Salt Iodization in the Kyrgyz Republic Davydova L. N., Chief of the Department for the State Sanitary and Epidemiological Control Ashgabat, November 2002

Iodine Deficiency Disorders Iodine Deficiency Disorders (IDD) are among the most common non-communicable diseases: –More than 1,5 million people in the world are affected by Iodine Deficiency Disoders (IDD); –900 million people in 118 countries suffer from large thyroid mass (endemic goiter); –40 million people have mental retardation due to the lack of iodine in their nutrition; Global causes of IDD: Lack of iodine in soil (endemic regions); Consumption of products grown in endemic regions

Pyramid of Iodine Deficiency 1%-10%Cretinism5%-30% Mental retardation (lowering of intellect) 30%-70% Lag in physical development due to Hypothyreodosis

In accordance with the WHO recommendations, Kyrgyz Republic is one of the countries in need of urgent measures on IDD elimination

IDD Morbidity, Kyrgyz Republic,

IDD Morbidity by Oblast, Kyrgyz Republic, 2001 (per )

Nutrition pattern has changed – consumption of sea products, rich in iodine, as well as meat and dairy products (also containing iodine) has considerably decreased – by 2-3 times. In addition, rural residents tend to consume local products grown in their households, and under the conditions of nature iodine deficiency, these products virtually do not contain iodine;Nutrition pattern has changed – consumption of sea products, rich in iodine, as well as meat and dairy products (also containing iodine) has considerably decreased – by 2-3 times. In addition, rural residents tend to consume local products grown in their households, and under the conditions of nature iodine deficiency, these products virtually do not contain iodine; Lack of local salt production industry;Lack of local salt production industry; A complete dependence on salt imports, up to 50% of which does not meet the iodine contents standards;A complete dependence on salt imports, up to 50% of which does not meet the iodine contents standards; Not-controlled turnover of technical salt;Not-controlled turnover of technical salt; Out of Control imports of salt in large quantities by individuals;Out of Control imports of salt in large quantities by individuals; Population consumes salt from local deposits, requiring additional industry processing and iodizing;Population consumes salt from local deposits, requiring additional industry processing and iodizing; Low level of awareness of population of IDD issues and necessity to consume iodized salt;Low level of awareness of population of IDD issues and necessity to consume iodized salt; Traditional practice of buying food salt in large quantities and storing it for 2-5 years.Traditional practice of buying food salt in large quantities and storing it for 2-5 years. Reasons, aggravating deterioration of IDD situation in Kyrgyz Republic

Findings of IDD Issues Survey in Schoolchildren ( ) Total of 3127 schoolchildren from 60 schools all over the country were interviewed; Both interview and express-test of salt samples, delivered by respondents from households, were conducted; Findings of the Survey: –Level of awareness of the ID problem – 91%; –Level of consumption of Iodized salt – 35%; –Level of awareness of IDD issues does not differs considerably in rural and urban populations; –The most important information sources – health workers and TV; –More than 30% of the population do not have adequate quality salt, due to purchasing it in the places of spontaneous sale or consuming the salt from local salt deposits;

Legislative framework for Control and Provision of quality and fortification of products Legal provisions of the Kyrgyz Republic: Decree of the KR President «On enforcement of State Regulation and Control of Production, Storage and Sale of Salt» (11 July 2002; №184);Decree of the KR President «On enforcement of State Regulation and Control of Production, Storage and Sale of Salt» (11 July 2002; №184); «On Standartization»;«On Standartization»; «On Certification of Products and Services»;«On Certification of Products and Services»; «On Sanitary-Epidemiological Welfare of Population»;«On Sanitary-Epidemiological Welfare of Population»; «On Prevention of Iodine Deficiency Disorders»;«On Prevention of Iodine Deficiency Disorders»; «On Protection of Consumers Rights»;«On Protection of Consumers Rights»; Code «On Administrative Responsibility»Code «On Administrative Responsibility»

Legislative framework for Control and Provision of quality and fortification of products (contin.) ► Decree of the KG Government №778 as of “On Implementation of the KR Law “On Sanitary Epidemiological Welfare of the Population" ► Decree of the KG Government №6 as of «On Implementation of the KR Law « On IDD Prevention» ► Decree of the KG Government №760 as of «On the List of Products requiring Mandatory Certification by Safety Indicators» ► Decree of the KG Government №229 as of «On Evaluation of Conformity of Imported Products with the requirements, set by Technical Standards Valid for KR» ► Decree of the KG Government №260 as of «On Licensing of Certain Types of Productions» ► Decree of the KG Government №834 as of «On Approval of Consensus to Use Technical, Medical, Pharmaceutical, Sanitary, Veterinary and Phyto-Sanitary Norms, Regulations and Requirements related to Goods, Imported into the NIS countries»

Legislative framework for Control and Provision of quality and fortification of products (contin.) ►Decree of the KG Government №194 as of «Regulations for Inspection of Business/Entrepreneurship Subjects by State Control Bodies». ►Decree of the KG Government №242 as of «On Approval of the Documents, confirming safety of products, subject to obligatory control upon imports into the KR». ►Decree of the KG Government №667 as of «On Measures to Implement the KR Law «On Protection of Consumers Rights». ►Decree of the KG Government №407 as of «Regulations on Disposal (reprocessing) of Products (goods), declared as ineligible for sale». ►Decree of the KG Government №289-p; ►Decree of the Chief State Sanitary Doctor №3 as of «On Introduction of Hygienic Conclusion», registered on in the Ministry of Justice under the Reg. Number №16. ►SanPin «Hygienic Requirements to Quality and Safety of Food Stuffs and Food Products».

