The Prevention and Control of Iodine Deficiency – Achievements and Problems in Bulgaria

Issue: 3/2018

Author: Ivanova, Ludmila B.

Faculty of Medicine, Sofia University “St. Kl. Ohridski”

Iodine deficiency is a global public health problem and the most common preventable cause of brain development disorder and reduced intellectual potential. Its prevention has been the focus of international organizations to implement the most efficient and cost-effective strategies for
its sustainable elimination. In Bulgaria, the prophylaxis of iodine deficiency can be divided into two periods: 1957-1993 and since 1994, which differ in preventive strategies, monitoring and coordination of the program. The first period began in the late fifties of the last century when, after an extensive epidemiological study to determine the prevalence and severity of goiter among the population, the territory of the country was divided into endemic and non-endemic areas. The prevention strategies – salt iodization and iodine supplementation of high-risk groups were introduced only in the
endemic regions. Prophylactic measures were effective and resulted in a significant reduction of goiter, which decreased to 12%, but after 1986
there was a new rising due to lack of iodized salt and other preventive measures. The second period after 1993 covered the entire territory of the
country, introduced “universal” salt iodization, adoption of the regulatory basis for iodization, monitoring and control of the impact on the population. Four national studies on iodine status of the population, measured by iodine excretion in the urine of high-risk groups have shown a sustainable elimination of iodine deficiency. Iodine excretion in school aged children increased from 111,5 μg / L (1996) to 175,5 μg / L (2012), pregnant women reached 161,0 μg/ L (2012) and 91,9% of householdshave access to adequate iodized salt (> 15 ppm). In order to ensure sustainability
of the prophylaxis, it is necessary to strictly control and document the quality of iodized salt, to prevent penetration of non-iodized salt in the
market, and to monitor regularly the high-risk population groups (pregnant women) and risk areas in accordance with the latest international recommendations.

Key words: thyroid, Iodine deficiency, iodized salt, universal salt iodization, iodine prophylaxis in Bulgaria

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