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SECTION 8.P65 Section VIII Reports from the Regions and the Countries by ICCIDD Regional Coordinators (RC) 1. Introduction 1.1 Classification of Countries by Iodine Nutrition with Tables for each Region 1.2 World Map showing Iodine Nutrition by Country 2. African Region-D Lantum RC 2.1 Overview 2.2 Cameroon 2.3 Nigeria 2.4 East & Southern Africa 3. South East Asia Region–CS Pandav RC 3.1 Lessons Learnt 3.2 Tracking Progress in the Region 3.3 India 4. China and East Asia Region–ZP Chen RC 4.1 People’s Republic of China 4.2 Tibet 4.3 Mongolia 4.4 Democratic Republic of Korea 5. Asia Pacific Region-C Eastman RC 5.1 Summary and Lessons Learnt 5.2 History and Background 5.3 Regional Activities 5.4 Indonesia 6. Middle Eastern and North African Region–F Azizi RC 6.1 Summary and Lessons Learnt 6.2 Background and History 6.3 Islamic Republic of Iran 6.4 Other Countries 286 Global Elimination of Brain Damage Due to Iodine Deficiency 7. American Region–E Pretell RC 7.1 Summary and Lessons Learnt 7.2 Introduction 7.3 Global and Regional Activities 7.4 Summary of Regional Experience 7.5 The Peru Country Program 7.6 Conclusion 8. European Region 8.1Western and Central Europe-F Delange 8.1.1 Summary and Lessons Learnt 8.1.2 Epidemiology 8.1.3 Public Health Consequence of IDD 8.1.4 Prevention & Therapy of IDD in Europe 8.2Eastern Europe & Central Asia-G Gerasimov 8.2.1 Summary and Lessons Learnt 8.2.2 Introduction 8.2.3 IDD Assessment and Surveillance 8.2.4 Iodized Salt Production-Supply and Consumption 8.2.5 Legislation 8.2.6 Monitoring Reports from the Regions and the Countries 287 I Introduction Basil S Hetzel 1.1 Classification of Countries by Iodine Nutrition The Regions follow those established by the World Health Organization. An Overview of the programs in each of the Regions is given with an Introductory Section on ‘Lessons Learnt’. Detailed data on the status of the program in each country by region is given in Appendix 1. A classification of the iodine nutrition of countries by Regions is shown in the following Tables, which provide a background to the discussion in this Section. These data are provided from the ICCIDD Data Base. They have been compiled by Dr John Dunn, Executive Director of the ICCIDD and refer to the situation as of early 2003. 1.2 World Map Showing Iodine Nutrition by Country These data are also shown in the World Map (in between page 294 and 295). In addition detailed data on the status of each country program is given in Appendix 1. 288 Table 1. Classification of African Countries by Iodine Nutrition Global EliminationofBrainDamageDuetoIodineDeficiency Deficient Likely Likely Status Severe Moderate Mild Deficient Sufficient Sufficient Excess Uncertain Gambia Ethiopia Mauritania Angola Algeria Botswana DR Congo Mali Sierra Leone Guinea Mozambique Burkina Faso Benin Egypt W. Sahara Senegal Zambia Burundi Cameroon Eritrea Sudan Cape Verde Kenya Gabon CAR Madagascar Liberia Chad Nigeria Libya Comoros Rwanda Malawi Congo (Braz) Togo Namibia Cote d’ Ivoire Uganda Sao Tome Equat. Guinea Zimbabwe S. Africa Ghana Swaziland Guinea-Bissau Tunisia Lesotho Morocco Niger Somalia Tanzania Reports fromtheRegionsandCountries Table 2. Classification of South East Asian Countries by Iodine Nutrition Deficient Likely Likely Status Severe Moderate Mild Deficient Sufficient Sufficient Excess Uncertain India Maldives Bangladesh Bhutan Myanmar Nepal Sri Lanka 289 290 Table 3. Classification of China/East Asian Countries by Iodine Nutrition Global EliminationofBrainDamageDuetoIodineDeficiency Deficient Likely Likely Status Severe Moderate Mild Deficient Sufficient Sufficient Excess Uncertain Mongolia North Korea China Table 4. Classification of Asia/Pacific Countries by Iodine Nutrition Deficient Likely Likely Status Severe Moderate Mild Deficient Sufficient Sufficient Excess Uncertain New Zealand Australia Thailand Singapore Japan Philippines Laos South Korea Papua New Guinea Malaysia Cambodia Indonesia Vietnam Fiji Reports fromtheRegionsandCountries Table 5. Classification of Middle East Countries by Iodine Nutrition Deficient Likely Likely Status Severe Moderate Mild Deficient Sufficient Sufficient Excess Uncertain Pakistan UAE Afghanistan Iran Bahrain Kuwait Iraq Jordan Oman Saudi Arabia Qatar Syria Yemen 291 292 Global EliminationofBrainDamageDuetoIodineDeficiency Table 6. Classification of Americas by Iodine Nutrition Deficient Likely Likely Status Severe Moderate Mild Deficient Sufficient Sufficient Excess Uncertain Haiti Bolivia Guyana Ecuador Argentina Chile Surinam Dominican Guatemala Peru Brazil Republic Cuba Venezuela Colombia Panama Belize USA El Salvador Paraguay Honduras Uruguay Nicaragua Canada Mexico Costa Rica Reports from the Regions and the Countries 293 Table 7. Classification of West/Central European