Swaziland Vitamin A

Tanzania

Iodine

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Monitoring
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EPIDEMIOLOGICAL DATA

Goiter  
Most Recent Goiter Survey a)  Tanzania Mainland, 16 out of 27 severely IDD affected districts were surveyed in 1999.
b)  Baseline survey for all districts of Tanzanian isles of Zanzibar and Pemba, 2001.
Date: a)  1999
b)  March/April 2001
Groups Surveyed: see tables
Sample Size: The expected sample size for goiter in Tanzania mainland was 19,200 schoolchildren while that of Zanzibar was 12,000 children.
Sampling Method: For Tanzania Mainland, a purposive sampling was done focusing on IDD affected districts that previously received both interventions i.e., iodinated oil capsules (IOC) and iodated salt that is also for national coverage. Systematic random sampling with a “proportionate to size” representation of boys and girls was used in both Tanzania Mainland and Zanzibar Islands.
Estimated Goiter Prevalence:

Estimated National Goiter Prevalence  TZ-mainland   Date: 1999        Indicator: Goiter

Age Group

Sample Size

Prevalence ( %)

6-10

11-15

16 and above

Total

3075

11,113

2,034

16,222

12.5

26.0

26.7

23.5

 

Estimated National Goiter Prevalence  Zanzibar Date: 2001    Indicator: Goiter

Age Group

Sample Size

Prevalence ( %)

6 to 10

11 to 15

16 and above

Total

3763

7339

865

11.967

12.3

32.2

27.2

25.6

 
 
Urinary Iodine
Most Recent Urinary Iodine Survey
    The location and duration was the same as the afore-mentioned surveys for goiter.  They were done to a sub-sample of schoolchildren surveyed.  Systematic random sub-sampling procedure were applied to both surveys done in Tanzania mainland and Zanzibar islands. Expected sample size Tanzania mainland-2400 and for Zanzibar it was 600 urine samples.
 
Estimated Prevalence of IDD:  Indicator < 100 microgram/L
 

Region/Group

Sample size

Prevalence in Sample

Pop. with Low Urinary Iodine

Median Urinary Iodine Level

TZ Mainland (1999):  Ages 6 - 16 2076 NR   235.0
Zanzibar Islands (2001):   Ages 6 - 16 559 40.2% (< 100mcg/L)   127.0
    21.8% (<50mcg/L)    

NR = Not Reported

 
 
TSH (Thyroid Stimulating Hormone) -  Has not been measured.
 
 
 

POLICY AND LEGISLATION

 

Legislation on IDD

    

IDD legislation in South Africa was passed in 1994, and are referred to as the Salt Acts.

    

Under the Salt Acts, the iodization level is 75 to 100ppm. It was recently reviewed to be 50-70ppm, but has not been incorporated in the legislation yet.

 
Government Agency to Address IDD
    

Tanzania Food and Nutrition Centre(TFNC).  This agencies function is coordination and monitoring at the community level, while the National Food Control Commission (NFCC) monitors at the factory and distribution levels.

    

Contact Information:  email:tfnc@muchs.ac.tz or fsn@ud.co.tz

   
     

PROGRAM DATA

Supplementation
     Oral supplementation with iodized oil capsules is currently being used and has been since 1986.  The entire population of people living in IDD endemic areas are targeted, over 6 million people.
Fortification
Production and Importation of Salt
    

There is iodized salt production.

    

The intended level of iodization under the existing salt regulation is 75-100ppm, but another level under review is 50-70ppm and will be effected once is incorporated in the salt regulations.

    

The large-scale salt iodization started in 1995.

    

In 1990, there were 200 producers but the current number is not known.  They are all supposed to iodize their salt, but some don’t iodate, while others do not iodate adequately.

    

Potassium iodate is used to iodize salt.

    

Regarding packaging methods, two types are currently in use: i) The salt is packed in 50kg laminated/or with inner lining bags, especially for the course salt.  ii) 20 kg cartons of 500gm or 1kg packets, this is commonly used for crushed, fine or refined salt.

