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Progress Towards Optimum Iodine Nutrition in Turkmenistan
October, 2004
Dr. Chandrakant.S. Pandav, Professor and Head, Centre
for Community Medicine, AIIMS, New Delhi
Progress Towards Optimum Iodine Nutrition in Turkmenistan
• Ministry of Health and Medical Industry• State Concern “Turkmendokunkhimiya”• Ministry of Trade • Standard Agency “ Turkmenstandartlary”• State Custom• Food Industry Association• In collaboration with• UNICEF Turkmenistan and ICCIDD• (Mission supported by USAID)
Objectives
To provide an independent assessment of :
• The history and present situation of National Iodine Deficiency Disorders Elimination Program in Turkmenistan
• The ongoing national efforts toward optimum iodine nutrition, with special emphasis on universal salt iodization
• The progress made in elimination of Iodine Deficiency Disorders in Turkmenistan with special attention to sustainability
Team members - 1• National Counterparts:
• Mr. Annamurad Orazov – Deputy Head of the State Sanitary and Epidemiological Service
of MoH
• Mr. Annamyrat Nazarov - Head of Sanitary Department, State Sanitary and
Epidemiological Service
• Mr. Chary Nazarov – Director of MCH Centre named after Gurbansoltan-Eje
• Mr. Agamurad Akiev - Deputy Head of the Production Departnment of the State Concern
“Turkmendocunkhimiya”
• Mr. Annakurban Mollayev – Director of Guvlyduz Salt Plant
• Ms. Raisa Sukhova – Chief of Production and Laboratory Department of the Salt plant
Team members - 2• National Counterparts:
• Mr. Kurban Khashimov - Head of the Sanitary and Epidemiological Service of Balkan
Velayat
• Mr. Charyyev Anakurban- Head of Sanitary & Epidemiological service of
Turkmanbashy city
• Ms. Shirin Turaeva - Head of Reproductive Department, Mother and Child Health
Centre
• Hasanova, Dilara - Laboratory Specialist, Mother and Child Health Centre
• Mr. Rejep Geldiev – Head of Information Health centre
• Mr. S. Mukhammetkulyev - Head of the State Surveillance Department of the State
Service “Turkmenstandartlary”
• Mr. R. Godina - Deputy Head of the Reformation and Certification Department of
Food Industry Association of Turkmenistan
• Mr. G. Berdiev - Head of the State Custom of Ashgabat city and Akhal valayat
Team members - 3• UNICEF Turkmenistan:
• Ms. Enegul Djumaeva - Assistant Project Officer
• Ms. Dilara Ayazova – Project Assistant Health and Nutrition
• UNICEF Consultants:
• Dr Chandrakant Pandav – Team Leader, ICCIDD
• Mr. Lorenzo Locatelli – Rossi – Salt Production and monitoring, ICCIDD
Special Acknowledgements • Mr. G. Berdimukhammedov -
Deputy Prime Minister, Minister of Health and Medical Industry
• Mr. S. Khanov – Head of the State Concern
Turkmendokuhkhimiya
• Mr. B. Sopiev
Deputy Minister of Health and Medical Industry
• Ms. L. Shamuradova
Deputy Minister of Health and Medical Industry, Head of the
State Sanitary Epidemiological Service
• Mr. Mahboob Shareef – Head of UNICEF in Turkmenistan
• Ms. Regina Molera – Program Coordinator, UNICEF in
Turkmenistan
• Mr. Bradford Camp - Country Representative USAID in
Turkmenistan
Methodology & Agenda of Review
• Considered
- Programme Policy & Management- Salt Iodization- Health Information & Communication- Monitoring & Quality Assurance
• International collaboration and experience exchange
• Interviews with existing stakeholders
• Field visits to Guvluduz Salt Plant, SES
• Visit to shops & markets
• Review of existing reports and documents
Basic Country Facts
Location: Central Asia, bordering the Caspian Sea, between Iran and Kazakhstan
Coastline: Turkmenistan borders the Caspian Sea (1,768 km)
Climate: subtropical desert
Terrain: flat-to-rolling sandy desert with dunes rising to mountains in the south; low mountains along border with Iran; borders Caspian Sea in west
Natural resources: petroleum, natural gas, coal, sulfur, salt
Important Ethnic Groups include: Turkmen 85%, Uzbek 5%, Russian 4%, other 6% (2003)
Government: Republic.
