Iodine Deficiency Disorder

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	EPIDEMIOLOGICAL DATA


Goiter
Most Recent Goiter Survey		Fourth National Nutrition Survey - nationwide, all 76 provinces in all regions of the Philippines, including 8 clusters of cities and municipalities in Metro Manila.
	Date:	1993
	Groups Surveyed:	7 - 49 yr.olds, including pregnant and lactating women
	Sample Size:	16,144
	Sampling Method:	Sample households were drawn using a stratified two-stage sampling design. Stratification was done by region, province and urban/rural classification. The barangay and household served as primary and secondary units.
	Estimated Goiter Prevalence:

Area/ Location	Group	Sample Size	Prevalence of Goiter (%)
Area/ Location	Group	Sample Size	Nodular	Diffuse
Philippines	All ages	16,144	0.7	6.0
Males	7-14 y	2,379	0.1	0.5
	15-20 y	995	0.0	3.1
	21 & over	4,250	0.4	1.1
Females	7-14 y	2,200	0.1	4.7
	15-20 y	843	0.9	15.6
	21 & over	3,661	1.8	11.5
Pregnant	13-20 y	80	0.0	27.4
	21-49 y	685	2.1	20.7
Lactating	13-20 y	78	0.0	22.3
	21-49 y	970	2.2	15.0

Prevalence of goiter in age group 7 years and older in the Philippines

Area/ Location

Sample Size

Prevalence of Goiter (%)

Nodular

Diffuse

Philippines

16,144

0.7

6.0

NCR

1.560

1.1

8.6

Ilocos

843

0.7

5.6

Cagayan

946

0.2

8.3

CAR

929

3.7

4.7

Central Luzon

1.130

0.8

4.6

Southern Tagalog

2.028

1.5

6.8

Bicol

1.102

0.8

11.2

Western Visayas

1.247

0.8

4.4

Central Visayas

797

0.6

1.4

Eastern Visayas

1.187

0.1

11.3

Western Mindanao

612

0.0

3.0

Northern Mindanao

1.401

0.5

5.7

Southern Mindanao

1.162

0.2

3.2

Central Mindanao

582

0.4

4.3

ARMM

619

0.0

6.0

Urinary Iodine
Most Recent Survey: Fifth National Nutrition survey
	Date:	1998
	Groups Surveyed:	Nationwide coverage (all 16 regions of the Philippines, all Provinces, except Basilan and Lanao del Sur) – groups surveyed: children, 6 months to 5 years old, pregnant, and lactating women.
	Sample Size:	10,616
	Sampling Strategy:	The survey followed a two-stage sampling design, with the barangays (villages) as the primary stage and the individuals as the secondary units.

Estimated Prevalence of IDD: Indicator < 100 microgram/L

Median urinary iodine excretion (UIE, mcg/L) and % of school-age children with UIE <50 mcg/L
Area/ Location	Sample Size	Prevalence/Indicator
Area/ Location	Sample Size	MedianUrinaryIodine Excretion (mcg/L)	UIE < 50mcg/L (%)
Philippines	10,616	71	35.8
NCR	1,143	94	21.7
Ilocos	459	82	30.7
Cagayan	515	83	30.5
CAR	668	63	40.1
Central Luzon	741	110	23.4
Southern Tagalog	1,294	79	30.5
Bicol	668	56	42.8
Western Visayas	850	69	38.8
Central Visayas	767	67	35.2
Eastern Visayas	644	67	35.9
Western Mindanao	348	56	44.6
Northern Mindanao	498	34	63.9
Southern Mindanao	880	63	39.2
Central Mindanao	402	58	45.9
CARAGA	420	56	44.9
ARMM	319	103	24.9

TSH - Thyroid stimulating hormone has not been measured.

	POLICY AND LEGISLATION

Legislation on IDD
	Republic Act 8172, "An Act Promoting Salt Iodization Nationwide (ASIN) and for Related Purposes", also referred to as ASIN Law is in its 6th year of implementation. The law requires all food grade salt, i.e. salt for human and animal consumption, to be iodized. It also mandates all salt producers and traders to make iodized salt available to all Filipinos.
	Republic Act 8172 was signed into law on 20 December 1995 and took effect on 20 January 1996. Its implementing rules and regulations are currently being revised to strengthen certain provisions particularly on the enforcement of sanctions.
	Iodization of salt is mandatory, however the law has not been fully enforced. (Per survey response)
	The mandatory level of salt iodization at production/Port of entry/warehouse- 70-150 ppm iodine for bulk packaging (>2 kg) and 60-100 ppm for retail packaging ( < 2 kg); at retail site (market) > 50 for Bulk and > 40 ppm for retail packs.

Government Agency to Address IDD
	Section 8 of RA 8172 calls for the creation of the Salt Iodization Advisory Board (SIAB). The SIAB serves as the program's advisory board and functions as the policy and coordinating body on salt iodization programs and activities. It is composed of the National Nutrition Council Governing Board (NNC-GB), with representatives from various departments and sectors, namely: the Departments of Agriculture; Health; Social Welfare and Development; Education; Science and Technology; the Interior and Local Government; Trade and Industry; Labor and Employment; Budget and Management; the National Economic and Development Authority; three private sector representatives; and, representatives from the Department of Environment and Natural Resources, the medical profession and salt manufacturers.
	In addition to this, there is a subcommittee on salt iodization which mainly functions to coordinate activities. There is also an expert/group that serves as an advisory body.


