Assessment of the success of implementation of new rule book on salt iodination in Federation of Bosnia and Herzegovina

The aim of this study was to determine the success of an increase in the level of salt iodization which was increased to 20-30 mg iodine per kilo of salt, 2 yr after the introduction of the new mandatory salt iodination. This prospective study was performed at level of Federation of Bosnia and Herzegovina (FBH). We singled out 60 cluster school-based surveys (6 cluster surveys in each canton) with equal representation of urban and rural areas. Within each cluster, between 10 to 30 subjects (both males and females) aged 11, 12, 13 and 14 were randomly selected. The study included a total of 962 schoolchildren. The mean iodine level per 1 kg of salt for whole FBH was 21.4±5.2. It ranged from 2.1 to 41.3 mg/kg. A significant improvement in urinary iodine excretion medians was detected in the current survey in all cantons and on the entire territory of FBH, compared to results from a previous study conducted in 1999. The urinary iodine excretion in schoolchildren in the whole FBH varied from 50.6 to 303.8 μg/l with a median of 139.5 μg/l. Values of urinary iodine <100.0 μg/l were found in 15.9% of samples of schoolchildren, whereas no values <50.0 μg/l were found. In conclusion, the results of the study indicate that increased iodine supplementation of salt in 2001 was successful and that FBH is presently iodine sufficient. In the future, however, program for monitoring of iodine prophylaxis has to have two major aims: firstly, control of iodine content in salt at different levels especially at retail shops and at imported salt and secondly, iodine deficiency disorders control. Also, a periodic measurement of urinary iodine excretion needs to be planned together with the neonatal TSH screening and the establishment of a notification system for cases of hyperthyroidism.