IDD NEWSLETTER AUGUST 2016 ABKHAZIA 15 Abkhazia is a partially recognized state at the crossroads of Western Asia and Eastern Europe, on the eastern coast of the Black Sea, south of Russia and northwest of Georgia. It covers 8,660 sq. km and has a population of around 240,000. Its capital is Sukhumi. While Georgia exerts no control over its former Autonomous Republic, the Georgian government, the United Nations and the majority of the world's govern- ments (with the exception of Russia and few other countries) consider Abkhazia part of Georgia. Like in other parts of the former USSR, iodine deficiency in the Caucasus Republics (Georgia, Armenia, and Azerbaijan) was virtually eliminated in the 1950s to 1980s, which helped to significant- ly reduce the prevalence of endemic goiter and eliminate the most severe manifestations of IDD, such as cretinism. While many of the other newly independent states managed to successful- ly revive their IDD prevention programs in the mid 1990s, and went on to achieve significant improvements in iodine nutrition status by 2010, Abkhazia lagged significantly behind. It was only recently (in May 2016) that the Ministry of Health, with technical support from the IGN and UNICEF, con- ducted the first ever survey of iodine nutri- tion and use of iodized salt in Abkhazia. The survey recruited 212 participants from three administrative districts: Gagra, Sukhumi and Gali (see map). Among them were 151 school-age children (SAC, 8–12 year-old), recruited from schools, and 61 pregnant women aged 18–39 years mostly in the 2nd and 3rd trimester of pregnancy, recruited from prenatal clinics. Of the 151 SAC 67 were living in urban and 84 in rural areas. The two urban sites (Sukhumi and Gagra) are located on the Black Sea coast, while the rural schools are all inland. The women attending the prenatal clinic in Gali were mainly from rural inland villages; those from Sukhumi and Gagra were from coastal towns. Spot urine samples as well as samples of household kitchen salt were collected at each survey site. All salt samples were tested for iodine content using qualitative rapid test kits (RTKs: MBI Kits, India). Quantitative testing of the salt was not carried out, as only very few salt samples were found to contain any iodine. The urinary iodine concentration (UIC) was measured at the laboratory of A.D. Sakharov Environmental Institute of the Belarus State University in Minsk. The survey findings are concerning: the median urinary UIC in school-age children is only 29 μg/L (optimal range: 100–299 μg/L), while the median UIC in pregnant women is 27 μg/L (optimal range: 150–499 μg/L), which suggests that both population groups may be iodine deficient (see Table 1). In SAC, the median UIC was higher in urban compared to rural areas (36.3 μg/L vs 24.1 μg/L). No such diffe- rence was observed in pregnant women. Children and pregnant women in Abkhazia are iodine deficient Gregory Gerasimov IGN Regional Coordinator for Eastern Europe and Central Asia; Andrei Tulisov UNICEF and Northern Medical University, Arkhangelsk, Russia; Andrei Tuzhba Polyclinic of the Sukhumi Region, Abkhazia; Alla Belyaeva Center of Public Health, Sukhumi, Abkhazia; Sergei Petrenko International Ecological Institute, Minsk, Belarus Main street in Abkhazia’s capital and largest city, Sukhumi. Map of Abkhazia. The numbers represent the three Districts (Gagra, Sukumi, and Gali) selected for the assessment of iodine nutrition and use of iodized salt in Abkhazia.