    

Salt iodine content at production level is assessed some with titration, while the majority use rapid field test kits.

     Salt is imported from Kenya, Eritrea, South Africa, India and Yemen.
     The iodization level of imported salt should be equal or above 18.5ppm.
Retail
   

*  The average retail cost of salt (iodized and not) is  US $0.30 - $0.40 per kg salt of crushed/fine salt. For course salt, it is between US $0.10 to $0.20 per kilo.

   

*  The only regional differences is the preference of course salt in the rural areas, while urban areas prefer fine /crushed salt.

 
Household Consumption
     It has been established by the survey report carried in four districts in 1990, that the average per capita consumption of salt is 8g per person per day (range 6.6-9.4g per person per day).
     The estimated percent of adequately iodized salt consumed, as a national average:  Data for nationwide availability of adequately iodized salt survey is still 68 percent with urban areas leading by having an average of 86 percent (Tanzania Reproductive Child and health Surveys 1999) and for the 16 districts surveyed at the same time it was 83 percent.  But according to the on-going sporadic surveys conducted between October 2000 and April 2001, as part of process monitoring, it is now at an average of 87 percent in 17 the IDD endemic districts.  For Zanzibar Islands, the adequately availability of iodated salt at the household is 30 percent.
  Source:  Survey reports from 1999 and from the Process monitoring data collected from the established iodated salt surveillance at household level. For Zanzibar is IDD situation-Baseline report March /April 2001.
 
Iodized Salt Surveys

    

The most recent salt iodization survey was the UNICEF MICS 1998.
    
Survey Results

 

Survey Level

(producer/ retail/ household)

 

Date of Survey

 

Geographic area/ other grouping

 

Sample size

 

Sampling Method

%  of samples with > 18.0 ppm

Average and/or Range of Iodine Content

 

Household

1999

16 IDD Endemic districts

21153

Purposive systematic

83.3%

18.5 - 100

Wholesale/retail

1999

As H/Hold above

148

Random

68.2

Mean=47.5 Range= 0.0-240.1

For Zanzibar

Household

2001

All islands

15824

Purposive systematic

30.0

 

Wholesale/retail

2001

 

80

 

27.5

Mean=16.3 Range=0.0-138.9

 

Other Programs Related to Control of IDD
Mass Media Campaigns
    

All mass media has been sensitized on the IDD problem and its control through consumption of iodized salt. IDD is part of the nutrition programs aired in the mass media frequently. For Zanzibar plans are underway to involve mass media.

Community-Based Programs

     Establishing the surveillance of iodated salt at the household level in Tanzania mainland is part of community involvement in promoting the good iodine status at that level. Already 600 schoolteachers from 51 schools in 17 districts have been trained on the IDD problem and its control through consumption of iodated salt. They were also equipped with tools for monitoring salt such as test kits for iodate and report forms. At the same time, schoolchildren and district/ ward and village leaders were sensitized during training activity in schools.  Future plans are to establish sentinel schools for all districts in Tanzania to carryout the surveillance of salt at given intervals during the year.
   
 
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MONITORING
 
Salt Iodine
Current monitoring activities for iodine levels in salt
     The surveys described above are not currently being repeated. 
     There is community-based monitoring of household/facility salt (e.g. used by creches) using the UNICEF field test kits.
    

IDD Indicators

     There is no monitoring of goiter rate.
     A national micronutrient laboratory located within the Tanzania Food and Nutrition Centre (TFNC) carrys out all analyses related to establishing the iodine status in the Tanzania’s population. It has enough human resources, but it needs some training to update the knowledge of the staff.
     
     
PROGRAM RESOURCES
 
Donor and Implementing Agencies Involved in IDD Programs
     UNICEF is a major supporting agent the IDD program in Tanzania. Other support was from the Government of Japan through its International Cooperation Agency, JICA, who supported supplies for potassium iodate and provided the last round of 3.14 million capsules to the most iodine deficient districts in Tanzania.