engleski

Monitoring of IDD control programme in Croatia

At the end of 80-ies and beginning of 90-ties results of epidemiological surveys and clinical examinations indicated a considerable increase in goiter prevalence among schoolchildren in Croatia. On the basis of such findings it has been decided to increase iodine level in all salt intended for human consumption and animal feed. From previous 10 mg/kg +/-5 it has been increased to 25 +/-5 mg of KI per kg of salt. Aim: To determine the magnitude and distribution of IDD within a population as well as to evaluate the efficiency of implementation of IDD control program in the country. Methods: Since Croatia is a country with different geographical settings and nutritional habits, prevalence survey encounters different geographic areas (three regions and a capital city). Survey is conducted in Rijeka, Krk, Osijek, Dakovo, Pazin, Bednja, Zagreb, Rude and Dubrovnik. In order to assess the goiter prevalence among schoolchildren, on the large sample of schoolchildren from all parts of Croatia, age 7-11 years (1739 children), palpation of neck and where necessary neck ultrasound was performed. Goiter classification by ICCIDD/WHO was used. Urine iodine excretion measurement on the urine samples collected from same schoolchildren is underway. Neonatal screening of TSH is also monitored by applying DELFIA neonatal hTSH immunochemical method. Neonatal TSH levels determined from full blood samples obtained from newborns (born before the change of regulation during October/November 1996 - 3029 samples, and after the change of regulation, during January 1998 - 3786 samples and January 1999 - 3529 samples) have been analyzed. Monitoring of iodine concentration levels in locally produced and imported salt intended for human consumption and animal feed is monitored as well. Samples obtained from retailers, households and salt plants are analyzed (including iodine degradation) by use of titrimetric method. Results: From the total goiter rate in Croatia it could be concluded that 18.3 % of children have mild goiter enlargements and additional 1.5 % of examined children have size II of goiter. Data revealed that 12.8 % of newborns born during January 1998 year and 15.7 % of newborns born during January 1999 had TSH levels above 5 mU/L. Conclusion: Initial preliminary results indicate that in the 3 year period, correction of the Rule for basic standards for salt intended for human consumption (by increasing iodine content in salt to 25 mgKI/kg of salt +/-5 mg KI) has contributed to very modest lowering of total goiter rate in Croatia and that it is necessary to continue monitoring of IDD in order to strengthen control and implementation of national IDD prevention program in Croatia.

iodine; goiter; TSH; Croatia

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