Strengthening the strategy to sustain optimal iodine status in the Republic of Moldova: Assessing the use of iodized salt in industrially processed foods.

BACKGROUND: Although national legislation in the Republic of Moldova includes the use of iodized salt in processed food industry as well as household (cooking and table) salt, little is known of the actual use of iodized salt in the food industry and its contribution to the overall iodine intake of the population. This study has helped to address the gap in understanding about how much iodized salt is used in the production of different foods and to identify where more information is still required in order to more fully characterize the contribution of food industry salt to population iodine intake. METHODS: Using the available food consumption and production data, the assessment introduces a novel modelling technique, based on the methodology of the IGN Programme Guidance to assess the use of iodized salt in industrially produced foods (IPF). The method included the identification of key salt containing IPF and modelling of the salt and potential iodine intake in two groups of the population, non-pregnant adults and pregnant women. The findings were synthetized to develop a list of recommendations for adjustment or strengthening the existing salt iodization strategy. MAIN RESULTS: In RM, the salt used for industrially produced bread and household use provide almost 80% of all salt intake for adults. The intake from iodized salt at household level and the 8 key salt- containing IPF is estimated to currently meet 89% and 53% of the recommended nutrient for adults and pregnant women, respectively. If all salt used at household level and industrial bread baking would be iodized, then, potentially, it could ensure 181% and 109%, respectively, of the required iodine intake. CONCLUSIONS: Use of iodized salt in the processed food industry is of growing significance and universal use of iodized salt at household level and in bread production could result in a desirable increase in iodine intake. The national salt iodization strategy should include strengthened regulatory monitoring of iodized salt use in the bread baking industry.

Correction: Strengthening the strategy to sustain optimal iodine status in the Republic of Moldova: Assessing the use of iodized salt in industrially processed foods.

[This corrects the article DOI: 10.1371/journal.pone.0289142.].

Analysis of public health operations, services and activities in the Republic of Moldova

The public health system in the Republic of Moldova has undergone various reforms since 1992. The inherited sanitary–epidemiological services were transformed into a broader public health service. Reorganization of the public health system will continue in the coming years, both at national and regional levels, in order to strengthen the institutional framework, building a system that can address and respond to both communicable and noncommunicable diseases. To evaluate the current public health services and to make recommendations for strengthening their capacities, an overall assessment was carried out during 2011–2012, using the WHO European Region self-assessment tool. This report presents the results of the assessment, a joint effort of the WHO Regional Office for Europe, the WHO Country Office in the Republic of Moldova, the Ministry of Health, the National Centre of Public Health, and representatives of Centres of Public Health and health institutions within the country. It addresses the major challenges in the health sector, including demographics, the low level of public health service financing, and the significant burden of noncommunicable diseases and social and health inequalities. It also argues in favour of promoting public health governance and a “Health in All Policies” approach through multi- and intersectoral collaboration, including the coordination of public health activities within the health sector and beyond it. The main conclusions and recommendations will serve as a base for the development of the National Public Health Strategy 2013–2020, a policy document for effective interventions to reduce health inequalities and improve population health.