Assessment and perspectives of the iodized salt program in

Lao PDRUniversal Iodized salt program in Lao PDR:

current situation, development and perspectives

25 – 26 JUNE 2015

Bounthom PHENGDYDirector of Nutrition Center, Department of Hygiene and Health PromotionMinistry of Health

Outline of the presentation

Background of the IDD in Lao PDR : Evidence based data of IDD and salt consumption by HH

National Health Survey, 2000 School Survey, 2005 MICs III, 2006 School Survey, 2014

Indicators for program achievement

Some recommendations for future direction on IDD eradication

Background

IDD was identified as main public health problem since 1993 Evidence showed:

Π95% of school age children 6- to 12 years old had urine iodine excretion < 100 mcg/l

Π65% had urine iodine excretion < 60mcg/l

Background

In 1995, then the Universal Salt iodization (USI) program was announced and implemented under the PM decree number 42

After five year of USI was implemented, the NHS2000 showed

Mean urine iodine excretion among school children was 155.30mcg/l and

only 27% had urine iodine excretion < 100mcg/l (68%drop from 1993)

Coverage of adequate Iodized salt at household level was 76%

9% of school children were identified as goiter grade 1-+2

Progress of USI

In 2005, the school based survey was conducted nation wide And MICS survey also provided data on its coverage, 2006

Can IDD eradicate in LAO PDR?

National coverage of iodized salt at household level: School based survey

2005

Borikhamxay

Xiengkhoang

Sayaboury Saysomboun

OudomxayBokeo

Luangnamtha

Luangprabang

Phongsaly

Saravan

ChampasackAttapeu

Sekong

Houaphan

Savannakhet

Khammouane

Vientiane M.

Vientiane P.

Average coverage 85% iodized salt consumption nation wide

Vietnam

Thailand

Myanmar

China

CambodiaSource: Recently School Based Survey 2005 by MOH, MOEH

< 70%

70 – 90%

> 90%

Missing data

Salt iodization (MICS 2006)

0102030405060708090

100

Consume iodized salt Consume adequatelyiodized salt

Adequate urinaryiodine

83.8%

58.3%

87.2%

Mics and Nutrition survey 2006

Since 2005, Eradication of IDD from this country was discussed and planned

…However,

Survey in the target 5 provinces in 2008

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

Series1 59 % 52 % 52 % 64 % 97 % 55 %

Phongsaly Houaphanh XiengkhuangKmammouan

eAttapeu 5 provinces

In the year 2008: In the year 2008:

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0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Xiengkhouang province Xiengkhouang province

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Houaphanh Province 2008

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Sources of salt (XiengKuang province, 2008)

Lao salt producer

Import salt

Others

37%

62.7%

0.3%

Sources of salt (Huaphanh province , 2008)

Lao salt Producer

Vietnam

Others

53.5% 42%4.5%

Sources of salt Phongsaly province, 2008

Lao salt producer

Small salt factory

Import salt

40.8%

40.8%

18.4%

Sources of salt Khammouane province, 2008

Lao salt Producer

Small factory (Thagnam)

Import salt

Others

60.7%33.3%4.1%1.6%

Soures of salt Attapeu province, 2008

Lao salt producer

Import salt

Others

92.4%

6.7%0.8%

Salt producer, 2008

Veunkham

Ban Bo

Khoksa ath

Nataeu

kengkok

Songkhone

Boten

Small factory

Thai

China

Vietnam

Others

48%

23.5%

7.7%

4.1%

4.4%

Quality of salt testing by WYD test 2008

0 ppm

< 20 ppm

20-40 ppm

>40-60 ppm

42.2%

55.2%

2.2% 0.4%

Getting to Zero of the IDD: Challenges for Lao PDR

School Survey 2013-2014

2013-2014 School survey

The median urinary iodine concentration (UIC) =103 µg/L(95% CI 96-114)

89.1% of the salt was “iodized” based on RTK tests (compared to 85% in 2005 and 79.5% in 2011-12),

Only 37% of the salt samples had actually a measured iodine level >15 mg/kg (compared to 68.3% in 2005).  

Compared to the results of the 2006 NNS (median UIC was 205.4 µg/L), the median UIC nationwide has decreased by almost 2 times from optimal to borderline due to suspension of iodized salt production.

The underlying causes for the failing, or poorly executed, salt iodization strategy in Lao PDR were the lack or temporary shortage of essential supplies (potassium iodate and/or WYD solutions)

This was combined with temporary weakened official enforcement and oversight and led to failures in the salt factory’s commitments to continually adhere to the national USI mandate.

Challenges, and Why?

To secure the potassium iodate supply, consolidate all the required supplies for USI though a newly established Lao USI Secretariat/PIRF,

Efforts to ensure QA measurements and required reporting in all salt factories

Creation of a central QA data analysis and information capacity.

What to do next?

10 Indicators to measure Progress for USI program achievement

1. Iodized salt coverage > 90% Urine iodine excretion

Œ < 50% Urine iodine excretion <100 mcg/lŒ < 20% Urine iodine excretion < 50 mcg/l É

Quality of salt with adequate iodine (90%):Œ HH level 20Œ40 ppm, Œ Factory level 40Œ60 ppm

2. Existing of National Committee from multi-sectors for IDD eradication

3. Existing clear policy and strategy for USI and IDD eradication

4. Existing Committee secretariat for IDD eradication5. Existing regulations on control and management of IDD,

Existing regular monitoring system for the progress of the USI with good laboratory for testing iodine in salt and urinary iodine excretion

10 Indicators to measure Progress for USI program achievement

(continue)

6. Existing IEC program for the community on IDD and iodized salt consumption

7. Existing regular data on iodine at factory level, household level, and retail shop

8. Existing data from laboratory regularly on urinary iodine excretion for school children with focus on high risk areas

9. Existing good collaboration among salt producers in management and quality control

10. Existing data collection and record system with regular monitoring

Some recommendations for future direction on IDD eradication to

Concerned bodies

Control measurement/enforcement to monitor factory salt production and imported salt from neighboring countries

Salt for human and animal consumption should fortified with iodine

Control check point at the border for imported salt and allow only salt with adequate iodine levelTest kit should be available at Control check

point

Some recommendations for future direction on IDD

eradication

To salt factory Quality Control at factory level on salt

production with adequate iodine Regular improvement internal and external

production system To Community

Educating community to understand the importance of IDD and the use of salt iodization for IDD prevention

Educated community on how to store and use iodine salt properly

There is a need for multi-sectoral collaboration to work

together

MOH, MOIC, MOE, Mass organization

Conclusion Iodized salt Status in Lao PDR

8479

89

58

37

percent

Where we are in the Region?

Unicef: Sustainable Elimination of Iodine Deficiency

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Kor

ea

Phi

lippi

ne Thai

Mya

nmar

Nep

al

Cam

bodi

a

Indo

nesi

a

Lao

PD

R

Chi

na

Vie

tnam

Where we are in the Region?

Unicef: Sustainable Elimination of Iodine Deficiency

korea Phillipine Myanma Nepal CambodiaIndonesia Lao PDR China Thailand Vietnam

New data 2012 for Thailand

Thank you for your kind attention