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Progress and Strategies in Controlling Iodine Deficiency Disorders in Bulgaria

This report outlines Bulgaria's multi-sectoral efforts to combat iodine deficiency disorders (IDD) through legislation, institutional support, and monitoring. Since the establishment of the national program in 1958 (updated in 1994), measures such as iodizing salt and forming intersectoral committees have led to significant improvements in iodine intake among the population. The report details the current iodination status, urinary iodine excretion rates, goiter prevalence, and incidence of congenital hypothyroidism. It concludes that Bulgaria is on track to eliminate IDD and has made considerable progress since the initiation of universal salt iodination.

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Progress and Strategies in Controlling Iodine Deficiency Disorders in Bulgaria

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  1. IDD Status in Bulgaria Ivanova, L*. B. Lozanov**, Zv.Timcheva*** *National Center of Hygiene, Medical Ecology and Nutrition, Sofia ** Clinical Center of Endocrinology, *** Ministry of Health

  2. National Program for Control of IDD - Multisectoral Efforts • Legislation: Since 1958; Updated 1994 • Decree 96/94 of Council of Ministers; Ordinance RD-09-244/94 of the Chief Sanitary Inspector; Amendment of the Bulgarian State Salt Standard • Institutional support / Intersectoral Co-ordination • National Coordinating Committee for IDD Control (MOH,- Industry, -Trade, Salt Producers, Thyroidologists, Nutritionists, NGO,s) • Expert Council on IDD at Ministry of Health

  3. Salt production/iodination • Local production - 40% ; import - 60% • Local production - 6000 t/last year iodized salt - 20 % of iodized salt required for humans • Iodine compound: KIO3 • Level of iodination: 19-32 ppm I2 (28-55 ppm KIO3) • Availability of iodized salt : general

  4. Assessment/Monitoring/Evaluation • Monitoring plan of IDD status Indicators  Proportion of adequately iodized salt at the market  Urinary Iodine Excretion  Total Goiter Rate: palpation; ultrasound  Neonatal TSH

  5. IDD STATUS • Total Goiter Rate:18 % (5-26%) (National survey, 1996) 14.8% -palpation; 2.7% ultrasound (Sofia-city, 2001) • Urinary Iodine Excretion: 111.4 mcg/L (1996); 145.0 mcg/L(2001) • Incidence of Congenital Hypothyroidism: 1: 4000 live births • Incidence of Transient Hypothyroidism in newborn:8.8% • Neonatal TSH > 5 U/mL: 9.2%

  6. Percentile Distribution of ioduria from representative surveys of schoolchildren 1994-2001

  7. Conclusions • The legislation and capacity building of the IDD Program was completed. • The iodine intake of Bulgarian population was substantially improved after the implementation of universal salt iodination in 1994. • Our country is already achieving the final goal - eradication of IDD at population level

  8. Thank you

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