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Noguera, Viteri, Daza & Mora |
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Noguera, Viteri, Daza & Mora |
EVALUATION OF THE CURRENT STATUS OF
ENDEMIC GOITER AND PROGRAMS
FOR ITS CONTROL IN LATIN AMERICA
TABLES
(Scroll right to see the whole table)
Table 1. Legislation on salt lodization and its control. ________________________________________________________________________________________________________________ Date lncludes lncludes Date of Date Coverage of iodization imported salt for Country approval law decreed legislation started salt animais ________________________________________________________________________________________________________________ Argentina 1967 1967 National 1970 Yes Yes Bolivia April 1968 December 1968 National 1977 Yes Yes Brazil March 1953 1953-1977 National 1957 Yes No Chile 1959; repealed in 1982 - - - - - Colombia December 1947 March 1955 National 1959 Yes No C. Rica April 1941 November 1970 National 1972 Yes No Cuba There are no laws - - - - - Ecuador November 1968 June 1969 National 1973 Yes No El Salv. February 1961 June 1967 National 1972 Yes No Guatem. October 1954 March 1955 National 1959 Yes Yes Hond. May 1960 September 1961 National 1971 Yes Yes Mexico May 1963 October 1963- - - - - December 1974 National 1963 Yes No Nicar. January 1969 September 1977 National 1978 Yes Yes Panama January 1965 November 1969 National 1970 Yes No Paraguay April 1958 February 1966- - - - - December 1980 National 1966 Yes (a) Yes Peru January 1969 November 1971 National 1972 Yes Yes Uruguay November 1961 July 1963- - - - - April 1975 Partial 1963 No (a,b) No Venez. November 1966 January 1968 National 1968 Yes Yes _______________________________________________________________________________________________________________ (a). All salt is imported. (b). Iodization is done in the country.
Table 2. Latest studies on endemic goiter prevalence. _________________________________________________________________________________________________________________ Type of popula- Population Size of Method of goiter Overall prevalence Country Year tion studied sampled sample classification (%) _________________________________________________________________________________________________________________ Argentina 1967 Schoolchildren Departrnental 4,431 Pérez & Scrirnshaw 49.8 (12.5-61.9) 1967 Adults 20 years Departmental 47,679 Pérez & Serimshaw 15.6 (4.3-53.6) Bolivia 1976 Schoolchildren La Paz 4,200 WHO modified (a) 68 1979 Schoolchiidren Pando 680 WHO modified (a) 77 1981 Schoolchildren National 38,500 WHO adapted 60.8 Brazil 1966 Schoolchildren 45 municipalities 45,924 - 27.2 1967 Schoolchildren 41 municipalities 48,443 - 21.9 1975 Schoolchildren National 266,373 WHO adapted (b) 14.7 Chile 1972 General Community 8,407 Pérez & Scrimshaw 24.8 Colornbia 1945 Schoolchiidren National (c) 183,243 Old classification 53 1945 Schooichildren Departmental (d) 8,062 Old classification 83.1 1952 Schoolchildren Departrnental (e) 6,511 Oid classification 33.9 1965 Schoolchildren Departmental (f) 2,166 Old classification 1.8 Costa Rica 1966 General National 4,065 Pérez & Serimshaw 18.0 1979 Schoolchiidren National 5,061 Pérez & Serimshaw 3.5 Cuba 1974 6-20 years Baracoa 2,664 Pérez & Scrimshaw 30 1976 General Havana 6,149 Pérez & Scrimshaw 3.4 Ecuador (g) 1969 Schoolchildren National 28,639 Pérez & Serimshaw 23.7 1978 Schoolchildren National 36,962 Pérez & Scrimshaw 12.0 El Salvador 1966 General National 3,231 Pérez & Scrimshaw 48.0 Guatemala 1949 General National - Old classification 38 1965 General National 4,113 Pérez & Scrirnshaw (Orig.) 5.2 1979 Schoolchildren National 2,995 Pérez & Scrimshaw 10.5 Honduras 1966 General National 3,654 Pérez & Scrimshaw 17.0 Mexico 1950 General 8 states 1,000,000 5-46 Nicaragua 1966 General National 3,477 Pérez & Serimshaw 32.0 1977 General National 13,814 Pérez & Serimshaw 33.0 1981 General National 6,252 Pérez & Serimshaw 20.0 Panama 1967 General National 3,071 Pérez & Scrimshaw 16.5 1975 General National 4,084 Pérez & Scrimshaw 6.0 Paraguay 1976 General National 4,078 Pérez & Scrimshaw 18.1 1980 Maternal/child 3 communities 343 WHO modified 23.6 1982 Schoolchildren 6 communities 420 WHO modified 16-40 Peru 1968 Schoolchildren National 181,118 Pérez & Serimshaw 22 1976 General National 9,293 WHO modified 151 Uruguay 1973 Schoolchildren Departmental 2,5l5 Pérez & Serimshaw 9 1980 Schoolchildren Departmental 1,254 Pérez & Serimshaw 2 Venezuela 1966 Schoolchildren National 470,207 Pérez & Scrimshaw 13.0 1981 Schoolchildren and adolescents National 14,709 WHO modified 21.37 ________________________________________________________________________________________________________________ (a) WHO Classification, adjusted locally. (b) Only the inspection criterion was considerei. (c) 385 municipalities examined. (d) municipalities. (e) Same municipalities. (f) same municipalities. (g) In 1969 and 1978 the same localities were examined. (h) Average prevalence in mountains, jungle, and coast.
