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Assessment of Iodine
Deficiency Disorders and Monitoring their Elimination : A guide for programme
managers, Second Edition. ICCIDD/UNCF/ WHO, 2001
Continued . . .
Annex 1 Titrimetric method
for determining salt iodate content
The iodine
content of iodated salt samples
is measured using iodometric titration (see References on the
following page for further details).
Description of the reaction
The
reaction mechanism inclues two steps:
* Liberation
of free iodine from salt:
addition of H2SO4 liberates free iodine from the iodate
in the salt sample. Excess KI is added to help solubilize the free iodine,
which is
quite insoluble in pure water under normal conditions.
* Titration
of free iodine with thiosulfate:
free iodine is consumed by sodium thiosulfate in the
titration step. The amount of
thiosulfate used is proportional to the amount of free iodine liberated from
the salt. Strach
is added as
an external (indirect) indicator
of this reaction and reacts with free iodine to
produce a blue
colour. When added
towards the end of
titration (that is, when only a trace
amount of free iodine is left)
the loss of blue colour, or end-point, which occurs
with further titration, indicates
that all remaining free iodine has been
consumed by thiosulfate.
Reaction steps for iodometric titration of iodine
1. lO3 -
+ 5l - +
6H+ 3l+3H2O
(from
(from (from
salt)
Kl) H2SO4)
2. 2Na2S2O3
+ l2 2Nal
+ Na2S4O6
Sodium Iodine Sodium Sodium
thiosulfate iodide tetrathionate
Reagent preparation
The preferred water for this method should
be boiled distilled water, which
requires provision of
distillation unit. As a
simpler alternative, regular tap water
treated with a mixed bed deionizing resin
can be used, thus avoiding
the need
for an expensive distillation
unit
0.005 M
Sodium thiosulfate (Na2S2O3):
Dissolve 1.24 g Na2S2O35H2O in 1000 ml water. Store in a cool, dark place. This volume
is sufficient for 100-200
samples, depending on
their iodine content. The solution is stable for at least one month, if stored properly.
2 N Sulfuric acid (H2SO4): Slowely add 6 ml concentrated H2SO4 to
90 ml water.
Make to 100 ml with water.
This volume is sufficient for 100 samples. The solution is stable indefinitely.
Always
add acid to water, not water to acid, to avoid excess heat formation and
spitting of acid. Stir solution while
adding acid.
10% Potassium iodide (Kl): Dissolve 100 g kl in 1000 ml water.
Store in a cool, dark place. This volume is sufficient for 200 samples.
Properly stored the solution is stable for six months, provided no change occurs in the
colour of the solution.
Starch indicator
solution: Dissolve reagent-grade sodium chloride (NaCl)
in 100 ml
double-distilled water. While stirring, add NaCl until no more dissolves. Heat the contents of the beaker until excess
salt dissolves. While cooling, the NaCl crystals
will form on the sides of the beaker.
When it is completely
cooled, decant the supernatant into a
clean bottle. This
solution is stable for six to twelve months. Dissolve 1
g chemical starch in 10 ml double-distilled water. Continue
to boil until it
completely dissolves. Add the
saturated NaCl solution to
make 100 ml
starch solution. This
volume is sufficient for testing 20 to 45 samples. Prepare
fresh starch
solution
every day, since starch solution cannot be stored.
Reference
UNICEF,
De
Maeyer EM, Lowenstein FW, Thillym
Annex
2 Method for determining thyroid size
by ultrasonographyLongitudinal and transverse scans are performed
allowing the measurements of the depth (d), the width (w) and the
lenght (l)
of each
lobe. The volume of the
lobe is
calculated by the formula:
V
(ml) = 0.479 X d X w X 1 (cm).
The thyroid volume is the sum of the volumes of
both lobes. The volume of the isthmus is
not included.
Thyroid volume
can be easily calculated using a
calculator or personal computer
during data entry.
Portable ultrasound
equipment is relatively
rugged, but requires
electricity. However, it can be
operated from a car battery with the aid of
a transformer. Trained operators can perform up to 100 or
more examinations per day.
The body surface area is calculated using the
formula of Dubois and Dubois (Archives
of Internal Medicine, 1916, 17:863):
BSA
(m2) = W0.425 X H0.725 X 71.84 X 10-4
It should
be emphasized that by
using the ultrasonographic criteria, a thyroid gland
will be called goitrous when its values will
be above the 97th percentile of the volume found
in an iodine replete population
used as control.
Normal values
for the median and 97th
percentile for thyroid volume, as a function of both age and body
surface area (BSA), are being developed. In areas with a high prevalence of
protein-energy malnutrition, the BSA reference is recommended.
Annex 3
Method for measuring urinary
iodine using ammonium persulfate (Method A)
Principle
Urine is
disgested with ammonium
persulfate. Iodine is the
catalyst in the reduction of ceric
ammonium sulfate (yellow) to cerous from
(colourless), and is detected
by rate
of colour disappearance
(Sandell-kolthoff reaction).
Equipment
Heating block
(vented fume hood not necessary),
colorimeter, thermometer,
test tubes (13 X
100 mm),
reagent flasks and bottles, pipettes, balance scales.
Reagents
1. Ammonium persulfate (analytical grade)
2. As2O3
3. NaCl
4. H2SO4
5. Ce(NH4)4 (SO4)4 2H2O
6. Deionized H2O
7. KIO3
Solutions
1.0 M
Ammonium persulfate: Disolve
114.1 g H2N2O8S2 in H2O; make up to 500 ml with H2O. Store away from light. Stable
for at least one month.
5
N H2S04: Slowely add 139 ml concentrated
(36 N) H2So4 to about 700 ml deionized
water (careful - this generates heat!). When cool, adjust with deionized water to a
final volume of 1 litre.
Arsenious
acid solution: In a 2000 ml Erlenmeyer
flask, place 20 g As2O3 and 50 g NaCl, then slowely add 400 ml 5 NH2SO4.
Add water to about 1 litre, heat gently to dissolve, cool to
room temperature, dilute with
water to 2 litres, filter, store in a dark bottle away from light at room
temperature. The solution is stable for
months.
Ceric ammonium sulfate solution: Dissolve 48 g
ceric ammonium sulfate in 1
litre 3.5
Standard
iodine solution, 1 ug iodine/ml (7.9 umol/l):
Dissolve 0.168 mg KIO3 in deionized water to a final volume of
100 ml (1.68 mg KIO3 contains 1.0 mg iodine; KIO3 is
preferred over KI because it
is more stable,
but KI has been
used by some laboratories without
apparent problems). It
may be more convenient to make a more concentrated
solution, e.g., 10 or 100 mg iodine/ml, then dilute to 1 ug/ml. Store in a
dark bottle. The solution is
stable for months . Useful standards are
20, 50, 100, 150, 200, and 300 ug/l.
