SEATTLE — Iodine deficiency is one of the most prevalent contributing factors to preventable brain damage worldwide. Iodine deficiency disorders are considered a significant public health issue in 118 countries. Two organizations, the Global Alliance for Improved Nutrition (GAIN) and the Iodine Global Network (IGN), have introduced salt iodization programs to combat iodine deficiency in developing countries.
Salt Iodization a Cost-Effective Way to Lower Iodine Deficiency
Iodine deficiency particularly impacts the mental development of children. Brain damage and permanent mental retardation are two severe consequences of iodine deficiency. Without proper iodine levels, the thyroid cannot synthesize enough thyroid hormone. The resulting cognitive impairments are called iodine deficiency disorders.
Approximately 1.5 billion people are at risk of iodine deficiency disorders. The 1990 World Summit for Children aimed to eliminate iodine deficiency by 2000. According to leading economists in the Copenhagen Consensus, adding iodine to salt is one of the most economical investments in international development. Salt iodization is a simple way to increase iodine levels in deficient populations because of the regularity of salt consumption.
The cost-effectiveness of salt iodization programs depends on the relative frequency of salt consumption by the population, the quality of iodine storage facilities in the target country and the percentage of the population that suffers from iodine deficiency. Overall, using fortified salt to increase iodine levels is estimated to cost between $0.02 and $0.10 per person per year.
Both the Global Alliance for Improved Nutrition and the Iodine Global Network have introduced salt iodization programs to fight iodine deficiency in developing countries.
Global Alliance for Improved Nutrition’s Universal Salt Iodization Program
The Global Alliance for Improved Nutrition works to increase access to nutritious foods to malnourished populations around the world. One of GAIN’s major initiatives focuses on iodine deficiency in developing countries. GAIN promotes salt iodization in 17 countries, 14 of which fall under the GAIN-UNICEF Universal Salt Iodization Partnership Project. The Partnership Project, started in 2018 with a grant from the Bill & Melinda Gates Foundation, works to eliminate iodine deficiency in developing countries.
The organization implements different initiatives across countries, including advocacy for iodine legislation, provision of training and equipment to salt producers and education for elected officials. GAIN targets countries with high incidences of iodine deficiency where salt iodization can be easily scaled up.
An example of a country-specific GAIN initiative is the work conducted by the nonprofit in Ethiopia. GAIN began its involvement in Ethiopia by hiring an officer to represent the Universal Salt Iodization program in 2008. GAIN then helped set up a government fund for potassium iodate, eliminating reliance on occasional donations from nonprofits. In 2009, GAIN donated six iodization machines and generators to salt producers in Ethiopia; each machine with a generator costs about $33,000. GAIN also donated iodine checkers to salt producers and government offices.
To supplement its donations, GAIN trained government staffers how to use iodine checkers. Throughout its involvement in the country, GAIN campaigned for universal salt iodization legislation, and an official USI law was passed in Ethiopia in 2011.
GAIN has conducted surveys in 11 countries to determine the effectiveness of these country-specific initiatives. On average, GAIN estimates that the organization’s USI program has created a 2.5 percent increase in access to iodized salt.
Iodine Global Network Targets Iodine Deficiency in Developing Countries
Like GAIN, the Iodine Global Network introduces country-specific initiatives aimed at increasing access to iodized salt. GAIN and IGN have worked collaboratively to fight iodine deficiency in developing countries.
The Iodine Global Network is the only organization that focuses exclusively on eliminating iodine deficiency. IGN advocates for universal salt iodization in countries where iodine deficiency is prevalent. Specifically, the organization employs expert regional coordinators who meet with country representatives and policymakers to emphasize the importance of salt iodization. IGN also creates national stakeholder coalitions composed of elected officials, nonprofits and salt producers.
IGN has achieved legislative success in target countries such as Sudan. According to a 2005 study, only 10 percent of Sudanese households used iodized salt. IGN began advocacy in Sudan in 2010 when a regional coordinator visited with officials in the country. Shortly after this visit, iodine legislation was enacted.
Implementation of the changes required by the salt iodization legislation was hindered because salt producers lacked the necessary equipment and training. However, UNICEF reallocated $400,000 within the GAIN-UNICEF Universal Salt Iodization Partnership Project to help Sudan make the necessary changes.
IGN also utilized new funding to scale up operations in Sudan. IGN brought in a consultant to train salt producers on iodization techniques and purchased lab equipment so producers could test iodine levels in their salt. The organization also allocated funds to continue the work of the regional coordinator, who continued to meet with government officials as an advisor.
The collaborative efforts of IGN and the GAIN-UNICEF Partnership Project contributed to an increase in iodized salt consumption. The percentage of Sudanese households consuming iodized salt was estimated to be 11 percent in 2013.
– Katherine Parks