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Current Iodine Deficiency Disorder Situation
Population
Population: 53.6 million
Population growth rate: 3.1%
Population < 15 years: 48 %
Birth rate: 46 per 1000
Life expectancy at birth: 49 years
Infant mortality: 127 per 1000
Prevalence of Goiter/ UIE
Median urinary iodine: 495 mcg/L. A careful survey was carried out in 2001, originally to include 30 health zones in the country's 11 provinces, but limited to 18 health zones in 7 provinces because of war. A total of 6,035 students, from three schools randomly selected, aged 6-12, both genders.
The overall goiter prevalence by palpation was 5.7%, ranging from 3.8% in Kinshasa to 10.3% in Kasai-Oriental.
The median urinary iodine for the total of 1,101 samples was 495 mcg/L. Medians for the provinces: Bandundu, 650 mcg/L; Bas-Congo, 630 mcg/L; Equateur, 595 mcg/L; Kasai-Occidental, 570 mcg/L; Kasai-Oriental, 220 mcg/L; Katanga, 150 mcg/L; and Kinshasa, 630 mcg. 66% of samples were > 300 mcg/L.
Surveys in previous decades have shown severe iodine deficiency particularly in the north and east. Extensive studies in the Lake Kivu area by Belgian investigators in the 1960's and 70's showed severe goiter, frequent cretinism, particularly the myxedematous type.
The African Multicenter study visited four areas, two in the Kivu region and two in the Katanga region. Urinary iodines were 368 mcg/L and 303 mcg/L in the two Kivu areas and 160 mcg/L in Katanga .
A 1997 survey (IDD NL 14:24, 1998) reported that urines from 11 sentinel sites (100 samples each) medians ranging from 72 mcg/L to 630 mcg/L.
Iodized salt Coverage
Household iodized salt use: 96%
Salt Situation Analysis Production
No salt production, 100% imported from many countries, including Namibia , South Africa , Botswana , Tanzania , Kenya
Consumption
- Estimated daily per capita salt consumption: no data
- Estimated % of all salt consumed by people which is adequately iodized (household level): 96%
Iodine Procurement and Utilization
KIO3, 80-100 ppm
Universal Salt Iodization Program
Information, Education, Communication (IEC) Activities
Legislation
- Legislation: Interministerial order 1993, all imported salt to be iodized
- Legislation for Animals: yes
- Year Enacted: 1993
Program Monitoring and Evaluation
A National Bureau against IDD exists within the Ministry of Health. A National Council for Control of IDD was created in 1988. The Interministerial Order of 1993 organized production, quality control and marketing of iodized salt for human and animal consumption, set national norms for iodizing salt. Measures to implement regulations went into force in 1994, including sensitizing operators and consumers, forbidding importation of non-iodized salt, equipping laboratories to carry out testing for iodine in salt and in urine, systematic assessment of iodine content of salt at importation points by customs and intermediate depots.
Each region collects salt and urine samples to the MOH for analysis.
A careful survey was carried out in 2000/2001 described above.
Capacity for assessment includes urinary iodine concentration, thyroid size by palpation, and iodine levels in salt, by titration and by kit.
Other Interventions
Extensive program of injected iodized oil in the 1960's-1980's. None recently.
Key Lessons Learned
Challenges and Constraints
Future Plans for Sustained IDD Elimination All recent studies show the country no longer has iodine deficiency. Instead, the concern is now iodine excess. The national program recognizes this, and has recommended revision of regulations so that iodized salt at importation should contain 20-40 ppm.
Sources:
IDD NL 18(1):2-3, 2002
IDD NL 14(2):24-25, 1998
IDD NL 13(2):23, 1997
IDD NL 13(4):54, 1997
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