TACOMA, Washington — Iodine deficiency disorders (IDD) can be effectively eliminated by establishing a sustainable salt iodization method in iodine-deficient areas. This is according to a universal salt iodization program-monitoring manual produced by the World Health Organization (WHO) and the United Nations Children’s Emergency Fund (UNICEF). The challenge lies in ensuring the established method is accessible, permanent and effective. So, the organization Nutrition International has proposed that iodizing small-scale salt producers will be the solution to Universal Salt Iodization (USI).
Why Are People Iodine Deficient?
Iodine does not naturally occur in foods the way nutrients like calcium, iron and vitamins do. Instead, it is distributed throughout the soil. Only foods grown in iodine-rich soil will contain iodine, but due to the uneven distribution of iodine across the Earth’s crust, some areas end up iodine deficient. For example, Central Africa suffers from iodine-deficient soil, which is not easily remedied with fertilizer. This results in many cases of IDDs in that region.
Iodine Deficiency Disorders
When a person has micronutrient deficiencies, their body is not adequately nourished even if they have a full stomach. IDDs include goiter, mental retardation, infant mortality and decreased fertility rates. Pregnant women in particular require substantially more iodine to regulate the development of the fetal brain and nervous system. Due to iodine-deficient mothers, 38 million babies are born iodine-deficient every year and 18 million are mentally impaired as a result. This issue is associated with production losses worth 10% of GDP, harming a country’s socio-economic development.
The WHO and UNICEF state that iodine deficiency will be eliminated through the provision of daily iodine needs to each individual. Salt became the best choice by which iodine could be delivered to those deficient. Iodine is needed in minuscule amounts daily, and small amounts of salt are consumed by most people at constant levels throughout the year. Salt is mostly made from seawater, which loses its naturally occurring iodine during salt production.
Microdosing salt with iodine is therefore a cheap, simple process that restores sea salt’s natural iodine content and allows the nutrient to reach a wide variety of people. Consumption of iodized salt increased iodine consumption in Ethiopian households from 5% to 54% in 2015.
Problems Faced by Universal Salt Iodization
Despite this globally successful solution, 30% of households still do not have access to adequately iodized salt. These households are typically the poorest and most vulnerable. Some populations are difficult to reach because they obtain salt in more traditional ways and do not purchase market-produced salt. Others cannot afford the slightly higher cost of iodized salt.
Cheaper village-level iodization methods do exist where some iodine can be introduced to the diets of poorer persons. However, these methods often involve hand-mixing potassium iodide or potassium iodate into small amounts of dry salt. This produces inadequately iodized salt due to uneven distribution and loss of iodine. Salt iodization is most efficient and reliable when performed on a larger scale.
Iodizing Small-Scale Salt Producers As a Solution
Nutrition International posits that iodizing small-scale salt producers could be the solution to reach the last 30% of households. While iodizing small-scale salt producers would increase access, the issue of cost remains. The cost of salt iodization is about two to seven U.S. cents per kilogram, which is less than 5% of salt’s retail price in most countries.
However, this is still an added cost to small-scale producers. They would need financial support to purchase special equipment, chemicals and packaging as well to prevent the loss of iodine during salt transport. Investments must be made to keep costs low for both the producers and consumers, but these must be done sustainably.
This solution is possible, especially with public-private partnerships. Nutrient International references the success of this method in Pakistan, where government partnership with small and medium-scale farmers reduced the incidence of IDDs in women from 37% to 3%. Further, Senegal’s small-scale producers now account for 50% of the production of their iodized salt, thanks to support from the Micronutrient Initiative. Supporting producers until iodized salt production becomes profitable for them decreases the risk of them returning to unfortified salt production. It also supports the USI initiative.
The WHO, UNICEF and the International Council for Control of Iodine Deficiency Disorders (ICCIDD) state that IDDs will begin to be eliminated in children within one year of the provision and consumption of adequately iodized salt. This will lead to better health and overall performance. Adults with goiter will likewise experience no worsening of symptoms.
Nutrition International states that investment, technical support, enforcement and commitment are critical components in iodizing small-scale salt producers, who can then help improve the health of vulnerable populations. They have been working with small-scale producers, providing exactly these resources as they fight to end the inequitable issue of iodine deficiency.
– Serah-Marie Maharaj