Salt Iodization in Salt Iodization in the Kyrgyz the Kyrgyz RepublicRepublic

Davydova L. N. , Chief of the Department for the State Sanitary

and Epidemiological Control

Ashgabat, November 2002

IodineIodine D Deficiency Disorderseficiency Disorders

• Iodine Deficiency Disorders (IDD) are among the most common non-communicable diseases: – More than 1,5 million people in the world are

affected by Iodine Deficiency Disoders (IDD); – 900 million people in 118 countries suffer from

large thyroid mass (endemic goiter); – 40 million people have mental retardation due

to the lack of iodine in their nutrition;• Global causes of IDD:

Lack of iodine in soil (endemic regions); Consumption of products grown in endemic

regions

Pyramid of Iodine DeficiencyPyramid of Iodine Deficiency

1%-10%1%-10%CretinismCretinism

5%-30%5%-30%Mental retardationMental retardation

(lowering of intellect)(lowering of intellect)

30%-70%30%-70%Lag in physical development Lag in physical development

due to due to HHypothyreodosisypothyreodosis

In accordance with the In accordance with the WHO WHO recommendationsrecommendations,,

Kyrgyz Republic Kyrgyz Republic is one of the is one of the countries countries in need of in need of urgent urgent

measures on IDD eliminationmeasures on IDD elimination

IDD Morbidity, Kyrgyz Republic, 1995-2001 IDD Morbidity, Kyrgyz Republic, 1995-2001

52619470

17981 21949

75510

179237189057

1995г 1996г 1997г 1998г 1999г 2000г 2001г

IDD Morbidity by Oblast , Kyrgyz Republic, 2001 IDD Morbidity by Oblast , Kyrgyz Republic, 2001 ((per per 100 100..000 )000 )

1130,5

2929 2986,5 3054,63204,8

5542,85890,1

7072,7

0

1000

2000

3000

4000

5000

6000

7000

8000

Нарынскаяобл

Чуйская обл. Иссык-Кульская обл

Ошская обл. г.Бишкек Жалал-Абадская обл

Баткенскаяобл.

Таласскаяобл.

• Nutrition pattern has changedNutrition pattern has changed – – consumption of sea products, rich in iodine, consumption of sea products, rich in iodine, as well as meat and dairy products (also containing iodine) has considerably as well as meat and dairy products (also containing iodine) has considerably decreased – by decreased – by 2-3 2-3 times. In additiontimes. In addition, , rural residents tend to consume local rural residents tend to consume local products grown in their householdsproducts grown in their households, , and under the conditions of nature and under the conditions of nature iodine deficiency, these products virtually do not contain iodine; iodine deficiency, these products virtually do not contain iodine;

• Lack of local salt production industryLack of local salt production industry;;• A complete dependence on salt importsA complete dependence on salt imports, , up to up to 50% 50% of which does not meet of which does not meet

the iodine contents standardsthe iodine contents standards;;• Not-controlled turnover of technical saltNot-controlled turnover of technical salt;;• Out of Control imports of salt in large quantities by individualsOut of Control imports of salt in large quantities by individuals;;• Population consumes salt from local depositsPopulation consumes salt from local deposits, , requiring additional requiring additional

industry processing and iodizing; industry processing and iodizing; • Low level of awareness of population of IDD issues and necessity to Low level of awareness of population of IDD issues and necessity to

consume iodized salt; consume iodized salt; • Traditional practice of buying food salt in large quantities and storing it for Traditional practice of buying food salt in large quantities and storing it for

2-5 2-5 years.years.

Reasons Reasons ,, aggravating deterioration of IDD aggravating deterioration of IDD situation in Kyrgyz Republic situation in Kyrgyz Republic

Findings of IDD Issues Survey in Findings of IDD Issues Survey in Schoolchildren Schoolchildren ( (2001-20022001-2002))

• Total of 3127 schoolchildren from 60 schools all over the country were interviewed;

• Both interview and express-test of salt samples, delivered by respondents from households, were conducted;

• Findings of the Survey:– Level of awareness of the ID problem – 91%;– Level of consumption of Iodized salt – 35%;– Level of awareness of IDD issues does not differs considerably in

rural and urban populations;– The most important information sources – health workers and TV;– More than 30% of the population do not have adequate quality

salt, due to purchasing it in the places of spontaneous sale or consuming the salt from local salt deposits;

Legislative framework for Control and Provision Legislative framework for Control and Provision of of quality and fortification of productsquality and fortification of products

Legal provisions of the Kyrgyz Republic: Legal provisions of the Kyrgyz Republic:

