eduardo a. pretell regional coordinador for america, iccidd improving public health through the...
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Eduardo A. PretellEduardo A. Pretell
Regional Coordinador for America, ICCIDDRegional Coordinador for America, ICCIDD
Improving Public Health Through the Optimal Intake of Iodine and Sodium
Washington DC, PAHO; March 31, April 1, 2011
Plans of ICCIDD for LAC and participation of IRLI Network
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ITS POTENTIAL TO SECURE THE SUSTAINED ELIMINATION OF IDD
WHILE REDUCING THE CONSUMPTION OF SALT TO PREVENT CVD
IODIZED SALT IODIZED SALT
IN LATIN AMERICAN COUNTRIESIN LATIN AMERICAN COUNTRIES
What do we have in favor ?
What is needed to be worked our for ?
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North America Mexico
Central America Belize
Costa Rica
Salvador
Guatemala
Honduras
Nicaragua
Panama
The Caribbean Cuba
Dominican Rep.
Haiti
South America Argentina
Bolivia
Brazil
Chile
Colombia
Guyana
Ecuador
Paraguay
Peru
Uruguay
Venezuela
Official IDD Control Program
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
?
No
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Iodization level (ppm)
20-40
--
25-40
30-100
20-60
50-100
30-100
20-60
18-23
30-100
--
20-40
40-60
20-60
20-60
50-100
--
30-50
40-60
30-40
30-40
40-70
Coverage %
100
?
100
100
60
100
100
100
100
78
?
?
94
100
100
100
?
100
100
100
100
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Advanced technology (large scale producers)
Rudimentary technology (small/median scale producers)
> 70 % > 70 % 100 %
Argentina (?) Panama Bolivia
Brasil Costa Rica
Colombia Cuba
Chile El Salvador
Ecuador Guatemala
Mexico Honduras
Paraguay Nicaragua
Peru Dominican Rep
Uruguay
Venezuela
Production of iodized salt
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GUATEMALA (small scale producerss)
Quality of iodized salt
Iodization level Production plants Retail
30 - 60 ppm 43.5 %
> 15 ppm 64 %
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Quality control at retail
Large Median Small
> 15ppm 96 % 90 % 54 %
MEXICO
Production of iodized salt
Scale producers
Large Median Small
83 % 12 % 5 %
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0 10 20 30 40 50 60 70 80 90 100Haiti 2006
Rep Dom 2006Guatemala 2003
Argentina 1999Venezuela 2006
Salvador 2005Cuba 2006
Bolivia 2005Belice 1994
Mexico 2006Peru 2006
Colombia 2006Paraguay 2006Nicaragua 2006
Chile 2006 Brasil 2006
Panama 2006Honduras 2004
Costa Rica 2006Ecuador 2006Uruguay 2006
Iodine content in salt at retail/household level
≥15 ppm, %
Country Year
Data collected more than 5 years ago
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International Resource Laboratories for Iodine (IRLI) Network
Resource laboratory for Latin America:
Laboratory of Endocrinology, High Altitude Research Institute, Cayetano Heredia Peruvian University, Lima, Peru
(IRLI Harmonization Workshop in Cape Town, South Africa, Nov. 2002)
Main activities:
1.Quality assurance of laboratories for urinary iodine.
2.Technical support to improve their capacity for diagnosis and monitoring
3.Processing urine samples (surveys, research), as requested by
countries
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Accomplishments
Starting point: 20 laboratories were recorded: only 12 operating with different methods, 1-2 times/year. A quality control disclosed that only 2/3 were OK By 2006 the number of registered laboratories increased up to 25.
1.Technical support provided to laboratories in Argentine, Bolivia, Brazil, Chile, Costa Rica, Cuba, El Salvador, Mexico, Panama, Paraguay, and Uruguay.
2.Training of personnel and support to set up their own labs: 6 professionals from Argentina, Brazil, Cuba, and Mexico.
