"Public Expenditure Tracking in Africa", presentation by Babatunde Omilola at the AU Ministers of Agriculture Meeting, Addis Ababa Ethiopia, April 20-24, 2009.
"ReSAKSS Regional Analysis on Agricultural Expenditures and Agricultural Policy Bias: Africa Wide", presentation by Babatunde Omilola and Melissa Lambert. April, 2009.
"Public Expenditure Tracking in Africa", presentation by Babatunde Omilola at the AU Ministers of Agriculture Meeting, Addis Ababa Ethiopia, April 20-24, 2009.
"ReSAKSS Regional Analysis on Agricultural Expenditures and Agricultural Policy Bias: Africa Wide", presentation by Babatunde Omilola and Melissa Lambert. April, 2009.
Achieving Universal Salt Iodization: Lessons learned and Emerging IssuesMicronutrient Initiative
This presentation provides an overview of the progress in IDD Elimination through salt iodization by reviewing some lessons learned from key programmatic indicators and discusses emerging issues such as IDD prevalence in Europe, role of small salt producers, salt in processed foods and monitoring and data issues.
Iodine Deficiency Disorders refer to a spectrum of health consequences resulting from inadequate intake of iodine. The adverse consequences of iodine deficiency lead to a wide spectrum of problems ranging from abortion and still birth to mental and physical retardation and deafness, which collectively known as Iodine Deficiency Disorders (IDDs).
The last two decades have shown that it is possible to defeat the scourge of poverty. Progress has not been uniform across countries, and there have been setbacks and disappointments. But overall, the rate of progress in reducing poverty and in increasing access to basic health, education, water, and other essential services is unparalleled in many countries’ histories.
This summary is part of initial findings from an ongoing review of development progress, which will include a set of ‘MDG indicators to construct league tables’ highlighting progress on these indicators. The review will generate comparative analysis that illustrates relative and absolute progress at national, sub-national and regional levels. In addition, a number of analytical case studies will provide a deeper understanding of the nature of progress and its contributing factors.
The Millennium Development Goals Report 2012 was launched in New York by the Secretary-General on 2 July 2012. The report presents the yearly assessment of global progress towards the MDGs, highlighting several milestones – three important MDG targets have been met well ahead of the target date of 2015. The report says that meeting the remaining targets, while challenging, remain possible - but only if Governments do not waiver from their commitments made over a decade ago. The report is based on a master set of data compiled by the Inter-Agency and Expert Group on MDG indicators led by the Statistics Division of the Department of Economic and Social Affairs.
Achieving Universal Salt Iodization: Lessons learned and Emerging IssuesMicronutrient Initiative
This presentation provides an overview of the progress in IDD Elimination through salt iodization by reviewing some lessons learned from key programmatic indicators and discusses emerging issues such as IDD prevalence in Europe, role of small salt producers, salt in processed foods and monitoring and data issues.
Iodine Deficiency Disorders refer to a spectrum of health consequences resulting from inadequate intake of iodine. The adverse consequences of iodine deficiency lead to a wide spectrum of problems ranging from abortion and still birth to mental and physical retardation and deafness, which collectively known as Iodine Deficiency Disorders (IDDs).
The last two decades have shown that it is possible to defeat the scourge of poverty. Progress has not been uniform across countries, and there have been setbacks and disappointments. But overall, the rate of progress in reducing poverty and in increasing access to basic health, education, water, and other essential services is unparalleled in many countries’ histories.
This summary is part of initial findings from an ongoing review of development progress, which will include a set of ‘MDG indicators to construct league tables’ highlighting progress on these indicators. The review will generate comparative analysis that illustrates relative and absolute progress at national, sub-national and regional levels. In addition, a number of analytical case studies will provide a deeper understanding of the nature of progress and its contributing factors.
The Millennium Development Goals Report 2012 was launched in New York by the Secretary-General on 2 July 2012. The report presents the yearly assessment of global progress towards the MDGs, highlighting several milestones – three important MDG targets have been met well ahead of the target date of 2015. The report says that meeting the remaining targets, while challenging, remain possible - but only if Governments do not waiver from their commitments made over a decade ago. The report is based on a master set of data compiled by the Inter-Agency and Expert Group on MDG indicators led by the Statistics Division of the Department of Economic and Social Affairs.
