National salt iodization programs

From these limited examples, it appears that the knowledge level of iodine nutrition varies virtually from one extreme to the other in different countries. These variable knowledge levels have the potential to impact not only on the iodine status of the population, but also on the sustainability of national salt iodization programs. Because knowledge of iodine nutrition is viewed as one of the important determinants in the success of salt iodization programs, we take an in-depth look at the fundamentals of iodine knowledge in this chapter. 

No national-level data exists in India on the prevalence of Graves disease before or after the salt iodization program. 

After 5 years of the salt iodization program, the prevalence of goiter decreased substantially. However, the amount of iodized salt produced annually was limited to 20000 metric tons, which was not enough to cover the entire population in the affected areas. IDD was included in the fourth and fifth National Social and Economic Development Plan (1977—1986) as one of the priority health issues to be tackled, and production and distribution of salt iodization was also set as a main strategy. 

As a result, by 1999, in the absence of an efficient national universal salt iodization (USI) program, we introduced a program of iodine implementation designed to encourage voluntary consumption of iodized salt in both fertile-age and pregnant women fiving in the moderately iodine-deficient area previously studied. 

Another example of a maternal condition that contributes to birth defects is low circulating iodine. Cretinism is one of the most profound, but completely preventable, syndromes of malformation known. Characteristic consequences of prenatal iodine deficiency include pervasive mental and physical retardation, deaf-mutism (due to primary malformation of the inner ear), lack of muscle tone with a spastic or rigid walk, and failure to attain a height at maturity of more than 1 m. Today, this condition (known as endemic cretinism) is most prevalent in impoverished areas of African and East Asian countries. Prior to implementation of a national program of iodized salt in the early part of the twentieth century, endemic cretinism was commonplace in Switzerland. After institution of iodized salt, deaf-mutism declined 50% within 8 years and no cretins have been born in that country since 1930. 

The WHO/UNlCEF/lCClDD report on progress in the elimination of IDD in 1999 indicated remarkable progress in that, of the 130 IDD-affected countries, 105 (81%) had an intersectoral national body (committee or commission) with responsibility for the program. Other details are shown in Table 74.3. Of the 5 billion people Hving in countries with IDD, 68% of them had access to iodized salt, compared to an estimated 20% before 1990. 

The mean daily intake of salt in Sweden in 2006 was 12 g, corresponding to 60 pg iodine. It has been estimated that about 75% of Swedish households use iodine-supplemented salt, whereas the use of iodized salt in ready-made food is limited and rapidly diminishing, because of European Union restrictions. High intake of sodium chloride and its association with hypertension has been recognized by the National Food Administration of Sweden, and a long-term program to reduce the total daily intake to 5 g of salt has now been launched. 

The intake of iodized salt by this program was estimated to be around 4g/day, and the iodization level was set to 13 ppm. Bread is a staple food in Denmark, and simulation studies performed by the Danish National Food Agency based on Danish food surveys had shown that iodized salt in bread, in combination with iodized table salt, would distribute the iodine nearly as evenly in the population as iodization of all salt used by the food industry. 

April 1996 Mali participated at the Conference on the Sustainable Elimination of Iodine Deficiency Disorders Africa by the Year 2000, which was hosted by the Government of Zimbabwe November 1997 The National Directorate for Public Health in Mali organized a workshop to revitalize the IDD program a national communication strategy for the utilization of iodized salt was developed... 

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