The ThyroMobil model for standardized evaluation of iodine deficiency disorder control in Indonesia

Indonesia used to be affected by varying degrees of iodine deficiency. Salt iodization has been the adopted strategy on a national basis since 1979. T he prevalence of goiter in school-age children (SAC) determined by palpatio n subsequently markedly decreased within the next 15 years. The objective o f the present work was to perform an updated evaluation of the status of io dine nutrition in Indonesia by using standardized methods for the measureme nt of thyroid volume by ultrasounds and the concentration of urinary iodine in SAG. The survey included 7,447 SAC ages 6 to 12 years from 129 sites se lected by multistage and stratified sampling in five provinces (4 in Java p lus Sumatra and the Province of ball). A mobile unit (ThyroMobil van) equip ped with a sonographic device and facilities for the collection of urine sa mples visited all sites. In Java plus Sumatra, the median urinary iodine wa s 195 mug/L. Thirty-four percent of the values were within normal limits (b etween 100 and 200 mug/L); 17.2% were below 100 mug/T, and 48.8% were above 200 mug/L, including 18.2% above 300 mug/L and 0.7% above 1000 mug/L. In B ali, the median was 81 mug/L with 58.3% of the values below 100 mug/L and o nly 14.7% of the values above 200 mug/L. The prevalence of goiter determine d by ultrasounds and using the World Health Organization/International Coun cil for Control of Iodine Deficiency Disorders (WHO/ICCIDD) normative value s for gender and age was 3.0% in Java plus Sumatra and 1.9% in Ball. The va lues were 8.0% and 12.5%, respectively, when using reference values for Ind onesia established during the present survey in an iodine replete area in c entral Java. In conclusion, (1) iodine deficiency has been eliminated in la rge parts of Indonesia; (2) ball is still affected by mild iodine deficienc y; (3) in many places, iodine deficiency has been replaced by iodine excess , occasionally potentially toxic; (4) the WHO/ICCIDD normative values for t hyroid volume measured by ultrasound in SAC are not valid for Indonesia; (5 ) in Indonesia, the level of salt iodization could be decreased and the bio logical monitoring of urinary iodine at the population level should be rein forced and maintained; (6) the ThyroMobil model has, as in other parts of t he world, demonstrated its efficiency in the organization of partnership ev aluation and monitoring of iodine nutrition, as well as in social, mobiliza tion.