USEO F O R A L I O D I Z E D O I L TO C O N T R O L I O D I N E DEFICIENCY IN I N D O N E S I A JuliawatiU n t o r o Promotoren: Dr.J . G . A . J . H a u t v a s t Hoogleraar in d e leer van de v o e d i n g en d e v o e d s e l b e r e i d i n g , Lanbouwuniversiteit W a g e n i n g e n C.E.W e s t , P h D .D S c . Universitair hoofddocent aan de Afdeling Humane Voeding en Epidemiologie, Departement Levensmiddelentechnologie en Voedingswetenschappen, L a n d b o u w u n i v e r s i t e i t W a g e n i n g e n Visiting Professor of International Nutrition, Rollins School of Public H e a l t h , E m o r y U n i v e r s i t y , A t l a n t a G A , U S A Co-promotor: Dr. I r .J . W . S c h u l t i n k Gastdocent aan de Afdeling Humane Voeding en Epidemiologie, Departement Levensmiddelentechnologie en Voedingswetenschappen, L a n d b o u w u n i v e r s i t e i t W a g e n i n g e n Team Leader German Technical Cooperation (GTZ) at SEAMEO T R O P M E D Regional C e n t e r f o r Community Nutrition, University o f I n d o n e s i a , J a k a r t a , I n d o n e s i a USEO F O R A L I O D I Z E D O I L TO C O N T R O L I O D I N E D E F I C I E N C Y IN I N D O N E S I A Juliawati Untoro Proefschrift ter v e r k r i j g i n g v a n d e g r a a dv a n d o c t o r op g e z a g v a n d e r e c t o r m a g n i f i c u s , van d e L a n d b o u w u n i v e r s i t e i t W a g e n i n g e n , dr. C M . K a r s s e n , in h e t o p e n b a a r t e v e r d e d i g e n opw o e n s d a g 17f e b r u a r i 1 9 9 9 des n a m i d d a g st e v i e r u u r i n d eA u l a ;>. ., jt J Theresearch was carried out withinthe framework of German-Indonesian Technical cooperation through the Deutsche Gesellschaft fur Technische Zusammenarbeit (GTZ)GmbH at the RegionalSouth-East Asian Ministersof Education Organization Centerfor Community Nutrition, at theUniversity of Indonesia, Jakarta. Financial support for the publication of this thesis by the Wageningen Agricultural Universityand GTZ is gratefully acknowledged. Use o f o r a l i o d i z e d o i lt o c o n t r o l i o d i n e d e f i c i e n c y in I n d o n e s i a Juliawati U n t o r o Thesis Landbouwuniversiteit Wageningen. - W i t h ref.- W i t h s u m m a r i e s in Dutch a n d Indonesian. ISBN 9 0 - 5 8 0 8 - 0 2 3 - 4 Subject h e a d i n g s : oral i o d i z e d o i l ,i o d i n e d e f i c i e n c y , s c h o o l c h i l d r e n , Indonesia Cover d e s i g n : Sandra L o h m a n n Printing: Ponsen & L o o i j e n B V , W a g e n i n g e n ©1999 J .U n t o r o BIBUOTHEEX !A M D B O U W U N I V E K S I T E I T WAGENINGEN Stellingen (Propositions) 1. The efficacy of iodized peanut oil is greater than that of iodized poppyseed o i l i nc o m b a t i n g i o d i n e d e f i c i e n c y (thist h e s i s ) . 2. Although many indicators have been used to assess whether and to what extent a population is iodine deficient and to monitor the effectiveness of iodine deficiency control programs, urinary iodine concentration a n dt h y r o i d v o l u m e m e a s u r e d b y u l t r a s o u n d a r et h e m o s t suitable ( t h i st h e s i s ) . 3. Iodine d e f i c i e n c y disorders are recognized not only as a p u b l i c health nutrition issue, but also as an obstacle to human development (this thesis). 4. The d e v e l o p m e n t o f c o g n i t i v e p e r f o r m a n c e o f s t u n t e d s c h o o l c h i l d r e n i s lesst h a nt h a t o ft h e i r n o n - s t u n t e d c o u n t e r p a r t s (thist h e s i s ) . 5. Non-iodized s a l t a v a i l a b l e in t h e m a r k e t w h i c h is c h e a p e r t h a n iodized salt, may s u b v e r t the effectiveness of iodized s a l t in c o m b a t i n g iodine deficiency (thist h e s i s ) . 6. Simple g o i t e r ist h e e a s i e s t o f a l l k n o w n d i s e a s e s t o p r e v e n t . It m a y b e excluded from the list of human diseases as soon as society determines t o make t h e effort (D Marine. Prevention and treatmentof simplegoiter, Atl.Med. J. 1923; 26:437-443). 7. When t h e t w e n t i e t h century ends, it w o u l d be s a t i s f y i n g to be able t o look b a c k a n d s a y : " T h a t w a s t h e c e n t u r y w h e n i o d i n e d e f i c i e n c y was eliminated f r o m t h ef a c e o f o u r p l a n e t " . 8. Selling i o d i z e d s a l tt o a p o p u l a t i o n w i t h e n d e m i c i o d i n e d e f i c i e n c y isn o t like m a r k e t i n g ' C o c a - C o l a ' . 9. Cybernet e n a b l e s people to contact others all over the world within seconds, b u t r e d u c e s m e a n i n g f u l c o n t a c t b e t w e e n p e o p l e . 10. S i g n i f i c a n t i s n o t a l w a y s r e l e v a n t . 11. Learning does not end with the completion of formal education. Learning is a lifelong experience for those with an appetite for knowledge. 12. T h e r e i s n o t h i n g w r o n g w i t h h a v i n g d i f f e r e n t o p i n i o n s , b u t i t ' s a b s o l u t e l y wrongt o e n f o r c e o n e ' s o p i n i o n ,n o m a t t e r w h a t t h e r e a s o n .