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To Overcome IDD : Indonesian Experience. Triono Soendoro Ministry of Health. 1979: M.D. ( Airlangga Medical School, Indon ) 1985-1989 : M.Sc , M.Phil , Ph.D , Yale Univ , USA. 1991-2000: Director Health & Nutrition, Bappenas - PowerPoint PPT Presentation
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To Overcome IDD:Indonesian Experience
Triono SoendoroMinistry of Health
1. 1979: M.D. (Airlangga Medical School, Indon) 2. 1985-1989: M.Sc, M.Phil, Ph.D, Yale Univ, USA. 3. 1991-2000: Director Health & Nutrition, Bappenas 4. 2000-2001: Leadership Fellow at the Gates
Institute, University of Johns Hopkins, USA5. 2001: Secretary of Decentralization Unit and
Policy Advisory Group to MoH;6. 2001-now: Senior Associate, Bill and Melinda
Gates Institute, Johns Hopkins University, USA 7. 2006-2009: Director General of NIH-RD, MoH; 8. 2009 –now: Senior Advisor to MoH. 9. 1997-now: Faculty Member of O/G, Reproductive
Endocrinology, Med Sch Udayana Univ, Bali.10. 2001-now: Visitng lecturer at several universities.11. 2012- : Assist Indon President to Post MDG 2015
Outline
1. Setting the Objectives2. Assessing IDD Progress3. The Challenges 4. The Way forward
Outline
1. Setting the Objectives2. Assessing IDD Progress3. The Challenges 4. The Way forward
The Objectives
1. To increase the national coverage of adequate iodized salt consumption at household level
2. To sustain the coverage of adequate iodized salt consumption in all districts
5
Outline
1. Setting the Objectives2. Assessing IDD Progress*3. The Challenges 4. The Way forward
Assessing IDD Progress
• IDD surveys: 93, 96/98, ‘03 (TGR, UIE)
• HH’s Iodized Salt: –CBS (Susenas 1998-2003), –MOH (Riskesdas 2007 - 2013)
• Urinary Iodine Excretion (UIE): –Riskesdas 2007 (sub-samples in 30
districts)
IDD Survey: ‘93, ’96/’98, & ‘03 Design ‘93 survey Baseline
(96/98)Evaluation (‘03)
Province 5 27 28
District/City 25 276 343
Sub-district 170 3916 -
Cluster Primary school Primary school Primary school
60 in every province 3 in every sub-district
25 in every district
Palpation of thyroid gland enlargement
School children 6-10 School children 6-12 School children 8-10
Pregnant women <35 Pregnant women <35
School children Pregnant women School children
Urine sample for urinary iodine level
Analysis urine sample: wet acid digestion method using potassium chlorate
Analysis urine sample: wet acid digestion method using potassium chlorate
Analysis urine sample: wet acid digestion method using ammonium persulfate
Pregnant women Pregnant women (in 2 provinces)
-
Progress: IDD Elimination/TGR
80/82 96/980
10
20
30
40
50
III
II
IB
IA
YEAR OF SURVEY
PE
R C
EN
TA
GE O
F S
CH
OO
L
CH
ILD
RE
N S
AM
PLED
Note: Only sub-districts included within the 80/82 sample frame were included from the 96/98 sample for comparison
Progress: IDD Elimination/TGR
80/82 96/98 20030.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
30.0
9.8 11.0
Year of Survey
% T
GR
Sch
ool A
ge C
hild
ren
The Changes: District Endemicity
EndemicityDistrict/City
96/98 03Category TGR N % N %
Non-endemic < 5.0% 123 44.7 148 43.3
Mild endemic 5.0 – 19.9% 106 38.6 122 35.7
Moderate endemic
20.0 – 29.9%
30 10.9 42 12.2
Severe endemic
>= 30% 16 5.8 30 8.8
T o t a l 275 100 342 100
Changes: 268 District Endemicity
EndemicityDistrict/City
1996/1998 2003
Category TGR N % N %
Non-endemic < 5.0% 122 45.5 115 42.9
Mild endemic 5.0 – 19.9% 104 38.9 96 35.8
Mod- endemic
20.0 – 29.9% 28 10.4 35 13.1
Sev- endemic
>= 30% 14 5.2 22 8.2
T o t a l 268 100 268 100
Distribution of Province by Category of Endemicity in ’96/’98
and ‘03
EndemicityProvince
1996/1998 2003
Category TGR N % N %
Non-endemic < 5.0% 9 34.6
