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© UNICEF/UKR/Maxim Bitsenko
Alina, 8 years old

Alina is a study in contrasts: an eight-year-old Ukrainian girl with dark hazel eyes and fair hair, a strong look and timid smile, and a tragically unhealthy childhood that could have been prevented.

For her mother, Alina's contrasts were one long source of heartbreak. When the girl was one year old, her mother was worried that the baby was unusually quiet. She rarely cried, and when she did, her voice was hoarse and shrill, recalls neurologist Elvira Bikulova.

Alina's concerned young mother took her to the district paediatrician in the suburb of Kharkiv in Eastern Ukraine, who reassured her. The child was normal. There was no cause for alarm.

But the mother's fears persisted, and at 18 months of age, Alina had no teeth, could not walk and was unable to speak. Convinced something was wrong, her mother consulted a paediatric neurologist. The doctor confirmed that the girl had growth and mental retardation and prescribed neurological treatment. But it did no good and the specialists who saw the child were perplexed.

A year later, when Alina was two-and-a-half year old, one of the doctors began to suspect the true cause of the trouble: low secretion of hormones containing vital iodine from the thyroid gland. Endocrinologists confirmed the diagnosis.

Alina had been horribly affected by a totally preventable condition: iodine deficiency as a result of poor iodine nutrition during the pregnancy of her mother.

"The thyroid gland plays a vital role in the human organism. Sufficient quantities of iodine through diet are vital for the thyroid gland to synthesise hormones," says Nina Kravchun, chief endocrinologist of Kharkiv region. "Without those quantities, hypothyroidism results, and development can be severely delayed." Rich sources of iodine in diet are fish and seafood, nuts and others, but the salt is customary and recommended vehicle for distributing iodine and best food source, consumed by everybody on daily basis.

Alina's hypothyroidism had caused her retardation. She was treated with synthetic hormones containing iodine - a treatment that had a striking and immediate impact. In two months, she was starting to walk. Then she got her first teeth. And within a year, she uttered her first words. Her mother was overjoyed.

Today, Alina is eight. Her level of development is that of a five-year-old. She is in third grade, instead of fifth, but she is making great progress. She is one of the best students in her class at a boarding school for children with disabilities. But she continues to experience the aftermath of her iodine deficiency, including health problems, developmental delay and difficulty with logical and abstract thought.

She is unwilling to talk to strangers. When asked about what she likes or who she wants to become, she can only nod or provide yes or no answers. Speaking a full sentence is an arduous task. And when she does manage to express her ideas, other people may find it difficult to understand her.

"Sadly, Alina's diagnosis came late, when the state of her illness was very serious. The central nervous system was affected and she suffers from immunodeficiency. Her vision was reduced by half, she has gastrointestinal tract problems, and she suffers from chronic tonsillitis. The girl often catches a cold and misses school. She will depend on hormone injections for the rest of her life," says Elvira Bikulova. "What is tragic is that this was all preventable. If her mother had received 150-200 milligrams of iodine per day during pregnancy, this would not have happened," Elvira added.

Iodine deficiency can be prevented by ensuring adequate iodine intake every day during one's whole life. In iodine deficient areas eating iodine-rich foods such as fish and other seafood can not satisfy the requirements of everybody since these foods are not consumed on a daily basis. In Ukraine, as in other iodine deficient countries, the population does not get sufficient iodine from vegetables and crops grown or animals reared on soil that is, itself, deficient in iodine.

As Antonina Dubinina, an expert in consumer goods at the Kharkiv State Academy of Technology and Nutrition Management explains: "Recent economic hardship meant 70% of the Ukrainian population was living on less than one dollar a day. It is not realistic to expect people can afford to consume fish and seafood or other iodine rich foods and the use of iodised salt on a universal basis remains the only solution to the problem."

© UNICEF/UKR/Maxim Bitsenko
Alina, 8 years old

The most simple, safe and affordable form of prevention of iodine deficiency is iodised salt - a staple food that should be available in every food shop. And because salt is inexpensive and widely used, it is a highly effective way of ensuring that people get the iodine they need in their diet. UNICEF is championing the use of iodised salt across Ukraine in partnership with local leaders such as Alina Rudakova, the supervisory teacher at Kharkiv Specialised Secondary School No. 162. An active campaigner for iodised salt, she has started a course on the prevention of iodine deficiency at her school.

"In many cases we spend more time with children than their parents, because children spend much of their time in school," the teacher says. "We see their difficulties: laxity, weakness, apathy and retardation. It gave me the idea that I could perhaps explain to the children in an entertaining way the source of these ailments and show them an easy way to solve them. Our children gladly listen to these lessons and want information on their illnesses. And they tell their parents about the dangers of iodine deficiency, which is so important."

A group of school teachers created teaching materials approved by the Ministry of Education and Science of Ukraine. Two editions, 'Creating a School of Healthy Living' and 'Educational Work as a Means of Prevention of Iodine Deficiency Disorders among Schoolchildren' were issued in cooperation with the Kharkiv Regional Scientific and Methodological Institute of Continuing Education. The materials detail methods of preventing iodine deficiency and include them throughout the school curriculum, including in courses in Ukrainian, English and Russian languages, mathematics, history, geography, biology, chemistry, safe living and medical studies.

In Kharkiv, consumption of iodised salt increased by 313% between 2001 and 2004 according to the Kharkiv Regional Statistics Bureau, reducing the number of iodine deficiency cases. More pregnant women are now protected from giving birth to children with mental or physical disorders as a consequence of iodine deficiency. Teachers, medical staff and the media have given seminars on the Kharkiv methods to inform others about their successes.

Unfortunately the consumption of iodised salt is still insufficient to ensure that the whole population prevented from iodine deficiency disorders on a sustainable basis. The only way to achieve this is to make salt iodisation mandatory so that iodised salt becomes a part of a healthy diet for everyone.

"Our school has implemented the programme over the past year," says Alina Rudakova. "During this time, children have used iodised salt at home and in school. They, and their parents, have become very committed to this, and the results are showing. Their health is improving, and they are more active, happy and successful in their studies."

And that is a contrast that everyone is happy to see.



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