Wheel model for IDD Elimination Program

Prevalence IDD Urinary iodine Salt iodine

Resource allocation

Program

Education

Training

Community groundswell

Prevalence IDD Urinary iodine Salt iodine

Resource allocation

Program

Education

Training

Population at risk Prevalence IDD Salt economy

Health profession and public

Figure 6 Wheel model for the iodine deficiency disorders (IDD) elimination program. The model shows the social process involved in a national IDD control program. The successful achievement of this process requires the establishment of a national IDD control commission, with full political and legislative authority to carry out the program. (Reproduced from Hetzel BS (1989) The Story of Iodine Deficiency: An international Challenge in Nutrition. Oxford: Oxford University Press.)

Population at risk Prevalence IDD Salt economy

Health profession and public

Intersectoral commission

Figure 6 Wheel model for the iodine deficiency disorders (IDD) elimination program. The model shows the social process involved in a national IDD control program. The successful achievement of this process requires the establishment of a national IDD control commission, with full political and legislative authority to carry out the program. (Reproduced from Hetzel BS (1989) The Story of Iodine Deficiency: An international Challenge in Nutrition. Oxford: Oxford University Press.)

4. Achieving political will requires intensive education and lobbying of politicians and other opinion leaders.

5. Implementation requires the complete involvement of the salt industry. Special measures, such as negotiations for monitoring and quality control of imported iodized salt, will be required. It will also be necessary to ensure that iodized salt delivery systems reach all affected populations, including the neediest. In addition, the establishment of cooperatives for small producers, or restructuring to larger units of production, may be needed. Implementation will require training in management, salt technology, laboratory methods, and communication at all levels.

In addition, a community education campaign is required to educate all age groups about the effects of iodine deficiency, with particular emphasis on the brain.

6. Monitoring and evaluation require the establishment of an efficient system for the collection of relevant scientific data on salt iodine content and urinary iodine levels. This includes suitable laboratory facilities.

Striking progress with USI has occurred, as indicated by the WHO/UNICEF/ICCIDD report to the 1999 World Health Assembly. Data show that of 5 billion people living in countries with IDD, 68% now have access to iodized salt. Of the 130 IDD-affected countries, it was reported that 105 (81%) had an intersectoral coordinating body and 98 (75%) had legislation in place.

Criteria for tracking progress toward the goal of elimination of IDD have been agreed on by ICCIDD, WHO, and UNICEF. These include salt iodine (90% effectively iodized) and urine iodine in the normal range (median excretion, 100-200 mg/l).

The major challenge is not only the achievement but also the sustainability of effective salt iodization. In the past, a number of countries have achieved effective salt iodization, but in the absence of monitoring the program lapsed with recurrence of IDD. To this end, ICCIDD, WHO, and UNICEF offer help to governments with partnership evaluation to assess progress toward the goal and also provide help to overcome any bottlenecks obstructing progress.

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