Iodin supplementation
oral oily iodin supplementation Saskia van der Kam 07.07.98
oral oily iodin supplementation -Reply Arnold Timmer 07.07.98
correction of iodine deficiency André Briend 08.07.98
iodine in water André Briend 11.07.98
Re: idd-corresp on ngonut John T. Dunn 14.07.98


Date: Mon, 7 Jul 1997 16:05:10 +0100

From: sakatamsterdam.msf.org (Saskia VD KAM)

Subject: oral oily iodin supplementation

 

Subject: oral oily iodin supplementation

From: Saskia van der Kam

In an area in the Sahel belt, an area beyond control of any government, we think to implement an iodin prevention campaign with oral oily iodin.

Who has experience with this? What protocols are used up to now and who produces (or how to order) the oral oily iodin.

 

Saskia van der Kam

nutritionist MSF Holland, Amsterdam

E-mail: Saskia_vd_Kamatamsterdam.msf.org


Date: Mon, 07 Jul 1997 16:44:55 +0200

From: Arnold Timmer <TIMMERatunhcr.ch>

Subject: oral oily iodin supplementation -Reply

 

Iodized oil supplementation can be done (orally or through injection) and is done in several countries where iodized salt is not available yet or where it does not reach the users and where IDD is prevalent.

The injections have a better performance as the iodine is stored in the muscle with a slower release and protects for about 4 years, while the oral iodine administration is partly directly absorbed by the thyroid, partly stored in the fat and partly excreted and protects for about one year.

The oral capsules contain 0.2 g of iodine and have to be administered by trained health workers and record keeping is important as one person should not receive the capsule twice in a short period of time.

In Sudan we (WHO) distributed iodized oil capsules in high endemic areas. It is costly though and labour intensive. Manufacturer is Hofman La Roche.

Did you look into other iodine sources like iodized salt? If you also distribute food in the area or if you could possibly supply iodized salt in the region you could also consider that as it is a cheaper and easier way of dealing with the problem.

There are many guidelines available through WHO, ICCIDD.

You may consult Anna Verster, regional Nutrition Adviser WHO-EMRO, email: 106022.126atcompuserve.com or Versteraatwho.sci.eg. She deals a lot with IDD and intervention measures in her region of the Middle east and North Africa.

 

Arnold Timmer, Nutritionist

PTSS UNHCR, Geneva


Tue, 8 Jul 1997 11:04:05 +0200 (METDST)

From: briendatext.jussieu.fr (Andre' BRIEND)

Subject: correction of iodine deficiency

 

Dear Saskia,

I fully agree with Arnold that a lot has been written on correction of iodine deficiency. This is a complex issue and you should have a look on available manuals/ litterature before starting a project (see ICCIDD/WHO/UNICEF papers/ newsletters etc..).

If you want practical tips, you may turn to MSF France (you know the address) who distributed iodine capsules in some remote parts of Tajikistan last year. You also may ask the following group in Sweden who wrote a series of papers on the evaluation of iodine capsule distribution in Eastern Africa.

Contact :

Stefan Peterson MD, MPH

International Child Health Unit, Dept of Pediatrics, Uppsala University S-751 85 UPPSALA, SWEDEN

Phone: +46-18-665935,direct +46-18-665996, secretary

OR +46-8-6290519, also voice-mail

Fax: +46-18-508013 E-mail: Stefan.Petersonatich.uu.se

There are several groups in Belgium too with extensive experience of control of iodine deficiency in ex Zaire. (see Pr. Pierre Bourdoux : pbourdouatresulb.ulb.ac.be, who works with the group in Sweden)

Some groups advocate putting a slow iodine releasing component into drinking water tanks or wells to correct iodine deficiency. This approach can work only in places were people collect their drinking water from a small number of wells. Did you consider this approach which may be more cost effective and sustainable as iodine capsules in the Sahel were usually number of sources of drinking water is limited ?

By the way, there are several other sources of iodine capsules beyond Roche.

ICCIDD/WHO/UNICEF manual (a practical guide to the correction of iodine deficiency, 1990) mentions Guerbet in France (BP50400, 93943 Roissy, tel : 33-1-45 91 50 00 fax : 33-1-45 91 51 99) and another company in Wuhan, China.

