THE THYROMOBIL PROJECT IN LATIN AMERICA: PERSPECTIVES FOR AN EVALUATION OF BRAZIL’S SITUATION CONCERNING IDD IN THE YEAR 2000

 

Geraldo Medeiros-Neto, M.D.

University of Sao Paulo Medical School

Coordinator of the THYROMOBIL project in Brazil

 

  1. The evaluation of Iodine Deficiency Disorders in Europe was, recently, conducted using an adapted van THYROMOBIL equipped with an ultrasound apparatus, a computer unit, a freezer to store specimens and supplies. The THYROMOBIL traveled from one country to another collecting data on thyroid volume, urinary excretion of iodine and content of iodine in the local source of salt. The excellent results of the THYROMOBIL project in Europe encouraged Dr. Eduardo Pretell to ask Merck KGaA, from Darmstadt, Germany, to finance a similar project in Latin America. In 1997, Merck finally agreed to fund such a project and send the THYROMOBIL to Latin America in 1998.

  2. Main objectives – The main objectives of the Project are: 1) to update the present situation of IDD in the Latin American countries; 2) to evaluate the progresses in the universal salt iodination strategy (USI) and in their IDD control programs; 3) to increase the awareness on IDD; and 4) to stimulate the commitment of local governments to reach the goal of IDD eradication by the year 2000.

  3. Methodology – The study will cover 17 countries, Argentina, Brazil, Bolivia, Colombia, Chile, Ecuador, Paraguay, Peru, Uruguay, Venezuela, Costa Rica, Guatemala, Honduras, El Salvador, Nicaragua, Panama and Mexico. An average of 13 towns in each country will be evaluated. The towns will be selected among those previously known as severely affected by iodine deficiency or new ones.

The target population will be school children, 6-14 years old of both sexes.

A team composed by a specialist in ultrasonography and an assistant will be in charge of the field work, for which a van equipped with an ultrasound, a computer unit, and a freezer will travel from one country to a next one, in a proper sequence to save time. The selection of places and routing will be predetermined in each country.

Data collection

Authorizations from parents, school teachers, and local authorities will be obtained, as required in each country.

The average time for the survey in each country is estimated in 4-12 weeks.

  1. The THYROMOBIL has completed its objectives in eleven countries, with a total of 129 villages visited. Thyroid volume was measured in more than 13,000 schoolchildren, about 6,500 specimens of urine were analyzed for its iodine content, and about 1,300 salt samples were collected for iodine content in the locally consumed salt.

  2. The THYROMOBIL was planned to land in Brazil in August-September 1999. However, due to the large size of the country, the perspectives of covering close to 6,000 miles (North to South) and the complexity of the logistics concerning the project, the THYROMOBIL project was postponed to March 2000. The main reasons for this postponements were the proximity of the raining season (October-January) that would make the travel of the THYROMOBIL quite difficult, considering the state of the local small roads.

Moreover the Brazilian Health Authorities pointed out that the project should be approved, first at the coordinator’s University and then by the Ethical Committee of the Ministry of Health. Other legal requirements should also be attended, namely, the parent’s authorization to examine the children, the request for cooperation from local Health Authorities and the Principals of the elementary schools that would be visited, the proper planning of the long trip and the necessary authorization for foreign doctors to perform tests in children.

At this writing, most of the requirements have been attended and as soon as the "dry" season starts (March 2000) the THYROMOBIL will disembark in the Northern part of Brazil (Belem, Para) to start its southward long trip of 6,000 miles. A total of 30 villages will be visited, with 100 children examined in each village. Urinary specimens will be collected and salt samples will be obtained directly from the house holds (brought in by the children).

The local coordinator (Prof. Medeiros-Neto) is quite optimistic of the success of this project and has received full support from the Ministry of Health and from the several Agencies involved in this Project (UNICEF, Pan American Health Organization, ICCIDD).

Moreover at this moment when the Brazilian Health Authorities have decided to change the current system of supplying free potassium iodate to all salt mills in Brazil, it is quite appropriate, once again, to call the attention of the Brazilian population for the importance of consuming iodized salt, to alert the Health Authorities for the need of continuously monitoring the correct iodine content in the salt and to pay special attention to regions in Brazil that are recognized as at risk for Iodine Deficiency Disorders.

 
Home Page | New | Links | Join | E-Mail | Members Only |
Bulletin | Files | Directory | Council | Awards | Meetings | IDD |