[Eliminating iodine deficiency disorders in Nepal through precede-proceed].
OBJECTIVE
Assess the PRECEDE-PROCEED model's suitability for developing countries. Analyze the Iodine Deficiency Disorders (IDD) control program in Nepal according to PRECEDE-PROCEED.


METHODS
Primary and secondary data analysis within the framework of PRECEDE-PROCEED's first five steps. Key informant interviews. Qualitative data from Nepal's IDD control program participants were assessed according to PRECEDE-PROCEED's third through fifth steps.


RESULTS
According to the first and second steps of PRECEDE-PROCEED for social and epidemiological assessment, Nepal's IDD control program needs improvement. Limited data were available for the assessment, making it difficult to execute the first two steps with certainty. Social and epidemiological assessments can be problematic in any developing country since the necessary data are typically not available. Behavioral and environmental assessments (step three) showed that: Most people are unaware of IDD and manage iodized salt poorly. The environment within which iodized salt is managed is insufficient for maintaining proper salt iodination at the consumer level. Educational and ecological assessments (step four) pointed out several problems, including: Inadequate understanding of IDD Incorrect beliefs about refined salt Poor supply of refined salt in markets Weak regulation of non-iodized salt importation and sales Finally, administrative and policy assessments (step five) emphasized the need for an active role of the Salt Trading Corporation in Nepal, with a significant manpower and budget, in improving the IDD program. Data for completing PRECEDE-PROCEED steps three through five were readily available. In addition to providing a framework within which to assess Nepal's IDD control program, the model helped highlight specific action goals for behavioral and environmental objectives (consume more iodized salt, improve quality of salt warehouses and increase iodized salt's market availability).


CONCLUSIONS
Though it was difficult to obtain data for social and epidemiological assessments, the PRECEDE-PROCEED model proved useful in analyzing IDD control in Nepal. The model can comprehensively analyze ongoing interventions and assess the status of various nation-wide health programs, highlighting areas of modification needed to help programs achieve their goals.
Jimba
M
M
Murakami
I
I
D003906:Developing Countries; D006266:Health Education / Q000458:organization & administration; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007455:Iodine / Q000172:deficiency*; D017145:Models, Educational; D009390:Nepal; D011314:Preventive Health Services / Q000458:organization & administration*; D016730:Program Development
D007455:Iodine