Evaluation of Policy Implementation to Control and Prevent Iodine Deficiency among Pregnant Women in Health Region 9

Abstract

Background : Iodine deficiency disorder affects population of all age groups. However, iodine deficiency in pregnant women can cause delay and abnormalities in both neurological and physical developments of the newborns.

Objectives : The purpose of this article was to evaluate health policy implementations, according to the national health strategy, to control and prevent iodine deficiency in pregnant women.

Methods : The study utilized the CIPP model which was comprised of 4 aspects: context, input, process and products. During July-September 2015, researchers interviewed 64 health administrators, 71 health practitioners, 446 pregnant women from antenatal care clinics, and staffs of 14 animal-food production facilities. Research instruments were 1) interview forms for health administrators, health practitioners, pregnant women, and staffs from animal-food production facilities. 2) knowledge and attitude test of pregnant women (with Cronbach’s alpha coefficients of 0.76 and 0.78 respectively). Statistics used were percentages, means, medians, minimums and maximums, and Spearman’s correlation.

Results: 1) Context - iodine deficiency disorder is still the important public health problem in Thailand. National and international experts suggested the use of universal salt iodization as an important strategy. Thailand’s Ministry of Public Health enforced that all salt for consumption, including salt used in food manufacture and fish sauce and seasonings, must meet iodine content standard. 2) Input - policy was acknowledged by all health administrators at all levels from national to sub-district levels. However, there were insufficient of budgets, personal, materials and supplies. 3) Process - policy implementation fully covered the health region which included running public campaigns, administrative & empower networking, surveillance, and iodine supplemental pill distribution. There was one evidence of research and development in this issue due to service workloads of health practitioners. There was only 1 out of 14 animal food production facilities that claimed of adding iodine salt into its animal feeds while other facilities claimed that the use of ordinary mixed animal food formula that already included iodine. 4) Product – pregnant women reported having good knowledge in iodine deficiency (56.1%) while 39.0% having a moderate knowledge level. Most of them had a good attitude level (87.9 %). Majority of the pregnant woman samples received iodine supplement pills (86.5%). Others who did not received reported attending antenatal care at private clinics or hospitals. The vast majority of those who received the iodine supplement pills did take the pills every day (94.8%). Median iodine urine met the recommended level of 155.7 microgram per deciliter. Pregnant woman reported having inadequate iodine consumption (47.5%) while those who reported having adequate, more than adequate and excess iodine consumption were at 25.8, 16.8, and 9.9 percent respectively. The percentage of household consuming adequately iodized salt was 86.2%. The research showed there was no relationships between quality of iodized salt in household and urine iodine concentrations in pregnant women (r=0.47).

Conclusion: This study found that the national iodine strategy was appropriate with emphasis on quality. Iodine supplement pill could be more extensively distributed to private antenatal care clinics and hospitals. The Regional Health Promotion Center 9 should play role in research & development to develop surveillance system on iodine excess. The Office of Health Region 9 should support in terms of policy and budget.