Regards,

 

Dr. André Briend


Fri, 11 Jul 1997 10:17:51 +0200 (METDST)

From: briendatext.jussieu.fr (Andre' BRIEND)

Subject: iodine in water

 

Dear all,

The idea of adding iodine in water came back to fashion recently because of the advent of new components able to slowly release iodine, but it is not really a new idea. Following Saskia mail, I delved out a reference book on "Prevention and control of idodine deficiency disorders" (Ed. Hetzel BS, Dunn, JT, Stanbury JB, Elsevier, 1987, pp 135-136). I found that the idea was first tested in 1923. The technology looks very simple and quite similar to that of adding chloride in water, with control of level by a colorimetric kit. Iodine has the property to kill bacteria, which is an additional advantage.

Refugee camps often have a central source of drinking water where sanitation workers add chloride every day. I wonder whether the idea of adding iodine (instead, or along with chloride) was ever considered ? This may be simpler in some cases than importing fortified salt.

For info, a new reference on iodine deficiency and mortality. Taking care of iodine deficiency is not very spectacular, but apparently may save lives.

Cobra C, Muhilal, Rusmil K, Rustama D, Djatnika, Suwardi SS, Permaesih D, Muherdiyantiningsih, Martuti S, Semba RD. Infant survival is improved by oral iodine supplementation. J Nutr 1997;127(4):574-8.

Although reports suggest that infant mortality is increased during iodine deficiency, the effect of iodine supplementation on infant mortality is unknown. A double- masked, randomized, placebo-controlled, clinical trial of oral iodized oil was conducted in Subang, West Java, Indonesia to evaluate the effect of iodine supplementation on infant mortality. Infants were allocated to receive placebo or oral iodized oil (100 mg) at about 6 wk of age and were followed to 6 mo of age. Six hundred seventeen infants were enrolled in the study. Infant survival was apparently improved, as indicated by a 72% reduction in the risk of death during the first 2 mo of follow-up (P < 0.05) and a delay in the mean time to death among infants who died in the iodized oil group compared with infants who died in the placebo group (48 days vs. 17.5 d, P = 0.06). Other infant characteristics associated with reduced risk of death included weight-for-age at base line, consumption of solid foods, female gender and recent history of maternal iodine supplementation. Oral iodized oil supplementation had a stronger effect on the mortality of males compared with females. This study suggests that oral iodized oil supplementation of infants may reduce infant mortality in populations at risk for iodine deficiency.

 

Dr. André Briend


Mon, 14 Jul 1997 14:34:42 -0400

From: "John T. Dunn" <jtdatavery.med.virginia.edu>

Subject: Re: idd-corresp on ngonut

 

Dear Michael,

To comment briefly on your query about iodized water. ICCIDD completed a study within the last year under the sponsorship of the Micronutrient Initiative. The report has been submitted and I will publish a summary soon, probably in the August IDD Newsletter. A few brief comments follow. Iodized water is a physiological way to present iodine to the body because it is taken regularly, like salt and unlike iodized oil. The most successful examples have been in the longhouses of Malaysia and in school drinking water in northern Thailand, also in several villages in Sicily. Delivery methods range from the Rhodifuse system of Rhone-Poulenc to the simple addition of drops in drinking water. The latter is effective IF it has responsible oversight, and costs almost nothing. The Rhodifuse system also works but is expensive and depends on external supplies.

Various simple iodinators are available that vary in complexity, cost, and sustainability. The choice of iodization method depends on the local circumstances. Water iodization will be worth considering where iodized salt is not practical soon enough and where one of the possible water methods will be sufficiently inexpensive, sustainable, compatible with water use conditions, and properly monitored. The levels required to be bactericidal are considerably higher than those to achieve iodine sufficiency, and carry some risk of iodine excess and its consequences, especially iodine-induced hyperthyroidism and perhaps an increase in autoimmune thyroid disease and in microscopic papillary thyroid cancer, but this is a complex subject. Also, for water sterilization it must be in the I2 form, instead of the iodide in Rhodifuse. Studies with high-dose iodinators are in progress in Chile.

Incidentally, you might point out to others on your mailing list that the ICCIDD Newsletter is on the web, in collaboration with the MI, and is reachable via http://avery.med.virginia.edu/~jtd/iccidd

We are in the process of updating and indexing it.

Regards,

 

John Dunn