Iodine Deficiency Disorder - Central African Republic

Vitamin A

Central African Republic

Iodine

Iron

Chad




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Country Index		Epidemiological Data
Country Profile		Policy & Legislation
		Program Data
		Monitoring
		Program Resources

	EPIDEMIOLOGICAL DATA

Goiter

Most Recent Goiter Survey

National

Date:

1991

Groups Surveyed:

Children 8 - 18 yrs.

Sample Size:

7200

Sampling Method:

The sampling scheme was systematic stratified random cluster sampling. The country was stratified into 17 districts, and one sub-district area per district was randomly selected and included in the study. In each sub-district selected, 400 school children aged 8-18 years old were surveyed in schools and in the neighboring community (totaling about 7200 children, and representing at that time 1 % of the target population).

Estimated Goiter Prevalence: Indicator: total goiter = grade 1a+1b+ 2 + 3

*Region/Group (Sub-districts)**	Sample size	Population in districts (if available)	Prevalence in sample %
Bakouma	406	111,179	80.00 %
Ouadda	559	74,865	90.30 %
Dekoa	155	74,844	72.08 %
Djema/Zemio	480	27.113	72.80 %
Alindao	413	179,676	68.60 %
Birao	400	32,118	82.38 %
Mbres	400	76,531	68.38 %
Bambio	525	61,093	56.10 %
Bamingui	420	27,441	76.86 %
Grimari	420	192,811	61.10 %
Paoua	513	255,091	62.00 %
Carnot	326	207,650	62.90 %
Boali	162	170,584	64.55 %
Baoro	350	172,754	53.00 %
Boda	349	156,329	27.55 %
Bossangoa	400	243,097	40.00 %
Bangui	414	427,455	39.37 %
National	6692	2,463,616	62.50 %

Urinary Iodine
Most Recent Urinary Iodine Survey
	Date:	1991
	Groups Surveyed:	Children 8 - 18 yrs.
	Sample Size:	7200
	Sampling Method:	For the urinary iodine survey, about 40 school age children (8-18 years old) were randomly selected in each selected sub-district sample had urines collected for iodine testing (691 samples collected). A total of 664 urines samples were finally tested for iodine.

Estimated Prevalence of IDD: Indicator < 100 microgram/L

Region/Group (Sub-districts)	Sample Size	Pop. (if known)	Median urinary iodine in mcg/dl (Cutoff point : 5 mcg/dl)	Prevalence in Sample
Bakouma	41	Idem as below	3.78	Not available
Ouadda	39		1.71
Dekoa	40		1.71
Djema/Zemio	44		4.55
Alindao	39		1.24
Birao	40		0.80
Mbres	40		1.52
Bambio	38		3.63
Bamingui	39		1.01
Grimari	40		6.16
Paoua	42		1.89
Carnot	37		2.57
Boali	40		5.95
Baoro	40		4.01
Boda	30		1.63
Bossangoa	36		3.96
Bangui	39		4.18
National	664		2.96

TSH

Thyroid stimulating hormone has not been measured.

	POLICY AND LEGISLATION

Legislation on IDD
	There is no IDD legislation in CAR, nor is it being developed.
	Iodization of salt is mandatory. The mandated level of iodization is 100ppm.
	The government has published documents regarding IDD.
	- The Head of State, signed a decree in 1994, defining the characteristics of edible salt authorized in CAR and the level of iodine required to producers. According to this text, non-iodized salt is forbidden all over the country and official services were identified (customs officers, commerce officers and health officers), to monitor the implementation of the decree

Government Agency to Address IDD
	Direction of preventive medicine and disease control, MOH. This agencies function is both coordination, monitoring and funding.
	B.P. 883 Ministere de la Sante Publique et de la Population


	PROGRAM DATA

Supplementation
	Oral supplementation with iodized oil capsules is not currently used, however it was used in 1994-1995.

Fortification
Production and Importation of Salt
	There is no iodized salt produced.
	Imported salt is iodized. It is imported from South Africa, Namibia, Cameroon, and Senegal.
	The intended level of iodization for imported salt is100 ppm.
	Salt iodine content at production level is assessed by sample survey.


