ดาวน์โหลดงานนำเสนอ
งานนำเสนอกำลังจะดาวน์โหลด โปรดรอ
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Rajata Rajatanavin, MD, FRCP, FACP, FACE
Paradigm shift in the control of IDD Rajata Rajatanavin, MD, FRCP, FACP, FACE Ramathibodi Hospital, Mahidol University, Bangkok 12 October 2015 Bangkok
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the presence of cretins
Goiter rate % (NE) 58 % (N) % (N) % (Phrae) the presence of cretins
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Paradigm shift 1: salt iodization
Pilot project : salt iodization Goiter rate : near zero (Phrae) ,000-10,000 tons of iodized salt/yr.
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total goiter rate in school children
Resurveyed of goiter rate in 14 northern provinces National resurveyed of goiter rate total goiter rate in school children 19.3 % the presence of cretins
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Paradigm shift 2: IDD control as national policy
1992 National Commission for Control of IDD Master plan to correct IDD
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Paradigm shift 3: IDD affects cognitive function
Single most common cause of preventable mental retardation and brain damage in the world
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Paradigm shift 4: Legislation of iodized salt
for human consumption only Iodine conc. at least 30 ppm Thai FDA 1993
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25 19.3 20 16.7 15.3 15 12.2 Goiter rate (%) 9.8 10 7.9 5.4 5 4.2 3.3 2.1 1989 1990 1991 1992 1993 1994 1995 1996 1997 2001 Department of Health MOPH, Thailand
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Limitation of Goiter Rate
May not be reliable Takes time to decrease May not reflect current iodine status
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Paradigm shift 5: New indicators for IDD control
Indicator Goal Salt iodization Proportion of households using adequately iodized salt > 90 % Urinary iodine Proportion below 100 g/L < 50 % Proportion below 50 g/L < 20 % Median UI > 100 g/L Programmatic indicators Attainment of the indicators At least specified 8 of the 10 WHO/UNICEF/ICCIDD, 2001
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Paradigm shift 6: Universal Salt Iodization
Iodized salt for human consumption food industry livestock Quality Distribution
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Iodized salt plants (No.)
<700 ton/y 700-1,000 ton/y 1,001-5,000 ton/y 5,001-10,000 ton/y >10,000 Total Central 43 9 20 1 73(39%) North 37 2 5 45 (24%) Northeast 59 4 65 (35%) South 2 (1.1%) 140 (76%) 13 (7%) 29 (16%) 2 (1%) 1 (0.5%) Division of Nutrition Department of Health, MPOH : 2009
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Iodine content in salt at retailer* 2011
(ppm) % 0-20 15.07 20-40 15.8 40-80 33.09 >80 36.32 * 103 Shops 27 Provinces In 2004 coverage of standard iodized salt (20-40 ppm) in households 56.1% Department of Health
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Paradigm shift 6: Universal Salt Iodization (USI)
Quality Innovation of high quality salt mixer Mahidol model
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A field test kit for iodized salt
“ New product capable of semi-quantitative and consistent test for at least 18 months” Accurate Convenient Rapid Stable Ruenwongsa and Panijpan
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Paradigm shift 8: Set upper limit of iodine content in salt
Legalized iodized table salt Iodized salt for human consumption only Iodine conc. at least 30 ppm Paradigm shift 8: Set upper limit of iodine content in salt Iodine conc ppm Thai FDA 2010
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Paradigm shift 7: Co-ordination of related agencies
Ministry of Industry Ministry of commerce Ministry of Interior Ministry of Social Development and Human Security Ministry of Education Ministry of Public Health
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Family Care Team