President Saparmurat Niyazov
Number of regions/provinces: 5 provinces (welayatlar,singular - welayat):
Ahal Welayaty (Ashgabat),
Balkan Welayaty (Balkanabat),
Dashoguz Welayaty,
Lebap Welayaty (Turkmenabat),
Mary Welayaty (Mary)
Population : 6,4 million
Economy : GDP - composition by sector:
• agriculture: 27% (cotton, grain, livestock)
• industry: 50% (gas 57%, oil 26%, cotton fiber 3%, textiles 2% (2001)
• services: 23% (2001 est.)
Basic Country Facts
Indicators of measuring progress towards sustainable elimination of
IDD• Salt Iodization
- Proportions of households using adequately iodized salt > 90%
• Urinary iodine below 100 µg/L < 50 %- Proportion below 50 µg/L < 20 %
• Programmatic indicators- Attainment of the specified indicators :
at least 8 out of 10
Salt Iodization
• Local production and/or importation of iodized salt (IS) in a quantity sufficient to satisfy potential human demand (4-5 kg/person/year)
• 95% of salt for human consumption must be iodized
• Household IS of adequate quality must be at least 90%
• Iodine estimation at the point of production or importation must be determined by titration; at household level may be determined by certified kits
Population iodine status
• Median UIE should be at least 100 µg/L
with less than 20% below 50 µg/L
• The most recent monitoring data should have been
collected in the last 2 years
Programmatic indicators - 1
• An effective functional national body (council or committee) responsible to government for the national program. It should be multidisciplinary with a Chairman appointed by the Minister of Health
• Evidence of political commitment to USI and elimination of IDD
• Appointment of a responsible executive officer for IDD elimination program
• Legislation or regulations for USI, ideally covering both human and agricultural salt
Programmatic indicators - 2
• Commitment to assessment and reassessment of progress towards elimination with access to laboratories able to provide accurate data on salt and urinary iodine
• A program of public education & social mobilization on importance of IDD & consumption of iodized salt
• Regular data on salt iodine at the factory, retail and household levels
• Regular laboratory data on UIE in school age children with appropriate sampling for higher risk areas
Programmatic indicators - 3
• Cooperation from the salt industry in maintenance of quality control
• A database for recording of results of regular monitoring procedures particularly for salt iodine, Urinary Iodine Excretion, and if available Neonatal TSH monitoring with mandatory public reporting
95.4 94.3
59.9
92.1
70.6
88.2
83.4
99.7 98.7 100 99.7
92.6
97.7 98.8100 100 100 100 100 100 100
0
20
40
60
80
100
120
2001 95.4 94.3 59.9 92.1 70.6 88.2 83.4
2002 99.7 98.7 100 99.7 92.6 97.7 98.8
2003 100 100 100 100 100 100 100
Ashgabat city Ahal province Balkan province Dashoguz province Lebap province Mary province Turkmenistan
Comparative Data on Coverage of Iodized Salt for
2001-2002-2003
Household Coverage with Adequately Iodized Salt
(2003-2004) Results of quality testing of iodized salt in Turkmenistan
Velajats Amount of salt samples tested by rapid tests
Tested positively for iodine
Amount of salt samples tested by titration
Conforming requirements of GOST 630-2003
Balkan 90 90 30 30
Akhal and Ashgabat city
210 210 70 70
Mary 210 210 105 105
Lebap 210 210 105 105
Dashgovuz 180 180 90 90
TOTAL for Turkmenistan
900 900 400 400
Frequency distribution of UI levels (mg/L) in samples from Turkmenistan survey
(2003-2004)
01020304050607080
Balkan
vela
yat
Ahkal ve
layat
and A
shgab
at City
Mar
y ve
layat
Lebap
vel
ayat
Dashoguz v
elay
t
Turkm
enis
tan
< 20
20-49,9
50-99,9
100-299
> 300
Frequency distribution of UI levels in samples from Turkmenistan survey
(2003-2004)
Balkan232 mcg/l Akhal and
Ashgabat city – 194 mcg/l Lebap –
168 mcg/l
Mary – 160 mcg/l
Dashoguz – 156 mcg/l
• Long history of iodine deficiency &
prevention in Turkmenistan
• Presidential patronage & support to the
National Iodine Deficiency Disorders
Elimination Programme : Three Presidential
Decrees in last 10 years
• IDD elimination has been a major priority of
the Ministry of Health & Medical Industry and
Concern “Turkmendocunkhimiya”
• National Commission on,’ Salt Iodization and Flour Fortification with Iron’ formed in 1996
• Deputy Prime Minister is the Chairman• As a result, highest priority given to IDD &
many programme elements receive priority attention
• Regular and effective on-going inter-sectoral collaboration
• Monitoring data linked to decision making process e.g. Increased iodine content in salt at production level from 23 +/- 11.5 ppm to 40 +/- 15 ppm in the year 2002 based on DHS Survey results of the year 2000
Key events: 11991-1993 - After dissolution of Soviet Union in 1991 production of iodised salt in Turkmenistan seized due to breakdown of economic ties within the former state and lack of some necessary equipment, reagents and supplies.
