Iodine Deficiency Disorder: The creeping problem imperilling Georgian children’s mental health
By Sarah Marcus for UNICEF Georgia February 2010
All of Tinatin’s children are healthy and developing normally, because a serious threat to their health and mental development was spotted during Tinatin’s first pregnancy five years ago. ‘When I was expecting Nino I went to the doctor for a pregnancy check-up and I was diagnosed with iodine deficiency disorder,’ said Tinatin. She had been feeling somewhat weak and unwell but she did not suspect she was suffering from a disorder which in pregnant women can cause serious problems including severe mental retardation in their children. Iodine deficiency disorder can also cause miscarriages, infertility and other pregnancy complications. Tinatin was prescribed iodine pills and another medicine and told to take both during her first and subsequent pregnancies. She was also instructed to take her children for iodine testing. Tinatin and her children were saved from the dangers of iodine deficiency disorder because when she was first pregnant Georgia was in the process of addressing the causes and implications of the disorder. Iodine deficiency disorder can be easily treated through ensuring salt is iodised and properly kept to preserve the iodine content. An existing historical problem of iodine deficiency in Georgia had been combated during the Soviet era through a prophylactic programme of iodising salt. But with the fall of the Soviet Union the programme collapsed and soon Georgia found itself facing a problem of endemic proportions – by 1998 58 per cent of the child population had goitre – a condition caused by iodine deficiency disorder - and by the end of the 1990s 60 per cent of pregnant women were afflicted with the disorder, according to Zurab Sekhniashvili, director of the National Centre for Nutrition in Georgia’s capital Tbilisi . Sekhniashvili said that a study carried out by nutritionists in conjunction with the Tbilisi-based Institute of Psychological Development in 1998 revealed a worryingly low IQ index in children which could be attributed to iodine deficiency. Iodine tablets were introduced as an immediate way of combating the problem and with UNICEF’s help a comprehensive programme of monitoring of iodine content in salt and of salt intake, as well as a public information campaign, were gradually rolled out between 1998 and 2005. Centres to monitor goitre and iodine deficiency, where treatment was free, opened throughout Georgia. In 2004 in response to UNICEF-led lobbying, the Parliament of Georgia adopted a law forbidding the import of non-iodised salt into Georgia. By 2005 a countrywide survey revealed that the programme had enjoyed great success: the problem of iodine deficiency, according to Sekhniashvili, had been close to eradicated and Georgia had almost reached the WHO indicator for consumption of iodine.
But in 2007 the Georgian government withdrew funding for the monitoring programme and since then there has been no comprehensive monitoring of iodine content in salt or of iodine intake or levels among the Georgian population. In addition to this, treatment to combat iodine deficiency disorder at the National Nutritional Centre is no longer free, as it was under the previous programme to combat the problem, and as a result only those with money now come for treatment, said Sekhniashvili. ‘Now we don’t know what sort of problems we have, but a limited survey carried out in 13 districts of Tbilisi in 2008 revealed 25-28 per cent of school-aged children have mild iodine deficiency,’ he explained. The Ministry of Health requested UNICEF’s support to carry out a universal iodisation impact monitoring survey in the Kvemo Kartli region of Georgia in 2008. The survey found that the situation had worsened since the previous cross-country monitoring survey was carried out in 2005 and the Kvemo Kartli population showed levels of mild iodine deficiency. Experts believe that this worsening was due to lack of knowledge of how to preserve and consume iodised salt properly. Without constant state-supported monitoring of iodine content and iodine intake and accompanying public information campaigns, iodine deficiency is likely to increase in Georgia. At the department for women’s consultation of the Kutaisi Obstetrics-Gynaecological Hospital, doctors managed to continue monitoring pregnant women after the state monitoring programme was discontinued. Recently they have seen a sharp and worrying rise in the disorder among pregnant women. The doctors recount one particularly distressing story. When a 22-year old woman was referred to their clinic 12 weeks into her pregnancy with a problematic thyroid gland, they realised she was suffering from acute iodine deficiency. When they ran an ultrasound test to determine whether the woman’s unborn baby had been affected by this they saw that the foetus was developing abnormally and had to consider aborting it. The doctors said that the abnormal development was due to the late detection of the pregnant woman’s iodine deficiency. Out of the 80-100 pregnant women monitored per month, 50-60 per cent suffers from the disorder. As in the 22-year old woman’s case, by the time this diagnosis is made, when the woman is already pregnant, it is often too late to address the problem and too late to save the foetus from abnormal development, the doctors said. They added that the problem could be even more acute in the high mountain regions of the country, where access to information and healthcare is more limited. The answer to this problem, said the Kutaisi doctors, is nationwide, state-sponsored monitoring of the population, especially pregnant women, in order to prevent complications and plan interventions. Sekhniashvili said that monitoring of iodine levels should be carried out at least once per year in each region of Georgia. Such a programme can only be sustained for the long term with ongoing, guaranteed state support. In addition to monitoring, public information campaigns on the importance of sufficient iodine intake, as well as the right way to keep and use salt to preserve iodine content, are essential. Regaining and retaining control of the problem of iodine deficiency disorder in Georgia requires determination and a firm financial commitment on the part of the government. But the only alternative is to risk allowing Georgian children to grow up with adversely affected mental development.
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