in educational efforts, especially for consumers.
Institute of Pathophysiology and Nuclear Medicine, Skopje , has conducted careful surveys with palpation, ultrasound, UI, and has capacity to monitor on ongoing basis.
Salt samples collected at import, analysed in government labs, reported within 24 hours. MOH has 104 inspectors, in addition to 160 for Ministry of Economy and Trade. Controls at border and at distribution. Importers must register in advance for importatnio and include an invoice specifying quantity and quality, and include a laboratory certificate from the country of origin. Of 825 spot controls in 2002, only 20 did not meet specifications.
Other Interventions
Supplements of 100 mcg daily as KI are recommended during pregnancy and lactation.
Key Lessons Learned
Challenges and Constraints
Future Plans for Sustained IDD Elimination
Sources:
External review of progress in F.Y. Republic of Macedonia towards sustainable optimal iodine nutrition: report of expert team, May 2003 (Unicef/WHO/ICCIDD)
IDD NL 18(4):54, 2002
IDD NL 17(4):53, 2001
IDD NL 16(4):55, 2000
IDD NL 12(4):59, 1996. |
