Iodine Deficiency Disorder

Malaysia

Vitamin A

Mongolia

Iodine

Iron

Myanmar

	EPIDEMIOLOGICAL DATA


Goiter
Most Recent Goiter Survey		Second National Nutrition Survey - nationwide.
	Date:	1999
	Groups Surveyed:	7 - 11 yr.olds
	Sample Size:	3,255
	Sampling Method:	15 aimags (provinces) were selected from a total of 21 aimags.
	Estimated Goiter Prevalence:

Region/Group*	Sample size	Population in region/group (if available)	Prevalence in sample %
Arkhangai	207		22.7
Bayan-Ulgii	200		29.5
Bayankhongor	199		15.5
Gobi-Altai	200		16.0
Umnugobi	177		9.1
Zavkhan	159		27.5
Dornod	200		17.5
Dundgobi	200		11.0
Khovd	200		27.5
Khuvsgul	180		28.3
Selenge	200		25.5
Khentii	200		20.3
Sukhbaatar	200		19.5
Orkhon	133		30.8
Ulaanbaatar	600		20.3
National Total:	3255		21.4

Urinary Iodine
Most Recent Survey: Second National Nutrition survey
	Date:	1999
	Groups Surveyed:	7 - 11 yr.olds
	Sample Size:	3,255
	Sampling Strategy:	15 aimags (provinces) were selected from a total of 21 aimags.

Estimated Prevalence of IDD: Indicator < 100 microgram/L

Region/Group*	Sample size	Population in region/group (if available)	Prevalence in sample %
Arkhangai	Not Reported		37.70
Bayan-Ulgii			22.49
Bayankhongor			38.97
Gobi-Altai			32.23
Umnugobi			34.41
Zavkhan			75.86
Dornod			50.57
Dundgobi			68.52
Khovd			33.63
Khuvsgul			56.42
Selenge			124.38
Khentii			143.64
Sukhbaatar			137.66
Orkhon			61.42
Ulaanbaatar			267.85
Dornogobi			47.27

TSH (Thyroid stimulating hormone) - Not Reported

	POLICY AND LEGISLATION

Legislation on IDD
	The National Program on Elimination of IDD was implemented during 1996-2001. Recently this program was revised.
	Iodization of salt is mandatory. This is mandated at the national level.

Government Agency to Address IDD
	Ministry of Health (MOH) and Ministry of Food and Agriculture (MoFAg).
	Contact Information: Ms. Ts. Bat-Erdene, MoFAg and Dr. B. Byambatogtokh (PHI, MOH)

Supplementation
	Oral supplementation with iodized oil capsules is not currently used, but was used in the past.
	The target population for iodized oil capsules were pregnant/lactating women and children with goiter.

Fortification
Production and Importation of Salt
	There is iodized salt production.
	The total annual national production of iodized salt is 1500 - 2000 tons. (Year not reported)
	Large scale iodization started in 1996.
	There are approximately 18 - 20 small factories for salt productionl.
	Potassium Iodate is used for iodization.
	The type of packaging used is polyetalin plastic bags.
	Imported salt is iodized. It is imported from Russia and China.
	Salt iodine content at production level is assessed by the manufacturers using Unicef testing kits.
	There are no other measures of fortification with iodine in widespread use.


Retail
	Average retail cost of salt per kilo: Iodized – 22-50 cents Uniodized – 3-10 cents
	Regional differences:	urban: Iodized - 30 cents, Uniodized – 9-10 cents
		rural: Iodized – 22-50 cents, Uniodized – 3-8 cents


Household Consumption
	The daily per capita consumption of salt is about 11 grams per capita per day and 3 kg per year per capita.
	Approximately 99.3% of households had salt, and of those, 44.9% had adequately iodized salt.

(Source for above information on IDD: MICS-2 Survey, 2000

Iodized Salt Survey - Helen Keller International 2001 survey covering 9 out of 16 regions.

Survey Level	Date of Survey	Geographic area/ other grouping	Sample size	Sampling Method	% of samples with > 15 ppm
Household	2000	Urban	766	cluster	62.7
Household	2000	Rural	766		28.7

Other Programs
	TV Program
	Radio Serials
	National IDD Day
	Advocacy workshops for policy-makers, decision-makers, local authorities
	Training for teachers of primary and secondary schools and health staff
	Improved participation of Association of Consumers’ Right Protection

	MONITORING

Salt Iodine
Current monitoring activities for iodine levels in salt
	Regular monitoring visits from the City and Aimag Inspectorate Department for market and salt factories.
	Monitoring of the Subprogram of Elimination of IDD at the provincial level.
	Regular monitoring from the Department of Monitoring and Information, MOH and MoFAg.
	Review meeting on 1^st phase of National Program of Elimination IDD.
	Community based monitoring: Trained-adolescents check salt iodine in the market by using UNICEF salt testing kits.

IDD Indicators
	There is no ongoing monitoring of goiter rate.
	Clinical Biochemistry, food and IDD control laboratory of the Public Health Institute can examine urinary iodine and TSH for children. Human capacity is good, however there is a shortage of testing kits.

Donor and Implementing Agencies Involved in IDD Programs

Implementing Agency	Description of Activities	Expenditure in current year ($ 000)
Implementing Agency	Description of Activities	Supplementation (if applicable)	Salt Iodization	Other (specify)
National/State Governments	Improve coordination mechanism Improve iodine salt production Training and IEC Monitoring and research
External Agencies*
UNICEF	Improve iodine salt production Training and IEC Monitoring and research Supply	-	7.2	30.8
ADB	Improve iodine salt production / Training and IEC	-	102	153

Total IDD Program Funding History and Forecast for Country

Year	IDD Activity				Total $(000)
	Suppl. $(000) (if applicable)	Fort. $(000)	Other (specify)
			Activity	$(000)
1997			Advocacy and IEC	14.3	53.8
			Research and monitoring	4.6
			Capacity building	25.8
			Supply	9.1
1998			Research and monitoring	10.9	46.6
			Advocacy and IEC	23.7
			Capacity building	9.5
			Supply	2.5
1999			Research and training	3.7
2000	None	Improve iodine salt production 0.9	Create legal environment	15.6	16.5
			Research and training
			Monitoring
			Supply
2001	None	Improve iodine salt production 7.2	Improve coordination mechanism	23.6	30.8
			Training and IEC
			Monitoring
			Supply

EPIDEMIOLOGICAL DATA