Focus on Ethiopia - Jul 2007

HIGHLIGHTS IN THIS ISSUE:

- IODINE DEFICIENCY "THE SILENT EMERGENCY"

- REGIONAL OVERVIEW

- UPCOMING & ONGOING MEETINGS

Focus on Ethiopia is produced by UN Office for the Coordination of Humanitarian Affairs (OCHA), in collaboration with other UN agencies and partner NGOs. Focus on Ethiopia provides a monthly overview of humanitarian trends and activities in Ethiopia, as well as focusing on particular issues of interest. Send comments, suggestions and contributions to ocha-eth@un.org

IODINE DEFICIENCY "THE SILENT EMERGENCY"(1)

By Michelle Langdon

The large round mass that bulges from Abebe's neck is the lead weight that threatens his future. The 10-year-old suffers from a goiter, caused by Iodine Deficiency Disorder (IDD).

The affliction is easily prevented but impossible to treat once developed.

An estimated twenty-eight million Ethiopians suffer from IDD. The disorder poses serious health risks for pregnant women and their unborn babies. It is the world's leading cause of preventable brain damage and mental retardation. IDD has been virtually eradicated in the industrialized world, yet the prevalence rate in Ethiopia remains shockingly high, estimated at up to 83 percent of women and children.

While the problem is devastating, regular use of iodized salt constitutes a simple prevention. "The amount of iodine needed over a lifetime is equivalent to a mere teaspoonful," Says Dr. Iqbal Kabir, a nutrition expert from UNICEF. "Prevention costs less than a cup of tea."

IDD poses a particular risk to women and children. The prevalence of goiter in Ethiopia increased from 26% in 1981 to 40% in 2005 with rates as high as 63% among children in some areas. It is the cause of approximately 50,000 pre-natal deaths of Ethiopians each year. A mother with IDD suffers from a high risk of spontaneous abortion and/or still birth. The survival of her child after birth is put in jeopardy. Iodine deficiency is also the world's leading cause of negative and irreversible effects on brain development. This is particularly true in early childhood years, resulting in potential IQ reduction of up to 15 points and in extreme cases may result in cretinism and mental retardation.

The highland populations of Ethiopia are particularly susceptible to the disorder because iodine is missing from the soil. Run-off from the highlands causes the earth to lose minerals. Soil degradation from floods and overfarming also puts local populations at risk.

In 2007, a rapid assessment was conducted by the Federal Ministry of Health to identify Iodine deficiency "hotspot" areas in 5 regional states -- Amhara, Oromiya, Tigray, SNNP and Beneshangul Gumuz. This rapid assessment identified approximately eight million people with moderate-to-severe cases. Resettlement sites and migrant areas appeared to be much more vulnerable to Iodine deficiency for reasons that have yet to be clearly understood.

While regular use of iodized salt will provide adequate protection less than five percent of salt available in Ethiopia is iodized. And the situation is deteriorating. "A decade ago approximately 80 percent of households had access to imported iodized salt," says Kabir. "Ethiopia now falls well below global IDD standards."

A Universal Salt Iodization (USI) campaign for Ethiopia was developed by the Federal Ministry of Health (FMOH) with a start date of November 2006, though it has yet to be implemented. In an effort to restart the process, the Ministry of Health and the Ministry of Mines and Energy along with its partners in the USI campaign, UNICEF, Micronutrient Initiative, and Ethiopian Health and Nutrition Research Institute, have conducted a salt mapping survey to determine the number and location of salt producers and their capabilities in Afar Region, Ethiopia's primary salt-producing region. The results are being finalized and the group is working to obtain the required equipment to iodize all domestically produced salt in order to implement the USI program. Discussions are underway between officials at the FMOH, the regional state and salt producers in the Afar Region. Ninety percent of the salt consumed in Ethiopia currently comes from the Afar and their cooperation is imperative to finding a sustainable solution to the problem.

In the meantime, nutrition experts believe there is an urgent need for an interim relief strategy to prevent the irreversible effects of iodine deficiency. A plan has been developed by the Nutrition Unit of the FMOH, in collaboration with UNICEF, to provide iodine supplementation targeting kebeles in the five regions with highest goiter rates: Amhara, Oromiya, Tigray, SNNP and Beneshengul Gumuz. The intervention can be channeled through the current Enhanced Outreach Strategy (EOS) programme in order to minimize costs and maximize efficiency and access. However, the government/implementing actors lack the resources necessary to carry out this strategy. The cost of an iodine supplementation program is estimated to be $1.3 million, targeting over three million women and children. According to Dr. Iqbal, "Any further delay in providing supplementation will put 300,000 newborns a year at risk in these hotspot areas."

Note

(1) All data can be found in the document: Iodine Deficiency Disorders National Survey in Ethiopia (2005), conducted by Ethiopian Health and Nutrition Research Institute (EHNRI), Federal Ministry of Health (FMoH) and UNICEF.