Launch of IFPRI’s 2012 Global Food Policy Report with Shenggen Fan, Director General of IFPRI; Mary Bohman, Administrator of the Economic Research Service, US Department of Agriculture; Michael Elliott, President and CEO of ONE; Andrew Steer, President and CEO of World Resources Institute. IFPRI, 14 March 2013
The 2011 GHI has improved by slightly more than one-quarter over the 1990 GHI, but globally, hunger remains at a level categorized as “serious.” In addition to presenting the 2011 GHI scores, the report examines the issue of price spikes and excessive food price volatility, which have significant effects on poor and hungry people.
Author:
von Grebmer, Klaus
Torero, Maximo
Olofinbiyi, Tolulope
Fritschel, Heidi
Wiesmann, Doris
Yohannes, Yisehac
Schofield, Lilly
von Oppeln, Constanze
"Public Sector Budget Allocation to Agriculture and Effeciency of Resource Use: A Review of Status, Trends and Implications." presentation by Babatunde Omilola at the CAADP Donors and Partners Meeting, Sept. 6, 2009.
Similar to Universal Salt Iodization in Central and Eastern Europe and the Commonwealth of Independent States (20)
Immunization is a core component of the human right to
health and an individual, community and government responsibility. Protected from the threat of vaccine –preventable diseases, immunized children have the opportunity to thrive and a better chance of realizing their full potential.
Knowledge, attitudes and practices of parents from the northern municipalities regarding pre-school education (December 2014) by IPSOS and UNICEF Montenegro
The UN Convention on the Rights of the Child turned 25 in November 2014. This compendium highlights the events and celebrations organized by UNICEF in cooperation with partner organizations and children around the world.
It is right and just for young Roma children and their futures to be at the centre of this important research.
The Roma Early Childhood Inclusion+ (RECI+) Studies and Reports are a joint initiative between the Sponsoring Agencies, namely: the Roma ‘Kopaçi’ Initiatives at the Early Childhood Program (ECP) of Open Society Foundations (OSF), the Roma Education Fund (REF) and UNICEF.
Croatia 2015
The 2014 Serbia Multiple Indicator Cluster Survey (MICS) and 2014 Serbia Roma Settlements Multiple Indicator Cluster
Survey were carried out in 2014 by the Statistical Office of the Republic of Serbia as part of the global MICS programme.
Technical and financial support was provided by the United Nations Children’s Fund (UNICEF).
The global MICS programme was developed by UNICEF in the 1990s as an international household survey programme
to support countries in the collection of internationally comparable data on a wide range of indicators on the situation of children and women. MICS surveys measure key indicators that allow countries to generate data for use in policies and programmes, and to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Universal Salt Iodization in Central and Eastern Europe and the Commonwealth of Independent States
1. UNIVERSAL SALT IODIZATION IN CENTRAL AND EASTERN
EUROPE AND THE COMMONWEALTH OF INDEPENDENT STATES
SUMMARY REPORT
Experiences, achievements and lessons learned
during the decade 2000-2009
4. UNIVERSAL SALT IODIZATION IN CENTRAL AND EASTERN
EUROPE AND THE COMMONWEALTH OF INDEPENDENT STATES
Experiences, achievements and lessons learned during the decade 2000 -2009
FIGURE 1: IMPROVEMENTS IN NATIONAL USI STRATEGIES DURING THE PAST DECADE
USI Progress in Central and Eastern Europe and the Commonwealth
of Independent States, 2000-2009
100%
4 more countries attained USI
90%
80%
SUMMARY REPORT
2 more are close to the goal
Proportion of countries
70%
4 more have coverage of 50-69%
60%
50%
40% Coverage
The number of countries with I >90
30%
coverage <50% fell by 8 I 70-89
20% I 50-69
I 20-49
10%
I <20
0%
± 2000 ± 2009
Obviously, more needs to be done to close the remaining margins. Nevertheless, the key important
lesson learned from a decade of action is that despite the unique socio-cultural environment and the
signifi cant political and economic transitions that lasted into the decade, the USI strategy was readily
adopted, pursued and carried forward in most countries of the region. The findings of this study
support the evidence that the public health problem of iodine defi ciency can be effectively overcome
by USI, and they add to the growing global confidence that IDD can be eliminated by establishing salt
iodization as the universal norm.