Procedure
1. Mix urine to suspend sediment.
2. Pipette 250 ul of each urine sample into a 13
X 100 mm test tube. Pipette each iodine standard into a test
tube, and then add
H20 as needed to make a final volume of 250 ul.
Duplicate iodine standards and a set of internal urine standards
should be included in each assay.
3. Add 1 ml 1.0 M ammonium persulfate to each
tube.
4. Heat all tubes for 60 minutes at 100 C.
5. Cool tubes to room temperature.
6. Add
2.5 ml arsenious acid solution.
Mix by inversion
or vortex. Let stand for 15
minutes.
7. Add 300 ul of ceric ammonium sulfate
solution to each tube (quickly
mixing) at 15-30 second intervals between
successive tubes. A stopwatch
should be used for this. With practice,
a 15 second interval is convenient.
8. Allow to sit at room temperature. Exactly 30 minutes after addition of ceric ammonium sulfate to the first
tube, read its absorbance at 420 nm. Read successive tubes at the same interval
as
when adding the ceric ammonium sulfate.
Calculation of results
Construct a
standard curve on graph
paper by
ploting iodine concentration of
each standard on the
abscissa against its optical density of 405 ug/l (OD405) on
the ordinate.
Notes
1. This
is modified from the former
method (see reference below), substituting ammonium persulfate for chloric
acid (more toxic) as digestant.
2. Since the digestion procedure has no
specific end-point, it is essential to
run blanks and standards with each assay to allow for variations in heating
time, etc.
3. The
exact temperature, heating time, and cooling time
may vary. However, within each
assay, the interval between the time of
addition of ceric ammonium sulfate and the time of the reading must be the same
for all samples, standards, and blanks.
4. With the longer ceric ammonium sulfate
incubation and with 15 second interval additions of CAS, up to 120 tubes can be
read in a single assay.
5. The volumes and proporations of samples and
reagents can be varied to achieve different concentrations or a
different curve shape, if conditions
warrant. If different tube sizes
are used, corresponging sized holes in
the heating block are also needed.
6. If necessary, this method could probably be
applied without a heating block, using a water, oil, or sand bath, but this
is not recommended. It is essential that all tubes be
uniformly heated and that the temperature be constant within the
range described above.
7. Test
tubes can be refused if they are carefully washed
to eliminate any iodine contamination.
8. Various steps of this procedure are suitable
for automation. For example, the colorimetric readings can be done in microtiter
plates with a scanner, and the standard
curves plotted and read
on
a simple desk computer.
Reference
ICCIDD, UNICEF,
WHO. Dunn JT et al. Methods
for measuring iodine in
urine. The
Annex 4
Methodology for selection of survey
sites by PPS sampling
In the
selection of survey sites, the basic goal is to
select sites that will be representative of the area to be
surveyed. Methods used
for performing
household-based and school-based surveys are described in this
annex.
Household-based
surveys
The
first step is to obtain the `best available' census data for all of the communities in the area of
interest. This inforamtion is usually available from the central
statistical office within the Ministry
that performs the census to the country.
From
the census data, select the data for the area chosen for the surveys. Make
a list with four columns (see
Table 10). The first column lists the name of each
community. The second column
contains the
total population of each community.
The third column contains the cumulative population - this is
obtained by adding the
population of each
community to the
combined population of all the communities preceding it on the
list. The list can be in any order:
alphabetical, from smallest to largest
population, or geographic.
The
sampling interval (K) for the survey is obtained by dividing the
total population size
by the number of clusters
to be surveyed. A
random number (x) between
1 and the
sampling interval (k) is chosen as the starting point using random number tables, and
the sampling interval is
added cumulatively. The communities to be surveyed are those with
the (x+n)th person, the (n+2n)th, (x+3n)th, person and so on up to the
(x+30n)th person.
The 30
clusters should be plotted on a map.
Next, a logical sequence for the fieldwork should be developed for
each of
the survey teams.
An
example of selecting communities in a cluster survey
In the ficititious area of El Saba, there are
fifty communities (Table 10).
In practice there would usually be many
more than fifty communities,
but this number is used
for illustrative purposes to
describe the method.
In Table 10 on the opposite page, the first
column contains the names of the
communities, the second column the
population of each community, and the third column the
cumulative population. A
forth column is used for
identifying which communities will have one or more clusters selected.
Follow four steps to select communities to be
included in the survey:
* Calculate
the sampling interval
by dividing the
total population by the number of clusters. In this example, 24,940 / 30 = 831.
* Choosen a random starting point (x) between 1
and the sampling interval (k, in this example, 831) by using the random
number table. For this example,
the number 710 is randomly selected.
* The first cluster will be where the 710th
individual is found, based on the cumulative population column, in this
example, Mina.
* Continue to assign clusters by adding 831
cumulatively. For example, the
second cluster will be in the
village where the value 1,541 is located (710 + 831 =
1,541), which is Bolama. The third
cluster is where the value 2,372 is located (1,541 + 831 = 2,372),
and so on. In communities with
large populations, more than one cluster
will probably be selected.
If
two clusters are selected in one community, when the survey is performed the
survey team would divide the city into two sections of approximately equal population size and
perform a survey in
each section.
Similarly, if three or more clusters
are in a community,
the community will be divided into three
or more sections of approximately
equal population size.
Annex 6 Legislation on
iodized slat: ASIN Law, The Philippines
Republic Act No. 8172
An Act Promoting
Salt Iodization Nationwide
and for Related Purposes (ASIN LAW)
and its Implementing Rules and Regulations
Republic of the
Congress of the Philippiness
Metro
First Regular Session
Begun and Held in Metro
Manila, on Monday the twenty-fourth day
of July, nineteen hundred and ninety-five
[Republic Act No. 8172]
AN ACT PROMOTING SALT IODIZATION NATIONWIDE
AND FOR RELATED PURPOSES
Be it enacted by the Senate and House of Representatives
of the Philippines in Congress assembled:
SECTION 1.
Title - This Act shall be known as "An Act for Salt Iodization Nationwide (ASIN)".
SEC. 2.
Declaration of Policy - It
is hereby declared
the policy of the State to protect and produce the health
of the people, to maintain an effective food regulatory
system, and to provide the entire population especially women and
childen with proper nutrition. For this purpose, the State shall
promote the nutritional fortification of
food to combat
micronutrient malnutrition as a priority health program for the nation.
SEC.
