Iodine Deficiency Disorder

Year	IDD Activity				Total $(000)
	Supplementation. $(000) (if applicable)	Fortification. $(000)	Other (specify)
	Supplementation. $(000) (if applicable)	Fortification. $(000)	Activity	$(000)
1998		$100,000- Revolving fund of Iodate $200,000- Monitoring of salt (include intersectoral action for control of commerce of non-iodized salt, lab maintenance, analysis, and report) $50,000- Technical assistance/producers	Communication and surveillance of villages. Training and supervision Technical assistance to the program and to the small producers by UNICEF	400,000 150,000 80,000	Government= $900,000 UNICEF= $80,000 ation and $980,000
1999		$100,000- Revolving fund of iodate $200,000- Monitoring of salt (include intersectoral activities)	Communication Surveillance of villages. Technical assistance to the program and to the small producers by UNICEF	100,000 100,000 50,000	500,000 50,000 ation and 550,000
2000		$30,000- Revolving fund of iodate $50,000- Technical assistance to small producers. nnnnnn $100,000- Monitoring of salt	Communication Technical assistance to small producers and technical support to the program by UNICEF	50,000 50,000	400,000 50,000
2001		$30,000- Revolving fund of iodate $85,000- Monitoring of salt	Surveillance of villages Technical Support (UNICEF)	21,000 30,000	136,000 30,000 166,000
2002		$30,000- Revolving fund of iodate $100,000- Monitoring of salt	Surveillance of villages Technical Support (UNICEF)	44,000 76,200	184,000 76,200 260,200
2003		$30,000- Revolving fund of iodate $110,000- Monitoring of salt	Surveillance of villages	44,000	184,000
2004		$30,000- Revolving fund of iodate $100,000- Monitoring of salt	Surveillance of villages
2005		$30,000- Revolving fund of iodate $100,000- Monitoring of salt	Surveillance of villages


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Goiter
Most Recent Goiter Survey		Tyromobil Project
	Date:	1998
	Groups Surveyed:	Children 6-12 years of age.
	Sample Size:	2184
	Sampling Method:	Children in accessible areas of Sierra were evaluated using ultrasonagraphy methods which resulted in finding less than 1% prevalence in that area.

Urinary Iodine
Most Recent Urinary Iodine Survey National Micronutrient Survey
Date:	October-December 1999
Groups Surveyed:	Children 6-12 years of age.
Sample Size:	4936
Sampling Method:	The sample population for the survey was based on two criteria. First the region of Sierra was broken down into geographical sub-regions. Second, risk level assessment was observed in each sub-region based on iodized salt consumption and previous urinary values.

Legislation on IDD
	There is IDD legislation in Peru since 1969 and it has not been significantly revised.
	Iodization of salt is mandatory with a mandated level of salt iodization at 30-40 ppm.
	The government has published many documents regarding IDD.
	The government documents are 'Rules for application of the law for mandatory iron fortification of salt' (1971), 'Office of Goiter Endemic' (1983), 'Technical norms for control of endemic goiter and cretinism' (1984), 'National Program' (1987), and 'Technical norms for control of endemic goiter and cretinism' was reviewed and published for national application in 1997, this plan integrated micronutrients vitamin A and iron as well as iodine.
	National Network (1988) was established by the Ministry of Health through government funds assigned in the health annual budget.

Government Agency to Address IDD
	The government agency that deals with IDD is the Ministry of Health which functions as a coordination and monitoring of salt and community surveillance agency.
	Ministry of Health also gives assistance to small salt producers and is responsible for training and communication of health personnel. Agency also head of administration that coordinates the revolving fund for iodine in the country.
	Contact information: Walter Vilchez Davila, Director, Nutrition Office Ministry of Health.

EPIDEMIOLOGICAL DATA

POLICY AND LEGISLATION

PROGRAM DATA

MONITORING

PROGRAM RESOURCES

IDD Activity

IDD Activity

Supplementation
	Oral supplementation with iodized oil capsules is not currently used but has been used in the past
	Past supplementation programs have focused on the entire population of the sierra, which is broken down in 6 geographical sub-regions.