Table 3. Latest studies on urinary excretion of iodine. _______________________________________________________________________________________________ Type of popula- Population Size of lodine excretion Country Year tion studied sampled sample (mcg, mean and limits) _______________________________________________________________________________________________ Argentina - - - - - Bolivia 1962 General Altiplano-Valle-Llano 251 40-108/g creatinine Brazil - - - - - Chile - - - - - Colombia - - - - - Costa Rica 1966 General National 879 25/day 1979 Schoolchildren National 1,064 557/g creatinine Cuba 1974 6-20 years Baracoa 520 15-46/g creatinine 1976 General Havana - 90/g creatinine Ecuador 1979 Schoolchildren 6 communities at 2,276 38-91/0.9 g creatinine different levels El Salvador 1966 General National 600 25/day Guatemala 1965 General National 835 400/day 1979 Schoolchildren National 684 70/g creatinine Honduras 1966 General National 599 25/day Mexico - - - - - Nicaragua 1966 General National 479 25/day 1977 General National 1,488 5l/g creatinine 1979 General National 252 82/g creatinine 1981 General National 751 99/g creatinine Panama 1967 General National 559 25/day Paraguay 1965 General National 262 16-38/g creatinine Peru 1969 General 4 cities 179 13-ll5/day (endemic andnonendemic) Uruguay - - - - - Venezuela - - - - - ________________________________________________________________________________________________
Table 4. Epidemiologic surveillance systems of endemic goiter. ________________________________________________________________________________________________________ Responsible Population Country institution Date initiate studied Variables observed Frequency ________________________________________________________________________________________________________ Bolivia Ministry of Health December 1982 General Goiter Not determinei Ecuador Ministry of Health January 1983 Schoolchildren Goiter and ioduria To be defined (INIMS) (a) Nicar. Ministry of Health January 1977 General Goiter and ioduria Quinquennial ________________________________________________________________________________________________________ (a) Institute of Nutritional and Sociomedical Research (INIMS).
Table 5. Salt iodization systems and utilization of installed capacity.
_______________________________________________________________________________________________________
Legal level of Capacity of Actual
Iodization plant iodization Iodization production production % Of
Country (location) (PPM) I -/salt method (M.T.) (M.T.) utilization
______________________________________________________________________________________________________
Argentina - 30 Dry Mix - 699,500 -
Bolivia Quimbabol 50 Dry Mix-Drip - 4,000 -
Uyunense
Brazil - 10(15-30)a Drip - - -
Chile - - -
Colombia Cajicá and Cartagena 70-100 Aspersion 225,000 184,000 82
Costa Rica - 30-50 Aspersion 21,000 7,000 33
Dry Mix 6,000 500 5
Cuba - -
Ecuador Guayaquil 50 Drip and Dry 87,000 50,000 57
Santa Elena Mix
El Salvador - 60-100 Dry Mix 20,000 4,000 20
Guatemala Salinas CAPAN 60-100 Dry Mix 5,OOO 5,OOO 100
Honduras - 60-100 Dry Mix 34,090 34,090 100
Mexico - - -
Nicaragua - 30-50 Dry Mix 46,719 17,115 37
Aspersion 4,992 2,404 48
Panama - 30-50 Dry Mix 73,920 9,000 12
Paraguay - 60-80 - - -
Peru Lima, Ica, Puno, 30-40 Dry Mix 141,696 82,520 58
Moquegua
Uruguay - 30 Dry Mix - - -
Venezuela Araya-Cumaná 20-30 Aspersion 235,000 152,000 65
Olivitos
Cumaraguas
_____________________________________________________________________________________________________
(a)New levels proposed by the National Institute of Food and Nutrition.