3. Purposes - The purposes of this Act
are to:
(a) Contribute to the elimination of
micronutrient malnutrition in the
country, particularly iodine deficiency disorders, through the cost effective
preventive measure of salt iodization;
(b) Require all producers/manufacturers of
food-grade salt to iodize the salt that they produce,
manufacture, import, trade or
distribute;
(c) Require the Department of Health (DOH) to
undertake the salt iodization program
and for its Bureau of Food and Drugs
(BFAD), to set and enforce
standards for food-grade iodized salt and
to monitor compliance thereof by the food-grade salt manufacturers;
(d) Require
the locl government units
(LGUs), through their health officers and
nutritionist-deiticians, or in their
absence through their sanitary
inspectors, to check and monitor
the quality of food-grade salt being sold in their market in order to
ascertain that such salt is properly iodized;
(e) Require
the Department of Trade and
Industry (DTI) to regulate and monitoring trading of iodized
salt;
(f) Direct the Department of Science and
Technology (DOST), in collaboration with
the Technology and Livelihood Resource
Center (TLRC), to initiate,
promote, and cause
the transfer of technology for salt iodization;
(g) Authorize the National Nutrition Council
(NNC), the policy-making and
coordinating body on
nutrition, to serve
as the advisory board on salt iodization;
(h) Provide
mechanisms and incentives
for the local
salt industry in the
production, marketing, and
distribution of iodized salt; and
(i) Ensure the sustainability of the salt
iodization program.
SEC. 4.
Definition of Terms - For purposes of this Act,
the following terms shall mean:
(a) Micronutrient malnutrition
- a disorder resulting
from deficiencies in vitamin A, iron, iodine and other micronutrients which the body needs in minute
quantities everyday.
(b) Iodine
deficiency disorders - a broad
specturm of deficiencies resulting
from lack of iodine in the diet
which leads to the
reduction of intelectual and physical
capacity affecting everyone who
is iodine-deficient and may
manifest as goiter, mental
retardation, physical and
mental defects, and cretinism.
(c) Food fortification - the addition of
nutrients to processed foods at levels
above the natural state.
(d) Salt iodization - the addition of iodine
to salt
intended for human or animal
consumption in accordance with specifications as to form, fortificant, method,
manner and composition as may be
prescribed
by the BFAD.
(e) Food-grade salt - salt for human and animal
consumption as distinguished from
industrial salt.
(f) Regulatory requirements - the provisions of
all applicable laws regulations,
executive orders, and other enactment's related to food quality and safety,
purity, nutritional composition, and
other aspects of food regulation or control.
(g) Industrial salt - salt used in the treatment,
processing, and/or manufacture of non-food commercial products.
(h) Manufacturer
- one who produces, imports,
trades in and distributes salt.
(i) Subsistence producer/manufacturer - one who
produces, trades in or distributes salt not exceeding two metric tones (2m.t.)
per year.
(j) Small
producer/manufacturer - one who
produces, imports, trades in or distributes salt ranging from more than
two metric tones (2m.t.) to three
hundred metric tons (300 m.t.) per year.
(k) Medium producer/manufacturer - one who produces,
imports, trades in or
distributes salt ranging
from more than
three hundred metric tons
(300 m.t.) to two thousand
metric tons (2,000 m.t.) per
year.
(l) Large
producer/manufacturer - one who produces,
imports, trades in or distributes salt exceeding two thousand metric
tones (2,000 m.t.) per year.
SEC.
5. Applicability -
(a) This Act shall apply to the entire salt industry, including salt producers/manufacturers, importers, traders
and distributioins, as well
as government and
non-governmental agencies involved in salt iodization activities.
(b) Iodized salt that conforms to the standards
set by the BFAD to meet national and
nutritional needs shall be made available to consumers: Provided, That the
implementation of this Act shall be enforced
over a staggered period of one (1) year for large
and medium
producers/manufacturing;
two (2) years
for small
producers/manufacturers; and five
(5) years for subsistence producers/manufacturers.
(c) All
food outlets, restaurants,
and stores are
hereby required to make available to customers only iodized
salt in their establishment upon
effectivity of this
Act. These establishments shall
be monitored with the help of
the LGUs through its health officers and
nutritionist-dietitians, or in their
absence, the sanitary inspectors to check and monitor the quality
of food-grade salt
being sold or
served in such establishments.
(d) In
areas endemic to iodine deficiency
disorders, iodized salt shall be
made available. Local government
officials at the provincial and
municipal levels shall provide
mechanisms to ensure enforcement
of this provision through
ordinances and public information
campaigns.
(e) All food manufacturers/processors using
food-grade salt are also required
to use iodized salt in the
processing of their products and
must comply with the provisions of
this Act not later than one (1) year from its
effectivity: Provided, That the use of
iodized salt shall not prejudice the quality and safety of their fod products: Provided, however, That the
burden of proof and testing
for any prejudicial effects
due to
iodized salt fortification lies
in the said food manufacturers/processor.
(f) Salt producers/manufacturers shall register
with the BFAD, which shall
maintain an updated
registry of salt producers/manufacturers and
shall monitor compliance
with the salt iodization program.
(g) All
food-grade salt shall be labeled in a manner that
is true and accurate,
not likely to mislead
purchases and in accordance with the requirements
prescribed by the BFAD.
(h) For a period of three (3) years from the
effectivity of this Act, the DOH
shall provide free iodized
salt to indigents residing in sixth class
municipalities as may be allowed by their annual appropriations.
SEC. 6.
Support to the Salt Industry - The
following agencies and institutions
shall support the
sale iodization program through their respective internal
programs:
(a) The DTI is hereby required to assist and
support local salt
producers/manufacturers in upgrading
their production technologies to include iodization by helping them obtain
soft loans and financial
assistance for the procurement
of salt iodization machines,
packaging equipment and
technology and fortificant; and by ensuring the systematic distribution
of the iodized salt in the market;
(b) The Cooperative Development Authority (CDA)
shall assist the formation of
cooperatives of local salt
producers/manufacturers in order that they can economically engage in
salt iodization and distribution of iodized salt.
(c) The DOST, in collaboration with the TLRC,
shall develop and implement comprehensive programs for the acquisition
of, design and manufacture of salt
iodization machines and transfer to salt
iodization technology to
small and subsistence
local salt
producers/manufacturers; and
(d) The Department of Environment and Natural
Resources (DENR) and other appropriate government agencies shall identify
areas that are suitable
for use as salt farms with
the purpose of protecting such
areas from environmental
risks to ensure sustainability of iodized salt
production.
SEC. 7.
Public Information - The benefits and rationale of the use of iodized salt shallbe adequately
disseminated and promoted through
organized, systematic and nationwide information campaign which shall involve
major sectors of society to be spearheaded by the DOH, in cooperation and
coordination with the LGUs and other
agencies concerned, particularly the Department of
Education, Culture and Sports (DECS), the Philippine
Information Agency (PIA),
provincial science centres, private sector, and students.
