Swiss Agency for Development and Cooperation Swiss Red Cross Kyrgyz-Swiss Health Reform Support Project Tobias Schüth The power of test kits: Inducing

Swiss Agency for Development and Cooperation

Swiss Red CrossKyrgyz-Swiss

Health Reform Support ProjectTobias Schüth

The power of test kits:Inducing change from below

Tobias Schüth

Kyrgyz-Swiss Health Reform Support Project





Objective: Exclusive selling of iodised salt through local dealers

Strategy: • Testing campaign of salt in all households with information on

IDD• Documentation of test results including the name of the dealer

from whom salt was bought• Contact with all local salt dealers demanding provision of

iodised salt (consumer pressure)• Provision of test kits to all dealers (winning dealers as allies)





The setting: 2 areas, 2 variations of one strategy

1) Jumgal rayon, 40,000 people, remote mountainous region of Naryn oblast

2) Remaining 4 rayons of Naryn oblast and Naryn city with 210,000 people





Two variations of one strategy1)Jumgal rayon

– Tests done by Village Health Committees and staff of Family Group Practices (FGP)

– Test kits given to all dealers (kits for iodate salt only)

2)Naryn oblast– Tests done by Staff of Family Group Practices

– No test kits to dealers




Testing campaign, Jumgal rayon

76%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

households villages0

2

4

6

8

10

12

14

16

6643 households

16 villages(of 16)

Initial campaign, Jul-Aug 2002:Coverage by households and villages, Jumgal rayon





19%

70%

11%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

iodised non-iodised

non-iodisediodidiodate

89%

Initial distribution of salts in households Jul-Aug 2002

n = 6643 households of all 16 villages of Jumgal rayon





71%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

households villages

0

2

4

6

8

10

12

14

16

6159 households

15 villages (of 16)

Monitoring testing, Oct-Dec - 02:Coverage by households and villages, Jumgal rayon





71%

18%

10%

91%

4%

5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


89% 95%95%

Baseline Monitoring

Salt in households at initial campaign and 4 months later

Baseline Jul-Aug 2002, n=6382 households (15 villages of Jumgal rayon )Monitoring Oct-Dec 2002, n=6182 households (15 villages of Jumgal rayon)

non-iodised non-iodisediodised iodised





10%

5%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Lama

Dyikan

Bayzak

Tugol-Sai

Epkin

Kuiruchuk

Ornok

Chon-Dobo

Tash-Dobo

Doskulu

Kyzyl-Jyldyz

Kok-Oy

Aral

Center, Chaek

Minkush

average

Average

Average

Change of prevalence of households with non-iodised salt after 4 months, by village

Baseline Jul-Aug 2002, n=6382 households (15 villages of Jumgal rayon )Monitoring Oct-Dec 2002, n=6182 households (15 villages of Jumgal rayon)

baseline monitoring





1%

5%

10%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Lama

Dyikan

Bayzak

Tugol-Sai

Epkin

Kuiruchuk

Ornok

Chon-Dobo

Tash-Dobo

Doskulu

Kyzyl-Jyldyz

Kok-Oy

Aral

Center, Chaek

Minkush

average

Average

Average

Results after 8 months 9 villages, 3312 households, Jumgal rayon

baseline 4 months 8 months





23

21

25 23

0

5

10

15

20

25

dealertest kitssalt samplesiodised

Dealers with test kits

Dealers tested Salt

samples tested

Iodised salt samples

Dealers Salt samples

Checking the Dealers: presence of test kits and of iodised salt,

9 months after initial campaign (March 03)




Testing campaign, Naryn oblast

73%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

10

20

30

40

50

60

70

80

90

100

110

29793 households

Initial test campaign, Sep-Oct 2002: Coverage by households and villages

Naryn oblast (4 rayons and Naryn city)

Households Villages

87 villages and

cities (of 118)





0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Initial test campaign, Sep-Oct: 2002:Coverage of households by rayon

Ak-Tala At-Bashy Kochkor Naryn Naryn city





64.0%

22.6%

13.3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


86.6%

Initial distribution of salts in households (Sept-Oct 2002)

n = 29793 households of 4 rayons and Naryn city

iodised non-iodised





61%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

10

20

30

40

50

60

70

80

90

100

110

Monitoring testing Feb-March 2003: Coverage of by households and villages

4 rayons and Naryn city

Household Villages

63 villages and cities (of 118)28939

households





0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Monitoring testing Feb-March 2003:Coverage by rayon

4 rayons and Naryn city

Ak-Tala At-Bashy Kochkor Naryn Naryn city





63.9%

22.7%

13.4%

78.3%

16.4%

5.4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


86.6%94.7%

Salt in households at initial campaign and 5 months later

baseline n = 28939 households, Sep-Oct 2002, monitoring n = 24771 households, Feb-March 2003 4 rayons and Naryn city

iodised iodisednon-iodised non-iodised





5%

13%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

Ak-tala

At-Bashy

Kochkor

Naryn

Naryn City

average

Change of prevalence of households with non-iodised salt, after 5 months, by rayon

4 rayons and Naryn city, baseline: n = 28939 households, monitoring: n = 24771 households)(in Naryn city and Kochkor tests were done with iodat test kit only,

therefore iodid salt was measured as negative)

Average

Average

Baseline Monitoring




The dealers and their salt

92%

78%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Checking the dealers: iodat salt samples at salt dealers, March 2003

in 3 rayons of Naryn oblast (Naryn, Kochkor, At-Bashy, n = 92), and Jumgal rayon, n = 25)

3 rayonsJumgal




The dealers and their salt

60%

75%71%

91%

4%

18%

4%

21%20%

5%12% 11%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

iodatiodidnon-iodised

Baseline3 Naryn

Monitoring Monitoring

3 rayons

Baseline

Jumgal

Effect of providing dealers with test kits:Prevalence of iodate and iodid in households

of Jumgal rayon (dealers with iodat test kits) and of 3 other rayons (dealers without test kits, At-Bashy, Ak-Tala, Naryn), Feb-March 2003





Costs of initial testing campaign and one monitoring round

Test kitsUS $

TrainingUS $

TotalUS $

Jumgal rayon(40,000 people)

55 285 340

Naryn oblast(without Jumgal,210,000 people)

515 992 1507

Total 570 1277 1847





Conclusions• The combination of a salt testing campaign in households

and of involvement of dealers can dramatically increase consumption of iodised salt in a very short time.

• Provision of test kits to dealers can influence the kind of salt people consume

• The intervention is very low cost





Extension of the campaign• March 03: initial testing campaign in Jalalabad oblast

(800,000 population)

• Further oblasts until June 03

Documents

Swiss Agency for Development and Cooperation Swiss Red Cross Kyrgyz-Swiss Health Reform Support Project Tobias Schüth The power of test kits: Inducing