1994:•Decree of Turkmenistan President № 1656 “On Supply of Salt to the Population of Turkmenistan free of charge” (February) •UNICEF opens its office in Turkmenistan •First survey of IDD with support of UNICEF and ICCIDD (March)•Turkmenistan Govt hosts ministerial level ECO/UNICEF/WHO meeting on IDD (June).
1996:•President of Turkmenistan S.Nyazov adopted a Decree № 2626 “On salt iodization and flour fortification with iron" (April)•Ministry of Health and other government agencies approved the use of potassium iodate (KIO3) for salt iodization at the level of 23 +/- 11 mg/kg. • Local production of potassium iodate on Khazar Chemical Plant restarted•UNICEF provided “Guvlyduz” salt plant with necessary iodization equipment to produce iodized salt.
Key Events – 2
1999: Training workshop in IDD monitoring was conducted in MCH Center with UNICEF support.
2000: •Government of Turkmenistan invested in construction of a new factory for iodization and packaging of edible salt. •Demographic Health Survey (DHS) was performed in Turkmenistan with support of UNICEF and US Agency for International Development (USAID).
2002:•State Customs forbid import of non-iodized salt. •By resolution of the Ministry of Health and in agreement with State Standard Service “Turkmenstandardlary” and State Consortium “Turkmendokunkhimia” the level of salt iodization was increased from 23 +/- 11.5 mg/kg to internationally recommended level of 40 +/- 15 mg/kg. •Resolution of Ministry of Health and Medical Industry of Turkmenistan № 61 (6.05.2002) «On constant laboratory control and monitoring of iodized salt quality» •With UNICEF support all provincial (velajat) SEI were equipped with laboratories for qualitative iodine measurement in salt by titration & personnel trained in this method.
Key Events – 3
2003 •Resolution of Khalk Maskhatly № 35 extended action of Turkmenistan President Decree «On free supply of Turkmenistan population with electricity, natural gas, water and edible salt” up to 2020 (August). •Turkmenistan President adopted a Decree № 6351 “On Exemption of salt plant “Guvlyduz” from taxes”. (August) •On high level International Meeting for the Sustained Elimination of Iodine Deficiency Disorders in Beijing (15-17 October 2003) with attendance by 27 countries and 10 international agencies and organizations Turkmenistan announced that the country reached USI and is close to elimination of IDD among its population.