The
implementing agency, in coordination with the PIA, shall seek the cooperation
of the media
sector to assist
in public information dissemination. Salt iodization and
its benefits shall also be
included and given emphasis in all levels of health subjects in both public and
private schools.
SEC. 8.
The Salt Iodization Advisory Board
- The National Nutrition Council
(NNC), as presently
composed, including
representatives of the DENR, the medical profession and the salt
manufacturers,
shall serve as the salt iodization advisory
board and shall function as the
policy and coordinating body on salt iodization programs
and activities. It shall
coordinate the efforts of all
agencies concerned and monitor the
implementation of the provisions
of this Act. It shall also submit an
annual report to the Congress of
the Philipines on the progress of the
salt iodization program
and offer recommendations for
its improvement.
SEC.
9. Sanctions - The procedures for
imposing sanctions under this Act and
for inspecting and investigating the premises
where any salt is
received, held, manufactured,
labeled, stored, displayed, delivered,
distribution, sold or located, or where it is reasonably believed these
activities are being carried out or where
salt is located, shall be in
accordance with the provisions of the Republic Act No. 3720, otherwise known
as the Food, Drugs
and Cosmetics Act, As Amended: Provided,
That any person, whether
natural or juridical, who violates any
of the provisions of
this Act or any of the
rules and regulations promulgated for its effective
implementation shall be punished by a fine of not less than One thousand pesos
(P1,000) nor more than One hundred thousand pesos (P100,000): Provided,
however, That if the violation is commited by any officer, director or member
of a business and a juridical entity
acting beyond the scope of his authorigy, such officer, director or
member responsible therefore shall be personally liable for the fine: Provided,
further, That such violater shall suffer a revocation of
its business permit and/or
a ban of its product from the market: Provided, finally, That the BFAD, in coordination with
the LGUs concerned, shall be
authorized to impose and collect the
fines from the violaters, and such collections shall accure
to the BFAD for its use in the
implementation of this Act.
SEC. 10.
Appropriations - The
amount necessary for
the implementation of this Act shall initially be charged
to the appropriations of the
agencies concerned as may be
appropriated, under the current
General Appropriations Act.
Therefore, such amount as
may be necessary for its
implementation shall be included in the annual General
Appropriations Act.
SEC. 11.
Implementing Rules and
Regulations - The
DOH, in cooperation with
the agencies concerned,
shall formulate the necessary
rules and regulation for the effective
implementation of this Act within sixty (60) days from its approval.
SEC. 12.
Separability Clause - If any portion of this Act is
declared invalid, the remainder of this Act shall not be affected by such
declaration and shall remain valid an enforceable.
SEC.
13. Effectivity Clause - This Act shall
take effect fifteen (15) days after its publication in the Official Gazette or
in two (2) national newspapers of general circulation,
whichever is earlier.
This Act,
which is a consolidation of Senate
Bill No.112 and house
Bill No.45 was finally passed by the Senate and the House of
Representatives on November 16,
1995 and November 5, 1995, respectively.
IMPLEMENTING RULES AND REGULATIONS OF
REPUBLIC ACT NO.8172
AN ACT
PROMOTING SALT IODIZATION
NATIONWIDE
AND FOR
RELATED PURPOSES
BACKGROUND
Pursuant to Section 2 of Republic Act No.8172, entitled
"An Act Promoting Salt Nationwide" (ASIN), approved by the
President on 20 December
1995 and which took effect on
20 January 1996, mandating the Department of Health (DOH) as the
lead agency in the implementation of said Act and, in accordance
with Section 11 of said Act mandating the DOH to formulate the Implementing
Rules and Regulations (IRR) in
cooperation with the other government agencies involved in the
implementation of the law, the following Rules and Regulations are hereby adopted
to implement effectively the provisions of R.A. No.8172.
RULE I
COVERAGE
SECTION
1. These Rules and Regulations shall
apply to:
(a) All
producers/manufacturers/importers/traders of
salt for human or animal
consumption,
(b) All restaurants and other food establishments
where food is being served hot or sold,
(c) All
food
manufacturers/processors
using salt in
their manufacturing processes,
(d) All local government units (LGUs),
(e) All other government agencies,
(f) All non governmental agencies and
related professional
organizations; and
(g) All government and private hospitals and
other institutions.
RULE II
INTERPRETATIONS
SECTION 1.
These Rules and Regulations shall be construed in a manner that can achieve the objectives of
R.A. 8172 namely: a) to contribute
to the elimination of
micronutrient malnutrition,
particularly iodine deficiency disorders; b) to
require salt
producers/manufacturers to iodize the
salt they manufacture, produce, distribute, trade and/or import; c) for
the government agencies to
undertake their roles
and responsibilities in carrying
out the provisions
of this Act; d)
for the food processing and the food service industries to use only
iodized salt; e) to
provide mechanisms and
incentives for the
salt industry; and f) to
ensure the sustainability of
the salt iodization program.
Any question
or doubt as to the intent and
meaning of the provisions shall be construed or resolved
in accordance with the Policy and
Purposes as provided in R.A. 8172.
RULE III
DEFINITION OF TERMS
In the
implementation of the Act,
terms that have
specified meaning shall be
construed in accordance
with the general definitions provided in Section 4 of
the Act, to wit:
(a) Distribution - means the exchange,
transmittal, conveyance, consignment,
supply, delivery, trade, sale, or disposal of
food-grade salt, whether for remuneration or other considerations.
(b) Distributor - refers to an establishment
which distributes, sells or imports salt
for distribution to retailers.
(c) Fortificant - in relation to the process of
salt iodization, the term shall
refer to potassium iodate or
other suitable fortificant as
recommended by DOH, taking into consideration
the circumstances of quality, effectiveness, stability, availability and new discoveries that can bring salt iodization
in the
most effective and economic manner.
(d) Food fortification - the addition of
nutrients to processed foods at levels
above the natural state.
(e) Food-grade
salt - refers to salt for
human and animal consumption as distinguished from
industrial salt.
(f) Food
manufacturers/processors - refers
to the business/enterprise of
manufacturing or processing
food using salt in their
products.
(g) Food service establishments - refers to
hotels, restaurants, carinderias, catering firms, hospitals and other
related outlets which serve or sell food
to consumers.
(h) Industrial
salt - refers to salt used
in the treatment, processing and/or manufacture of
non-food commercial products.
(i) Iodine
deficiency disorders - a broad
spectrum of manifestations resulting from lack of iodine in the diet
which leads to the reduction of intellectual and
physical capacity affecting everyone who is iodine deficient and may manifest
as goitre, mental retardation, physical and mental
defects, and cretinism.
(j) Manufacturer
- one who produces, imports, trades in and
distributes salt and is categorized as follows:
1) Large
producer/manufacturer - one
who produces, imports, trades and/or distributes salt
exceeding two thousand metric tons (2,000 MT) per year.
