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Health and NutritionHealth and Nutrition

Ministry of Health of Azerbaijan Republic

and UNICEF

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Problems Addressed of 1999 • No National policy:

– No Law/Legislation on Food Codex/Food Production/Quality Control

– No Law on Salt Iodization– No National program on IDD elimination/Nutrition,

Micronutrient Deficiencies– No intersectoral or sectoral activities on IDD/USI

• Domestic salt production of iodized salt - 0%• Household consumption of iodized salt - 0%• Lack of public awareness on IDD/Salt Iodization• Low professional commitment to elimination of IDD• High prevalence of goiter among children in endemic

districts, including IDP/Refugee Concentrated districts (up to 90%)

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IDD Prevalence by Districts (per 100 population), Azerbaijan, 1998

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Health and Nutrition Program 2000-2004

Project: Mother and Child HealthIntegrated Management of Childhood IllnessesAcute Respiratory Infections and Diarrhea DiseasesSafe Motherhood and Newborn Care

Project: Expanded Program on Immunization

Project: Malaria

Project: Nutrition and MicronutrientsBreastfeeding and Baby Friendly Hospital InitiativeIodine Deficiency Disorders and Universal Salt IodizationIron Deficiency DisordersNutrition and Surveillance

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Progress in AzerbaijanProgress in Azerbaijan

• Production and import of iodized salt were limited till 1998 year,

• As a result of active work of all partners and UNICEF’s assistance 41% of households consumed iodized salt in 2000 (MICS, 2000),

• The law “On prevention of iodine deficiency disorders,” which establishes universal salt iodization beginning from January 2003 year.

Source: MICS 2000 6

Iodized Salt Consumption (percentage), Azerbaijan, 2000

41.3

34.7

10.6

43.8 45.8 47.8

0

10

20

30

40

50

60

Country total Baku Area Naxcivan

Center North West, Southwest South

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Situation in AzerbaijanSituation in Azerbaijan

• Nowadays there is a lack of national normative of requirement for marking and shelf life of iodized salt.

• Not adequate metod is being used in quantitative determination of iodine in salt,

• Little number of investigation of iodine in salt (15 in 2001), limited to one laboratory in Baki.

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Sub-legal and Sub-legal and normative acts of normative acts of governmentgovernment are necessary are necessary

• Decree of Cabinet of Ministers that regulates coming into force of law on prevention of iodine deficiency,

• Orders, regulations and normative acts of Ministries and Departments, detailing the legislation and determining the ways of it’s implementation,

• Regulations of monitoring aspects of the program is to a considerable extent within the authority of the Ministry of Health.

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Sample of Russia, Ukraine, and Belarus: the quality of iodized salt was sharply

increased after accepance of new normatives

• STANDARD 1991• Iodine content 23+/-

11mg/kg of salt

• Unstable potassium-iodide (KI) was used

• Excessive packing reguirements

• Shelf-life is 3 months

• STANDARD 2000• Iodine content 40+/-15

mg/kg of salt

• Stable potassium-iodate (KIO3) is being used

• Reasonable packing requirements

• Shelf-life is up to 12 months

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Azerbaijan Law“On prevention of iodine

deficiency disorders”Article 5.11.

-To carry out evaluation of dynamics of iodine deficiency disorders for monitoring purposes and efficiency of prevention measures and to report the results to concerned organs

Article 7.1.

- Iodine content in salt is determined by the correspondent organs of executive power.

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Azerbaijan Law“On prevention of iodine

deficiency disorders”Article 5.11.

-To carry out evaluation of dynamics of iodine deficiency disorders for monitoring purposes and efficiency of prevention measures and to report the results to concerned organs

Article 7.1.

- Iodine content in salt is determined by the correspondent organs of executive power.

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Monitoring of iodized salt in Azerbaijan Monitoring of iodized salt in Azerbaijan should be implemented in all the levels should be implemented in all the levels

on the regular baseson the regular bases

• Personal (domestic) system of quality central of to salt producers (quantitative method),

• State quality control on production (import) and salt trade (quantitative method) levels,

• Monitoring of iodinezed salt in household level (qualitative method)

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RECOMMENDATIONS RECOMMENDATIONS (1)(1)To establish by the order of state head

sanitary doctor the followings:• the rate of iodine content in salt within the level

of 40+/-15 mg/kg

• the use of only potassium-iodate for salt concentration,

• Shelf-life of iodized salt - 12 months, and it’s utilization order after the expiry date.