STUDY METHOD
An analysis of public health research and practice reveals that USI strategies make progress from
the planned simultaneous actions in four key strategic areas, namely: salt iodization, communication,
monitoring and evaluation, and joint collaborative oversight (Figure 2). The actions taken in these
areas were analyzed for their inputs and resources, and their outcomes and impact obtained with
the specifi c USI strategy in each country. The findings of these analyses were put in the typical time-
sequence of a Logical Framework Analysis.
The full report includes a detailed summary of the national USI strategy in each of the 20 countries
during the past decade, which helped informing the overall conclusions and lessons learned. The criteria
used for assessing the outcomes and impacts followed the international expert recommendations of
the World Health Organization, UNICEF and the International Council for Control of Iodine Defi ciency
Disorders (ICCIDD). This summary presents the important conclusions and lessons learned from the
analysis of a decade of action on USI.
|2
5. UNIVERSAL SALT IODIZATION IN CENTRAL AND EASTERN
EUROPE AND THE COMMONWEALTH OF INDEPENDENT STATES
Experiences, achievements and lessons learned during the decade 2000 -2009
FIGURE 2: MAIN ACTION AREAS FOR THE EXECUTION OF A NATIONAL USI STRATEGY
Key Components in IDD Elimination Programming
Salt lodization
SUMMARY REPORT
Strategy
Oversight
Advocacy & Evaluation &
Social Mobilization Surveillance
HISTORY OF IODINE DEFICIENCY AND SALT IODIZATION IN THE
REGION
Publications from the countries in this study before 2000 show abundant and widespread problems of
goiter and cretinism. In the Balkans, voluntary iodization of household salt was first introduced during
the 1950s in former Yugoslavia, Romania and Bulgaria. When surveys during the 1960s showed only
small decreases in the burden of goiter, mandatory iodization of all the salt destined for use in the
food industry and the households became enacted in Bulgaria and Yugoslavia, which in each case was
followed by a drastic decline of goiter prevalence within a decade. The turmoil with the breakup of
the Yugoslav Federation prevented the swift adoption of modern assessment methods, yet population-
representative surveys carried out near the turn of the century demonstrated optimum iodine nutrition in
the populations of Macedonia FRY and the Federation of Serbia and Montenegro. In Romania meanwhile,
the iodization of food industry salt became prohibited and the iodization of table salt remained voluntary.
Studies in 30 counties of Romania showed that iodine deficiency persisted beyond the year 2000.
Two surveys dated from before 2000 in Albania had demonstrated 30-40% goiter prevalence plus the
existence of endemic cretinism – equivalent to moderate-to-severe iodine deficiency.
In the former USSR, the iodization of salt was governed for a long time by a 1956 ordinance from the
Ministry of Health in Moscow that defined the administrative divisions with a high burden of goiter
to which iodized salt should be supplied. While the list of IDD-affected regions increased toward
the majority of regions throughout the Soviet Union, iodized salt was practically made mandatory
and the trade in common salt became ever more restricted. A tremendous increase took place in the
production of iodized salt, from ±100,000 tons in 1950 to almost 1 million tons in 1965. Consequently,
population surveys undertaken during 1965-1969 across the vast expanse of the USSR demonstrated
that endemic goiter had virtually been eliminated and that new cretinism cases were no longer
observed. As a result, the Ministry of Health declared that the problem had been overcome and it
abandoned its central oversight and monitoring.