Table 6. Iodization control level.
______________________________________________________________________________________
No. of iodization
plants with Iodization control
laboratory In plants process in markets At consumer level
__________________ _______________ _________________ __________________
Quanti- Quali- Quanti- Quali- Quanti- Quali- Quanti- Quali-
Country tative tative tative tative tative tative tative tative
______________________________________________________________________________________
Argentina - - x - x - - -
Bolivia - - - - x - - -
Brazil 1 - x - - - - -
Chile - - - - - - - -
Colombia 2 - x - x - - -
Costa Rica 1 - x - x - - -
Cuba - - - - - - - -
Ecuador - - x - x - - -
El Salvador - - x - - - - -
Guatemala - - x - - - - -
Honduras - - x - x - - -
Mexico - - - - - - - -
Nicaragua - - x - x x - x
Panama - - x - - - - -
Paraguay - - - - x - - -
Peru - - - - - - - -
Uruguay - - - - - - - -
Venezuela 2 - x - - - - -
_______________________________________________________________________________________
Table 7. Control measures in the last year (August 1982-July 1983).
_________________________________________________________________________________________
In the plants In the markets At consumer level
__________________ _________________ ____________________________
No. of No. of No. of % Iod./
Country Year samples X 1-PPM samples X 1-PPM samples X 1-PPM % no Iod.
_________________________________________________________________________________________
Argentina - - - - - - - -
Bolivia - - - - - - - -
Brazil 1983 252 19-31 - - - - -
Chile - - - - - - - -
Colombia 1983 720 86-106 83 50 - - -
Costa Rica - - - - - - - -
Cuba - - - - - - - -
Ecuador 1981 339 9-67 - - - - -
El Salvador 1982 303 - - - - - 10/90
Guatemala - - - - - - - -
Honduras 1982 267 60 1,576 60 - - -
Mexico - - - - - - - 99/1
Nicaragua 1981 438 40 3.090 - - - -
Panama 1983 36 - - - - - 47/53
Paraguay 1983 - - 77 14 - - - -
Peru - - - - - - - - -
Uruguay - - - - - - - - -
Venezuela 1981 24 20 - - - - -
__________________________________________________________________________________________
Table 8. Annual salt production (metric tons).
_____________________________________________________________________________________________________________
Type and quantity of salt produced annually (M.T.)
Mine Sea
________________________________ _____________________________
Plant or production In In rough In rough
Country zone block grain Refined Total grain Refined Total
______________________________________________________________________________________________________________
Argentina San Luís, Tucumán, La Pampa,
Buenos Aires, Mendoza - 665,621 33,879 699,500 - - -
Bolívia Afloramientos and Minas - - - 40,000 - - -
Brazil Atlantic Coast and Minas - 836,000 - 836,000 2,131,500 634,800 2,766,300
Chile - - - - - - - -
Colombia Zipaquira and Atlantic Coast - 438,000 102,000 - 550,000 - 1,090,000
C. Rica Coopronasal - - - - 20,500 7,000 27,500
Cuba - - - - - - - -
Ecuador Pacific Coast - - - - 8,447 46,128 54,575
El Salv. Oriental Zone, Pacific
Coast 36 plants - - - - 38,474 7,500 45,974
Guatem. Sipacate Zone - - - - 18,500 - 18,500
Champerico Zone - - - - 9,000 - 9,000
Tahuesco Zone - - - - 1,000 - 1,000
San José de Ias Lisas Zone - - - - 1,000 - 1,000
Casas Viejas Zone - - - - 1,000 - 1,000
Ocos and Tilapa Zone - - - - 1,000 - 1,000
Others - - - - 500 - 500
Honduras South Oriental Zone - - - - 45,818 - 45,818
Mexico
Nicaragua Oriental Zone, Pacific
Coast 13 piants - - - - 52,435 - 52,435
Panama Pacific Coast - - - 28,500 9,000 37,500
Paraguay(a) - - - - - -
Peru Pacific Coast
Juliaca, Cafiamac - 15,297 - 15,297 138,401 24,718 178,406
Uruguay(a) - - - - - - -
Venezuela - - - - - - -
________________________________________________________________________________________________________________
(a)Does not produce salt.
