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TURKEY IODINE DEFICIENCY DISORDERS AND SALT IODISATION PROGRAMME. SITUATION IODINE DEFICIENCY DISORDERS TURKEY. IDD SITUATION: ENDEMIC GOITRE IN TURKEY. TOTAL THYROID HYPERPLASIA % 30.5

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TURKEY

IODINE DEFICIENCY DISORDERS AND SALT IODISATION PROGRAMME


SITUATION

IODINE DEFICIENCY DISORDERS TURKEY


IDD SITUATION:

ENDEMIC GOITRE IN TURKEY

TOTAL THYROID HYPERPLASIA% 30.5

(When it is evaluated with all grades)2. GRADE PREVALANCE % 4.33. GRADE PREVALANCE % 1.84. GRADE PREVALANCE % 0.5

BIG GOITRE PREVALANCE % 2.4(TOTAL OF 3. VE 4. LEVELS)

THYROID NODULE PREVALANCE % 2.8

 Prof. Urgancıoğlu, Hatemi and his friends 1980 - 1987 WHO indicators, 73.757 persons


SCREENED REGIONS

(1997-1999 )


IODINE SITUATION AND GOITRE PREVALANCE OF SCHOOL AGED CHILDREN IN HIGH RISK PROVINCES 1997-1999

  • RESULTS:

  • GOITRE PREVALENCE FOR CHILDREN IS % 31.8

  • 30% AND HIGHER PROVINCES ARE;

  • KASTAMONU, BAYBURT, TRABZON, ERZURUM

  • MALATYA, SAMSUN, EDİRNE, AYDIN , KAYSERI

  • THROUGH THE URINARY IODINE MEASUREMENTS : 14 PROVINCES ARE MIDDLE/HIGH,6 PROVINCES HAVE LOW LEVEL OF IODINE DEFICIENCIES.


IODINE DEFICIENCIES WITH CHILDREN IN HIGH RISK PROVINCES 1997-1999

SONOGRAPHIC PREVALANCE

PROVINCES AT RISK 1997-1999

Bolu

Çorum

Burdur

HIGH (9), MIDDLE (4), LOW(7)

5-19.9 % Low level

20-29.9 % Middle level

30 % + High level


IODINE SITUATION AND GOITRE PREVALANCE IN 20 PROVINCES SCHOOL AGED CHILDREN

RESULTS:

GOITRE PREVELANCE OF SCHOOL CHILDREN IN 20 PROVINCES IS 31.8 %.

WITH GOITRE PREVALANCE;

THERE ARE 9 PROVINCES HIGHER THAN 30%

( KASTAMONU, BAYBURT, TRABZON, ERZURUM

MALATYA, SAMSUN, EDİRNE, AYDIN VE KAYSERI)


IODINE DEFICIENCIES WITH URINARY IODINE SCHOOL AGED CHILDREN

MEASUREMENTS PROVINCES AT RISK 1997-1999

Bolu

Çorum

Burdur

HIGH (3), MIDDLE(11), LOW(6)

50-100 mcg/lt Low level

20-49 mcg/lt Middle level

0-19 mcg/lt High level


LEGISLATION SITUATION SCHOOL AGED CHILDREN

TURKISH FOOD CODEX

TABLE SALT CIRCULAR

(09 JULY 1998 NUMBER: 23397 )

EDIBLE SALT

A) Table salt (directly goes to consumers, fortified with iodine, refined or unrefined edible salt )

B) Salt used in food Industry

****INTO TABLE SALTS

50-70 mg/kg. POTASSIUM IODIDE

25-40 mg/kg. POTASSIUM IODATE MUST BE ADDED.

SALT USED IN FOOD INDUSTRY NEED NOT BE FORTIFIED


IODISED SALT HOUSEHOLD CONSUMPTION RATES SCHOOL AGED CHILDREN

BY REGIONS-1995

23.6

15.6

18.3

18.6

16.5

URBAN:23.6

RURAL: 9.6

AVERAGE: 18.2


IODISED SALT CONSUMPTION SURVEY SCHOOL AGED CHILDREN

2002



%80-96 SCHOOL AGED CHILDREN 20 PROVINCE

%60-78 18 PROVINCE

%50-59 13 PROVINCE

%35-49 13 İL

%0-31 14 PROVINCE

IODISED SALT CONSUMPTION IN

PROVINCES- 2002

Siirt 0

Kırşehir 5.7

Hakkari 8

Batman 12



IODISED OIL CAPSULE SCHOOL AGED CHILDREN

SURVEY IN KAYSERI PROVINCE

2001-2002


Urinary iodine level in kapuzba village 2002 6 15 years old 91 children
Urinary Iodine Level in Kapuzbaşı Village -2002 SCHOOL AGED CHILDREN(6 – 15 Years old 91 children)

İyotlu tuz kullanımından önce

İyotlu tuz kullanımından sonra


Problems
PROBLEMS SCHOOL AGED CHILDREN

  • 1-High prevalance rate of iodine deficiency disorders

  • -total goiter rate: 30,5% (1987)

  • -school children goiter rate: 31,8 % (at risk provinces, 1997-1999 )

  • 2-- While consumption of iodised salt have been increasing still a sizeable segment of population is not using iodised salt due to lack of awareness of the population

  • 3- High number of small producers of non iodized salt (around 200)

  • 4- Difference between the prices of iodized and non iodized salt for food industry