3|
6. UNIVERSAL SALT IODIZATION IN CENTRAL AND EASTERN
EUROPE AND THE COMMONWEALTH OF INDEPENDENT STATES
Experiences, achievements and lessons learned during the decade 2000 -2009
The end of oversight by the Ministry of Health did not cause the salt industry to abandon the practice
of iodizing salt, however. The Ministry of Food Industry issued directions on annual production quota,
including iodized salt. But with the passage of time, the aging technologies and QA methods in the
salt enterprises became increasingly less capable to meet the industry’s iodization standards and in
combination with the poor paper packaging and the long railway supply lines, the quality of iodized
salt in retail outlets started to decline. The deterioration of the Soviet economy during the 1980s also
affected the production volumes of iodized salt and by 1990, the total realized iodized salt supply in
the USSR reached only half of the planned 1.4 million tons. It is therefore not surprising that IDD was
making a comeback. In November 1991, at an international symposium organized by ICCIDD, UNICEF
and WHO in Tashkent, Uzbekistan, reputed scientists from 10 Soviet Republics presented evidence
SUMMARY REPORT
dating from the 1980s that IDD had re-occurred in various regions and population groups across the
USSR. Evidence of the comeback of IDD as a major public health problem was confirmed from rapid
IDD assessments carried out in six newly independent states during 1994.
When the present decade started, salt iodization strategies had already progressed signifi cantly
in the Balkan area and in the CIS countries, the former Soviet guidance of iodized salt supplies to
areas with endemic goiter formed part of public memory. The need for iodizing salt to tackle a health
development issue was, therefore, not new in the countries of this study but after the demise of central
command, a Government-led health development objective could no longer become imposed on the
private industry. This made it necessary to adopt joint collaborative decisions for the planning and
management of a public health program of national importance. And the first critical challenge, as
borne out by global experience, was to ensure the enactment of a law on salt iodization.
NATIONAL DECISIONS ON USI LEGISLATON
The number of countries with a principle statutory law that mandates salt iodization increased during
the decade from fi ve (25%) to 18 (90%). In 14 countries, the law comprises the “true” USI strategy,
namely compulsory iodization of the salt supply for the food processing industries as well as the
households. The law was focused on the fraction of household salt in three countries, and it mandated
the food industry salt fraction in one country. A national law on salt iodization was not enacted in the
Russian Federation and Ukraine, but the regulations in each of these countries prescribe the iodine
levels in case household salt is iodized. The convening power of UNICEF at executive level has been
a major factor in mobilizing multi-sector, public-private collaboration to create common, persuasive
testimony by the stakeholder organizations in favor of the USI legislation.
In the 18 countries with a law enacted, fully adequate iodized salt supply in combination with adequate
iodine nutrition in the population had been achieved by the end of the decade in 9 countries, while
in 6 other countries the target was tantalizingly close and population iodine nutrition indicators
were showing only minor imperfections. The major reasons for these accomplishments were the
conscientious quality assurance practices in the salt factories and the due diligence in salt industry
regulations by a State agency for Standardization and Metrology, together with dependable salt
inspection and release procedures, practiced by a Food Authority in particular in those countries that
depend on salt import. The progress in the 18 countries and their underlying reasons validate the
global knowledge that IDD legislation brings success when the stakeholders faithfully carry out their
respective duties.
|4
8. SUMMARY REPORT
