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Preventing Iodine-Deficiency Disease in China

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Ina Grose

on 24 April 2016

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Transcript of Preventing Iodine-Deficiency Disease in China

Preventing Iodine Deficiency Disease in China
What is Iodine?
How Much Iodine Do You Need?
Only a teaspoon!
Iodine Deficiency
Iodine Deficiency Disorders Control Project (1995-2000)
Funded by the World Bank, WHO, and UNICEF

The purpose of this project was to develop the infrastructure that was necessary to produce, package, and distribute iodized salt
Specific Measures
Increasing Public Awareness

Promoting Compliance

Quality Control
Public Health Impact
Iodized salt was reaching 95% of the nation by 2002
Compared to 80% in 1995
Overall, the quality of iodized salt improved
High quality salt samples increased from 30% in 1995 to 81% in 1999
Goiter rates for school children decreased significantly
From 20.4% in 1995 to 8.8% in 1999

Populations Susceptible to Iodine-Deficiency
Economic Impact
Current Challenges
Continuing Improvements
Iodine is a mineral found naturally in some foods.

The body needs iodine to make hormones in the thyroid.
Question:
Based on the natural availability of iodine, which population groups do you think would be deficient in iodine?
References
National Institutes of Health. Iodine: Fact Sheet for Consumers. U.S. Department of Health and Human Services. http://ods.od.nih.gov/factsheets/Iodine-QuickFacts/. Updated June 24, 2011. Accessed April 14, 2014
Levine R. Case Studies in Global health: Millions Saved. Sudbury, MA: Jones and Bartlett Publishers; 2007:113–119.
Guardian. Pass the Salt?. Guardian News and Media Limited. http://static.guim.co.uk/sys-images/Guardian/Pix/pictures/2008/10/21/salt.jpg. Updated January 11, 2010. Accessed April 14, 2014.
Medline Plus. Goiter - simple. U.S. Department of Health and Human Services. http://www.nlm.nih.gov/medlineplus/ency/article/001178.htm. Updated February 24, 2014. Accessed April 14, 2014
Eastman CM, Zimmermann M. The Iodine Deficiency Disorders. Thyroid Disease Manager. http://www.thyroidmanager.org/wp-content/uploads/2011/06/34-6.jpg. Updated February 12, 2014. Accessed April 14, 2014.
Medline Plus. Hyperthyroidism. U.S. Department of Health and Human Services. http://www.nlm.nih.gov/medlineplus/ency/article/000356.htm. Updated February 26, 2014. Accessed April 14, 2014
Sichuan Jiuda Salt Manufacturing Co. Ltd., Alibaba. http://jdsalt.en.alibaba.com/product/50037207-218126326/iodized_salt.html. Accessed April 14, 2014.
The Iodine Deficiency Disorders. Thyroid Disease Manager. http://www.thyroidmanager.org/chapter/the-iodine-deficiency-disorders/. Updated February 12, 2014. Accessed April 14, 2014.
Workers harvest crude salt in Lianyungang, China's Jiangsu. Xinhuanet. http://news.xinhuanet.com/english/photo/2012-09/19/c_131860733.htm. Updated September 19, 2012. Accessed April 14, 2014.
Nutrition in China. UNICEF. http://www.unicef.cn/en/index.php?m=content&c=index&a=show&catid=200&id=3750. Updated July 3, 2013. Accessed April 14, 2014.
Central Intelligence Agency. The World Factbook. Madagascar. CIA website. https://www.cia.gov/library/publications/the-world-factbook/geos/ma.html. Updated April 1, 2014. Accessed April 14, 2014.
Fallica Giuseppe. Madagascar Desert. National Geographic. http://travel.nationalgeographic.com/travel/countries/madagascar-photos/#. Updated February 1, 2014. Accessed April 13, 2014.
UNICEF. Sustainable Elimination of Iodine Deficiency. http://www.unicef.org/publications/index_44271.html. Published May 2008. Accessed April 14, 2014.
Rowe, Angie. Malagasy Girl. National Geographic. http://travel.nationalgeographic.com/travel/countries/madagascar-photos/#/st-luce-madagascar_8404_600x450.jpg. Updated February 1, 2014. Accessed April 13, 2014.
Iodine is scarce in many inland and mountainous regions, especially if subject to heavy rainfall.
740 million people (13%) of the world's population suffer from iodine deficiency, which results in a range of health problems
Goiter
Stillbirths/Miscarriages
Brain damage
Stunted growth
Excess of Iodine
Burden in China
The thyroid gland can also produce too much thyroid hormones, resulting in
hyperthyroidism
increased appetite
increased sweating
weight loss
Globally, China bears the heaviest burden in iodine deficiency (40%).

In 1995, 20.4% of children between 8-10 years old displayed some signs of goiter
Challenges
Public awareness
Goiter was common in many regions
Low demand for iodized salt
Universal compliance
Salt producing lands

Public Awareness
Central government made provincial governors aware of the seriousness of the problem

Nationwide public health campaign
Posters, newspaper editorials, documentaries
Increase demand for iodized salt

Licensing Regulations

Technological assistance to enable licensed salt producers
Upgraded old factories, established new iodation centers and packaging centers

Banned the sale of edible non-iodized salt
Promoting Compliance
Political Commitment
Pricing
Local police expose illegal salt operations
Salt inspectors sample salt in retail stores, hotels, restaurants, and households
In sea salt producing provinces, the China National Salt Industry Corporation encouraged selling raw salt to refinement centers
In 1993, the World Bank estimated that it would cost less than 0.3% of China’s GNP to treat micronutrient deficiencies

5% of GNP is lost to deaths, disabilities, decreased productivity, and lower educational potential

Financing the Project
Estimated cost of $152 million
Iodation costs
Laboratory monitoring, equipment
World Bank contributed $20 million
Increased price of iodized salt
China's Commitment
Schoolchildren are regularly monitored

Delivering iodized salt to villages

Remaining Challenges
Reaching vulnerable populations

Unwilling to pay for iodized salt
The poor, remote mountainous regions in western china
Highly accessible salt producing lands, dehydrated salt lakes, or sea salt
Iodized Salt
In order to promote proper iodine levels in a normal diet, salt is now fortified with iodine.
cost-effective
used by everyone
Millennium Development Goals
Goal 5: Improve Maternal Health
- Lower rates of thyroid disease and other clinical results of iodine
deficiency improve the health of women of reproductive age.
Goal 4: Reduce Child Mortality
Reducing iodine deficiency lowers rates of miscarriage, stillbirth and
other pregnancy complications, and neonatal death
Goal 8: Develop a global partnership for development
Programs for sustainable elimination of
iodine deficiency strengthen partnerships at global, regional and country levels.
Estimated that only 16% of population has low levels of urinary iodine
China had a high national mean coverage of 95% in 2002 for adequate iodized salt
According to National IDD Surveillance Report in 2010, 96.6% of households are consuming iodized salt
Reaching vulnerable populations
Provinces like Qinghai, Tibet, and Xinjiang
Unwilling to pay for iodized salt
The poor, remote mountainous regions in western china
Highly accessible salt producing lands, dehydrated salt lakes, or sea salt
Lessons to Learn
Enforcement is important to the success and sustainability of salt iodination
Chinese government made a firm and long-standing commitment to eliminating Iodine deficiency
Allowed all sectors across country to work together
Financing strategy was clearly defined
Full transcript