2003-2004•The National IDD Laboratory established•National IDD Survey conducted
2004•Turkmenistan government prepared Official Report on the Achievement of Elimination of Iodine Deficiency in Turkmenistan through Universal Salt Iodisation. •Team for tracking the progress for country certification
National Iodine Deficiency Disorders Elimination Programme - 1
Byashim SopievDeputy Minister of the Ministry of Health and Medical Industry
Gurbangully BerdimukhammedovDeputy Prime Minister, Minister of the Ministry of Health and Medical Industry
Guljemal EzizovaDepartment of treatment and Prevention of the
Ministry of Health
Bike GayirovaChief Pediatrician
Department of treatment and Prevention of the Ministry of Health
Gary NazarovDirector of the Scientific and Clinical Centre of Mother and Child
Health
Shirin Torayeva Head of the Laboratory Department
MCH Centre
Leyla Shamuradova
Deputy Minister, Head of the State Sanitary and Epidemiological Service of the Ministry of Health and Medical Industry
Annamurad OrazovDeputy Head of the State Sanitary and Epidemiological Service
Nazarov AnnamyratHead of the Sanitary Department of the State Sanitary and
Epidemiological Service
Heads of Velayat’sSanitary Epidemiological Services
Heads of Etrap’sSanitary Epidemiological Services
National Iodine Deficiency Disorders Elimination Programme - 2
Agamurad AkievConcern “Dokunchemistry”
Mr. Elly GurbanmuradovDeputy Prime Minister
Annakurban MollaevDirector of the “Guvlyduz” Salt Plant
Ms. Raisa SukhovaChief of the Laboratory Department
“Guvlyduz” Salt Plant
Yazmuradov Atamurad
Concern “Dokunchemistry
Yagshiyev Sary HaylievichDirector of Khazar Chemical Plant
Ms. Ogulbibi Ashirova Head of Production Section
Suleyman Khanov Head of the Concern “Dokunchemistry”
National Iodine Deficiency Disorders Elimination Programme- 3
State Service
“Turkmenstandartlary”
Ministry of Trade State Custom Food Industry
Association
Only one producer “Guvlyduz” Salt Plant
• Production capacity of salt : 500,000 tons
Actual production of salt: 230,000 tons
• Production capacity of iodised salt :70,000 – 80,000 tons per year
• Actual production of iodised salt ( as per requirement):
25,000 - 32,000 tons per year
Turkmenistan is self sufficient in salt production and Potassium iodate
Turkmenistan is self sufficient in salt production and Potassium iodate
Requirement :
•Total for edible : 32,000 tons
•Industrial use : 190,000 – 200,000 tons
•Personal : 400g per month/person (free of charge)
• Production of fortificant Khazar Chemical Plant :
potassium iodate - 40 tons/ year potassium iodide - 330 tons/year
• Requirement of Potassium iodate:
2.16 tons/year
Turkmenistan is self sufficient in salt production and Potassium iodate
•Salt is produced from self-segmenting of the Guvly Lake of a sea origin
•Located along Caspian sea coast
• 40 kilometers to the north of Turkmebashy city, Balkan Province
Guvly Lake: Salt production site
Regulations specifying iodine levels for salt
State Industry Standard GOST 630-2003 “Edible Salt. Technical Conditions”
Starting from January 2003 the level of salt iodization was increased from 23 +/- 11.5 mg/kg to internationally recommended level of 40 +/- 15 mg/kg State Customs forbid import of non-iodized salt Salt imported by private foreign Companies is negligible
Annual imports: 0,002%Types imported: iodizedCountries imported from: Iran, Turkey
Salt Production
• Salt iodination is done by adding a potassium iodate, using the using sprayer method for salt iodization (three lines producing iodized salt)
• Since 1 June 2003 the iodine content in salt is corresponding to new adopted standards 40+/-15ppm
• Potassium iodate is obtained locally from “Hazar” Chemical Plant
Internal (factory level) monitoring of salt iodization
Responsible Parties: Salt Plant and SES
Potassium iodate solution for spraying salt prepared under supervision of Senior official of Laboratory
Samples taken regularly from each batch to determine amount of iodine
Titration method used for testing of iodine in saltInternal/external quality control
Iodized salt samples systematically taken during production runs and tested for iodine.Results of control checks and measurements of iodine content in salt samples entered in a special laboratory logbook
Regulations for QA State Standard GOST-TS 630-2003
External monitoring of salt iodization
Responsible PartiesSanitary Epidemiology Service (SES)Standard Agency
Reporting
MoH Resolution № 61 (6.05.2002) «Constant laboratory control and monitoring of iodized salt quality» strengthened monitoring system for production, distribution and transportation of iodized salt
Monthly reporting forms and system for monitoring and laboratory assessment of iodine in salt
Monitoring and laboratory control for iodized salt quality at different levels and executed by specialists of sanitary service of cities and regions
Monitoring forms are reported to provincial (velayat) level and State Sanitary Epidemiological Service
Results of monitoring periodically reported to Cabinet of Ministers of Turkmenistan
Advocacy, Education, Communication for Salt
• Salt Iodization promotion activities
Produced video-spots on national TV, articles in newspapers calendars, posters
KAP Study, 2004 Development of National
Communication Strategy
• Product labeling examples - developed
• Logo for Iodized salt developed, tested and adopted by MoH and Concern Turkmendokunchemistry
• Public knowledge on the importance of IDD prevention is gradually being increased
• Information Health Centre and State Sanitary Epidemiological Service of the MOH&MI, responsible for IEC, with participation by MOE
• Variety of channels of communication at community level n are being utilized, including mass media, group activities & interpersonal communication
• Key messages have focused primarily on benefits of iodized salt with emphasis on prevention of IDD (IQ, need for regular consumption of iodized salt during pregnancy, etc.)