TURKEY SCHOOL AGED CHILDREN

IODINE DEFICIENCY DISORDERS AND SALT IODISATION PROGRAMME


GOAL OF THE PROGRAMME SCHOOL AGED CHILDREN

ELIMINATION OF IDD IN TURKEY


Mpo objectives
MPO OBJECTIVES SCHOOL AGED CHILDREN

  • Elimination of IDD of children until 2005

  • Reduction of IDD of adults 1/3 until 2005

  • To iodise 100% of table salt in the country

  • Raise3 awareness of all related organizations, salt producersand the community on the importance of iodisied salt

  • To establish effective monitoring and evaluation system for the whole programme in Turkey


Implementation on 1994 2002
IMPLEMENTATION ON 1994-2002 SCHOOL AGED CHILDREN

1. TRAINING

2. ON LEGISLATION

3.WITH SALT PRODUCERS ON HOW TO IODISE THE SALT

4.DEVELOPMENT OF MATERIALS

5-MONITORING AND EVALUATION


1. TRAINING ACTIVITIES SCHOOL AGED CHILDREN

  • FOR HEALTH PERSONNEL ( 81 PROVINCES)

  • FOR MINISTRY OF AGRICULTURE PERSONNEL(81 PROVINCES)

  • SALT PRODUCERS (220 FACTORIES)

  • MARKET REPRESENTATIVES

  • NGOS

  • MUNICIPALITIES

  • PROVINCIAL DIRECTORS

  • UNIVERSITIES


3. ACTIVITIES WITH SALT PRODUCERS FOR SALT IODISATION IMPLEMENTATION

  • Providing iodisation machines and on the job training for usage,

  • Providing Potasium Iodate to the producers,

  • Training of salt producers on how to produce iodised salt ,

  • 4 Firma

  • 15 Firma (KI)

  • 7 Firma (KIO3)


4 development of materials
4. DEVELOPMENT OF MATERIALS IMPLEMENTATION

  • For health personnel and community

  • Audio and visual materials training materials developed


NATIONAL MONITORING LEVELS OF THE PROGRAMME IMPLEMENTATION

A. MONITORING OF IODISATION LEVEL IN SALT

B. MONITORING IODISATION IN URINARY LEVEL OF THE PEOPLE

C. CHECKINGS AT THE FIELD LEVEL


WHO IS RESPONSIBLE FROM WHICH MONITORING ? IMPLEMENTATION

A ) MONITORING OF IODISATION LEVEL IN THE SALT

1.QUALITATIVE (WITH TEST KITS (KIO3 and KI))

2.QUANTITATIVE ANALYSIS (IN THE LABAROTORIES

RANDOM ANALYSIS IN 3. MONTH

38 PROVINCIAL AGRICULTURE LABORATORIES

MINISTRY OF AGRICULTURE

PRODUCTION STAGE

  • 81 PROVINCIAL PUBLIC HEALTH LABORATORIES

  • 1 REFİK SAYDAM

  • GENERAL HYGIENE CENTRAL ADMIN.

  • 7 REGION R.S.

  • 8 REGION R.S.

FROM PRODCUTION TO CONSUMPTION

MINISTRY OF HEALTH



YEARS IMPLEMENTATION

IODISED SALT

NON-IODISED

1997

20.773.527

83.970.861

1998

23.751.702

73.872.432

1999

62.104.893

35.943.198

2000

85.128.000

-

2001

171.000.000

-

PRODUCTION OF IODISED AND NON-IODISED SALT SITUATION

( Kg.)

22 ÜRETİCİDEN ALINAN VERİLER


Objectives
OBJECTIVES IMPLEMENTATION

  • To encourge and support the small salt producers in all regions to produce iodised salt in order to expand the consumption of iodised table salt in rural areas;

  • To ensure the use of potassium iodate instead of iodide in iodised salts at the national level in order to introduce a standard in quality as well as monitoring;

  • To establish quality control laboratories, fully equipped with the necessary tools and trained personnel, that can conduct iodine analysis in the 22 centres identified for the purposes of monitoring-assessment activities on the national scale by the end of 2001;

  • To promote nationwide use of iodised salt through community leaders, mass media, schools, the military, community groups etc;

  • To ensure that the consumption of iodised salt reaches 95% by the year 2005.

  • To conduct cross-sectional surveys within the framework of monitoring activities with the aim of providing guidance for the programme activities.


Strateg es
STRATEGİES IMPLEMENTATION

  • Increase demand for iodized salt in the community through innovative approaches in advocacy and social marketing

  • Strengthen collaboration with the school system as channel for promotion of iodized salt

  • Intensify support to salt producers


The programme activities
THE PROGRAMME IMPLEMENTATIONACTIVITIES

TRAINING:

  • Health Personnel (Health Managers of 81 Provinces )

  • Representatives of Provincial Agriculture Directors

  • Salt Producers

  • Market representatives, teachers

  • Production of training materials

    ADVOCACY AND SOCIAL MOBILIZATION :

    Through the school system:

    - Training of teacher trainers, students

    -Development and production of education material

    -Training of Community leaders, military, media etc.


The programme activities1
THE PROGRAMME IMPLEMENTATIONACTIVITIES

IODISATION OF SALT:

  • On the job training of salt producers

  • Legislation change

  • Ttechnical material support

  • Potassium iodate support

    MONITORING AND EVALUATION:

  • Situation Analysis, Household consumption and School based surveys

  • Establishment of monitoring system

  • Annual Evaluation meetings


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