Progress
Towards Optimum Iodine
Nutrition in Turkmenistan
Dr. Chandrakant.S. Pandav,
Professor and Head, Centre
for Community Medicine,
AIIMS, New Delhi
October, 2004
Progress Towards Optimum Iodine
Nutrition in Turkmenistan
•
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•
•
•
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•
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
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)
Basic Country Facts
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.)
Parameters of the
Tracking Progress
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
Current Situation in
Turkmenistan
Comparative Data on Coverage of Iodized Salt for
2001-2002-2003
120
100
99.7
100
95.4
98.7
100
100
100
94.3
99.7
100
100
97.7
100
98.8
100
92.6
92.1
88.2
83.4
80
70.6
59.9
60
40
20
0
Ashgabat city
Ahal province
Balkan province
Dashoguz province
Lebap province
Mary province
Turkmenistan
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
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)
Ah
k
al
Ba
ve
lk
la
an
ya
ve
ta
la
nd
ya
As
t
hg
ab
at
Ci
ty
M
ar
y
ve
la
ya
Le
t
ba
p
ve
la
ya
Da
t
sh
og
uz
ve
la
yt
Tu
rk
m
en
is
ta
n
80
70
60
50
40
30
20
10
0
< 20
20-49,9
50-99,9
100-299
> 300
Frequency distribution of UI levels in samples from
Turkmenistan survey
(2003-2004)
Dashoguz –
156 mcg/l
Balkan
232 mcg/l
Akhal and
Ashgabat city
– 194 mcg/l
Lebap –
168 mcg/l
Mary –
160 mcg/l
Main Findings
Programme Policy &
Management
• 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: 1
1991-1993 - 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
Gurbangully Berdimukhammedov
Deputy Prime Minister, Minister of the Ministry of Health and Medical Industry
Byashim Sopiev
Deputy Minister of the Ministry of Health and Medical Industry
Guljemal Ezizova
Department of treatment and Prevention of the
Ministry of Health
Bike Gayirova
Chief Pediatrician
Department of treatment and Prevention of the Ministry
of Health
Gary Nazarov
Leyla Shamuradova
Deputy Minister, Head of the State Sanitary and Epidemiological Service of
the Ministry of Health and Medical Industry
Annamurad Orazov
Deputy Head of the State Sanitary and Epidemiological Service
Nazarov Annamyrat
Head of the Sanitary Department of the State Sanitary and
Epidemiological Service
Heads of Velayat’s
Sanitary Epidemiological Services
Director of the Scientific and Clinical Centre of Mother and Child
Health
Shirin Torayeva
Head of the Laboratory Department
MCH Centre
Heads of Etrap’s
Sanitary Epidemiological Services
National Iodine Deficiency Disorders Elimination Programme - 2
Mr. Elly Gurbanmuradov
Deputy Prime Minister
Suleyman Khanov
Head of the Concern “Dokunchemistry”
Agamurad Akiev
Concern “Dokunchemistry”
Annakurban Mollaev
Director of the “Guvlyduz” Salt Plant
Ms. Raisa Sukhova
Chief of the Laboratory Department
“Guvlyduz” Salt Plant
Yazmuradov Atamurad
Concern “Dokunchemistry
Yagshiyev Sary Haylievich
Director of Khazar Chemical Plant
Ms. Ogulbibi Ashirova
Head of Production Section
National Iodine Deficiency Disorders Elimination Programme- 3
Ministry of Trade
State Service
“Turkmenstandartlary”
State Custom
Food Industry
Association
Main Findings
Salt Iodization
Turkmenistan is self sufficient in salt production
and Potassium iodate
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
Requirement :
•Total for edible : 32,000 tons
•Industrial use
: 190,000 – 200,000 tons
•Personal
: 400g per month/person
(free of charge)
Turkmenistan is self sufficient in salt production
and Potassium iodate
• Production of fortificant
Khazar Chemical Plant :
potassium iodate - 40 tons/ year
potassium iodide - 330 tons/year
• Requirement of Potassium iodate:
2.16 tons/year
Guvly Lake: Salt production site
•Salt is produced from selfsegmenting of the Guvly Lake of
a sea origin
•Located along Caspian sea
coast
• 40 kilometers to the north of
Turkmebashy city,
Balkan Province
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: iodized
Countries 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 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
Regulations for QA
State Standard GOST-TS 630-2003
External monitoring of salt iodization
Responsible Parties
Sanitary 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
Main Findings
Health Information &
Communication
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
Main Findings
Monitoring & Quality Assurance
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
Experimental-Industrial
Centre
Provincial Sanitary and
Epidemiology Services
Urban Sanitary and Epidemiology
Services
Sanitary and Epidemiology
Service of the Ashgabat
city
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

National Laboratory
for biological
monitoring of IDD
prevention was
equipped and reestablished at the
MCH Institute,
Ashgabat
Laboratory activities- 1

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 - 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 REPRESENTATIVE SURVEY OF PROGRESS IN ELIMINATION
OF IODINE DEFICIENCY IN TURKMENISTAN THROUGH UNIVERSAL
SALT IODIZATION
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
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 and
Ashgabat 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 on
Goals and indicators of elimination of
iodine deficiency in Turkmenistan
and 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)

100-300

170

Proportion of samples below 100 mcg/L

< 50%

13,3%

Proportion of samples below 50 mcg/Ll

< 20%

4,6%

> 90%

100%
Salt iodization:
 Proportion of households consuming quality
iodized salt
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 control
Yes. 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.
Main Findings
International Collaboration
And Experience Exchange
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
Recommendations
Programme Policy &
Management
• 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
Recommendations
Salt Iodization
Recommendations
Health Information &
Communication
• 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
Recommendations
Monitoring & Quality Assurance
• 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
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• 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
Recommendations
International Collaboration
And Experience Exchange
• 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%
• Urinary iodine below 100 µg/L < 50%
- Proportion below 50 µg/L < 20%
: 100 %
: 13,3%
: 4,6%
• Programmatic indicators
- Attainment of the specified indicators : 10 / 10
8 out of 10
UNICEF/WHO/ICCIDD
Certificate
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”