Interaction between Ministries and Agencies on the Issues of Fortification of Nutrition Products Ministry of Health, Implementing Agency Ministry of Justice Ministry of Finances Office of Prime-Minister of KG Ministry of Internal Affairs M of Labor and Social Protection Ministry of Education and Culture Ministry of Agrc Legislative Chamber of “Jogorku Kenesh” (Parliament) NGOs State TV- Radio Corporation State Custom Inspection Kyrgyz Standart 1 Ministry of External Trade and Industry

Manufacturer State Sanitary- Epidemiological Service, Ministry of Health of the Kyrgyz Republic Production Trade network Consumer Conditions of Production Storage conditions Transportation conditions Terms of sale Safety of the production on sale, iodine contents Safety of Production, Iodine contents Inspection control of Certified Production Certification of Raw Materials, Products, and Inspection Control of it* State Inspection on Standartization and Metrology under the Kyrgyz Government Accredited Bodies for Certification State Control of Quality of Iodized Products

Measures, taken by SES of the Kyrgyz Republic Region # test % dev # test % dev- s # test % dev- s # test % dev- s # test % dev- s # test % dev- s Bishkek 22286,621669,019954,323462,018642,58762,0 Chui Oblast 27654,753250,052031,725259, , ,5 Talas Oblast 10756,012642,019247,315631,019764,929231,5 Naryn Oblast 22366,823462,328063,547140,138055,135655,8 Osh Oblast , , ,146054, , ,4 J-Abad Oblast 74048, , ,480432,080030,780235,8 I-Kul Oblast 23242,240252,763037,961529,365140,168341,4 Batken Oblast 75658,471932,4 REPUBLIC301846, , , , , ,5 Years1996г.1997г.1998г.1999г.2000г.2001г. REPUBLIC kg kg kg kg kg50403 kg Number and Quality of Tested Samples of Food Salt Rejected Salt (In kg)

UNICEF – the cost of aid since 1997 comprised $122,000 – 2 technological salt iodizing lines and 200 kg of Iodate Potassium were provided; Social Mobilization Campaign and other activities were conducted. ADB - JFPR9005-Kyrgyzstan $ 700,000 have been allocated. ADB - JFPR9005-Kyrgyzstan Project with support of Japanese Fund of Poverty Alleviation «Improvement of Nutrition of Low-Income Mothers and Children in Asian Countries in Transition» - $ 700,000 have been allocated. Assistance, provided to KR by International Organizations to control and liquidate IDD

Solution of Problems with Partners, representing different layers of society PoliticalPolitical – people, identifying the policy; Bureaucratic and technocratic –Bureaucratic and technocratic – state employees and technical specialists; Professional, civil, public- NGOsProfessional, civil, public- NGOs, including religious, commercial, professional, industrial and special interests groups; Community Based Organizations –Community Based Organizations – different local associations, schools, high schools, etc.; Families and IndividualsFamilies and Individuals – family members, incl. mothers, fathers, grandparents, who can make decisions related to purchase and consumption of food products.

Barriers in Solution of IDD Problems Enterprises lack salt enriching supplement, so they have to buy it at a high price, and this increases the cost and market price of the product by 2-3 times compared to normal salt; For a long time the issue of modifying current legislation – Law «On IDD Prevention», Code «On Administrative Responsibility» has not been solved yet; The issue of control of turnover of technical salt is pending solution; In spite of existing 20 salt deposits in KG, the issue of establishment of local production of salt is not solved either.

Activities Implemented in KG Inter-State GOST «Food Salt» has been approved (contents of Iodine is fixed at the level of 40 mg.kg) The National Program to decrease the level of IDD has been drafted, approved by Ministries, is pending the Govt approval; Law «On Modifications and Addenda to some Legislative Acts of the KR» (Law «On IDD Prevention» - Section related to State guarantees and control of technical salt; Code «On Administrative Responsibility» - section on administrative responsibility for imports, production, sale of low quality salt, including non-iodized salt needs to be added; The issue of establishment of a specialized enterprise «Kyrgyz Тuz» as a state body to be in charge of salt turnover in the republic; Education work is being carried out for the population in IDD prevention towards changes of nutrition habits.

Ways to Solve Problems To fill the consumer market with Iodized food products, first of all food salt; To conduct active communication with population on ID problems; To build wide political support for IDD Control and Liquidation, including Social mobilization, with wide involvement of mass media; To coordinate interaction of all governmental and non- governmental organizations, international organizations, aimed at control of the above problem; To speed up the process of approval of Law «On Modifications and Addenda to some Legislative Acts of the KR»; To speed up approval of the National Program for the years on Decrease of IDD level; To speed up the establishment of a specialized enterprise «Kyrgyz Tuz»; To organize Association of Salt Manufacturers; To interact with Central Asian Region countries in the area of enhancement of control of salt quality,including information/feedback on imports of low-quality salt; To develop infrastructure of local enterprises, producing enriched food products, including salt.