Legislation on IDD Control as a Part of Effective Preventive Strategies in Bulgaria L. Ivanova, Tz. Timtcheva National Center of Hygiene, Medical Ecology and Nutrition Ministry of Health Sofia, Bulgaria

Bulgaria is a country with 1/3 of the territory being endemic For the first time a Regulation on IDD Prevention was introduced in The strategies were focused on endemic regions only. Salt iodization and iodine supplementation of target groups (children, pregnant women) was implemented The outcome was reduction of goitre from 55.9% to 12.1% in the following 15 years.

In 1994 the new Legislation was introduced based on:  Lessons learned by the previous National Regulation  IDD situation in Bulgaria  International Recommendations (ICCIDD/UNICEF/WHO)

National Legislation on IDD Control  Government Decree 96/ of the Council of Ministers (State Gazette 43/ )  Order N RD / of the Chief State Sanitary Inspector of the Republic of Bulgaria (State Gazette 52/ )  Amendment N 7/ to Bulgarian State Standard “Table salt”  Ordinance for Requirements to the composition and characteristics of food grade salt (State Gazette 11/ )

Government Decree 96/ was developed to set the foundational of the IDD Elimination Program Main Principles/Activities  Universal salt iodization covering all salt for human consumption, food industry and cattle breeding  Additional prophylaxis of risk groups in the “endemic regions” with iodine tablets  Trade policy stimulating the import of iodized table salt  Creation of national IDD monitoring system.

Government Decree 96/ of the IDD Elimination Program Main Principles/Activities  Implementation of a program for public education and social mobilization on the importance of IDD and the consumption of iodized salt  Establishment of an effective functional Interagency IDD Council of Ministers, under the Minister of Health (with representatives of Ministry of Industry, Trade, Finances, Agriculture, Committee of Standardization)

Order N RD / of the Chief State Sanitary Inspector of the Republic of Bulgaria  Prohibition of placing non-iodized table salt at the market  Definition of a system and methods for control of the quality of iodized salt  Creation of a database for recording results of iodized salt at the market through the Ministry of Health

Amendment N 7/ to Bulgarian State Standard “Table salt” Salt iodization with potassium iodate at level ppm ( ppm I).

Ordinance for Requirements to the composition and characteristics of food grade salt (State Gazette 11/ ) Sets requirements to the composition and characteristics of food grade salt for direct consumption, catering and food manufacture.

Ordinance for Requirements to the composition and characteristics of food grade salt (State Gazette 11/ ) Definition “For food purposes only salt iodized with KJO3 at level ppm must be used;  Expiry time, not longer than 12 months after iodization  Specification of storage condition (clean, closed and dry rooms)  Specification of Package material  Labeling (Ordinance for food labeling, Decree 136/2000(SG, 62/2000)

Ordinance for Requirements to the composition and characteristics of food grade salt (State Gazette 11/ )  Laboratory control: Sampling procedure (Ordinance 2/1997, SG 10/97); Methods-Bulgarian State Standard methods , BSS 2/92),

As a result of effective implementation of enacted legislation National Survey on IDD Situation in Bulgaria - Spring 2003

National Survey on IDD Situation in Bulgaria -Spring 2003 Urinary iodine Median (mg/L)198.0 Proportion below 100 mg/L6.9 % Proportion below 50 mg/L 0.8 %

National Survey on IDD Situation in Bulgaria -Spring 2003 Goitre grade (ultrasonography ) Proportion above P 97 (WHO, 1997)4.3%

Percentile distribution (P 25, P 50,P 75 ) of ioduria from schoolchildren for the period