Methodology for tracking USI program at a low cost in Armenia

Since the beginning of the global efforts in the early 1990’s to promote national salt iodization programs around the world, countries have primarily relied on relatively costly donor supported population-based surveys to assess coverage of iodized salt and iodine status among their populations.  Although the WHO recommends that such “nationally representative” surveys be conducted about every five years, in most countries data on rates of coverage of adequately iodized salt and population iodine status are >10 years old.  

In 2004, after the adoption of the RA government's decree on the mandatory iodization of food-grade salt, high performance indicators of the programme were recorded. National surveys in 2005 and 2016 confirmed 99% household coverage of any iodized salt, and mUIC >240 µg/L among school age children in 2016.  

In 2023, the Iodine Global Network (IGN) supported the “pilot” implementation of the FORTIMAS (Fortification Monitoring and Surveillance) methodology, adapted to tracking “effective coverage” of iodized salt, in Armenia. Primary analysis of non-probabilistic data showed high (92%) household coverage of adequately iodized salt and optimum (175.3 µg/L) median urinary iodine concentration among 1st trimester pregnant women, across purposively selected sentinel sites. Secondary analysis of data on production, imports and distribution of iodized salt indicated consistently high expected and assessed population coverage of iodized salt during the past decade. The prevalence of neonatal TSH levels above 5 mUI/L (an indicator of iodine status among pregnant women) over past 12 years was less than 3% with a general trend of decreasing from 2.35% in 2017 to 1.39% in 2023.

Armenia experience demonstrated that, consistency between the overall (dietary) iodized salt supply in the country and iodine status of the population, may be documented using the FORTIMAS methodology as a low-cost and rapid approach for on-going tracking of national salt iodization programs