Countries by Iodine Nutrition Deficient Sufficient Likely Sufficient Albania Austria Iceland Belgium Bosnia Luxembourg Denmark Bulgaria Norway France Croatia Sweden Germany Cyprus Greece Czech Republic Hungary Finland Ireland Macedonia Italy Netherlands Romania Poland Slovenia Portugal Spain Slovak Republic Turkey Switzerland Yugoslavia United Kingdom (Montenegro) Yugoslavia (Serbia) 294 Global EliminationofBrainDamageDuetoIodineDeficiency Table 8. Classification of East Europe/Central Asian Countries by Iodine Nutrition Deficient Likely Likely Status Severe Moderate Mild Deficient Sufficient Sufficient Excess Uncertain Azerbaijan Latvia Armenia Kazahstan Lithuania Tajikistan Georgia Uzbekistan Belarus Kyrgestan Turkmenistan Ukraine Estonia Russia Moldova Reports from the Regions and the Countries 295 2 African Region D Lantum, J Egbuta J Mutamba, T Ntambue 2.1 Overview 2.2 Cameroon 2.3 Nigeria 2.4 East & Southern Africa 296 Global Elimination of Brain Damage Due to Iodine Deficiency 2.1 Overview John T Dunn, D Lantum, J Egbuta J Mutamba, T Ntambue In collaboration with other Senior ICCIDD Members from Africa* 2.1.1 Summary and Lessons Learnt 2.1.2 Introduction 2.1.3 Urinary Iodine 2.1.4 Legislation 2.1.5 Iodized Salt 2.1.6 National Programs 2.1.7 Overall Status 2.1.8 Recommendations * M Benmiloud, OL Ekpechi, C Todd, P Jooste Reports from the Regions and the Countries 297 2.1.1 Summary and Lessons Learnt Africa has made great strides towards iodine sufficiency in the past 15 years. Approximately 23 of the 50 countries considered here, representing 59% of its population, appear to be iodine sufficient. The major push for iodized salt, currently used by about 62% of households, is chiefly responsible for this improvement. By comparison, the WHO/ UNICEF/ICCIDD Conference concluded that virtually every African country had some iodine deficiency. Much remains to be done. Over half the countries still harbour iodine deficiency, putting at least 330 million people at continuing risk for its consequences. The continent is only about halfway to its goal of virtual elimination of iodine deficiency by 2005, as pledged by the UN General Assembly Special Session (UNGASS) on children in May 2002. Strong efforts must be made towards more effective implementation of iodized salt, through stronger government programs, education, monitoring, and information gathering. 2.1.2 Introduction Africa has over 800 million people, about 15% of the world’s population. Virtually all of its countries have had iodine deficiency in the past. ICCIDD has periodically summarised overall progress, with frequent additional reports on individual countries or subregions (Ekpechi 1987; IDD Newsletter (1997, 1999). The present article offers an update, drawn principally from ICCIDD sources but in addition from UNICEF Country Offices (especially on iodized salt) and WHO as well as communication from various national and other commentators. The data are presented in three tables and a map. They include all of geographical Africa, although North Africa is also grouped with ICCIDD’s Middle East/North Africa region, and the ICCIDD regions differ slightly from those of WHO and UNICEF. However, information is frequently fragmentary or not available at all. Table 1 presents a classification of countries by iodine nutrition status and Table 2, an overall summary. The entries reflect our best judgement from what is available. Still, information on many items, especially monitoring and education, cannot be readily found. Often data on the same subject conflict; for example, different surveys may report different levels of iodine in the salt or urine, and choosing the more reliable figure has been arbitrary. More details appear in the pages for individual countries in ICCIDD’s CIDDS database (www.iccidd.org). 298 Global Elimination of Brain Damage Due to Iodine Deficiency 2.1.3 Urinary iodine In accordance with WHO/UNICEF/ICCIDD (2001) recommendations, urinary iodine concentration is the major indicator of iodine nutrition. Deficiency is defined as either severe (median UI <20µg/L), moderate (20- 49µg/L), or mild (50-99µg/L); sufficiency is 100µg/L or higher, and excess is >300µg/L. Several countries have had recent careful representative national surveys, but these are the exceptions. Often only regional surveys are available. Generally, information from urinary iodine concentrations correlates with that from goitre surveys when both are available. Almost no country has information about neonatal screening with TSH, a useful marker for iodine nutrition in more developed countries. 2.1.4 Legislation Some type of legislation for salt iodization and IDD exists in 38 of the 50 countries, and is pending in another. Eight countries do not have relevant laws, and the situation
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