• Decree of the KR President Decree of the KR President ««On enforcement of On enforcement of State State Regulation and Control of ProductionRegulation and Control of Production, , StorageStorage and and Sale of SaltSale of Salt»» (11 (11 JulyJuly 2002 2002;; №184) №184);;

• ««On StandartizationOn Standartization»;»;

• ««On Certification of Products and ServicesOn Certification of Products and Services»;»;

• ««On Sanitary-Epidemiological Welfare of On Sanitary-Epidemiological Welfare of PopulationPopulation»;»;

• ««On Prevention of Iodine Deficiency DisordersOn Prevention of Iodine Deficiency Disorders»;»;

• ««On Protection of Consumers RightsOn Protection of Consumers Rights»;»;

• CodeCode « «On Administrative ResponsibilityOn Administrative Responsibility»»

Legislative framework for Control and Provision Legislative framework for Control and Provision of quality and fortification of products (contin.)of quality and fortification of products (contin.)

► Decree of the KG Government №778 as of 10.12.2001 “On Implementation of the KR Law “On Sanitary Epidemiological Welfare of the Population"

► Decree of the KG Government №6 as of 09.01.2001 «On Implementation of the KR Law « On IDD Prevention»

► Decree of the KG Government №760 as of 28.12.2000 «On the List of Products requiring Mandatory Certification by Safety Indicators»

► Decree of the KG Government №229 as of 14.05.2001 «On Evaluation of Conformity of Imported Products with the requirements, set by Technical Standards Valid for KR»

► Decree of the KG Government №260 as of 31.05.2001 «On Licensing of Certain Types of Productions»

► Decree of the KG Government №834 as of 31.12.2001 «On Approval of Consensus to Use Technical, Medical, Pharmaceutical, Sanitary, Veterinary and Phyto-Sanitary Norms, Regulations and Requirements related to Goods, Imported into the NIS countries»

Legislative framework for Control and Provision Legislative framework for Control and Provision of quality and fortification of products of quality and fortification of products ((contin.contin.))

► Decree of the KG Government №194 as of 04.04.2002 «Regulations for Inspection of

Business/Entrepreneurship Subjects by State Control Bodies».► Decree of the KG Government №242 as of 23.04.2002 «On Approval of the Documents,

confirming safety of products, subject to obligatory control upon imports into the KR». ► Decree of the KG Government №667 as of 12.10.1998 «On Measures to Implement the

KR Law «On Protection of Consumers Rights».► Decree of the KG Government №407 as of 09.07.1997 «Regulations on Disposal

(reprocessing) of Products (goods), declared as ineligible for sale».► Decree of the KG Government №289-p;► Decree of the Chief State Sanitary Doctor №3 as of 29.01.2000 «On Introduction of

Hygienic Conclusion», registered on 10.02.2000 in the Ministry of Justice under the Reg. Number №16.

► SanPin 2.3.2.560-96 «Hygienic Requirements to Quality and Safety of Food Stuffs and Food Products».

Interaction between Ministries and Agencies on Interaction between Ministries and Agencies on the Issues of Fortification of Nutrition Productsthe Issues of Fortification of Nutrition Products

Ministry of Health,

Implementing Agency

Ministry of Justice

Ministry of Finances

Office of Prime-Minister of KG

Ministry of Internal Affairs

M of Labor and Social Protection

Ministry of Education and

Culture

Ministry of Agrc

Legislative Chamber

of “Jogorku Kenesh” (Parliament)

NGOs

State TV-Radio

Corporation

State Custom Inspection

Kyrgyz Standart

1

Ministry of External Trade and Industry

Manufacturer

State Sanitary-Epidemiological

Service, Ministry of Health of the Kyrgyz

Republic

Production

Trade network

Consumer

Conditions of Production

Storage conditio

ns

Transportation conditions

Terms of sale

Safety of the production on sale, iodine contents

Safety of Production,

Iodine contents

Inspection control of Certified

Production

Certification of Raw Materials, Products, and

Inspection Control of it*

State Inspection on Standartization and Metrology under the Kyrgyz Government

Accredited Bodies for Certification

State Control of Quality of Iodized Products State Control of Quality of Iodized Products

Measures, taken by SES of the Kyrgyz Republic Measures, taken by SES of the Kyrgyz Republic