	PROGRAM DATA

Supplementation
	Oral supplementation with iodized oil capsules is not currently used, but was used from 1993 - 1996.
	In 1993, the target population for iodized oil capsules were pregnant women (but in only one region) in the Cordillera Autonomous Region, a high prevalence area.
	In 1994-1996: to all women of reproductive age from 15 to 45 years old, including pregnant women.

Fortification
Production and Importation of Salt
	There is iodized salt production.
	Salt iodization in the Philippines started in 1974 on a pilot scale up to 1980. In 1992, one of the activities under the IDD Elimination Program in the Cordillera Administrative Region (CAR) was salt iodization. With the enactment of the ASIN Law, large-scale salt iodization started in 1996 particularly for salt producers who were recipients of salt iodization machines, which were provided through the assistance of UNICEF’s Country Program for Children (CPC).
	Based on a survey conducted by DOH in 2000, there are 32 large salt producers, 60 medium scale salt producers, and an undetermined number (>500) small scale salt producers. However, not all of these iodize the salt. Based on the same survey, only 62.5% of the abovementioned number of salt producers iodized their salt. Most of the large and medium scale salt producers iodize salt.
	Either potassium iodate (KIO3) or potassium iodide (KI) has been used in iodizing salt.
	Iodized salt are packed in high density polyethylene plastic bags, as 1 kilo, half kilo (1/2) or 1/4 kilo packages.
	Imported salt is iodized. It mainly comes from China, Thailand, India.
	The intended level of iodization in imported salt is 70 ppm iodine in bulk packaging, 60 ppm in retail packaging.
	Salt iodine content at production level is assessed by the manufacturers using titration and/or test kits.
	There are no other measures of fortification with iodine in widespread use.


Retail
	The average retail cost of a kilo of locally produced iodized salt is P 13.3 0 (approximately $0.20) while a kilo of imported iodized salt is P 20.13 (approximately $ 0.40). Uniodized salt which is usually unpacked (sold through the open heap /”takal” system) costs about 4-6 pesos per kilo. (Conversion: P50.00 = $1.00)


Household Consumption
	According to the 1993 Food Consumption Survey conducted by the Food and Nutrition Research Institute of the Department of Science and Technology (FNRI-DOST), the daily per capita consumption of salt is about 5 grams.
	The estimated percent of adequately iodized salt consumed is 22 - 25%.
	According to the 1998 National Nutrition Survey, also by the FNRI-DOST, 24.8% of households consume iodized salt. Results of surveys conducted by the Social Weather Stations and the Department ofHealth also showed that 23.0% of the population consume iodized salt.

(Source for above information on IDD: The 1998 National Nutrition Survey, conducted by the FNRI-DOST. Also, surveys conducted by the Social Weather Stations (SWS) and the Department of Health

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

Survey Level	Date	Area	Sample Size	Sampling	% with > 30 ppm
Retail Branded	2001	National	252	Random at stores	74
Household	1998	National/Regional	23,528 HH with 0-10 children	Two – stage, village as primary and children as secondary	24.8

Other Programs
Education Campaigns
	Use of known personalities/celebrities to convey both positive and negative messages relating to the usage and non-usage of iodized salt in television, radio, and printed IEC materials.

	MONITORING

Salt Iodine
Current monitoring activities for iodine levels in salt
	Aside from the survey by Helen Keller International (HKI) which covered 9 regions, and provinces (2001), the OMNI survey (1997), post National Vitamin A Supplementation Survey, government survey (SWS) and the monitoring have been done by a number of local governments.
	The surveys described above are being repeated.
	There is community based monitoring through the schools in some municipalities, using Lot Quality Assurance Sampling System (LQAS).

IDD Indicators
	There is ongoing monitoring of goiter rate. It is through the National Nutrition Survey done every five years by FNRI-DOST. Goiter prevalence was last measured on a nationwide basis in 1993. In the 1998 NNS, urinary iodine excretion was the indicator used to measure IDD prevalence.
	There are lab facilities in the Food and Nutrition Research Institute; also, a number of hospitals in Metro Manila have laboratories that are capable of measuring urinary iodine excretion.



	PROGRAM RESOURCES


Donor and Implementing Agencies Involved in IDD Programs
	UNICEF, USAID, Kiwanis
	External funds are provided through UNICEF. Provision of salt iodization machines, fortificant, test kits, funds for social marketing and IEC, technology transfer and monitoring.
	There is a project plan developed which provides information on funding needs for IDD control. The amount of money designated to the plan is approximately, less than a million pesos from UNICEF have been allocated for this year (2002).

EPIDEMIOLOGICAL DATA

Group

POLICY AND LEGISLATION

PROGRAM DATA

MONITORING

PROGRAM RESOURCES