IDD in Kyrgyz Republic: country situation and prevention programmes Chinara Aidyralieva

Extent of the problem Goiter rate in Kyrgyzstan ( ) 1993: Osh, Bishkek and Naryn oblasts TGR: 49.1% THS >5mU/l 60% 1994: Bishkek and Osh city TGR:26-79% THS >5mU/l 60,1%

Urinary excretion of iodine: 5 oblasts of the republic out of 6 in School children years 100 boys/100 girls in each oblast (sample size 1000 ) TGR %(19-31% average, with 64% in Jalal-Abad) on the basis of ultrasound goiter evaluation Median urinary iodine (20-50  g/L average, at the Jalal- abad oblast <20) Household consumption of iodised salt: 27% (DHS 1997)

Sources of salt КARAKOL TERMINAL «TORUGART» China NARYN Kazakhstan TERMINAL «AK JOL» Russia, Кazakhstan BISHKEK TERMINAL «CHALDOVAR» TALAS J.-ABAD Osh Tajikistan Uzbekistan, Kazakhstan TERMINALS «SAVAI», «BEGABAD»; «DOSTLIK» (Andijan oblast) Salt production sites 25% -local production (4 enterprises, 2 of them equipped by UNICEF kg of Potassium Iodate for start-up) 75% -import from Kazakhstan, Tajikistan, Uzbekistan, Russia, China

Support to the development of Law on the prevention of IDD Law was adopted early in It states that all salt for human and animal consumption should be iodised. Provisions of the law in general are adequate, but … It lacks a mechanism for the law implementation (with regard to the fine for those violating the law and control of import of technical salt, which is often then being sold as non-iodised). Introduction of amendments will require simultaneous changes at the Administrative and Customs Codes as well as the Law on Licensing. Inter-sectoral mechanism of collaboration is not in place

Support to the IDD monitoring Laboratories for iodine determination in urine and salt and set of reagents were supplied, installed, staff trained Programme of IDD monitoring at all levels was developed with participation of SES, Manas Health Reform project, WHO Health Policy Analysis project -at the production site -at the wholesale/retail level -at the school (knowledge of children and iodine content in salt) 60 schools targeted at all oblasts of the republic ¤ 91 % knew about IDD, mostly linking it to goiter (89%), 6% to mental retardation and tiredness ¤ 93 % of children were positive about possibility of IDD prevention

¤ 84% of urban and 77% of rural children suggested iodised salt as primary method of prevention (70% of urban children in Chui oblast preferred drugs for prevention and 24% of Batken children were not aware of prevention methods) ¤ Source of knowledge in 42% were medical workers, 26% - TV, 14% newspapers, 11% -relatives ¤ 67.7% are consuming only iodised salt, 29.6% - any, 2.8%- only non- iodised salt ¤ Only 35% of salt was adequately iodised, 34% had low levels of iodine, 31% was non-iodised (in Talas - 55% and in Osh - 43%) ¤ 23% of urban and 35% of rural citizens purchase non-iodised salt as iodised

IDD communication campaign First workshop was conducted in 2000 (facilitated by Fatima Jatdoeva) Two videospots, three audiospots were developed and broadcast for 3 months Three types of posters (for schools, health facilities and public places) and pocket calendar were developed, printed and distributed Teachers of biology will be trained to basic IDD messages through the cascade type of training Under the ADB/UNICEF project- national communication w/shop ? NGO engagement Swiss Red Cross project

Challenges Poor quality and limited availability of iodised salt down to the village level IDD activities are mainly led by health people and lacking of inter- agency coordination Introduction of changes into the law and establishment of mechanism of law implementation is time-consuming Licensing procedure needs to be established for all salt, including technical Communications strategies are not developed /partners are not engaged Procurement of potassium iodate by local producers is too complicated