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Establishing
An International Iodine Laboratory Network
Report
of the Bangkok Workshop, May 2001
Iodine deficiency
disorders (IDDs) comprise global public health problems and are the main
cause of preventable mental retardation, with over a billion people at risk
worldwide (World Health Organization (WHO) / United Nations Children’s
Fund (UNICEF) / International Council for the Control of Iodine Deficiency
Disorders (ICCIDD), 1994). The
most cost-effective and sustainable way to eliminate IDDs is to iodize all
edible salt (Universal Salt Iodization, USI), with the target of 90% of all
households consuming adequate iodized salt.
The measurement of iodine concentration in the urine is the
recommended way to assess the current iodine status of a population.
Most of the iodine ingested is excreted in the urine, resulting in
urinary iodine (UI) concentration being a good indicator of iodine intake.
Currently, several laboratories worldwide measure UI in different ways.
Iodine in salt is measured in the laboratory or in the field, with
field test kits providing only a qualitative or semi-quantitative response
and, in some cases, erroneous information.
As a result, it is often difficult to properly monitor iodine status
and salt iodization in many countries and regions.
Researchers, public health professionals, and policy makers from 31
countries who attended an international conference in Bangkok, Thailand,
from May 22-25, 2001 agreed that an international network of resource
laboratories and a global external quality assessment (EQA) program for UI
and salt iodine (SI) can provide the solution to most of these problems.
The conference, which was jointly sponsored by the Centers for Disease
Control and Prevention, WHO, UNICEF, and the Micronutrient Initiative,
allowed for review and discussion of country experiences and technical and
practical barriers related to the analysis of iodine in urine and salt in
developed and developing countries. Topics
included
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The value of urinary iodine monitoring to IDD surveillance,
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International Organization of Standards (ISO) quality assurance systems,
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Sub-regional and national laboratory networks past and present,
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Best practices in laboratory management,
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The sustainability of IDD elimination activities,
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Current inter-laboratory quality assurance programs,
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And various laboratory methods and procedures.
The relevance of these experiences to the establishment of an
international network of iodine laboratories was discussed and conclusions
drawn regarding a proposed structure and initial steps needed to create such
a network.
“There is a need for good quality standardized data demonstrating the
impact [of salt iodization programs],” said Dr. Chandrakant S. Pandav,
Regional ICCIDD Coordinator, All India Institute of Medical Sciences, New
Delhi, India. Dr. Pieter Jooste,
Director of Nutrition Program Research, Medical Research Council, Cape Town,
South Africa, described the difficulties associated with the lack of
resources faced by laboratories in most developing countries.
Dr. Guillermo Bianchi, Professor of Chemistry, Universidad de los
Andes, indicated that such national laboratories, working as part of a
coordinated international network, were able to significantly improve the
quality of their results. Subsequent
presentations from China, Australia, and the United States further supported
the idea that international laboratory cooperation for quality assurance in
salt and urinary iodine analysis could be feasible as well as effective.
Noting the need for sustained economic commitment by the sponsoring
international organizations to the international network, it was emphasized
that significant programmatic and technical knowledge and experience already
exists and can be used to create an international iodine laboratory network.
Given the strong support among international agencies,
non-governmental organizations, and national governments for a network, the
participants agreed that all stakeholders should move forward with its
creation as soon as possible.
The Bangkok meeting ended with
a sense of optimism and urgency, and those present agreed that the following
steps should be taken immediately:
1.
Prepare and distribute a draft plan of action to all network
stakeholders for review and comment. The
final plan of action should be achievable, sustainable, cost-effective, and
acceptable both to members and sponsoring organizations.
Such a plan will demonstrate the seriousness of the supporters of the
network and provide potential donors with a timeline and budget for its
creation.
2.
Form a coordinating body with representatives from the co-sponsoring
agencies. Responsibilities will
include coordinating communication, evaluating laboratory performance (in
the form of an external quality assurance program), training, and advocacy
to maintain political commitment and to secure the financial and material
resources needed to sustain the network.
3.
Collect nominations from the regions for resource laboratories. Existing regional networks need to understand that the network will
complement, not compete with them, and in fact that those designing the
network will need to draw heavily on the experiences of those who have
preceded them.
4.
Make the selection of resource laboratories for the initial phase of
the International Resource Laboratories for Iodine (IRLI) network.
Selection of
laboratories that will take part in the first phase of the network will be
based on a variety of objective criteria. These criteria will include
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Laboratory performance,
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Laboratory capacity and infrastructure,
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National regulation or legislation of IDD status and salt monitoring,
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Solid links to a national IDD programming body,
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The presence of a long-range plan of action for its role as a regional resource lab,
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And geopolitical representation.
Programs to monitor salt iodization and to evaluate the iodine status of
at-risk populations have begun in most countries, and the indispensability
of reliable laboratory data to such programs is beyond question.
An international iodine laboratory network will greatly improve the
quality of data that regional and national laboratories produce and thus
enhance the success of international IDD elimination programs.
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