Region

1996 1997 1998 1999 2000 2001 #

test

% dev

# test

% dev-

s

# test

% dev-

s

# test

% dev-

s

# test

% dev-

s

# test

% dev-

s

Bishkek 222 86,6 216 69,0 199 54,3 234 62,0 186 42,5 87 62,0

Chui Oblast 276 54,7 532 50,0 520 31,7 252 59,5 1517 56,7 1943 78,5

Talas Oblast107 56,0 126 42,0 192 47,3 156 31,0 197 64,9 292 31,5

Naryn Oblast 223 66,8 234 62,3 280 63,5 471 40,1 380 55,1 356 55,8

Osh Oblast 1218 38,3 1506 44,2 1960 46,1 460 54,1 1589 42,8 1615 29,4

J-Abad Oblast 740 48,3 1092 47,9 1015 49,4 804 32,0 800 30,7 802 35,8

I-Kul Oblast 232 42,2 402 52,7 630 37,9 615 29,3 651 40,1 683 41,4

Batken Oblast

756 58,4 719 32,4

REPUBLIC 30183018 46,5 41024102 49,0 47894789 45,0 29922992 44,3 6076 54,3 64976497 48,5

Years 1996г. 1997г. 1998г. 1999г. 2000г. 2001г.

REPUBLIC 510 825

kg97 282 kg 85 906 kg 290631 kg 162015 kg 50403 kg

Number and Quality of Tested Samples of Food Salt Number and Quality of Tested Samples of Food Salt

Rejected Salt (In kg) Rejected Salt (In kg)

UNICEFUNICEF – – the cost of aid since 1997 the cost of aid since 1997 comprised comprised $$122122,,000000 – – 2 technological salt 2 technological salt iodizing lines and iodizing lines and 200 200 kg of Iodate kg of Iodate PotassiumPotassium were provided; Social were provided; Social Mobilization Campaign and other activities Mobilization Campaign and other activities were conducted. were conducted.

ADBADB - - JFPR9005-KyrgyzstanJFPR9005-Kyrgyzstan Project with support of Japanese Fund of Poverty Alleviation «Improvement of Nutrition of Low-Income Mothers and Children in Asian Countries in Transition» - $$ 700 700,,000 000 have have been allocatedbeen allocated..

Assistance, provided to KR by International Assistance, provided to KR by International Organizations to control and liquidate IDDOrganizations to control and liquidate IDD

Solution of Problems with PartnersSolution of Problems with Partners,, representing different layers of representing different layers of

societysociety

• PoliticalPolitical – people, identifying the policy;• Bureaucratic and technocraticBureaucratic and technocratic – – state

employees and technical specialists;• ProfessionalProfessional, , civilcivil, , publicpublic- NGOs- NGOs, including

religious, commercial, professional, industrial and special interests groups;

• Community Based OrganizationsCommunity Based Organizations – – different local associations, schools, high schools, etc.;

• Families and IndividualsFamilies and Individuals – family members, incl. mothers, fathers, grandparents, who can make decisions related to purchase and consumption of food products.

Barriers in Solution of IDD Problems Barriers in Solution of IDD Problems

• Enterprises lack salt enriching supplement, so they have to buy it at a high price, and this increases the cost and market price of the product by 2-3 times compared to normal salt;

• For a long time the issue of modifying current legislation – Law «On IDD Prevention», Code «On Administrative Responsibility» has not been solved yet;

• The issue of control of turnover of technical salt is pending solution;

• In spite of existing 20 salt deposits in KG, the issue of establishment of local production of salt is not solved either.

Activities Implemented in KGActivities Implemented in KG • Inter-State GOST «Food Salt» has been approved

(contents of Iodine is fixed at the level of 40 mg.kg)• The National Program to decrease the level of IDD has

been drafted, approved by Ministries, is pending the Govt approval;

• Law «On Modifications and Addenda to some Legislative Acts of the KR» (Law «On IDD Prevention» - Section related to State guarantees and control of technical salt; Code «On Administrative Responsibility» - section on administrative responsibility for imports, production, sale of low quality salt, including non-iodized salt needs to be added;

• The issue of establishment of a specialized enterprise «Kyrgyz Тuz» as a state body to be in charge of salt turnover in the republic;

• Education work is being carried out for the population in IDD prevention towards changes of nutrition habits.

Ways to Solve Problems Ways to Solve Problems

• To fill the consumer market with Iodized food products, first of all food salt;

• To conduct active communication with population on ID problems;• To build wide political support for IDD Control and Liquidation,

including Social mobilization, with wide involvement of mass media;

• To coordinate interaction of all governmental and non-governmental organizations, international organizations, aimed at control of the above problem;

• To speed up the process of approval of Law «On Modifications and Addenda to some Legislative Acts of the KR»;

• To speed up approval of the National Program for the years 2003-2007 on Decrease of IDD level;

• To speed up the establishment of a specialized enterprise «Kyrgyz Tuz»;

• To organize Association of Salt Manufacturers;• To interact with Central Asian Region countries in the area of

enhancement of control of salt quality,including information/feedback on imports of low-quality salt;

• To develop infrastructure of local enterprises, producing enriched food products, including salt.