7 25.0
Mild endemic 5.0 – 19.9% 13 50.0
17 60.8
Moderate endemic 20.0 – 29.9% 2 7.7 2 7.1
Severe endemic >= 30% 2 7.7 2 7.1
T o t a l 26 100
28 100
Trend of HH’s Iodized Salt Consumption: 1998-2007
1998 1999 2000 2001 2002 2003 20070%
20%
40%
60%
80%
100%
65.2 63.6 64.5 65.4 68.5 73.262.3
15.1 18.0 18.4 16.7 15.4 12.723.7
19.7 18.5 17.0 17.9 16.1 14.1 14.0
Adequate Inadequate None
Source: Susenas 1998-2003, Riskesdas 2007
% HH Consume Iodized Salt: 2003-2007
NTB NTT
Sultr
aJa
tim Bali
Maluk
u
Bante
nJa
bar
Jate
ng
Sulse
l
Sulte
ng DKI
Bengk
ulu
Lam
pung DIY
Riau
Malut
Kaltim
Kalbar
Papu
a
Kalte
ngSu
lut
Sum
ut
Goron
talo
Sum
bar
Sum
sel
Jam
bi
Babel
0
10
20
30
40
50
60
70
80
90
100
2003 2007
% H
ousehold
consum
ed a
dequate
Iodiz
ed s
alt
Association between UIE and Iodized Salt Coverage
Urinary Iodine and Iodized Salt Coverage - Provincial datay = 1.6728x + 123.34
R2 = 0.4727
0
100
200
300
400
0 20 40 60 80 100Iodized salt coverage (%)
Uri
nar
y io
din
e (m
edia
n)
18Source IDD Survey 2003
HH’s Iodized Salt vs Iodine Urine (School Age Children)
Iodized Salt (ppm) UIE ug/L
<5 7,8% <20 0,4
5-15 29,4% 20-50 3,2
15-20 12,6% 50-100 9,3
20-30 25,7% 100-300 65,1
30+ 24,5%** >300 21,9*)
Source: Riskesdas 2007 (30 Districts)
*) Excessive:
Outline
1. Setting the Objectives2. Assessing IDD Progress3. The Challenges* 4. The Way forward
The Challenges• Universal Salt Iodization (USI) targets
have not been met nationally, but excessive iodine intake is beginning to manifest
• Focus of USI should be directed to Provinces/Districts with HH’s consume Iodized salt <50%
• Attention is also needed for areas where the UIE level >300 ug/L
• Health disparities*: PHDI
The Purpose: PHDI
• Describe public health development progress for entire districts in Indonesia
• Focused programs interventions (local specific) in each districts.
PHDI Progress: ‘07-’10 (‘13)
Composite PHDI (7 Indicator): Malnutr, Stunring, Imuniz ANC/MCH, Sanitation, Water
DIYBal
i
Kepri
Bengku
luJatim
Sumut
Sumbar
Jabar
Sumse
l
Jam
bi
Kalbar
Bante
nNTB
Pabar
Goron
talo
NTT
Maluku
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
indeks 2007
indeks 2010
Provinsi
Ind
eks
The Benefits• A tool to evaluate the process of
improving a certain area (district/municipality) on health status over time.
• An advocacy for province and district government to increase their health status using focused resources and programs interventions priority.
• As a criteria of health fund allocation from central to province and district government.
District DBK: The Areas
Category 2007 2012
• District/Urban DBK 130 156
• District/Urban Non DBK
310 341
Jumlah 440 497
P-DBK: 10 Prov as of ‘11 Aceh (14/21) NTB ( 6/9) NTT (11/16) Sulteng (7/10) Sultra (8/10)
Gorontl (5/5) Sulbar (4/5) Maluku (5/8) Pap Bar (6/9) Papua (14/20)
• Prop DBK: # total : 28 prop 130 kab/kot• Prop > 50% Kab DBK : 10 prop* 80 kab/kot• Prop < 50% Kab DBK : 18 prop 50 kab/kot
27
Sumber : Riskesdas 2007
Training
Actions
Organizational Change
Start End
Actions
RDSRDSTranslation
InternalSupportGroup
Mentoring
Learning History: Cohort of PDBK
The Challenges: Partnership
Comitment & Involvement
District Gorontalo (2011)
Profil 2010
Densus Profil 2010
Densus Profil 2010
Densus Gizburkur
Jumlah Ditimbang Gizburkur IPKM 2007
32,363 32,045
23,300
28,458
969 3,286
9,187
sejumlah
The Way Forward
• Increase knowledge and awareness of the population
• Establish a proper surveillance system
• Ensuring sustainability• Conduct national survey to
track progress
The Way Forward (2)
• It tells us “WHAT• It tells us “PROBLEM”
• But it does not tell us “HOW?• Left us with:
‘ISSUES , UNCERTAINTIES, and ‘HOPES’
Action Non Material Approach