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RECOMMENDATIONS RECOMMENDATIONS (2)(2)• marking requirements (production date, iodine

content rate, shelf-lives, information about prophylactic properties),

• laboratory methods on quantitative and qualitative iodine content in salt and required reporting forms,

• the group of authorized persons and organizations responsible for monitoring of iodized salt, and the order of implementation of controlling measures.

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RECOMMENDATIONS RECOMMENDATIONS (3)(3)

To hold investigations on consumption of iodized salt by households (with qualitative methods) periodically (not rarely than once in two years):

• to include iodized, salt investigation to planned demographic and medical researches,

• to attract consumer societies, women and youth organizations to investigations,

• to attract teachers and pupils to iodized salt researches.

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RECOMMENDATIONS RECOMMENDATIONS (4)(4)• Creation of a laboratory for determination of iodine

in urine (acquiring of equipment and reagents, training of staff),

• Carrying out pilot investigations in different regions in 2002-2003.

• Planning of nation wide investigation within the program of iodine deficiency elimination for 2003 - 2004 years,

• Achieving of liquidation of iodine deficiency in Azerbaijan till 2005 year.

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Criterions of elimination of Iodine Deficiency Disorders, proposed by WHO,

UNICEF and ICCIDD (1999)

• Salt iodizations > 90% (persentage of households consuming iodized salt)

• Goiter cases (frequency) < 5% (persentage of pupils with thyroid increase)

• Iodine content in urine 100 - 300 mkg/l (indicates real iodine intake by organism)

• Compliance of minimum 8 from 10 criterions of sustainability of iodine deficiency elimination.

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Effective Effective indicatorsindicators are are necessary for monitoring of necessary for monitoring of

the programthe program• Indicators are used for evaluation of

current situation and also are applied for monitoring of the change in situation in the course of time

• Indicators should be quantitative and qualitative

• Indicators can be direct and indirect

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EVALUATION/STUDIESMOH-UNICEF AZERBAIJAN

2000-2002

Program/Project Title Type Status Report

Nutrition and MicronutrientIodine Deficiency Disordersand Universal Salt Iodization(IDD/USI)

Salt situationanalysis

Assesment 2000completed

Nutrition and Micronutrients/Iron Deficiency Anemia (IDA)

Production and importof grain, flour andbread.

Assesment 2000completed

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EVALUATION/STUDIESMOH-UNICEF AZERBAIJAN

2000-2002

Program/Project Title Type Status Report

Breastfeeding and BabyFriendly Hospitals

10 steps for Baby FriendlyHospital

Assessment 2000-2002

Completed

Nutrition andMicronutrients(IDD/USI)

Iodized Salt Consumption atHouseholds

RapidAssessment 2002

Must becompleted

Health and Nutrition /NutritionalSurveillance

Vitamin A Deficiency Survey 2002 Completed

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Vitamin A status of the children under 5 years in Azerbaijan

% (laboratory survey)81

25

0

10

20

30

40

50

60

70

80

90

Deficiency Hard

Source: «Vitamin A status among the children» survey, 2002.

(Department of Nutrition of the Azerbaijan Medical University)

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Consumption of Iodized Salt among the population

in Azerbaijan55.8

44.2

0

10

20

30

40

50

60

Iodine yodized (15 PPM)

Source: «Iodized salt the status of consumption among the population»

(Independent Consumers’ Union)

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Lessons Learned

Community participation is an importantcomponent and their functions should bestrengthened and further supported throughcapacity building.

Strength youth volunteers and women civicorganizations participation

Collaboration with district health andeducation authorities have enhanced theefficiency of IDD/USI and Malaria activitiesin the districts

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Future plansNutrition and Micronutrients Provide survey on Vitamin A micronutrient deficiency and

proceed as per results Integrate IDD/USI topic to the curricula of education

program Set up monitoring system of the salt factories on the content

of iodine in the salt, labeling, shelf life and others by the labpersonnel of the Central MOH laboratory

Introduction and enforcement of IDD/USI law requiresdevelopment guidelines on laboratory measure andassessment of the laboratory facilities including needs

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Future PlansNutrition and Micronutrients

Develop and implement a procedure for licensing producersof iodized salt (per article 8.2 of the Law on IDD Prevention)and pocedures for warning, publicizing, fining and banningfor the non-compliance to the rules and regulations regardingquality of iodized salt

Carry out an assessment of existing laboratories capacitiesthrough quantitative testing of iodine in salt (using titration)and defined support needed (supplies/training). System ofsamples collection (where, how many), testing, reportingneeds to be worked out as well

Celebrate IDD day in the country

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Thank you very much!

Nutrition and Micronutrients