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News from the Secretary |
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News from the Secretary |
Message from the Secretary
March, 1st 1998
This is a report from our colleague Dr. Geraldo Medeiros about IDD in Brazil.
THE SALT IODINATION PROGRAMME IN BRAZIL: WHEN MORE IS LESS. Geraldo Medeiros-Neto, M.D.
(Professor of Endocrinology, Univ. of Sao Paulo Medical School, Sao Paulo, Brazil)A fresh start on the problem of controlling Iodine Deficiency Disorders in Brazil was done in 1981 by a handful of interested individuals, recruited from Professors of the Universities of Sao Paulo, Pernambuco and Brasilia, from Members of the National Health Foundation, and from officials of the National Institute for Food and Nutrition (INAN). Under this task force it was decided that all potassium iodate should be supplied, free-of-charge, to the 186 Brazilian salt mills, in order to have a concentration of 20-40 mg of iodine per kg of refined or rock salt (respectively, for human consumption or animal use). Samples of salt should be collected, at appropriate intervals, from the production line and at the local markets in order to assay the content of iodine in the salt samples. It was created 28 laboratories for iodine determination, strategically distributed through the national territory and periodically the National Institute for Food and Nutrition(INAN) would release the figures for each State and Territory. Moreover every year the members of the Advisory Committee would meet in Brasilia to check the results, to propose solutions, to correct the errors (1).
At the end of 1992, ten years after its implementation the National Programme for Eradication of IDD was a success. Iodine was being distributed through salt to all geographical areas of the extense territory of Brazil. Urinary random samples collected from a few areas confirmed the widespread use of iodine by the population.
Between 1992 and 1995 it was raised a question about the legal aspects of the free distribution of iodine to the salt mills. This was corrected by a Law voted and approved by the Congress and signed by the President in early March 1996.
However in 1997 the Health Authorities decided to dissolve the National Institute for Food and Nutrition (INAN) and, therefore, to extinguish the Advisory Committee that was responsible for the IDD control program. The various aspects of the IDD control surveillance, e.g., purchasing the potassium iodate, distribution of this chemical to the salt mills, collection of samples of salt and assaying the salt samples at the various laboratories were distributed among other units and departments of the Ministry of Health and the National Health Foundation. Therefore there is no longer a Supervising Committee as the various units and departments will individually report to the Secretary of the Ministry of Health. We have more people involved but less unity and this situation is not considered to be the ideal form of controlling IDD in a country with such a diversity of regions in a such vast territory. This is a major threat to the sustainability of the national iodination program (2).
Moreover a recent statement of the Brazilian Association of Salt Producers confirmed that the Ministry of Health purchasing and distribution of potassium iodate has been erratic and not sufficient to correctly iodinate the salt produced.
It would be advisable that the Ministry of Health would consider the installing of a Central Committee that would be responsible for the continuous surveillance of the IDD control program. For many experts in this field this is the only way to get an effective supply of iodine to the Brazilian population. A fragmented program, distributed among units and departments of the Ministry of Health with few communication links between them may result in a dramatic loss of effectiveness of the iodine supply conducting to irreparable damage to the population, specially the pregnant women and the newborns. It is still time to reconsider a new solution for the IDD control Program in Brazil.
References:
1. Medeiros-Neto GA Towards the eradication of iodine deficiency disorders in Brazil through an effective and well organized program of salt iodination. Bulletin World Health Organ 66:637-642, 1988.
2. Dunn JT Seven deadly sins in confronting endemic iodine deficiency, and how to avoid them. J Clin Endocrin Metab 81:1332-1335, 1996.