Table 9. Exports and imports of salt in metric tons per year.
_______________________________________________________________________________________________
Exports lmports
_______________________________________ ______________________________________
Country of Quantity Quantity Country Quantity Quantity
Country destination iodized noniodized of origin iodized noniodized
_______________________________________________________________________________________________
Argentina Bolivia and Paraguay - - - - -
Bolivia - - - - - -
Brazil - - - - - -
Chile - - - - - -
Colombia Panama - 7,500 - - -
Costa Rica - - - - - -
Cuba - - - - - -
Ecuador - - - - - -
El Salvador - - 10,000 - - -
Guatemala - - - Nicaragua, 4,500 -
El Salv., Honduras 5,500 4,000
- - -
Honduras Guatemala - 1,512 United States 128 -
Mexico - - - - - -
Nicaragua Guatemala 4,500 - Mexico - 25,000
Panama - - - United States 250 -
Paraguay - - - Brazil and Argentina 4,800 -
Peru - - - United States 2,206
Uruguay - - - Brazil - 60,000
Venezuela - - - - - -
_________________________________________________________________________________________________
Table 10. Annual availability of salt (metric tons).
_________________________________________________________________________________________________________________________
National production Exports Total availability
___________________________ ______________________ ___________________________________________
Country Sea Mine Total Sea Mine Total Imports Sea Mine Imported Total(a)
_________________________________________________________________________________________________________________________
Argentina - 699,500 699,500 - - - - - 699,500 - 699,500
Bolivia - 40,000 40,000 - - - - - 40,000 - 40,000
Brazil 2,766,300 836,000 3,602,300 164,000 - 164,000 - 2,602,300 836,000 - 3,438,300
Chile - - - - - - - - - - -
Colombia 550,000 540,000 1,090,000 7,500 - 7,500 - 542,500 540,000 - 1,082,500
Costa Rica 27,500 - 27,500 - - - - 27,500 - - 27,500
Cuba - - - - - - - - - - -
Ecuador 54,575 - 54,575 - - - - 54,575 - - 54,757
El Salvador 45,974 - 45,974 10,000 - 10,000 - 35,974 - - 35,974
Guatemala 32,000 - 32,000 - - - 15,000 32,000 - 15,000 47,000
Honduras 45,818 - 45,818 1,512 - 1,512 128 44,306 - - 44,434
Mexico - - - - - - - - - - -
Nicaragua 52,435 - 52,435 4,545 - 4,545 25,000 47,890 - 25,000 72,890
Panama 37,500 - 37,500 6,000 - 6,000(b) 250 31,500 - 250 31,750
Paraguay - - - - - - 8,400 - - 8,400 8,400
Peru 167,866 10.553 178,419 - - - 2,206 167,866 10,553 2,206 180,625
Uruguay - - - - - - 60,000 - - 60,000 60,000
Venezuela 375,000 - 375,000 - - - - 375,000 - - 375,000
__________________________________________________________________________________________________________________________
(a)Total is the result of national production + Imports - Exports.
(b)This amount was considerei potentially exportable.
Table 11. Use of available salt (metric tons).