2) Medium
producer/manufacturer - one who
produces, imports, trades in,
distributes salt ranging from more than three
hundren metric tons (300 MT) to
two thousand metric tons (2,000 MT) per
year.
3) Small salt producer/manufacturer - one who
produces, imports, trades in, or distributes salt ranging from more than
two metric tons (2 MT) to three hundred
metric tons (300 MT) per year.
4) Subsistence producer/manufacturer - one who
produces, trades in or distributes salt not exceeding two metric
tons (2 MT) of salt per year.
(k) Method
- refers to the scientifically
accepted technique that is
perceived to bring about the best and most effective way of salt iodization.
(l) Micronutrient malnutrition - refers to a
disorder resulting from deficiencies
in vitamin A,
iron, iodine and
other micronutrients which the
body needs in minute quantities every day.
(m) Registration - the process or acquiring a
business/enterpriselicense/permit to
manufacture, produce, trade or import
iodized salt with the Bureau of Food and Drugs (BFAD) or appropriate
LGU.
(n) Regulatory requirements - the provisions of
all applicable laws, regulations,
executive orders, and
other enactment's related to
food quality and
safety, purity, nutritional composition, and other aspects of food regulations
and control. In
applying or interpreting
the regulatory requirements, reference may also be made to scientifically accepted standards or regulations.
(o) Salt industry - refers to the business sector engaged in the production, distribution, trading,
retailing and importation of salt.
(p) Salt iodization - the addition of iodine
to salt
intended for human or animal consumption in accordance with specification as to form, fortificant,
method, manner and composition as may be perscribed by the BFAD of the DOH.
(q) Salt
Iodization Advisory Board (SIAB) -
composed of the National
Nutrition Council (NNC) Governing
Board, including a representative each
from the Department
of Environment and Natural
Resources (DENR), the medical profession, and the
salt manufacturers.
(r) Stores - refer to department stores, shops,
groceries, mini-marts, and other outlets
which wholesale or retail iodized salt
for the consumers and users.
(s) Trading - refers to the bullying and selling
of food-grade salt by wholesale or
retail.
RULE IV
STANDARDS and REQUIREMENTS
SECTION 1.
Iodized salt to be sold/distributed in
the Philippines, whether locally produced or imported, shall conform with
the standards formulated by the
BFAD or DOH which is in
Annex 1
of these implementing rules
and regulations. Such standards shall be periodically
reviewed and updated by the BFAD in
consultation with the SIAB adn other concerned parties.
SECTION
2. Failure to comply with the quality
specifictions and labeling requirements prescribed in the standards
shall mean a violation
of the provisions on adulteration
and misbranching under Sections
14 and 15 of R.A. 3720, otherwise known
as the Food, Drugs
and Cosmetics Act, as amended
and the relevant provisions of R.A. 7394 otherwise
known as the Consumer Act.
SECTION 3.
To ensure the quality of iodized
salt prior to distribution, all
manufacturers of iodized salt
shall conduct routine quality
assurance activities. Such activities
shall include, but shall not be limited to the following:
a) Iodine
levels testing: at regular
intervals, on a
daily basis, sample of
iodized salt shall be
collected from the production line and tested for iodine
content.
b) Equipment
inspection: at least twice daily
to ensure its proper operation.
c) Mixing
process: shall be monitored regularly
to ensure consistent mixing and
homogeneity of iodine content in the
batch being processed.
d) Monitoring of salt ready for
distribution: each lot shall be sampled
to ensure enformity to prescribed iodine level.
e) Packaging
and labeling inspection
shall be routinely conducted to ensure the integrity of the package
and conformity to prescribe labeling
requirements.
f) Record keeping: daily control charts and weekly summaries of
activities and coorective actions taken shall be maintained for a period of
at least 12
months from date
of manufacture. Manufactures
of iodized salt
shall provide traders
with a Certificate of Iodization of the specified batch or lot
sold to the traders.
SECTION
4. Iodized salt shall be distributed and
sold according to the principal of first in, first out. Iodized salt
may be sold at retail or final distribution points within
a period
of not more than 12 months from the date of manufacture, after which
it shall be considered expired. Expired salt shall be replaced by
or returned to
the last seller
or distributor in the
manufacturing-distribution chain.
SECTION 5. The
DOH shall put in place a system to
monitor the quality of iodized salt in collaboration with the
LGUs and
the Department of the Interior and Local Government (DILG). It shall also
seek the assistance of the Department of Finance (DOF) and LGUs
to determine the volume of production and
sale of the locally manufactured and imported iodized
salt.
SECTION 6.
Until such time when all food-grade salt
shall be iodized in
accordance with R.A.
8172, slat
manufacturers/producers, traders and retailers
shall maintain the proper
identification and segregation
of iodized salt from
non-iodized slat in storage and during display at
retail. They shall
make sure that salt buyeers
or consumers get
the appropriate kind of salt they purchase.
SECTION
7. Within one (1) year from the
effectivity of the Act, all food
manufacturers and processors shall utilize salt in their products expect when
the use of iodized salt will have an adverse effect on
a specified product.
In such cases,
the food
manufacturers/processors shall present
appropriate evidence to the BFAD which shall serve as basis for
exemption from compliance with
Section 5(e) of this Act. The BFAD shall submit
to the SIAB a list of food
manufactuers utilizing iodized salt and those with definite exemption, and
shall update this list annually.
RULE V
REGISTRATION OF IODIZED SALT MANUFACTURERS AND SALT
IMPORTERS/DISTRIBUTORS
SECTION 1.
All iodized salt
manufacturers and salt importers/distributors shall register
with the BFAD according to the following
schedule. The large and medium
manufacturers shall register within one
(1) year form the effectivity of
this Act; small manufacturers
within two (2)
years, and subsistence manufacturers within five (5) years. After the
effectivity of these IRR, new salt
producers/manufacturers shall register before operation.
SECTION 2. The
BFAD shall issue a Licence to Operate
(LTO) to iodized salt
manufacturers and salt importers/distributions
upon their compliance with
prescribed documentary and
technical requirements in Annex 2 and 3. Those engaged
in manual salt iodized salt iodized shall secure a
Certificate of Training from the DOH before
they can be provided with a LTO. If
any importer is already holding a valid
LTO as importer, he/she need not apply for
another license; however, the importer must comply with the technical
requirements and their products
shall be subject to monitoring.
SECTION 3. The
BFAD may delegate to the LGUs its
authority to issue LTOs in cities and municipalities other than
those in the National Capital
Region (NCR) and in areas where
the seat or office
of the DOH-Regional Field
Officers (RFOs) is
located, through a memorandum of
agreement between the BFAD and the LGU,
or the BFAD and the RFO, with the suggested terms and conditions contained in Annex 4 hereof. Such agreements shall be considered part of
these IRR.