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Standard iodized salt (iodine content 20-40 ppm) at household
60.3% 82.5% 83.5% Household coverage of iodized salt 91.6% (Target> 90%) Department of Health MOPH
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Iodized salt in food industry
Salt usage in food products Total (products) Use iodized salt Use non-iodized salt Beverages in sealed containers 156 18 174 Food additives 58 21 79 Food in sealed containers 158 97 255 Dietary supplement 10 Food with special purpose 7 Thai FDA 2015
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Iodized salt in food industry
Salt usage in food products Total (products) Use iodized salt Use non-iodized salt Coffee 1 Bread 68 69 Sauce in a sealed container 2 Flavored milk Dairy products 5 4 9 Instant food 16 Ice cream 484 (77.4%) 141 (22.6%) 625 Thai FDA 2015
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Iodized in food industry
Iodine in condiment Fish sauce Salt brine Soy sauce Iodine content: not less than 2 mg/L not more than 3 mg/L Effective : 31 December 2010 Thai FDA
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Iodine content in animal feed
(mg/kg of food) Requirement Cattle (n = 163) 2.46 ( ) 0.50 Hen (n = 59) 3.66 ( ) 0.33 Iodine in animal feed Present (%) Not present n = 38 42.1 57.9 Live Stock Department 2014
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Salt used in animal feed factory
Year Time period Non-iodized salt (tons) Iodized salt Total (tons) Oct 13- Sep 14 30,152.10 (92.8%) 2,325.10 (7.2%) 32,477.20 Oct 14- Mar 15 18,049.00 (94.2%) 1,120.50 (5.8%) 19,169.50 Live Stock Department 2014
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Paradigm shift 9: Monitoring urinary iodine level in pregnant women
µg/L *74 provinces Normal: before = 100 µg/L after = 150 µg/L Department of Health MOPH
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Urinary iodine in preschool children and elderly
Year Median UI (ug/L) 3-5 years >60 years 2011 229.2 129.0 2012 212.6 108.3 2013 226.6 113.8 2014 234.6 111.3 Normal ผลการเฝ้าระวังไอโอดีนในปัสสาวะตั้งแต่ปี ของกลุ่มเสี่ยงอื่น คือ เด็ก 3-5 ปี และผู้สูงอายุ พบว่า เด็ก 3-5 ปี มีแนวโน้มได้รับไอโอดีนเกินพอ ในขณะที่ผู้สูงอายุไม่พบปัญหาการขาดสารไอโอดีน ผลการสำรวจความครอบคลุมเกลือเสริมไอโอดีนในครัวเรือน ปี 2557 พบว่าแม้คุณภาพเกลือเสริมไอโอดีนดีขึ้น แต่ปัญหาคือ ยังคงมีครัวเรือนใช้เกลือไม่เสริมไอโอดีน ร้อยละ 8.4 Department of Health MOPH
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Comparison of iodine testing results in food seasoning, 2012 and 2014
Type of Food Seasoning Number of samples Did not meet standard of adequately iodized (%) 2012 2014 Mixed fish source 43 48 35 (81.4) 19 (39.6) Pure fish source 44 26 26 (59.1) 10 (38.5) Light soya sauce 20 15 13 (65) 4 (26.7) Seasoning sauce, soya sauce 19 12 15 (79) 4 (33.3) Total 126 101 89 (71) 37 (36.6) จากการสุ่มตรวจผลิตภัณฑ์ปรุงรสเสริมไอโอดีนเปรียบเทียบ ใน ปี 2555 และ ปี 2557 พบว่า ผลิตภัณฑ์ปรุงรสเสริมไอโอดีน มีคุณภาพตามมาตรฐานเพิ่มขึ้น แต่อย่างไรก็ตาม ยังคงพบถึง ร้อยละ 37 ที่ไม่เข้ามาตรฐาน ในปี 2557 Source : Bureau of Quality and Safety of food. Department of Medical Sciences, MOPH
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Paradigm shift 10: Anxillary measure Iodine supplement for pregnant and lactating women
iodine 0.15 mg. iron mg. folic acid 0.4 mg.
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Programmatic indicators
A. Effective functional national body B. Political commitment C. A responsible executive officer D. Legislation on USI E. Assessment/reassessment of the program WHO/UNICEF/ICCIDD, 2001
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Programmatic indicators (cont.)
F. Public education G. QA at iodized salt plant H. Regular lab data on urinary iodine I. Maintenance of Q.C. J. Database of regular monitoring WHO/UNICEF/ICCIDD, 2001
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Thank you
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