Indonesia - The ThyroMobil Model for Standardized Evaluation of Iodine Deficiency Disorder Control
According to the UNICEF, there are millions of children worldwide, who suffer from developmental disturbances caused by iodine deficiency.
Indonesia used to be affected by iodine deficiency to varying degrees too. As in many other cases, children have been the most affected. Salt iodization has been the adopted strategy on a national basis since 1979. The prevalence of goitre in school-age children (SAC) determined by palpation subsequently decreased markedly within the next 15 years. With substantial support from the GPHF, evaluation programs were initiated in 1998 and 1999. Centerpiece of the project was the use of a mobile examination and information unit (ThyroMobil van), provided with the help of the GPHF. The ThyroMobil is equipped with a sonographic device and facilities for the collection of urine samples.
The objective of the present work was to perform an updated evaluation of the status of iodine nutrition in Indonesia by using standardized methods for the measurement of thyroid volume by ultrasounds and the concentration of urinary iodine in SAC. Partners of the GPHF for the project were the University of Djakarta, the International Council of Control of Iodine Deficiency Disorders and one GPHF member, Merck. The survey included 7.447 SAC aged 6 to 12 years from 129 sites selected by multistage and stratified sampling in five provinces (4 in Java plus Sumatra and the Province of Bali). The ThyroMobil visited all sites. In Java plus Sumatra, the median urinary iodine was 195 µg/L. Thirty-four percent of the values were within normal limits (between 100 and 200 µg/L); 17,2 percent were below 100 µg/L and 48,8 percent were above 200 µg/L, including 18,2 percent above 300 µg/L and 0,7 percent above 1000 µg/L. In Bali, the median was 81 µg/L with 58,3 percent of the values below 100 µg/L and only 14,7 percent of the values above 200 µg/L. The prevalence of goitre determined by ultrasounds and using the World Health Organization/International Council for Control of Iodine Deficiency Disorders (WHO/ICCIDD) normative values for gender and age was 3,0 percent in Java plus Sumatra and 1,9 percent in Bali.
The values were 8,0 percent and 12,5 percent, respectively, when using reference values for Indonesia established during the present survey in an iodine replete area in central Java.
The ThyroMobil model has, as in other parts of the world, demonstrated its efficiency in the organization of partnership evaluation and monitoring of iodine nutrition, as well as in social mobilization.