SECTION
4. All distributors/traders of locally
produced iodized salt, whether or not
engaged in repacking iodized salt from
bulk to retail containers, shall register with the LGUs.
RULE VI
ROLE OF AGENCIES CONCERNED IN THE SALT IODIZATION PROGRAM
SECTION
1. The DOH shall lead in the
implementation of this Act.
Specifically, it shall:
a) Spearhead
a public information
drive in cooperation coordination with LGUs
and other agencies
particularly the Department of Education, Culture and Sports (DECS),
Philippine Information Agency
(PIA), Provincial Science
Centres-Department of Science and
Technology (DOST), private sector
and students. All
sectors in the salt industry shall also
assist in such information campaign
through tri-media and all
other social marketing activities
for a systematic
and sustained public information campaign;
b) Provide training on salt iodization technology and
quality assurance and control through its Nutritional Service (NS)
in coordination with the DOST and the Technology
and Livelihood Resource Centre
(TLRC); and
c) Set
and enforce standards for food-grade iodized salt
and monitor compliance thereof
bythe food-grade salt manufacturers through its BFAD.
SECTION 2.
The LGUs shall
support the development
and sustainability of the salt industry through:
a) The
formulation of ordinances and
information campaigns promoting
the availability and use of iodized salt;
b) Provision of budget for health and nutrition
programs;
c) Assistance
to other governmental
agencies in the implementation of the salt iodization
program;
d) Monitoring the quality of salt as provided by
law through its respective health officers and
nutritional-dietitians or, in their absence, through the sanitary
inspectors; and
e) Establishment and maintenance of a list of
salt producers in their respective
territorial jurisdiction. A list of registered salt producers in every province shall be
submitted to the BFAD
within 6 months from the effectively of these IRR
and shall be updated
annually. The list
shall reflect the
following information per salt producer/manufacturer:
1) Name and address of company and/or owner
2) Location of salt production site
(sitio/barangay)
3) Annual production capacity (in metric tons)
4) Types of salt produced:
i)
food-grade (coarse or fine)
-
iodized salt
-
non-iodized salt
ii)
industrial salt
f) Distribution channels, such as:
- direct sale to consumers within the province
- traders within the province
- traders from other provinces/regions
- food manufacturers within the province
- food manufacturers outside the
province/region
SECTION 3.
The Department of Trade and
Industry (DTI) shall assist
and support local
salt producers/manufacturers in upgrading
their production technolgies to include
iodination by helping them obtain soft loans and financial
assistance for the procurement of salt
iodization machines, packaging equipment
and technology, and fortificants; and by ensuring
the systematic distribution of the iodized salt in the market. Specifically, it shall:
a) Regulate an monitor the trading of iodized
salt in accordance with R.A. 7581 otherwise known as the Price Act;
b) Provide
incentives to the salt industry by
including salt iodization as a
priority investment program of the government through its Board of Investment;
c) Assist
salt producers/manufacturers obtain
soft loan for machines,
equipment and other materials such as fortificant and other chemicals needed to upgrade the
salt industry, through its Bureau of
Small and Medium Business Development (BSMBD) and Small Business Guarantee and
Finance Corportion (SBGFC); and
d) Provide assistance to salt
producers/manufacturers on matters of
package design and packaging technology through its
Product Development and Design Centre of the Philippines (PDDCP).
SECTION
4. The Department of Science and
Technology (DOST) shall develop and implements comprehensive program for
the acquisition of, design,
and manufacture of salt iodization
equipment, and transfer of
the salt iodization
technology to salt producers/manufacturers.
SECTION
5. The Technology and Livelihood
Resource Centre (TLRC) shall:
a) Assist the DOST in the development and
implementation of a comprehensive program
for the acquisition
of, design and manufacture of
salt iodization machines and
transfer of salt iodization technology
to small and
subsistence local salt producers/manufacturers.
b) Provide
funding assistance to qualified
small products, especially if
located in one of the priority provinces in support of the
government's poverty alleviation
and industry
decentralization drive;
c) Develop
a program of training entrepreneurs in
setting up micro/cottage/small business
enterprises to be located in its Technology and
Livelihood Development Centre
(TLDC) in the provinces;
d) Undertake an all-out information campaign to
promote the use of iodiozed
salt nationwide through its trimedia
information program and in its business technology courses.
SECTION 6.
The Cooperative Development Authority
(CDA) shall provide assistance
to the small
and subsistence salt producers/manufacturers so that they
may organize themselves into cooperatives
shall be registered to accordance with
the CDA guidelines, rules,
regulations and applicable laws.
SECTION 7. The
Department of Environment and
Natural Resouces (DENR) shall
provide assistance to the prospective
salt producers/manufacturers
in identifying suitable
land areas
appropriate
for use as salt works/farms. This
conversion of such lands into salt
farms shall require the concurrence
of the landowner and
the concerned agency/entity. The
DENR shall
ensure,
through the Environmental Impact Statement (EIS) System, that
proposed activities near the salt
farms do not adversely affect the latter.
The DENR shall also monitor the adoption
of anti-pollution control measures
by iodized salt producers/manufacturers.
SECTION
8. The Bureau of Customs of the
Department of Finance (DOF)
shall assist the DOH in
monitoring salt importation
by providing quarterly reports
of entries, including names
and
addresses of importers/consignees and quantity of
shipment. It shall likewise
inform the DOH on the quality and quantity
of importation of the iodized salt.
SECTION
9. Any assistance to salt
manufacturers/producers/traders/importers
shall take into favourable consideration the size and capability of
such salt producers as well as
their faithful
compliance
with laws on health, labor and employment, environment and ecology.
RULE VII
ADVISORY BOARD
SECTION 1. Creation of the Salt Iodization Advisory
Board - The Salt Iodization Advisory Board (SIAB) shall be
composed of all members
of the NNC Governing Board namely the
Departments of Agriculture; Health; Social Welfare and Development; Education, Culture and
Sports; Science and Technology;
the Interior and Local
Government; Labor and Employment; Trade and Industry; and Budget
and Management; the National Economic
and Development Authority; its three (3) private sector representatives, and a
representative from the DENR, the medical profession and the salt
manufacturers, as mandated
by Section 8 of
this Act. The Chairman
of the NNC Governing Board shall chair the SIAB.
The chairman shall convene the SIAB within one (1) month upon
the approval of these IRR.
SECTION 2.
Role - The SIAB shall function as
the policy and coordinating body
on the national salt iodization
program and activities. It
shall coordinate and monitor
all activities concerning the
salt iodization program
from production and marketing, to public information
campaign. It shall analyze the effectiveness of the slat iodization
activities and then evaluate the
progress of the
program annually based on
the reports submitted by
DOH and other
concerned agencies in
the implementation of this Act.