|6
TABLE 1: MAIN CHARACTERISTICS OF THE USI LAWS AND IODIZED SALT SUPPLY OUTCOMES
BALKAN AREA
Legislation on salt iodization Salt supply outcomes
Year Country Character of the law Standard Fortifi cant Year Country Food industry Households
2008 ALB True USI 25 Only KIO 3 2006 ALB No data 60% coverage (rapid test)
2001/5 BiH True USI 20 – 30 KIO 3 and KI 2008 BiH Yes, but no data Mean content 26.5 mg/kg
2001 BUL True USI 17 – 33 Only KIO 3 2003 BUL Yes, but no data Universal (rapid test)
2008 KOS True USI 18 – 23 Only KIO 3 2009 KOS Mean content of the national supply 28.5mg/kg
1999 MAC True USI 20 – 30 Only KIO 3 2005 MAC Yes, but no data 94% ≥ 20mg/kg
1974 MON True USI 12 – 18 KIO 3 and KI 2007 MON Yes, but no data Mean content 12.4mg/kg
2002 ROM Only household salt 15 – 25 KIO 3 and KI 2004 ROM None 74% ≥ 15mg/kg
1974 SER True USI 12 – 18 KIO 3 and KI 2007 SER Yes, but no data Mean content 13.9mg/kg
COMMONWEALTH OF INDEPENDENT STATES
2004 ARM True USI 50 ± 10 Only KIO 3 2005 ARM Yes, but no data 97% coverage (rapid test)
2001 AZE True USI 40 ± 15 Only KIO 3 2007 AZE Yes, but no data Mean content 22mg/kg
2001 BEL Only food industry salt 40 ± 15 Only KIO 3 2006 BEL Universal 94% coverage (rapid test)
2005 GEO True USI 40 ± 15 Only KIO 3 2005 GEO Yes, but no data 91% coverage (rapid test)
2003 KAZ True USI 40 ± 15 Only KIO 3 2006 KAZ Yes, but no data 92% coverage (rapid test)
2001 KYR True USI 40 ± 15 2007 KYR Probably Mean content 11.2mg/kg
UNIVERSAL SALT IODIZATION IN CENTRAL AND EASTERN
Only KIO 3
1997 MOL Only household salt 25 – 35 KIO 3 and KI 2006 MOL None 66% coverage (rapid test)
a
Experiences, achievements and lessons learned during the decade 2000 -2009
EUROPE AND THE COMMONWEALTH OF INDEPENDENT STATES
RUS No USI law 40 ± 15 Only KIO 3 RUS None 35% estimate
2002 TAJ True USI 40 ± 15 Only KIO 3 2009 TAJ Probably 58% coverage (rapid test)
2003 TUR True USI 40 ± 15 Only KIO 3 2006 TUR Yes, but no data 87% coverage (rapid test)
UKR No USI law 40 ± 15 Only KIO 3 2005 UKR None 18% coverage (rapid test)
2007 UZB Only household salt 40 ± 15 Only KIO 3 2006 UZB None 53% coverage (rapid test)
a
Only a few bread factories in Russia have started using iodized salt in bread baking
10. SUMMARY REPORT
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TABLE 2: LARGE-SCALE SALT COMPANIES IN THE REGION
Total salt supply Food-grade salt Iodized salt estimate
Country Producer Source of salt
estimate (1,000 MT/y) estimate (1,000 MT/y) (1,000 MT/y)
Rock salt and
Armenia Avan 40 15 15
solution mining
Belarus Mozyrsol Solution mining 350 280 100
Hemijski Kombinat
Bosnia and Herzegovina Rock salt mining 50 50 45
«Sodaso»
Tchernomorski Sea salt
Bulgaria 75 20 20
Solnitzy evaporation
Lake salt
Kazakhstan Araltuz 350 90 70
evaporation
Rock salt &
Romania Salrom 2,200 200 120
solution mining
Lake salt
Russia Bassol 1,250 450 125
evaporation
By product of kali
Russia Silvinit 900 90 30
mining
Russia Iletskol Rock salt mining 350 250 120
UNIVERSAL SALT IODIZATION IN CENTRAL AND EASTERN
Russia Tyretskii solerudnik Rock salt mining 300 90 40
Tajikistan Koni Namak Solution mining 45 30 20
Experiences, achievements and lessons learned during the decade 2000 -2009
EUROPE AND THE COMMONWEALTH OF INDEPENDENT STATES
Tajikistan Namaki Yovon Solution mining 15 15 10
Lake salt
Turkmenistan Guwlyduz 80 35 35
evaporation
Ukraine Artemsol Rock salt mining 950 450 170
Uzbekistan Khojiakontuz Surface mining 240 160 70
11. UNIVERSAL SALT IODIZATION IN CENTRAL AND EASTERN
EUROPE AND THE COMMONWEALTH OF INDEPENDENT STATES
Experiences, achievements and lessons learned during the decade 2000 -2009
MANAGING THE USI STRATEGY
A National Coalition represents the national arrangement for joint collaborative decisions on the
coordination of duties across stakeholders in the USI strategy. The main part of the study was directed at
exploring the experiences and achievements managed by the partnership in the four main USI components
salt iodization, communications, monitoring and evaluation, and national oversight. The findings of these
components led to the following conclusions.
