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Current Iodine Deficiency Disorder Situation
Population
Population: 16.0 million
Population growth rate: 3.0%
Population < 15 years: 45.0%
Birth rate: 42.7 per 1000
Life expectancy at birth: 55.4 years
Infant mortality: 83.6 per 1000
Prevalence of Goiter/ UIE
Median urinary iodine: 125 mcg/L (1998). 1989 National survey of 6 Provinces found the highest rates in Antananarivo and Fianarantsoa. It is estimated that some 75% of the population live in endemic areas, of whom over 33% (i.e. 3 million people) live in in severely endemic areas (TGR >30%).
1992 Quasi-national survey at 7 IDD Sentinel Sites in six provinces found average TGR of 48.22%, ranging from 34.55% to 66.85%. 1995, 49% in same 7 sentinel sites, children age 6-11 years. Another report of TGR in 1995 gave 23%. This same survey found a rate of several percent cretins and a median TSH of 3.47 mU/L. An earlier survey reported a median UI = 39 mcg/L.
In March 1998, TGR in sentinel sites was 14.8%, down from 45% in 1992. The national median urinary iodine concentration was 125 mcg/L in 1998 for the seven sentinel sites, an increase from 39 mcg/L in 1992. No new cretins were reported.
Iodized salt Coverage
Household iodized salt use: 76% (2000)
Salt Situation Analysis Production
No import. The country produces about 30,000 tons of salt: 60% by the Salt C ompany of Madagascar , in the north at Antsiranana; 40% by small salt producers of Toliary, in the south, who produce a salt of intermediate quality; and three small producers in Morondava, in the southwest. The small producers around Toliary have been divided into eight groups, each with an iodization machine of appropriate capacity. UNI C EF and the World Bank gave the producers a two-year supply of KIO3 and maintenance expense.
100% from large-scale producers, part from small-scale
Consumption
- Estimated daily per capita salt consumption: 5-8g
- Estimated % of all salt consumed by people which is adequately iodized (household level): 76%
Iodine Procurement and Utilization
KIO3, 50 ppm.
Universal Salt Iodization Program
Information, Education, Communication (IEC) Activities
Legislation
- Legislation: Decree #95-587 required all salt to be iodized.
- Legislation for Animals: yes
- Year Enacted: 1995
Program Monitoring and Evaluation
Responsible parties are Division of Nutrition, MOH; National Multisectoral committee; regional committees.
The program has a central laboratory and six dependent laboratories in the sentinel sites, responsible for quality control. A central technical and administrative coordinating team resides in the Nutrition Service of the Health Ministry in the capital. Data banks coordinating epidemiologic surveillance were described. Programs of information, education, and communication were carried out widely at the local level.
A central laboratory and six dependent laboratories in sentinel sites carry out quality control, central monitoring and administrative coordination with the Nutrition Service of the MOH, epidemiologic surveillance coordinated at central level.
Other Interventions
About 1.1 million, given iodized oil, 1993-1995. Oral administration plan geared towards: children ages 1-5 Pregnant Women School C hildren ages 6-15.
Key Lessons Learned
Challenges and Constraints
Future Plans for Sustained IDD Elimination
Sources:
IDD NL 15(1):6, 1999
IDD NL 14(2):30, 1998
IDD NL 13(2):19, 1997 |
