 |
| © UNICEF Azerbaijan/2002/ |
| Children of different ages all actively involved in community-based education on IDD and consumption of iodized salt. |
BAKU, 15 AUGUST 2002 -- In an idyllic setting, the last words someone expects to hear is "our water is bad." However, these words are echoed throughout the small mountain town of Shaki, in northern Azerbaijan.
When Zhale Khanjanova, a secondary school pupil in Shaki, was asked what this meant, she replied, "Our water has no iodine." People get ugly goiters if they don't have iodine, she said, adding that now they are using iodized salt which is being sold in the market. How does she know about the importance of iodized salt consumption? From learning about it in school in a programme sponsored by UNICEF, she says.
Shaki, nestled in the Greater Caucasus Mountains, served as a regional trading center for more than 2000 years, benefiting from its location as a crossroads between Europe and Asia. Now, though, this sleepy mountain town seems to have been forgotten as the republic deals with a large population of Internally Displaced Persons (IDP) and a potential oil boom while seeking political and social stability. Where Shaki once hosted a healthy tourist trade and had access to goods and services through the Soviet system, today it grapples with a diminishing quality of life and poorer living conditions, a result of the difficult post-Soviet transition period.
The incidence of malnutrition and micronutrient deficiencies has risen. Azerbaijan never used iodized water in the past. Rather delivery of iodine was accomplished through the provision of fortified salt. Average salt intakes vary considerably according to climates, culinary habits and occupation. In Azerbaijan where hot summers and heavy workloads result in excessive sweating and salt loss, people must consume 15-20 grams more than normal.
Under the Soviet system it was compulsory for iodized salt to be transported to even the smallest villages high up in the mountains. Therefore, iodine deficiency disorders (IDD), which can cause mental and physical retardation and affect the nervous system, were not widespread. Howeever, following independence, people throughout the Caucasus and Central Asia did not get enough iodized salt because of diminished social services, changes in the market and transport links. Non-iodized salt began to show up and iodized salt almost disappeared from the shelves. It was at this time that IDD began to be observed throughout the former Soviet republics, especially in endemic regions.
Azerbaijan has always been an endemic region for IDD. A 2000 study of iodine intake and goiter prevalence among school children reports a particularly high prevalence (86 per cent) throughout Azerbaijan. In the mountainous regions of the Caucasus, the prevalence reached 100 per cent while coastal areas along the Caspian Sea were only 60 per cent. Household consumption of iodized salt had dropped to zero throughout the Caucasus and Central Asia, placing them at the bottom of the global consumption ladder.
The challenge was to find a way to get iodized salt back into homes and diets.
Meeting the challenge
The Government of Azerbaijan, in cooperation with UNICEF, took up the challenge. The answer seemed apparent—to ensure universal salt iodization and access to iodized salt throughout the country. But to reach this goal required work. The extent of the problem was assessed and plans were drawn up using local and international experts. Local authorities, officials, parliamentarians, schools and non-governmental organizations also joined in. The National Interagency Committee on IDD/USI was formed, and coordination with regional partners helped to drive the effort. The decision to initiate the Universal Salt Iodization (USI) programme was taken by the Government and UNICEF for the period of 2000-2004. The Programme has been supported by Kiwanis International Foundation, which supports universal salt iodization/elimination of IDD worldwide.
The programme has a variety of components to address all aspects of IDD/USI in a coordinated and integrated fashion, from public awareness campaigns and strengthening local laboratories for monitoring, to a new national law that makes salt iodization compulsory and will disallow import of non-iodized food grade salt.
The project on Universal Salt Iodization has made real progress and is expected to have a great impact in reducing the prevalence of iodine deficiency disorders in Azerbaijan. Where household consumption of iodized salt in 1999 was assessed at zero per cent, it rose to 41 per cent in 2000. It is estimated that 80 per cent of all households now consume iodized salt, a result of the integrated approach taken by UNICEF, the government and their partners.
The success of this program attests to the effectiveness of all partners involved in identifying and implementing measures to help guarantee a better future for vulnerable populations. It also exemplifies an integrated approach for development. Preventative measures were not emphasized by the Soviet health system. The involvement and commitment of Azerbaijan's health professionals and officials in this project confirms their commitment to such practices.
Ultimately, this programme is aimed at enhancing the potential of the population. This young republic needs people who are creative and active, who are fully developed in every capacity. Eradicating IDD removes a serious physiological obstacle to this development. Iodized salt is essential for the young people of Azerbaijan to realize their full potential.