_____________________________________________________________________________________________________________________________________________________________
Salt produced locally Irnported salt Total availability
_____________________________________________ ____________________________________ __________________________________________________
Iodized Noniodized Iodized Noniodized Iodized Noniodized
_________________ ________________________ _____________ ____________________ ______________________ __________________________
Country H(a) A I H A I H A I H A I H A I H A I
_____________________________________________________________________________________________________________________________________________________________
Argentina 89,203 - - - - - - - - - - - - - - - - -
Bolivia 4,000 - - 16.000 10,000(b) 10,000(b) - - - - - - 4,000 - - 16,000 10,000 10,000
Brazil 467,500 - - - 1,019,800 1,664,600 - - - - - - 467,500 - - - 1,019.800 1,664,600
Chile - - - - - - - - - - - - - - - - -
Colombia 150,000 10,000 2,000 - 62,000 5,000 - - - - - - 150,000 10,000 2,000 - 62,000 5,000
Costa Rica 7,500 - - - 10,000 10,000 - - - - - - 7,500 - - - 10,000 10,000
Cuba - - - - - - - - - - - - - - - - - -
Ecuador 44,575 5,440 - - - 4,558 - - - - - - 44,575 5,440 - - - 4,558
El Salvador 4,000 - - 16,000 7,610 8,364 - - - - - - 4,000 - - 16,000 7,610 8,364
Guatemala 5,000 - - 15,000 6,000 6,000 10,000 - - 4,000 - 1,000 15,000 - - 19,000 6,000 7,000
Honduras 34,090 - - - 5,103 5,103 128 - - - - - 34,218 - - - 5,103 5,103
Mexico - - - - - - - - - - - - - - - - - -
Nicaragua 17,724 - 1,819 - 2,020 2,283 - - - - - 25,000 17,724 - 1,819 - 2,020 27,283
Panama 9,000 - - - 9,000 9,000 250 - - - - - 9,250 - - - 9,000 9,000
Paraguay - - - - - 8,400 - - - - - - 8,400 - - - - -
Peru 82,250 - - - 62,398 33,601 2,206 - - - - - 84,456 - - - 62,398 33,601
Uruguay - - - - - - - - - - - - - - - - - -
Venzeuela - - - - - - - - - - - - - - - - - -
_____________________________________________________________________________________________________________________________________________________________
(a)H = Human Consumption; A = Animal Consumption; I = Industrial Consumption.
(b)Estimated figures.
Table 12. Utilization of available iodized and noniodized salt (metric tons).
________________________________________________________________________________________
Utilization
Human Animal Industrial
__________ _______________ ________________
Country No. % No. % No. % Total
________________________________________________________________________________________
Argentina - - - - - - -
Bolivia 20,000 50 10,000 25 10,000 25 40,000
Brazil 467,500 14.8 1,019,800 22.35 1,664,600 52.8 3,151,900
Chile - - - - - - -
Colombia 150,000 65.5 72,000 31.44 7,000 3.01 229,000
Costa Rica 7,500 27.2 10,000 36.4 10,000 36 427,500
Cuba - - - - - - -
Ecuador 44,575 81.67 5,440 9.96 4,558 8.35 54,573
El Salv. 20,000 55.5 7,610 21.15 8,364 23.25 35,974
Guatemala 34,000 72 6,200 13 7,000 14.8 47,200
Honduras 34,218 77 5,103 11.48 5,103 11.48 44,424
Mexieo - - - - - - -
Nicaragua 17,724 26.6 21,839 32.67 27,283 40.8 66,846
Panama 9,250 33.9 9,000 33 9,000 33 27,250
Paraguay - - - - - - -
Peru 84,456 46.8 62,398 34.57 33,601 18.6 180,455
Uruguay - - - - - - -
Venezuela - - - - - - -
________________________________________________________________________________________
Table Summary 12.1. _________________________________________ Destination lnterval % _________________________________________ Human consumption 15%-82% 50.27 Animal eoilsumption 11%-36% 24.63 Industrial consumption 3%-53% 24.28 _________________________________________
Table 13. National availability of salt (metric tons). _________________________________________________________________________________ National production Imports Exports ____________________ _____________ _____________ Total Country No. %(a) No. %(b) No. %(c) availability(d) _________________________________________________________________________________ Argentina 699,500 100 - - - - 699,500 Bolivia 40,000 100 - - - - 40,000 Brazil 3,602,300 100 - - 164,000 4.5 3,438,300 Chile - - - - - - - Colombia 1,090,000 99.3 - - 7,500 7 1,082,500 Costa Rica 27,500 100 - - - - 27,500 Cuba - - - - - - - Ecuador 54,575 100 - - - - 54,575 El Salvador 45,974 100 - - 10,000 22 35,974 Guatemala 32,000 68 15,000 32 - 47,000 Honduras 45,818 - 128 0.3 1,512 3 44,434 Mexico - - - - - - - Nicaragua 52,435 66 25,00 34 4,545 9 72,890 Panama 37,500 84 250 0.8 6,000 16 31,750 Paraguay - - 8,400 100 - - 8,400 Peru 178,419 98.08 2,206 1.2 - - 180,625 Uruguay - - 60,000 100 - - 60,000 Venezuela 375,000 100 - - - - 37,500 __________________________________________________________________________________ (a)% of national production related to total availability. (b)% of imports related to total availability. (c)% of exports related to national production. (d)National production + imports - exports.
