Salt iodisation and public health campaigns to eradicate iodine deficiency disorders in Armenia Laura Rossi and Francesco Branca* Human Nutrition Unit, National Institute for Research on Food and Nutrition, via Ardeatina 546, 00178 Rome, Italy Submitted 14 October 2002: Accepted 29 January 2003 Abstract Background: Iodine deficiency disorders (IDD) are endemic in the mountain regions of Armenia. Universal salt iodisation has been chosen as the control measure. Objectives: (1) To measure the prevalence of iodine deficiency in the Armenian population; (2) to evaluate household use of iodised salt; and (3) to monitor iodised salt promotion strategies. Design: Cross-sectional study on a nationally representative sample of 2627 households, including 3390 children under five and 2649 women of fertile age. Cluster sampling design on four population strata: residents, refugees, rural and urban. Results: Thyroid was palpable in one-third of the women, 6% of them having a visible goitre. Median of urinary iodine excretion in children was 139.5 mgl 21 . One-third of the children showed low urinary iodine concentration. Iodised salt was consumed in 66% of the households. The national IDD control programme included modernisation of the Yerevan Salt Factory, legislative regulation of the iodine content of the salt, and public information by the media. Conclusions: Armenia was still an endemic zone for goitre in 1997. The iodine status of children under five in 1997 was not considered alarming even though 33% of them had low values of urinary iodine. After four years of intervention strategies, the use of iodised salt has increased by 17%. Further efforts should be made to control salt imports and to monitor IDD indicators in vulnerable groups. Keywords Iodine deficiency disorders Children Women Dietary prophylaxis Public health strategies Armenia Iodine deficiency is the world’s single most significant cause of preventable brain damage and mental retardation. Mild to moderate growth retardation is often present in healthy subjects residing in areas of iodine deficiency 1 . Endemic goitre is the most common consequence of iodine deficiency. The natural history of goitre may be complicated by multi-nodular evolution, thyrotoxicosis and neoplastic degeneration. Severe iodine deficiency leads to major neuropsychological defects such as endemic cretinism. The iodine content of foods depends on the iodine content of the soil on which they are grown. The low iodine content of the soil is the initial, necessary but not sufficient, cause of iodine deficiency disorders (IDD). Socio-economic conditions are a potent co-factor for the development of goitre and other IDD. IDD cannot be eliminated by changing dietary habits or by eating specific kinds of foods, but must be corrected by supplying iodine from external sources. While a variety of methods exist for the correction of iodine deficiency, in practice the most commonly applied is universal salt iodisation for human and livestock consumption. Other methods such as iodised oil (in capsules and injections), iodised bread, etc. are temporary remedies with high cost-effectiveness but poor sustainability 2 . The Republic of Armenia shows the typical contradic- tions of a transition country, with low population density, a high literacy rate, a high employment rate but low average monthly income 3 . In addition to that, the breakdown of the centrally planned sanitary system following independence from the Soviet Union, the 1988 earthquake and the armed conflict with Azerbaijan exacerbated the general situation, causing marginal health and nutritional status in high-risk population groups such as young children and women. Since 1974 Armenia had been supplied with iodised salt made in Ukraine, but economic collapse stopped this in the 1990s. As a result, the prevalence of IDD increased and the situation of goitre prevalence in endemic areas worsened. In 1995 a survey proved the extent of IDD in the mountainous regions of Armenia. The groups examined were 3211 schoolchildren (6–12 years old) and 633 pregnant women. Half of the pregnant women surveyed q The Authors 2003 *Corresponding author: Email f.branca@agora.it Public Health Nutrition: 6(5), 463–469 DOI: 10.1079/PHN2003461