• IDD is being taught to school children & health workers
Establishing the monitoring system
•IDD/USI Monitoring System throughout the country and for biological monitoring of IDD established, 2001
MCH Center and Sanitary Epidemiological Inspections (SEI), Ministry of Health responsible for assessment and reassessment of national IDD program
MCH Center acquired laboratory that provides data on urinary iodine
Network of regional (velayat) inspections received laboratories for iodine testing in salt by titration
Staff trained in laboratory procedures
SES established system for regular collection and analysis of data on salt iodine content on the production, retail and household levels.
Overview of Monitoring & Assessment of National IDD Elimination Program
Monitoring tools have been developed & there are data & numbers providing some information on different aspects of the IDD program, including:
Activity Frequency Representation indicators
Quality control at the Salt Plant
Daily by shift production site Adequacy of iodized salt by titration
Routine salt quality monitoring (SES)
Monthly All provinces Adequacy of iodized salt by titration and STK
School-based salt quality monitoring (SES)
Monthly Provincial Adequacy of iodized salt by STK
Biological monitoring of urinary iodine in School children
Annual National representation based on 60 etraps
UIE, IS
The organizational chart of the State Sanitary and Epidemiology Service, which carries out monitoring of the
iodized salt quality
State Sanitary and Epidemiology Service of the
Ministry of Health and Medical Industry of Turkmenistan
Provincial Sanitary and Epidemiology Services
Experimental-Industrial Centre
Sanitary and Epidemiology Service of the Ashgabat
city
Urban Sanitary and Epidemiology Services
District Sanitary and Epidemiology Services
The list of facilities
to be continuously monitored for the iodized salt quality during transportation, storage and realization, using rapid-test kits
1. Storage and trade facilities under the supervision of the Ministry of Trade and Foreign Economic Relations; 2. Storage and trade facilities under the supervision of the “Turkmenbirlishik” Consumers’ Association; 3. Canteens and storage facilities in schools, preschools, and Infant Homes; 4. Canteens and storage facilities in health centres and hospitals; 5. Canteens and storage facilities in seasonal child health-improving institutions; 6. Privately-owned enterprises and trade facilities;
7. Households .
The Quality Assurance for Salt
• samples taken regularly from each batch to determine amount of iodine
• titration method used for testing of iodine in salt
• internal/external quality control
• iodized salt samples systematically taken during production runs
and tested for iodine.