Table 14. lodization cost according to country (in US$).
___________________________________________________________________________________________________
Costs of iodized components Machinery costs (price range)
_______________________________
Purchase Cost Cost per Minimum Maximum
unit per M.T. Iodization __________________ _________________
Country (kg) unit of salt method Cost Capacity Cost Capacity
___________________________________________________________________________________________________
Argentina (KIO,3/K) - - Dry Mix - - - -
Bolivia 45(Yodo-cal) 150 4 Dry Mix - - - 10 M.T./h
Drip
Brazil 45 (KIO3) 1,000 1 Drip - - 58 10 M.T./h
Chile - - - - - - -
Colombia 1,000(K1) 11,118 3 Aspersion - - 1,250 12 T.M./h
C. Rica 45(Yodo-cal)a 150 8 Dry Mix - - 15,000 4 T.M./h
45(KIO3) 1,200 1.6 Aspersion(b) - 1,000 4 M.T./h
Cuba - - - - - - -
Ecuador 45(K1) 1,500 3 Drip and - - 150 9 T.M./h
Dry Mix
El Salv. 45 Yodo-cal) 150 8 Dry Mix - - 15,000 10 M.T./h
Guatem. 50(KLO3) 1,000 5 Dry Mix - - 15,00 4 M.T./h
Honduras 45(Yodo-cal) 150 8 Dry Mix - - 15,000 10 M.T./h
Mexico - - - - - - - -
Nicaragua 45(KLO3) 1,138 8 Aspersion 1,500 1M.T./h(c) - -
45(Yodo-cal) 135 17 Dry Mix - - 20,000 4 M./T./h
Panama 45(Yodo-cal) 160 8 Dry Mix - - 18,000 10 M.T./h
Paraguay - - - - - - - -
Peru 45(KLO3) 720 1 Dry Mix - - - 8 M.T./h
Uruguay (KLO3) - - Dry Mix - - - -
Venezuela 45(KLO3) 540 0.58 Aspersion(b) - - - 10 M.T./h
____________________________________________________________________________________________________
(a)Yodo-cal (Trade mark) Potassium iodate + calcium carbonate in 1: 9 ratio.
(b)Incorporated to the industry.
(c)Adjustable to larger capacity.
Table 15. Prices of iodized salt to the consumer. _______________________________________ Price of iodized salt Country (US$/kg) _______________________________________ Argentina 0.15 Bolivia 0.10-0.30 Brazil 0.20-0.05 Chile - Colombia 0.22 Costa Rica 0.22 Cuba - Ecuador 0.20 El Salvador 0.16-0.32 Guatemala 0.22 Honduras 0.26 Mexico - Niearagua 0.22 Panama 0.22 Peru 0.20 Paraguay 0.18-0.31 Uruguay 0.33 Venezuela 0.20 ________________________________________
Table 16. Salt consumption per capita/day.
_____________________________________________________________________________________
Consumption per capita/day
Country average (S.E.) range Method used for estimating
_____________________________________________________________________________________
Argentina 10-15 g Estimated for salt-makers
Bolivia 10 g Dietetic survey
Brazil 8.5-10.4 g Interior consumption salt/popul.
Chile - -
Colombia 11 g Dietetic survey
Costa Rica 3-7 g No reference
Cuba - -
Ecuador 7-10 g Dietetic survey
El Salvador 10 g No referenee
Guatemala 6-8 g Dietetic survey
Honduras 10 g No reference
Mexico - -
Nicaragua 12.4+(4.8)g; 11-14 g Weekly consumption survey of salt
per family/No. of hoseholds
Panama 10-18 g Dietetic survey
Paraguay 7.3 g Dietetic survey
Peru 8-13 g Dietetic survey direct weight per 7 days
Uruguay - -
Venezuela 3,3-1.8 g Dietetic survey
_____________________________________________________________________________________
Reprinted from "Towards the Eradication of Endemic Goiter, Cretinism, and Iodine Deficiency" with permission from Pan American Health Organization. This publication is available in full from the Pan American Health Organization, $10.- plus $6.- shipping and handling. To request a publications catalog, write to: Pan American Health Organization, Publications Program, 525 Twenty-third St., NW, Washington, DC 20037. Fax: 202/338-0869.