Retail
	The average retail cost of iodized salt is US$0.80 per kilo. Regional differences exist and are due to the distance from the city. The farther the location, the higher the price.


Household Consumption
	The estimated daily per capita consumption of salt is unknown.
	The estimated percent of adequately iodized salt consumed, as a national average is 86%. (Source: MICS 2000)

Other Programs Related to Control of IDD

Mass Media Campaigns

Multi media IDD campaigns were used to sensitize and mobilize the population for iodized salt consumption from 1995 to 2000 as major strategy to control IDD. This centralized activity has been handed over to local district mobilizers.

Community-Based Dietary Promotion

A community based nutrition program (minimum nutrition package) was designed to be implemented from this year on. It contains the promotion of good iodine status. It will be implemented in two UNICEF concentration districts, before being implemented on a national level.

Surveys of Iodized Salt

MICS/UNICEF 2000

Survey Results

Survey Level (producer/ retail/ household)	Date of Survey	Geographic area/ other grouping	Sample size	Sampling Method	% of samples with > 15 ppm	Average and/or Range of Iodine Content
Ombella Mpoko	2000	District	1285	Cluster sampling of households	88.6
Kemo	2000	District	438	Cluster	86.6
Nana Grebizi	2000	District	415	Cluster	90.9
Lobaye	2000	District	850	Cluster	89.6
Mambere Kadei	2000	District	1576	Cluster	85.7
Sangha mbaere	2000	District	321	Cluster	73.1
Nana Mambere	2000	District	867	Cluster	95.3
Ouham	2000	District	1240	Cluster	86.2
Ouham Pende	2000	District	1575	Cluster	89.6
Ouaka	2000	District	1035	Cluster	87.8
Bamingui Bangoran	2000	District	134	Cluster	65.7
Haute Kotto	2000	District	300	Cluster	53
Vakaga	2000	District	142	Cluster	14.7
Mbomou	2000	District	734	Cluster	86.2
Basse Kotto	2000	District	979	Cluster	87.7
Haut Mbomou	2000	District	240	Cluster	82.1
Bangui	2000	District	1900	Cluster	86.7
Total country	2000	Country	14,033	Cluster	86

	MONITORING

Salt Iodine
Current monitoring activities for iodine levels in salt
	Routine monitoring system using test kits performed at household level, local markets and stores by trained Volunteer controllers, health workers, and commerce agents all over the country.
	The surveys mentioned previously are being repeated.
	There is community-based monitoring of salt iodine. In the two UNICEF concentration zones, salt monitoring is included in the community based surveillance system, an information system aimed at assessing the situation of children and women and monitoring UNICEF programme impact. The community animators use rapid kits to test iodine presence in the salt at the household level.


IDD Indicators
	There is no monitoring of goiter rate.
	There are no lab facilities for biochemical measurements.



	PROGRAM RESOURCES


Donor and Implementing Agencies Involved in IDD Programs

Implementing Agency	Description of Activities	Expenditure in current year
Implementing Agency	Description of Activities	Supplementation (if applicable)	Salt Iodization	Detoxication of goitrogenic cassava:
National/State Governments	Planning, supervision, social mobilization, monitoring, coordination	NA	Unknown	Unknown
UNICEF	Support for planning, implementing, monitoring and evaluating the prevention and control of IDD.	NA	US$83,500	US$13,500

Total IDD Program Funding History and Forecast for Country

Year	IDD Activity				Total $(000)
	Supplementation $(000) (if applicable)	Fortification $(000)	Other (specify)
	Supplementation $(000) (if applicable)	Fortification $(000)	Activity	$(000)
1998		141
1999		86
2000		95.5
2001		104.5
2002		75
2003		69
2004		52
2005		45
2006		50

EPIDEMIOLOGICAL DATA

POLICY AND LEGISLATION

PROGRAM DATA

Sampling Method

MONITORING

PROGRAM RESOURCES

IDD Activity