• results of control checks and measurements of iodine content in salt samples entered in a special laboratory logbook
• The method used - titration
National Laboratory for biological monitoring of IDD prevention was equipped and re-established at the MCH Institute, Ashgabat
National Laboratory for biological monitoring
The laboratory team of four persons was formed and trained in performance iodine in urine analyses
Implemented:
• ammonium persulfate method for determination of ioduria
• Total Quality Control/Quality assurance being practiced
Laboratory activities- 1
Laboratory Activities - 2
MCH center established laboratory for urinary iodine for regular monitoring of iodine nutrition, specifically in high risk areas
2000 DHS survey provided basis for increasing level of salt iodization from 23 to 40±15 ppm in 2002
2004 National representative survey of iodine nutrition, MCH Centre
National Epidemiological Representative 30 cluster Survey, January-March 2004
Sampling of 879 schoolchildren aged 8-10 covering all administrative districts of the country
collection of salt samples : SES
collections of urinary samples: MCH Centre
NATIONAL REPRESENTATIVE SURVEY OF PROGRESS IN ELIMINATIONOF IODINE DEFICIENCY IN TURKMENISTAN THROUGH UNIVERSAL
SALT IODIZATION
Details of laboratory tests
Velayats Number of clusters
Number of samples tested for urinary iodine
Number of salt samples tested with rapid test kits
Number of salt samples tested by titration
Balkan 3 91 90 30
Akhal andAshgabat city
7 208 210 70
Mary 7 206 210 105
Lebap 7 205 210 105
Dashoguz 6 169 180 90
Turkmenistan 30 879 900 400
External Quality Assurance
Urinary samples (n=177) from Dashoguz velayat were analyzed at the Reference Laboratory in Sofia, Bulgaria
The results :
• median 150.0 g/L
• samples with iodine < 100 g /L – 28.8 % <50 g/L - 5.1 %
Median urinary iodine (UI) levels for Turkmenistan population
Velayats Number of clusters
Amount of urinary iodine
tests
Median UI levels
Minimal UI value
Maximal UI value
Balkan 3 91 232 32 490
Akhal and Ashgabat city
7 208 194 37 430
Mary 7 206 168 18 560
Lebap 7 205 160 20 380
Dashoguz 6 169 156,5 10 460
Total for Turkmenistan
30 879 170 10 560
Reporting
MoH Resolution № 61 (6.05.2002) «Constant laboratory control and monitoring of iodized salt quality» strengthened monitoring system for production, distribution and transportation of iodized salt
Monthly reporting forms and system for monitoring and laboratory assessment of iodine in salt
Monitoring and laboratory control for iodized salt quality at different levels and executed by specialists of sanitary service of cities and regions
Monitoring forms are reported to provincial (velayat) level and State Sanitary Epidemiological Service
Results of monitoring periodically reported to Cabinet of Ministers of Turkmenistan
Achievements related to sustained salt iodization
• Regulatory : Resolution of Khalk Maskhatly № 35 extended action of Turkmenistan President Decree «On free supply of Turkmenistan population with electricity, natural gas, water and edible salt” up to 2020 (August 2003)
• Producers: Turkmenistan President adopted a Decree № 6351 “On Exemption of salt plant “Guvlyduz” from taxes” (August 2003)
• Consumers: All segments of the population have access to the
iodized salt. The average per capita rate for free distribution of salt is 400 gram/month
• There is a clear set of rules & regulations that guide & support producer of iodized salt. Specifically:
- Salt standards are used- Legislation is adequate- Internal / external quality control &
assurance is adequate- There is a national logo
Main Findings onGoals and indicators of elimination of
iodine deficiency in Turkmenistanand status of Programmatic Indicators
Data of the National Representative Survey of iodine nutrition in Turkmenistan shows that country has achieved the goal of elimination of iodine deficiency among population
Indicators Goal Turkmenistan results
Urinary iodine levels:
Median (mcg/L)
Proportion of samples below 100 mcg/L
Proportion of samples below 50 mcg/Ll
100-300
< 50%
< 20%
170
13,3%
4,6%
Salt iodization: Proportion of households consuming quality
iodized salt
> 90% 100%
Programmatic indicators - 1
• An effective functional national body (council or committee) responsible to government for the national program. It should be multidisciplinary with a chairman appointed by the Minister of Health
• National Commission Chairman – Deputy Prime Minister Minister of Health & Medical Industry
It is multidisciplinary• Evidence of political commitment to USI & elimination of IDD• Highest Level : Three Presidential Decrees in last 10 years• Appointment of a responsible executive officer for IDD elimination
program• Executive Officer located in MH & MI• Legislation or regulations for USI, ideally covering both human &
agricultural salt• In place since 1996
Programmatic indicators - 2
• Commitment to assessment & reassessment of progress towards elimination with access to laboratories able to provide accurate data on salt & urinary iodine
• Yes, in place. Carried out,” base-line survey” in 1994, later DHS survey in 2000 and more recently country-wide IDD survey in 2003 - 2004
• A program of public education & social mobilization on importance of IDD & consumption of iodized salt
• Yes. Already developed. National logo for iodized salt present• Regular data on salt iodine at the factory retail & household levels• Yes. Meticulously maintained records and registers (Computerziation
recommended)• Regular laboratory data on UIE in school age children with appropriate
sampling for higher risk areas• Yes. Meticulously maintained records & registers(Computerzation
recommended)
Programmatic indicators - 3
• Cooperation from the salt industry in maintenance of quality controlYes. Active and regular collaboration between salt producer and Sanitary Epidemiology Service responsible for quality control
• A database for recording of results of regular monitoring procedures particularly for salt iodine and UIE
• Yes. Presently it is in the form of records and registers. (Computerization recommended)• (And if available neonatal TSH monitoring with mandatory
of public reporting)• Presently neonatal TSH not being carried out.