The SIAB shall submit an
annual report every end of
December to the Congress of the
Philippines on the status
of the salt
iodization program and
offer recommendations for its improvement.
RULE VIII
SANCTIONS
SECTION 1. The
BFAD Director is hereby authorized to impose
an administrative fine to existing salt
producers/manufacturers/importers/traders
based on the applicability of this Act.
The provision of this Act
shall be immediately applicable
to salt producers/manufacturers/importers/traders newly established or organized after the
effectivity of the Act.
The LGUs are authorized to impose administrative fine to
food service establishments and
outlets one year after the effectivity of the Act. The administrative fine shall be in the amount
of not less than One Thousand Pesos (P1,000,00) but
nor more than One Hundred Thousand Pesos (P1,00,000.00), after notice
and hearing of violation of any of the provisions of R.A. 8172 or its
implementing rules and regulations.
In the
imposition of the
said administrative penalty,
the imposable fine of One
Thousand Pesos (P1,000.00)
to Thirty Thousand Pesos (P30,000.00)
shall be considered minimum
penalty.
Thirty One Thousand Pesos (P31,000.00) to Sixty Thousand
Pesos (P60,000.00) as medium
penalty: provided that the maximum fine shall be in addition to the revocation
of the offender's License to Operate,
and provided further that in all
cases where the subject
matter of the offence is a
prohibited product, the Director
shall order the recall and/or withdrawl of the product from the market.
SECTION 2.
When the offence is committed
with the following circumstances, the minimum penality
shall be imposed:
a) A history or record of satisfactory
compliance with the rules and
regulations prior to the commission of
the offence, or absence of previous violation of R.A. 8172
or its IRR; and
b) Lack
of information on the part of the offender about
the rules and regulations or
requirements of the subject matter of the violation/offence.
SECTION 3.
When the act or omission in violation of
R.A. 8172 and its
implementation rules and regulations is attended by a
manifest intention to mislead, defraud
or deceive the consuming public, the
maximum fine and revocation of Licence
to Operate shall be imposed.
SECTION
4. The medium penalty shall be imposed
when the offence committed is not attended by any of the circumstances described in Section 2 and 3 hereof.
SECTION 5.
The BFAD Director may
delegate the conduct
of administrative investigation of any violation of R.A. 8172 or its
IRR to
the head of the LGU: provided
that the recommendation
shall
be subject to review and confirmation by the BFAD Director before the
same shall be deemed final and executory. In
such case, the LGU may be
authorized by the BFAD Director to
collect the fine that may be
imposed provided that such fine collected shall be held in trust for the
exclusive use by the investigating LGU in the implementation of this Act.
RULE IX
SEPARABILITY CLAUSE
If any provision of these Implementing Rules and
Regulations is declared null and void,
for any reason, the remaining provisions
shall not be affected thereby and shall remain valid.
RULE X
EFFECTIVITY
These
Implementing Rules and Regulations shall take effect thirty days after its
publication in a newspaper of general circulation.
ANNEX1
STANDARD FOR IODIZED SALT
1. Scope
This standard applies to iodized salt used as a
condiment or an ingredient in the
preparation of food in households, food service and food manufacturing
establishments.
2. Description
Iodized salt
is foof-grade salt that
contains the prescribed level of iodine. It shall be produced from refined or unrefined (crude) salt obtained from underground rock salt
deposits or by evaporation of seawater or natural brine. The finished
product shall be in the form or solid crystal or powder, white in color, without visible
spots of clay, sand, gravel, or
other foreign matters.
3. Iodization process
3.1 Salt
may be iodized
with potassium iodate
(KIO3) or potassium iodide (KI)
by means of any of the following methods:
a) Dry mixing if salts is in powdered form
b) Drip feeding or spray mixing if salt is in
crystal form
c) Submersion of salt crystals in iodate brine
4. Essential composition and quality facots
4.1 Purity requirements
To ensure
the stability of iodine,
salt to
be iodized must conform with the following purity
requirements:
|
Moisture max |
4% for refined salt |
|
|
7% for unrefined salt |
|
NaCl, min |
97% (dry basis) |
|
Calcium and magnesium, max |
2% |
|
Water insoluble, max |
0.2% |
|
Heavy metal contaminants, max |
|
|
Arsenic as As |
0.5 mg/Kg |
|
Cadmium as Cd |
0.5 mg/kg |
|
Lead as Pb |
2.0 mg/kg |
|
Mercury as Hg |
0.1 mg/kg |
4.2 Naturally present secondary products and contaminants
in raw salt
Notwithstanding the purity requirements in section 4.1,
the raw salt may contain natural
secondary products, which are present in varying amounts depending on the
origin and method of production of the
salt, and which are composed mainly of calcium, potassium, magnesium and
sodium sulphats, carbonates, bromides,
and of calcium potassium
magnesium chlorides as
well. Natural contaminants may
also be present in amounts
varying with the origin and the method of production of
the salt.
4.3 Iodine levels
In order to meet national needs,the prescribed
levels of iodine (I2) is iodized salt
shall be an indicated below:
Type of containers/Package
|
Sampling
Point |
Bulk (>20kg) |
Retail (<2kg) |
|
Production
Site |
70-150 mg/kg |
60-100 mg/kg |
|
Post of
Entry* |
70-150 mg/kg |
60-100 mg/kg |
|
Retail
Site |
>50 mg/kg |
>40 mg/kg |
*For imported
iodized salt; also at
importer's/distributor's warehouse
Food additives
All additives used, including KIO3, and KI, shall
be of food-grade quality and
shall conform to specifications prescribed by
JEFCA or the Food Chemicals Codex.
Permitted additives for iodized slat are listed below:
Anticacking Agents
Maximum
level in the final product
Coating agents;
Carbonates, 20 g/kg
singly ort in Calcium/magnesium, Magnesium oxide; combination and Tricalcium phosphate;
Silicon oxide, amorphous; Silicates of
calcium, sodium or magnesium; Alumin of sodiumor calcium
Coating
hydrophobic agents; aluminium, calcium, magnesium, potassium,or sodium salts of
myristic, palmitic or stearic acid
Crystal modifiers;
ferrocyanides,calcium, potassium or sodium10 mg/kg singly or in
combination expressed as [Fe(CN6)]3
Emulsifiers
Polysorbate 80 10 mg/kg
Processing aid
Dimethylpolysiloxane 10 mg of residue/kg
Packaging
All iodized
salt shall be packed in woven
polypropylene bags, clean and unused jute bags, or other non-porous
material with a lining of high density polyethylene to ensure
the retention of
appropriate
iodine level at the time of consumption.
