Progress toward Eliminating Iodine Deficiency in the Republic of Georgia

Iodine deficiency (ID) is the leading cause of preventable mental retardation worldwide. The most effective method of eliminating ID disorders (IDD) is promoting the widespread consumption of adequately iodized salt. To measure the impact of legislation banning the import and sale of noniodized salt, the Republic of Georgia government and UNICEF conducted a national survey of IDD prevalence in November 2005. A cross-sectional cluster survey of 970 school-aged children measured: 1) urinary iodine excretion (UIE), 2) prevalence of goiter by palpation, and 3) the iodine content of household salt. The median UIE was 320.7 μg/L, and only 40 (4.4%) of 900 urinary samples were below 100 μg/L. Palpation of 4420 children revealed a total goiter rate of 32.4% (95% confidence interval [CI]=27.2-37.5). Of 957 salt samples analyzed with rapid salt testing kits, 867 (90.6%, 95% CI=86.9-94.3%) were adequately iodized (≥15 ppm), and only 39 (4.1%) had no iodine. Iodization of salt was validated in 136 random samples using iodometric titration; 94.1% (95% CI=89.1-97.2%) were adequately iodized. Due in part to effective legislation and implementation, Georgia now meets the primary World Health Organization criteria for IDD elimination (i.e., >90% of households using adequately iodized salt and <50% of population with UIE <100 μg/L). Findings of potential excessive iodine intake should be further examined. To maintain elimination of IDD, it is important to continue to enforce legislation and sustain Georgia’s salt io-dization program.