	More recent supplementation have focused on protecting small villages in remote areas, where people did not have regular access to iodized salt.
Targeting
Targeting
	Fertile age Women and Children until 18 years of age.
Fortification
Capsule Information
	Not Reported
Fortification
Implementation
	The supplementation program occurred three times in Peru: 1987-93, 1996, and 1998. The first program reached 2 million people while the other programs reached 300,000 and 50,000 people respectively.
Fortification
Fortification
Production and Importation of Salt
	There is iodized salt production in Peru.
	Large-scale salt iodization started in 1970 as a government monopoly enterprise.
	Annual production of iodized salt in 2000: 178,700 metric tons total (25,000 metric tons was exported to other countries).
	There are currently 2 large and 50 small salt producers.
	Potassium iodate is used to iodize salt.
	The intended level of salt iodization is 30-40 ppm.
	Mechanical techniques are used by the large salt producers while small salt producers used manual methods in packaging the iodized salt.
	Bags weighing 1 kg are used for direct human consumption while bags weighing 50 kg are used by the food industry.
	These procedures are assessed every two weeks via monitoring systems which result in small producers obtaining 84% production level (30ppm) and large producers obtaining 100% production level (30ppm).
	Assessment is conducted through the monitoring and distribution of iodate supply by the Ministry of Heath for small salt producers, and every month through the Ministry of Industry and Commerce for large producers.
	As As of 2001, 94% of the total production reached target iodine levels.
	There are other methods of iodine fortification such as iodized salt being used in all food industry methods.
Fortification
Retail
	The average retail cost of 1kg of salt produced by large producers is US$0.15 and US$0.12 by small producers
Mass Media Campaigns
Household Consumption
	The estimated daily per capita of consumed iodized salt is 10g per day.
	The estimated national percent of adequately iodized salt consumed is 94% (data varies by region)
(Source for above information on IDD: Annual surveys of schools and monitoring system survey from National Food and Nutrition Center)

Other Programs
Mass Media Campaigns
	Supported by UNICEF, mass media campaigns increased from 1994-1997 with the aim of IDD prevention.
	In 1998 the government took over funding for mass media campaigns and increased the budget, however the budget was decreased significantly in 1999 and eliminated in 2001. This resulted in a halt to mass media campaigns.
Community-based Programs
Community-based Programs
	The qualitative field test, conducted at the household level within the community monitoring health activity, is the only community-based program in Peru.

Salt Iodine
Current monitoring activities for iodine levels in salt
	Qualitative controls are conducted at market levels.
	In addition, each region is divided in 6 lots from which 20 samples are collected from each lot. The samples are bought by health services and two samples are collected every two weeks from small producers for analysis.

Repeat Surveys
	The only survey being repeated is the school survey which is conducted annually.
	Every two months are free salt sample is given and a salt report is made through the monitoring system.
Repeat Surveys
Facilities for monitoring
	A qualitative kit is used as the community-based facility for monitoring.
	The kits are provided by the Program and are located at local health services.

IDD Indicators
	Goiter monitoring is conducted through health center records.
Lab facilities
	There are many lab facilities to conduct biochemical measurements in Peru.
	The first facility is located at the Cayetano Heredia University and its lab is responsible for interlaboratory assays for urinary iodine for Latin-America. The method for this analysis was recently standardized by the National Food and Nutrition Center.
	There are 16 other regional labs across the country that systematically conduct iodine salt analysis through samples obtained from producers and from the general market.
	The National Program also created labs with the cooperation of PAHO and UNICEF that will be incorporated into the National Lab Network from the National Health Institute.
	The National Food and Nutrition Center also conducts national interlaboratory assays that are performed twice a year (mainly in the Andean sub-region).
IDD Indicators
TSH
	There is no measurement of TSH currently in Peru.
IDD Indicators
Surveys of Iodized Salt (2001)

Survey Level (producer/retail/household)	Date of Monitoring	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
Small producer Large producer- make their own control	2001	All small producers	953	Al-azahar	100	84 100	38 ppm
Retail	2001	174 provinces	11,154	A convenience	91.9		34 ppm
School Survey	2001	104 provinces	2,449	Total	94
Household level (only by qualitative methods)	2001	29 health regions which contain 690 districts. Test is applied in each field visit.	551,544 (1 year; 10 samples by health services/month is requested)		89