International Collaboration & Experience Exchange
• Key role played by UNICEF, USAID (for financial resources) and ICCIDD since the beginning of the National IDD Elimination Programme
• ICCIDD provided technical inputs at all stages of program development
• UNICEF provided continued technical expertise and resources both capital and recurring
• Well defined guidelines of,’ ICCIDD / UNICEF/WHO Assessment of Iodine Deficiency Disorders and Monitoring their Elimination – A guide for Program Managers’ played a pivotal role
• Impressive political commitment as evidenced by three Presidential Decrees in last 10 years
• Build on to this success to other micronutrients – vitamin A , iron deficiency anemia, folic acid and to promotion of young child feeding practices
• Excellent leadership by MOH & MI for effective inter-ministerial collaboration
• Administrative infrastructure is effective and in place for on-going implementation and monitoring of sustainability of IDD Elimination
• Consider inviting representative of Livestock Department as a Member of Co-ordination Committee
• Initiate celebration of ,”IDD Day” for e.g. Presidents Birthday
• Organize Annual National Conference with participation from all stakeholders
• Document and print the success of National IDD Elimination Program and circulate widely both nationally and internationally
• Introduce National IDD Newsletter – later on include other micronutrients
• Display message at all eating places with National Iodized Salt Logo“We use only iodized salt”
• Integrate IDD messages into other on-going programs, especially those that target reproductive age women/adolescent girls
• Create forums for sharing innovative ideas, success stories & lessons learnt
• Introduce Annual Cyclical Monitoring Protocol
There are five provinces in Turkmenistan Select one province every year by rotation The whole country will be covered in five years time. For the sixth year, do a country-wide survey Sampling should be representative for each selected
province using 30 cluster methodology Target group is school children Main indicators are same as school-based survey, e.g.
urinary iodine excretion, iodine in salt from households brought by children as measured by titration
Also include 10 pregnant women per cluster
• Quality Assurance : Internal & external – Very good
• Introduce computerized Data System for Monitoring
• Initiate local production of salt testing kits
• Introduce new methods on urine iodine estimation (Hitachi) – 300 samples per day
• Plan already in place for modernization of iodization facility
• Since Turkmenistan is self – sufficient in production of common salt and potassium iodate and iodide,
• Consider actively exporting – iodized
salt, potassium iodate & potassium iodide
• In view of the success story of IDD Elimination, International collaboration and experience exchange to be actively promoted
• Organize training and demonstration workshops for regional and international fellows in Turkmenistan
• Actively promote participation of stakeholders in regional and international forums, meetings, conferences and seminars
Indicators of measuring progress towards sustainable elimination of IDD in
Turkmenistan• Salt Iodization
- Proportions of households using adequately iodized salt > 90% : 100 %
• Urinary iodine below 100 µg/L < 50% : 13,3%- Proportion below 50 µg/L < 20% : 4,6%
• Programmatic indicators- Attainment of the specified indicators : 10 / 10
8 out of 10
UNICEF/WHO/ICCIDDCertificate
Government of Turkmenistan on Achieving Optimal Iodine Nutrition, Through Universal Salt Iodization and Sustaining Elimination of IDD
In the field of nutrition and health, the task is to do what is possible, without forgetting to do what is necessary.
Universal Salt Iodization and Sustaining Elimination of IDD in Turkmenistan is a story where ,”So much has been achieved for so many, for all time to come, for so little, in such a short time”