Regulatory Monitoring Systems of Fortified Salt and Wheat Flour in Selected Asean Countries

Wijngaart, Annoek van den; Bégin, France; Codling, Karen; Randall, Philip; Johnson, Quentin

doi:10.1177/15648265130342s112

Cited by 25 publications

(27 citation statements)

References 6 publications

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“…This strategy remains as a recommended focus to accelerate progress toward achieving and sustaining optimal iodine status through USI, both nationally and subnationally, in Bangladesh, Ethiopia, Ghana, Indonesia, Niger, the Philippines, Senegal, and Tanzania. These challenge areas remain of particular importance in relation to small-scale salt-producing areas, in which industry modernization and consolidation, along with strengthened quality control and regulatory monitoring, will be crucial factors for successful improvements in iodization quality (42, 43). …”

Section: Discussionmentioning

confidence: 99%

Household Coverage with Adequately Iodized Salt Varies Greatly between Countries and by Residence Type and Socioeconomic Status within Countries: Results from 10 National Coverage Surveys

Knowles¹,

Garrett²,

Gorstein³

et al. 2017

J. Nutr.

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Background: Household coverage with iodized salt was assessed in 10 countries that implemented Universal Salt Iodization (USI).Objective: The objective of this paper was to summarize household coverage data for iodized salt, including the relation between coverage and residence type and socioeconomic status (SES).Methods: A review was conducted of results from cross-sectional multistage household cluster surveys with the use of stratified probability proportional to size design in Bangladesh, Ethiopia, Ghana, India, Indonesia, Niger, the Philippines, Senegal, Tanzania, and Uganda. Salt iodine content was assessed with quantitative methods in all cases. The primary indicator of coverage was percentage of households that used adequately iodized salt, with an additional indicator for salt with some added iodine. Indicators of risk were SES and residence type. We used 95% CIs to determine significant differences in coverage.Results: National household coverage of adequately iodized salt varied from 6.2% in Niger to 97.0% in Uganda. For salt with some added iodine, coverage varied from 52.4% in the Philippines to 99.5% in Uganda. Coverage with adequately iodized salt was significantly higher in urban than in rural households in Bangladesh (68.9% compared with 44.3%, respectively), India (86.4% compared with 69.8%, respectively), Indonesia (59.3% compared with 51.4%, respectively), the Philippines (31.5% compared with 20.2%, respectively), Senegal (53.3% compared with 19.0%, respectively), and Tanzania (89.2% compared with 57.6%, respectively). In 7 of 8 countries with data, household coverage of adequately iodized salt was significantly higher in high- than in low-SES households in Bangladesh (58.8% compared with 39.7%, respectively), Ghana (36.2% compared with 21.5%, respectively), India (80.6% compared with 70.5%, respectively), Indonesia (59.9% compared with 45.6%, respectively), the Philippines (39.4% compared with 17.3%, respectively), Senegal (50.7% compared with 27.6%, respectively) and Tanzania (80.9% compared with 51.3%, respectively).Conclusions: Uganda has achieved USI. In other countries, access to iodized salt is inequitable. Quality control and regulatory enforcement of salt iodization remain challenging. Notable progress toward USI has been made in Ethiopia and India. Assessing progress toward USI only through household salt does not account for potentially iodized salt consumed through processed foods.

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Section: Discussionmentioning

confidence: 99%

Household Coverage with Adequately Iodized Salt Varies Greatly between Countries and by Residence Type and Socioeconomic Status within Countries: Results from 10 National Coverage Surveys

Knowles¹,

Garrett²,

Gorstein³

et al. 2017

J. Nutr.

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“…Therefore it is recommended to implement the following eight interventions: (I) test the stability of iodine within Cambodian salt and market settings; (II) assess the impact of low iodization on the Cambodian iodine status; (III) assess Cambodian salt producers’ bottleneck; (IV) develop a monitoring system with the food administration authority to ensure that domestic and imports are iodized; (V) ensure that appropriate national budget is allocated to the enforcement of the legislation; (VI) develop regional standards and regulation for iodized salt including penalties [ 18 ]; (VII) ensure that fortification standards including iodization are integrated in the annual industry licensing and registration and finally (VIII) sensitize the population on fake labeling by industry promoting fortification including iodization.…”

Section: Discussionmentioning

confidence: 99%

Iodized Salt in Cambodia: Trends from 2008 to 2014

Laillou¹,

Borath

Oeurn³

et al. 2015

Nutrients

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Though the consequences of nutritional iodine deficiency have been known for a long time, in Cambodia its elimination has only become a priority in the last 18 years. The Royal Government of Cambodia initiated the National Sub-Committee for Control of Iodine Deficiency Disorders in 1996 to fight this problem. Using three different surveys providing information across all provinces, we examined the compliance of salt iodization in Cambodia over the last 6 years. Salt samples from the 24 provinces were collect at the household level in 2008 (n = 566) and 2011 (n = 1275) and at the market level in 2014 (n = 1862) and analysed through a wavelength spectrophotometer for iodine content. According to the samples collected, the median iodine content significantly dropped from 22 mg/kg (25th/75th percentile: 2/37 mg/kg) in 2011 to 0 mg/kg in 2014 (25th/75th percentile: 0/8.9 mg/kg) (p < 0.001). The proportion of non-iodized salt within our collected salt drastically increased from 22% in 2011 to 62% in 2014 (p < 0.001). Since the international organizations ceased to support the procurement of iodine, the prevalence of salt compliant with the Cambodian declined within our samples. To date, the current levels of iodine added to tested salt are unsatisfactory as 92% of those salts do not meet the government requirements (99.6% of the coarse salt and 82.4% of the fine salt). This inappropriate iodization could illustrate the lack of periodic monitoring and enforcement from government entities. Therefore, government quality inspection should be reinforced to reduce the quantity of salt not meeting the national requirement.

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“…This can be successfully undertaken by industry when strong regulatory monitoring practices are in place. 20 , 21…”

Section: Introductionmentioning

confidence: 99%

Regulatory Monitoring of Fortified Foods: Identifying Barriers and Good Practices

Luthringer

Rowe

Vossenaar

et al. 2015

Glob Health Sci Pract

104

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Food fortification with micronutrients often is not compliant with relevant standards, in large part because poor regulatory monitoring does not sufficiently identify and hold producers accountable for underfortified products. We propose these reinforcing approaches: clear legislation, government leadership, strong enforcement of regulations, improved financial and human capacity at the regulatory agency and industry levels, civil society engagement, simplified monitoring processes, and relationship building between industry and government.

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Regulatory Monitoring Systems of Fortified Salt and Wheat Flour in Selected Asean Countries

Cited by 25 publications

References 6 publications

Household Coverage with Adequately Iodized Salt Varies Greatly between Countries and by Residence Type and Socioeconomic Status within Countries: Results from 10 National Coverage Surveys

Household Coverage with Adequately Iodized Salt Varies Greatly between Countries and by Residence Type and Socioeconomic Status within Countries: Results from 10 National Coverage Surveys

Iodized Salt in Cambodia: Trends from 2008 to 2014

Regulatory Monitoring of Fortified Foods: Identifying Barriers and Good Practices

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