Labelling
Iodized salt
for commerical distribution
shall carry appropriate labeling
in accordance with
BDAD rules and regulations on labeling of prepackaged
foods. Specifically, the following
information shall be declared in
every container of iodized salt whether in bulk or retail
package:
For locally produced iodized salt
a) The
name of the product, "IODIZED SALT", printed
in bold capital letters
b) Name and address of manufacturer
c) Net weight (in metric units)
d) Iodine compound used
e) Chemical additives e.g. anticaking agents,
emulsifiers
f) Open date marking e.g. "Best
Before" or "Consume Before" Date
g) Lot Identification Code (Repackers must be
manufacturer's lot i.d. code)
h) Storage instruction: STORE IN COOL
For imported iodized salt
a) Same as in 7.1.1 (a), (c), to (h)
b) Name and address of importer/local
distributor
c) Country of origin
Labeling of Non-retail containers
In
the case of non-retail containers of at least 25 kg of iodized salt, the
labeling information required in section
7.1.1 (b), (d), (e)
or in 7.1.2 (b) may not be declared
if such bulk packages
are intended for delivery to distributors/repackers or food
manufacturers/institutional users, provided every shipment or
delivery is accompained by a document containing
all the information in 7.1.1 or
7.1.2
Storage, transport and display at retail
In order
to minimize avoidable losses of iodine,
iodized salt shall not be exposed to any of the following conditions
during storage, transport and display at retail outlets:
a) Direct sunlight or near source of strong
light.
b) High temperature and humidity.
c) Contamination with moisture e.g. rain, flood,
etc.
d) Contamination with dust or filth from the
environment..
Reference
An Act Promoting Salt Iodization Nationwide and
for Related Purposes (ASIN LAW)
and its Implementing Rules and
Regulatioins. Published by the
Nutrition National Council.
Printed in the Republic of the Philippines. 1996.
Annex 7 List of participants: IDD Consultation,
Geneva 1999
F.
Azizi, Director
Endocrine
Research Centre
of
Medical Sciences and
Health
Services
P.O.
Box 19395-4763
Teheran,
Islamic
Tel:
98-21-2409301-5
Fax:
98-21-2402463
E-mail:
azizi@erc-iran.com
H.Burgi,
Chief
Department
of Medicine
Burgerspital,
Solothurn 4500
Tel:
41-32-622.0302
Fax:
41-32-621.2435
E-mail:
buergi@smile.ch
Zu-Pei
Chen, Director
Institute
of Endocrinology/Chairman
National
IDD Advisory Committee
to
Ministry of Public Health
Tianjin
300070
People's
Republic of
Tel:
86-22-2352.5608
Fax:
86-22-2337.0618
E-mail:
zpchen@public1.tpt.tj.cn
F.
Delange, Executive Director
ICCIDD
153,
Avenue de la Fauconnerie
1170
Tel:
32-2-675.8543
Fax:
32-3-675.1898
E-mail:
fdelange@uld.ac.be
A.
Duffiel
Professional
Officer
Administration
Committee
on
Coordination
Sub-Coordination
on Nutrition
c/o
WHO, 20 Avenue Appia
1211
Geneva 27,
J.
Dunn
Professor
of Medicine
Secretary
of ICCIDD
Tel:
1-804-924.5929
Fax:
1-804-296.9275
E-mail:
jtd@avery.med.virginia.edu
B.Hetzel,
Chairman
ICCIDD
North
Adelaide 5006,
Tel:
61-8-8267.3768
Fax:
61-8-8204.7221
E-mail:
iccidd@a011.aone.net.au
P.
Jooste, Chief Scientist
National
Research Programme
for
Nutritional Intervention
Medical
Research Council
Tygerberg
7505
Tel:
27-21-938.0370
Fax:
27-21-838.0321
E-mail:
pieter.jooste@mrc.ac.za
M.G.
Karmarkar, Senior Adviser
ICCIDD
Centre
for Community Medicine
All
India Institute for Medical Sciences
Ansari
Nagar
New
Delhi 110029,
Tel:
91-11-371.0726
Fax:
91-11-686.3522
G.
Maberly
Professor
of International Public Health and Dirctor of PAMM
Department
of International Health
Rollins
School of Public Health
Tel:
1-404-727.4553
FAx:
1-404-727.4590
E-mail:
gmaberi@sph.emory.edu
C.
Pandav, Regional Coordinator
ICCIDD
Centre
for Community Medicine
All
India Institute for Medical Sciences
Ansari
Nagar
New
Delhi 110029,
Tel:
91-11-649.2693
Fax:
91-11-686.3522
E-mail:
pandav@iccidd,ernet.in
E.
Pretell, Head
Endocrine
Service
Regional
ICCIDD Coordinator
for
Cayetano
Heredia Peruvian University
Avenue
Cuba 523
Lima
11, Peru
Tel:
51-1-265.9118
Fax:
51-1-265.8094
E-mail:
epretell@per.itete.com.pe
K.
Sullivan, Assistant Professor
Department
of Epidemiology
Tel:
1-404-727.5846
Fax:
1-404-727.5369
E-mail:
cdckms@sph.emory.edu
J.W.
Schultink
Senior
Adviser, Micronutrients
UNICEF
3
United
E-mail:
wschultink@unicef.org
C.
Todd, Regional Health Adviser
Delegation
of the European Commission in
P.O.
Box 4252
Harare,
Zimbabwe
Tel:
263-4-701914-5 ext. 203
Fax:
263-4-725260
E-mail:
charles.todd@delzwe.cec.eu.int
WHO
Secretariat
H.
Allen
Department
of Nutrition for
Health
and Development
World
Health Organization
20
Avenue
1211
Geneva 27, Switzerland
Tel:
41-22-791.3322
Fax:
41-22-791.4156
E-mail:
allenh@who.ch
B.
de Benoist
Department
of Nutrition
for
Health and Development
World
Health Organization
20
Avenue Appia, 1211
Geneva
27,
Tel:
41-22-791.3412
Fax:
41-22-791.4156
E-mail:
debenoistb@who.ch
G.A.
Clugston, Director
Department
of Nutrition
for
Health and Development
World
Health Organization
20
Avenue Appiam, 1211
Geneva
27, Switzerland
Tel:
41-22-791.3326
Fax:
41-22-791.4156
E-mail:
clugstong@who.ch
A.
Verster, Director
Health
Protection and Promotion
Regional
Office of the
World
Health Organization
for
the
Nasr
City,
Tel:
202-670-25-35
Fax:
202-670-24-92 or 202-670-24-94
E-mail:
verstera@who.sci.eg
Source:-
Assessment of Iodine Deficiency Disorders and Monitoring their
Elimination : A guide for programme managers second edition.(WHO).