Sustainable universal salt iodization in low-income countries – time to re-think strategies?

Assey, Vincent; Peterson, Stefan; Greiner, Ted

doi:10.1038/sj.ejcn.1602737

Cited by 10 publications

(12 citation statements)

References 6 publications

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“…In another study, Taga et al measured large decreases in iodine concentration of salt at various points in the supply-chain and documented losses of around 44.8–82.3% (14). Similarly, different authors have described a high variability of iodine concentrations at the retailer or household levels (12, 14–16, 18–20, 24). …”

Section: Discussionmentioning

confidence: 92%

Post-production Losses in Iodine Concentration of Salt Hamper the Control of Iodine Deficiency Disorders: A Case Study in Northern Ethiopia

Shawel

Hagos

Lachat

et al. 2010

J Health Popul Nutr

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Iodine is essential for good function of the thyroid, and its deficiency is of public-health importance in Ethiopia. Iodization of salt is an effective and sustainable strategy to prevent and control iodine deficiency in large populations. The effectiveness of salt-iodization programmes depends on the conservation of iodine concentration in salt at various stages of the supply-chain. The overall objective of the study was to assess the loss of iodine in salt from production to consumption and to estimate the proportion of adults, especially pregnant women, at risk of dietary iodine insufficiency. A cross-sectional study was conducted during February-April 2007 in northern Ethiopia. Iodine concentrations of salt samples from producers (n=41), retailers (n=7), and consumers (n=32) were determined using iodiometric titration. A risk assessment was conducted for dietary iodine insufficiency among adults, including pregnant women, using a semi-probabilistic approach. The concentration of iodine in the sampled salts decreased by 57% from the production site to the consumers. The assessment of exposure showed that adults in 63% (n=20) of the households, including 90% (n=29) with pregnant women, were at risk of insufficient iodine intake. A monitoring and evaluation system needs to be established to ensure adequate supply of iodine along the distribution chain. Special attention is needed for the retailers and consumers. At these levels, dissemination of information regarding proper storage and handling of iodized salt is necessary to address the reported loss of iodine from salt.

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Section: Discussionmentioning

confidence: 92%

Post-production Losses in Iodine Concentration of Salt Hamper the Control of Iodine Deficiency Disorders: A Case Study in Northern Ethiopia

Shawel

Hagos

Lachat

et al. 2010

J Health Popul Nutr

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“…In line with this, national survey reports for Bangladesh (11), Senegal (13), and Ghana (personal communication from EF Amoaful, Ghana Health Services, 2016) indicate that subnational strata representing areas of extensive small-scale salt production had particularly low coverage of adequately iodized salt (<26% of households). The low coverage is suggested to be the result of lower technical capacity of small-scale salt producers to iodize salt, along with the increased challenges to establish effective quality assurance and regulatory monitoring of iodization in areas of widespread artisanal salt production (J Gorstein, unpublished results, 2015) (40, 41). …”

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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“…The Tanzanian IDD Control Program previously considered iodation of salt by manual spraying and mixing methods to be inappropriate, but the strategy of providing machine-operated salt-iodation machines to salt producers in Tanzania has been unsuccessful in the long run [ 20 ]. Nevertheless, despite failure to use iodation machines and/or breakdowns, the producers continued to manufacture iodated salt using alternative self-initiated technologies and maintained a reasonable percentage coverage of iodated salt at household level [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…An inventory of the salt-production sites[ 20 ] that had been supplied with salt iodation machines revealed that (1) most salt factories no longer used them owing to high running costs, (2) the capacity to repair breakdowns was minimal or non-existent and (3) cooperatives created to give many small-scale producers access to the equipment did not work. Both large- and small-scale producers were mainly using hand spray pumps and other small gadgets to spray potassium iodate solution on to the salt, producing highly variable iodine contents.…”

Section: Introductionmentioning

confidence: 99%

“…Both large- and small-scale producers were mainly using hand spray pumps and other small gadgets to spray potassium iodate solution on to the salt, producing highly variable iodine contents. In 2003, salt samples collected among the small-scale producers showed that 93% (n = 85) did not conform with the then recommended iodation levels; most were too low [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Improved salt iodation methods for small-scale salt producers in low-resource settings in Tanzania

Assey

Tylleskär

Momburi³

et al. 2009

BMC Public Health

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Sustainable universal salt iodization in low-income countries – time to re-think strategies?

Cited by 10 publications

References 6 publications

Post-production Losses in Iodine Concentration of Salt Hamper the Control of Iodine Deficiency Disorders: A Case Study in Northern Ethiopia

Post-production Losses in Iodine Concentration of Salt Hamper the Control of Iodine Deficiency Disorders: A Case Study in Northern Ethiopia

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

Improved salt iodation methods for small-scale salt producers in low-resource settings in Tanzania

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