3.Processing of urine samples from Bolivia, Brazil, Ecuador, Haiti, and Peru.
4.Interlaboratories Assay was run from 2003 to 2006 (interrupted because of lack of funds). In the last run 12 out of 21 labs sent back their results. showing a significant progress.
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LIST OF LABORATORIES ACTUALLY PROCESSING IODINE IN URINELIST OF LABORATORIES ACTUALLY PROCESSING IODINE IN URINE
1. Centro Nacional de Investigaciones Nutricionales. Salta, Argentina
2. Instituto Nacional de Laboratorios de Salud. La Paz, Bolivia
3. Centro de Investigación y Desarrollo de Tecnología de Alimentos. Santa Cruz, Bolivia
4. Instituto de Nutrición y Tecnología de los Alimentos, Univ. de Chile. Santiago, Chile
5. Iinstituto Nacional de Salud. Bogotá ,Colombia
6. Inst. Costarricense Nutr & Enseñanza Nutr y Salud. MOH. San José, Costa Rica
7. Instituto de Nutrición e Higiene de los Alimentos, MOH. La Habana, Cuba
8. Laboratorio de Yodurias. MOH. Quito, Ecuador
9. Laboratorio de Bioquímica. INCAP. Guatemala, Guatemala
10.Lab Central de Referencia de Estudios en Salud Pública. Panamá
11. Instituto Nacional de Alimentación y Nutrición. Asunción, Paraguay
12. Laboratorio de Micronutrientes. Fac Ciencias y Filosofía, UPCH. Lima, Perú
13. Centro Nacional de Alimentación y Nutrición, MOH. Lima, Perú
14. Fac. Química. Univ. Rep. Oriental del Uruguay. Montevideo, Uruguay
15. Dep. Bioquímica, Universidad de los Andes. Mérida, Venezuela1010
0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 320 340 360 380 400 420 440
Rep Dom 1993Haití 2002
Guatemala 1999Argentina 2000
Guyana 1997Mejico 1999
El Salvador 2000Belice 1995
Venezuela 2005Bolivia 2005
Panama 2006Cuba 2005
Costa Rica 1996Nicaragua 2004
Chile 2006Ecuador 2005
Peru 2006Uruguay 2004
Honduras 2005Brasil 2000
Colombia 2002Paraguay 2006
Urinary iodine
Median µg/l
Country Year
Data collected more than 5 years ago
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Plans of ICCIDD
Mainly pursuing of:
1. Improvement of the salt industry
2. Implementation of effective monitoring systems, and reporting
3. Sustained comunication and education
4. Regional LAC meeting, August 1-2, Lima, Peru, to address these subjects. The agenda includes the following:
- Discussion of the IDD control programs’ situation in each country- Discussion of the IDD control programs’ situation in each country
- H- How to improve the capacity and responsibility of the salt industryow to improve the capacity and responsibility of the salt industry
- Importance of optimal iodine nutrition in early life - Importance of optimal iodine nutrition in early life
- Implementation of WHO recommendations: - Implementation of WHO recommendations:
a) Securing the elimination of IDD by USI strategya) Securing the elimination of IDD by USI strategy
b) Reduction of salt consumption (sodium) to prevent CVDb) Reduction of salt consumption (sodium) to prevent CVD
- Current and future role of Agencies and NGOs- Current and future role of Agencies and NGOs
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The posibility of starting pilot trials to reduce dietary salt consumption, without risking optimal iodine intake, could be considered in one or more countries where programs for the control of IDD are well implemented.
Reaching the above objectives, will facilitate to start implementing a program towards an optimal sodium intake.
For this task, the recommended colaborating/integrating/coordinating work of stakeholders, including ICCIDD, is needed to be implemented on the field. The ICCIDD is a network of voluntary experts strongly commited to reach the goal of IDD elimination. In LAC we have focal points in almost all the countries.
ICCIDD is the only organization specifically dedicated to this objective, mainly through advocacy and scientific and technical assistance.
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