Iodine Deficiency Disorder

Iraq

Vitamin A

Jordan

Iodine

Iron

Lebanon




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Country Profile		Policy & Legislation
		Program Data
		Monitoring
		Program Resources

	EPIDEMIOLOGICAL DATA


Goiter
Most Recent Goiter Survey		Conducted by the MOH in cooperation with UNICEF .
	Date:	2000
	Groups Surveyed:	School children 8 - 10 yrs. old.
	Sample Size:	2601
	Sampling Method:	Primary sample units (PSUs) were selected from the list of all clusters (schools) in the country : PSUs were selected with probability proportional to their size, PPS with the same number of students selected in each cluster. A comprehensive list of all students in the target grades was prepared for each selected cluster. Classes were chosen at random from the above list to fulfill the total number if children needed for the cluster. Each selected child was subjected to both clinical examination and urine testing for iodine level.
	Estimated Goiter Prevalence:

Region/Group	Sample size	Population in region/group (if available)	Prevalence in sample %
Amman	832		28.4
Irbid	450		51.1
Balka	193		38.3
Ajloon	72		79.2
Madaba	77		22.1
Zarka	448		17.9
Karak	118		48.3
Ma’an	68		33.8
Aqaba	65		20.0
Mafrak	133		36.1
Tafelah	59		42.4
Jarash	86		14.0
National Total	2601		33.5

Urinary Iodine

Most Recent Urinary Iodine Survey - Same as goiter survey above. (Twenty milliliters of fresh urine were collected from each selected student in a container.)

Estimated IDD Prevalence:

Region/Group*	Sample size	Population in region/group (if available)	Indicator(s) specify cutoff and/or median urinary iodine	Prevalence in sample %
Amman	832		10.0-19.9 microgram/100ml	16.7
Irbid	450		10.0-19.9 microgram/100ml	15.0
Balka	193		=	13.5
Ajloon	72		=	12.0
Madaba	77		=	14.1
Zarka	448		=	17.0
Karak	118		=	18.1
Ma’an	68		=	21.9
Aqaba	65		=	26.3
Mafrak	133		=	11.0
Tafelah	59		=	16.9
Jarash	86		=	9.1
National Total	2601			15.40

TSH - Has not been measured

	POLICY AND LEGISLATION

Legislation on IDD
	IDD legislation in Jordan was passed in 1996 stating standards and specifications for salt iodization.
	Iodization of salt is mandatory at 40 - 60 ppm.

Government Agency to Address IDD
	MOH, Standard and Meterology. Their function is coordination, monitoring and funding.
	Contact information: Nutrition Department, Ms. Wisam Qarqash


	PROGRAM DATA

Supplementation
	Oral supplementation with iodized oil capsules is not currently used.


Fortification
Production and Importation of Salt
	There is production of iodized salt.
	The total annual national production of iodized salt is 19,000 - 22,000 ton/yr
	The intended level of salt iodization at the point of production is KIO3 40 – 60 ppm
	Large-scale of salt iodization started in 1996.
	Approximately how many salt producers are there now? 5 producers
	Potassium Iodate is used to iodize salt.
	Salt is imported from Arab countries and the USA.
	The intended level of salt iodization for imported salt is 40 - 60 ppm.
	A recent assessment of the percent of salt production that achieves the target level of iodine is 90%. This assessment is done by testing a collection of samples.


Retail
	The average retail cost of salt is 15 piasters per kg.


Household Consumption
	The estimated consumption of salt is 5 g. per capita per day.
	The estimated percent of adequately iodized salt consumed by all people is 88.3%.*

	* Source: UNICEF State of the Worlds Children

Iodized Salt Surveys

2000

Survey Results

Survey Level (producer/ retail/ household)	Date of Survey	Geographic area/ other grouping	Sample size	Sampling Method	% of samples with > 15 ppm	% of samples with > 30 ppm	Average and/or Range of Iodine Content
Retail	2001	South	195	Quantitative		44%	40 – 60ppm
		North	100			17.6%
		middle	195			8%

Other Programs Related to Control of IDD
Mass Media Campaigns
	T.V spots, Newspaper ads., Radio announcements, IEC materials (a poster and a flyer) distributed to health centers, schools, NGOs and Universities.

Community-Based Programs
	There are no programs reported.

	MONITORING

Salt Iodine
Current monitoring activities for iodine levels in salt
	In 1998, a national salt Iodization committee was formed to monitor salt iodization and ensure that salt available in the market is adequately iodized, and ensure the conformity of the producers with the legislation. An operational follow-up and monitoring system for salt Iodization exists where all health inspectors from different governorates submit monthly monitoring reports. (use of test kits)
	The surveys described above are being repeated. In 1993 a national survey was conducted, and in 2000 another survey to assess the impact of salt Iodization was conducted.
	There is no monitoring at the community level.

IDD Indicators
	There is no monitoring of goiter rate (or other IDD indicators) from clinic/hospital records, or sources other than the surveys as referred to above.
	There are lab facilities available for biochemical measurements in the central lab of the MOH.



	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	Other (specify)
National/State Governments	Surveys Training workshops communication plans Monitoring		$ 10,000
External Agencies*
*UNICEF	Support for: - Surveys - Training workshops - Communication plans For year 2000, activities are limited to support the following: - Cost of lab tests - Cost of spot test kits		$ 1,000
*WHO	Experts & capacity building		$ 10,000

Total IDD Program Funding History and Forecast for Country

Year	IDD Activity				Total $(000)
	Suppl. $(000) (if applicable)	Fortif. $(000)	Other (specify)
	Suppl. $(000) (if applicable)	Fortif. $(000)	Activity	$(000)
1998			Training Monitoring	5,000 10,000	15,000
1999			Communication campaign Monitoring	20,000 10,000	30,000
2000			Survey Monitoring	15,000 10,000	25,000
2001			Training Monitoring	5,000 10,000	15,000
2002			Monitoring	10,000	10,000
2003			Monitoring	10,000	10,000
2004			Monitoring	10,000	10,000
2005			Monitoring	10,000	10,000

EPIDEMIOLOGICAL DATA

POLICY AND LEGISLATION

PROGRAM DATA

MONITORING

PROGRAM RESOURCES

IDD Activity