Coverage of Adequately Iodized Salt Is Suboptimal and Rice Fortification Using Public Distribution Channels Could Reach Low-Income Households: Findings from a Cross-Sectional Survey of Anganwadi Center Catchment Areas in Telangana, India

Abstract

Food fortification is a cost-effective approach to prevent and control of micronutrient deficiencies in India. A cross-sectional survey of children 0–35 months of age residing in the catchment areas of anganwadi centers in the state of Telangana was conducted to assess the coverage of adequately iodized salt and the potential for rice fortification. Salt samples were collected and tested for iodine concentration using iodometric titration. Information on demographics, household rice consumption, and Telangana’s rice sector was collected and interpreted. In households of selected children, 79% of salt samples were found to be adequately iodized. Salt brand and district were significant predictors of inadequately iodized salt. Daily rice consumption among children and women averaged 122 grams and 321 grams per day, respectively. Approximately 28% of households reported consuming rice produced themselves or purchased from a local farmer, 65% purchased rice from a market or shop, 6% got rice from a public distribution system site, and 2% obtained it from a rice mill. In the catchment areas of Telangana’s anganwadi centers, there is significant variation in the coverage of adequately iodized salt by district. Future surveys in Telangana should measure the coverage of salt iodization in the general population using quantitative methods. Nonetheless, increasing the adequacy of iodization of smaller salt manufacturers would help achieve universal salt iodization in Telangana. Despite high consumption of rice, our findings suggest that large-scale market-based rice fortification is not feasible in Telangana due to a large proportion of households producing their own rice and highly fragmented rice distribution. Distributing fortified rice via Telangana’s public distribution system may be a viable approach to target low-income households, but would only reach a small proportion of the population in Telangana.

Availability of adequately iodized salt at household level in Dessie and Combolcha Towns, South Wollo, Ethiopia

“…The salt samples brought from Dessie household residents were found to be more likely adequately iodized as compared to salt samples from Combolcha Town. This report was in line with the WHO recommendation report [2], finding from studies conducted in West Ethiopia [22], Eastern Nepal [27] and Telangana, India [3] indicated that the level of moisture and humidity of areas affect the content of iodine in the salt. Additional reasons may be most of the households of Combolcha Town used open market salt for cooking and they exposed the salt to sunlight.…”

“…Even though there are many variation and strategies across countries, the finding of the study was also higher as compared to findings from other low income contries [13, 26]. In contrast to the above finding, adequacy of iodized salt in the study was lower than findings from EasternNepal (82.6%) [27] and Telangana, India (79%) [3]. …”

“…Study conducted by Kumar A., et al in Eastern Nepal [27] found that there is a significant association between use of open market salt and inadequacy of iodine content in dietary salt. Similarly studies from West Ethiopia [22], Sidama, SouthernEthiopia [25], Gondar, Ethiopia [23] and Telangana, India [3] stated that the use of packed salt has positive association with increased contents of iodine.…”

Assessing Coverage of Population-Based and Targeted Fortification Programs with the Use of the Fortification Assessment Coverage Toolkit (FACT): Background, Toolkit Development, and Supplement Overview

“…In all cases, the results were shared in-country with government, industry, and other partners, and have been used to identify and address implementation challenges. Detailed country-specific papers have been published elsewhere ( 15 , 16 , 19 – 22 ) or are in preparation.…”

High Coverage and Utilization of Fortified Take-Home Rations among Children 6–35 Months of Age Provided through the Integrated Child Development Services Program: Findings from a Cross-Sectional Survey in Telangana, India

“…The main objectives of the survey were to determine the coverage and utilization of the Bal Amrutham in areas of Telangana where the ICDS program was implemented, to assess the accessibility and utilization of the ICDS program, and to determine the associations between product coverage and other health and nutrition indicators. A secondary objective of the survey was to assess household coverage of iodized salt and the potential for rice fortification, the results of which are presented in another paper [ 10 ].…”