|
Current Iodine Deficiency Disorder Situation
Population
Population: 37.1 million
Population growth rate: 2.73%
Population < 15 years: 44.2%
Birth rate: 37.2 per 1000
Life expectancy at birth: 57.3 years
Infant mortality: 67.1 per 1000
Prevalence of Goiter/ UIE
Median urinary iodine: <100mcg/L .
A 1997 survey of 7 zones gave the following median UI, in mcg/L: Darfur , 20; Upper Nile , 40; Kordofan, 48; C entral, 70; Northern, 90; Khartoum , 96; Eastern, 98.
A 2000 survey of 984 children in the south showed median UI of 100 mcg/L.
Several goiter prevalence surveys conducted by the Government identified regions at high risk of IDD, including: Darfur State (TGR = 87%), surveyed were 5,885 <18 and female adults <45. C entral Region (TGR = 78%) and other regions with moderate goiter levels; Khartoum (TGR = 17%) and Port Sudan (TGR = 13%) National Goitre C ontrol Project established in 1989, now integrated into National Nutrition Program. Research study on water iodization in Kurdufan and Nuba Mountains found baseline TGR 69%, UI 15-20 mcg/L.
Iodized salt C overage
Household iodized salt use: 10%. A UNI C EF consultant described availability of iodized salt in the south. Most of the salt comes from Uganda ; coarse salt is preferred and appears well iodized by test kit. However, about 28% comes from the north and is not iodized (Locatelli-Rossi, 2000).
Salt Situation Analysis Production
There are 12 major private salt producers in the country, which produce around 180,000 tons of salt. The five largest produce 96% of the salt. Solar salt is produced at Port Sudan with very limited production of rock salt in Darfur and Khartoum . All salt is produced in the private sector, is not refined, and contains impurities. This requires it to be washed before iodization, so as to be pure enough to retain the iodine, and this is quite costly. Only one modern factory, produces 40,000 tons. Salt marketing is said to not be controlled. Very little salt reaches the far west of the country. UNI C EF recently donated 11 iodizing machines, but is not yet in operation, and also a semi-manual unit for Darfur state.
Small amount of salt imported in south from Uganda/Kenya.
Consumption
- Estimated daily per capita salt consumption: 10-20
- Estimated % of all salt consumed by people which is adequately iodized (household level): 10%: 40% in South; 5% in North
Iodine Procurement and Utilization
KIO3 at 50 ppm.
Universal Salt Iodization Program
Information, Education, Communication (IEC) Activities
Legislation
- Legislation: yes
- Legislation for Animals: no
- Year Enacted: 1994
Program Monitoring and Evaluation
Ministry of Health - National C ommittee for IDD C ontrol. Goiter surveys and urinary iodine concentration have been used in the past.
The IDD C ontrol program started in 1989 with support of Swedish Save the C hildren, UNI C EF, and USAID following many prevalence studies. The major activities of the program include: (a) prevalence surveys; (b) iodized oil distribution in hyperendemic areas; (c) laboratory monitoring (urinary iodine and TSH); (d) training; and (e) IE C .
A "National High Technical C ommittee" was formed which has now decided on iodized salt as the long-term control strategy rather than sugar. A plan of action for 1996/97 was submitted in continuation for the previous plans together with an MPO for the period 1996-2000 and is ready for donors.
Other Interventions
1,500,000 supplements to all children < 18 years and women under 45 years in Darfur State beginning in 1978. The number of doses reached 70% of the target population by 1990, 2 million doses of oil. In 1989 large-scale delivery of iodized oil was carried out in Darfur and reached 900,000 out of the 1.5 million target population in 6 months. Doses: oral - adult (400 mg), children (200 mg) / injectable - adult (1 ml), children (1/2 ml)
Efforts have been made to iodize and distribute sugar to small groups of families in Khartoum . There are two sugar factories, which could add iodide by spraying the sugar at the final stage. This has been discontinued. Water iodization research project with Rhodifuse in Kurdufan
Key Lessons Learned
Challenges and Constraints
Future Plans for Sustained IDD Elimination
Sources:
Dr. Izzeldin Hussein; private communication to I C C IDD, 2/2002
IDD NL 17(3):39, 2001
IDD NL 16(4):63, 2000
IDD NL 15(2):31, 1999
IDD NL 12(2):23, 1996
|