Salt Iodization
SUMMARY REPORT
Salt iodization takes place in the salt productive industry (Table 2). The CEE/CIS region is home to 15 large
salt industries that produce the majority of the salt that humans consume, either directly as household
salt or indirectly through the salt used in food industries. These companies are subject to rules for
technology approval, production safety standards, fortifi cant authorization and product quality standards,
upheld by a standardization and metrology authority typically under the Ministry of Industry and Trade.
Management standards certified by the International Standards Organization have been obtained by a
number of these companies. The experience during the decade about a leadership role by salt company
CEOs in the national partnerships illustrates a range from positive activism and support (for example in
Armenia, Bosnia and Herzegovina, Kazakhstan and Serbia) to a lack of sincere interest.
Iodine sources for the fortificant supply in the region are located in the Russian Federation, Turkmenistan and
Ukraine. In Russia, the Troitsky Iodine Plant in Krymsk, Krasnodar Territory, manufactures pure and analytical
grade potassium iodate from iodine recovered from iodine-rich drilling water. A second Russian potassium
iodate producer is the Uralsk Chemical Plant Verkhnyaia Pyshma in Sverdlovsk Region, which purchases the
iodine ingredient from the Troitsky plant. The Cheleken Chemical Plant in Turkmenistan is another source of
potassium iodate and in Ukraine, the fortificant is manufactured by the Iodobrom Company in the Crimean
Peninsula. Since 2008, the Neftçala iodine factory in South-east Azerbaijan is being rehabilitated with a
resumption of its production expected by 2009. Although some salt producers may base their actual purchases
on long-established trade relationships with supply sources outside the region, these iodine production
capacities can in theory provide for the entire fortificant needs of all the countries in CEE/CIS region.
A national salt industry association can potentially be useful, especially in countries – for example
Azerbaijan, Kyrgyz Republic and Uzbekistan – with a sizable number of small salt enterprises who typically
have cumbersome access to the fortificant at an affordable cost. The issues of iodized salt for livestock have
not been a factor of importance for national progress, although the supply of non-iodized salt for animal
husbandry can form a locally significant impediment. No evidence was found in successful countries that
the costs of salt iodization or the pricing by the producers were an obstacle. The evidence from surveys in
Tajikistan and Albania, however, showed that household poverty can be an important reason for persistently
low market shares of iodized salt in the economically disadvantaged areas.
Communication
The information from large, multi-channel communication campaigns was reviewed. The countries with
these campaigns during the decade – nearly half of the countries in the study – typically included NGOs
in the design and delivery, which added value by spreading the new information more readily and swiftly
through more layers of society and may have helped turning potential gatekeepers into supporters. The
number of large-scale campaigns was equally divided between the successful or near-successful countries
and the countries that did not reach success. This suggests that an intensive public promotion effort did
not make the difference for achieving success, and it does not lend support to the expectation that public
demand would grow the supply of iodized salt. Therefore, public information campaigns in support of
the USI strategy should not aim at changing the purchase behavior of the public. Messages aimed to
strengthen the public’s acceptance are suffi cient.
9|
12. UNIVERSAL SALT IODIZATION IN CENTRAL AND EASTERN
EUROPE AND THE COMMONWEALTH OF INDEPENDENT STATES
Experiences, achievements and lessons learned during the decade 2000 -2009
Other important communication activities in many countries were stakeholder stimulation (including
salt producers), influencing gatekeeper’s opinions and knowledge insertion into ongoing education
curriculums. Stimulation of the salt industry could benefi t from more comprehensive in-depth analysis
and on-the-job training of staff in the small salt enterprises to meet their specifi c needs in systemic
capacity, especially better quality assurance procedures and more effective product promotion.
The insertion of essential learning about the dangers of IDD and the benefi ts of USI in educational
curriculums at secondary and graduate technical levels contributed to a foundation for sustained
success in a number of countries.
In a broad area of Eastern Europe and Western CIS, the objections by technologists in the fruit and
SUMMARY REPORT
vegetable preservation industry became apparent during the decade as a barrier against the use of
iodized salt in the food industry. This was, for example, the reason for prohibiting the use of iodized
salt by the food industry in Romania. In Moldova, Ukraine and Russia, a bread bakery regulation from
Soviet times is frequently quoted to justify objections against the use of iodized salt in bread bakeries.
The underlying beliefs are that the use of iodized rather than common salt would affect the organoleptic
characteristics of the industry’s products, a factor that has been dispelled by various model studies in
Moldova, Russia and Romania. Moreover, the use of iodized salt use in food industries, especially in
bread baking, is common practice in Western countries such as Denmark, Germany, the Netherlands,
Switzerland, Australia and New Zealand.
Monitoring and Evaluation
The ability to manage national progress depends on the data and information from monitoring and
evaluation, which is the third strategy area studied. Although an analysis of the national salt situation
-typically with the amounts of national salt supplies included- were recognized early as an essential
element for oversight, obligatory reporting of these supplies was achieved in only four countries.
Little data is available from monitoring of the quality of salt used in the food manufacturing industries
even though this fraction accounts for a major share of the total salt supplies in the countries of the
region. Therefore, “watching over” the salt supply situation to verify the amount of national iodized
salt provisioning in each of the salt supply channels cannot yet be reliably conducted in most of the
region.
The review revealed that inspections by Food Authority offi cials in the consumer markets are typically
strict in a number of countries. The quarterly reporting of salt inspection results to the national
coalition has been made obligatory in Kazakhstan. The information about the use of iodized salt in the
households is dependent on intermittent household surveys, which may have sizable time intervals.
Universal use (>90% of households) of adequately iodized consumer salt was attained in 11 countries
of the region, including Serbia and Montenegro where the salt iodine standard is below international
convention.
For assessing the population iodine nutrition status (Figure 3), 14 countries have a national laboratory
that can generate data of urinary iodine assays, eight of which are collaborating successfully in the
CDC-provided external quality assurance program EQUIP. Surveys stratified by region and 30x30
population-proportional designs each constituted half of the surveys during the decade. School-
age children were the target group in most national iodine surveys while the inclusion of pregnant
women in iodine nutrition surveys was increasing. The time-lapse since the most recent survey is
more than five years in six countries, while a nation-wide population-representative survey was
not undertaken in two countries. The available reports from population surveys indicate that the
approach of data analysis and interpretation is improving: Increasingly, UI distribution analysis is
used for an index of optimum iodine nutrition and also the use of statistical techniques to analyze
the relationship between indicators of iodine supply and those of iodine consumption and iodine
nutrition status is improving.
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13. UNIVERSAL SALT IODIZATION IN CENTRAL AND EASTERN
EUROPE AND THE COMMONWEALTH OF INDEPENDENT STATES
Experiences, achievements and lessons learned during the decade 2000 -2009
FIGURE 3: KEY RESULTS FROM NATIONAL POPULATION SURVEYS OF IODINE NUTRITION a
Balkan Area Urinary Iodine Concentrations in School-age Children CIS Area
350
300
250
200
150
SUMMARY REPORT
100
50
0
BUL MAC ROM ALB MON SER BIH KOS TUR ARM GEO BEL MOL AZE KYR TAJ
2003 2004 2005 2006 2007 2009 2004 2005 2006 2007
Urinary Iodine Concentrations in Pregnant Women
Balkan Area CIS Area
300
250
200
150
100
50
0
BUL MAC ROM ALB MON SER BIH KOS UKR* KAZ* AZE KYR TAJ
2001 2003 2004 2006 2007 2008 2009 2002 2006 2007 2007
a
Median urinary iodine concentrations in µg/L. Shaded areas indicate the normative range for each group. A national
survey has not been conducted in Russia and Uzbekistan. *The 15-49 year old women surveyed in Ukraine (2002) and in
Kazakhstan (2006) were not pregnant.
National Oversight
Finally, a review of the information, where available, of the forms and structures for national oversight
suggests that both formal and informal interactions characterize the partnership arrangements in the region.
The level of these interactions, and therefore the structure used, naturally depends on the issues arising and
the importance being accorded to the decisions that need to be made. A national committee or commission
tasked with IDD elimination exists at least on paper in most countries. Obligatory MOH reports and publicity
of national progress made are typical accountability examples of national collaboration for USI progress.
INTERNATIONAL RECOGNITION
During the decade, the guidelines and criteria developed by WHO/UNICEF/ICCIDD expert groups
stimulated national assessments of USI strategies in a number of countries, followed in each case by
an independent external review. The global Network for Sustained Elimination of Iodine Deficiency has
acknowledged that elimination of iodine deficiency was achieved through USI in Macedonia (2003),
Turkmenistan (2004), Armenia (2006), Bulgaria (2007) and Kazakhstan (2009) – the highest proportion of
countries in any region of the world.
11 |
14. UNIVERSAL SALT IODIZATION IN CENTRAL AND EASTERN
EUROPE AND THE COMMONWEALTH OF INDEPENDENT STATES
Experiences, achievements and lessons learned during the decade 2000 -2009
CONCLUSIONS AND NEXT STEPS
The present study of 20 countries in the CEE/CIS region re-confirmed the strong improvements of the
iodine nutrition situation that took place during the past decade thanks to USI strategies. The analysis
of the successful countries shows that a steadfast implementation of true USI laws successfully
eliminates iodine defi ciency in the population within a short time. Strong public-private-civic
partnerships were the underlying reason for the exemplary progress in each case. Most of the salt
companies in the region have embraced quality iodized salt production as the universal norm and the
due diligence in enforcing the salt iodine standards remains a critical factor for continued assurance
SUMMARY REPORT
of optimum iodine supplies. Communications have improved the prospects for sustained success in a
number of countries, especially through stimulating the range of stakeholders, keeping the opinions
of potential gatekeepers at bay, and inserting the essential learning into key educational curriculums.
Finally, the capacity for surveillance of the population’s iodine nutrition situation has developed
signifi cantly. Summing up, the experiences in USI strategies during a decade of action in the region
revealed a tremendous improvement of the capacities for fighting iodine defi ciency at national scale.
In taking advantage of the experience of most of the countries in this study, the remaining challenges
can be tackled by a combination of actions as follows:
• Establish a “National Salt Watch” for quantitative salt supply monitoring in each country
• Promote self-reliant input procurement and strengthen the quality assurance practices in small
salt enterprises
• Insert essential IDD and USI knowledge in ongoing education curriculums in each country
• Promote diligent quality assurance of the salt imports in countries where progress is lagging
(Albania, Kyrgyz Republic, Moldova, Romania and Uzbekistan)
• Professional training on public health principles-based analysis and action for current and future
medical specialists
• Organize periodic re-advocacy and counter the political objections with the use of socio-normative
principles from the Universal Declaration of Human Rights and the Convention of the Rights of the
Child.
Even though USI is not specifi cally stated in the Millennium Development Goals, the success of IDD
elimination contributes importantly to several fundamental values for society, such as the reduction of
child mortality, improvement of maternal health, and effective primary education. In 2007, the World
Health Assembly called on its States Members to establish national coalitions for monitoring the state
of national iodine situation every three years. With the capacities that have been built and the excellent
available experiences in many countries, the region is uniquely positioned to be the first in the world
where IDD may become completely and sustainably eliminated through USI.
| 12
15.
16. Contact Information:
UNICEF Regional Offi ce for Central
and Eastern Europe
and the Commonwealth
of Independent States
Palais des Nations
CH-1211 Geneva 10, Switzerland
Telephone: +41 22 909 5543
Fax: +41 22 909 5909
www.unicef.org/ceecis
The printing of this summary has been made possible by funds contributed by the Global Alliance for Improved Nutrition (GAIN).
The GAIN-UNICEF Universal Salt Iodization (USI) Partnership Project, funded by the Bill and Melinda Gates Foundation, contributes
to global efforts to eliminate iodine defi ciency through salt iodization in 13 countries with the lowest coverage of iodized salt and
the greatest burden of iodine defi ciency. By the end of the Project, the Partnership will have helped to reach more than 790 million
people not yet covered by worldwide salt iodization programs, including more than 19 million newborn infants every year.
The activities undertaken by GAIN and UNICEF will help to highlight key “success factors” which will enhance the design and
implementation of sustainable USI programming.