Women in Burundi are deficient in iodine, leaving newborns vulnerable to lifetime lower I.Q.s
by Festo Kavishe and Vincent Assey Based on the first survey in Burundi in more than a decade, the salt iodization program is failing to impact women of reproductive age and protect newborns from mental impairment.
Women of reproductive age in Burundi are iodine deficient, according to results from the first national survey in more than a decade. Poor iodine nutrition during pregnancy could put newborns at risk of irreversible impaired brain development and lifelong lower I.Q.s.
With these new results, we now have a sense of the iodine public health problem in Burundi and a profound urgency to address it. We also have a better understanding of some of the contributing factors.
High birth rates are associated with iodine deficiency, and low literacy poses a challenge to efforts to raise awareness of the importance of iodine nutrition. The women we surveyed had low rates of educational attainment and high birth rates, including teenage childbearing.
Likely sources of iodine in the diet were also investigated: salt and drinking water. While almost all salt in Burundi is iodized, just over half contains enough of iodine, and drinking water contains none.
Nutrition experts are now exploring how the salt iodization program could be improved to address iodine deficiency.
"With these new results, we now have a sense of the iodine public health problem in Burundi and a profound urgency to address it."
Iodine deficiency in Burundi was declared a public health problem back in 2005, when the first national survey was conducted.
Burundi is a landlocked country in the Great Lakes region of Eastern Africa, with a long internal crisis of political conflicts.
Despite the turmoil, the Government of Burundi has shown impressive commitment to tackle malnutrition, joining the Scaling Up Nutrition (SUN) movement and passing legislation in 2016 making it mandatory for importers and domestic producers to add micronutrients to selected foods, including iodine to salt.
After being stalled due to civil unrest, this most recent iodine survey progressed in early February 2018, led by the Ministry of Public Health with the Institute of Statistics and Economics (ISTEEBU) and the National Institute of Public Health (INSP), with support from IGN and UNICEF, and guided by the Integrated National Food and Nutrition Program (PROPIANUT). The World Health Organization and World Food Programme were also part of discussions and likely to be involved in resulting interventions.
Field workers in Burundi received training on how to collect data for the national survey.
Women surveyed and iodine results
Among the 600 women surveyed in Burundi, 54% did not have a formal education, and 30% had given birth more than four times. Of adolescent women ages 15 – 19, a high proportion were married, contrary to the global drive against teenage pregnancy and marriage.
On average, women were mildly iodine deficient. The World Health Organization recommends a median urinary iodine concentration over 100 micrograms per liter in non-pregnant women, and over 150 micrograms per liter during pregnancy. Non-pregnant women and pregnant women in Burundi had median urinary concentrations of 80.4 and 86.7 micrograms per liter. This suggests iodine intakes of both groups are too low to meet their needs.
Sources of iodine in the diet
Salt samples from households were analyzed for iodine content. Burundi does not produce salt itself, but imports it, mostly from Tanzania. While almost all salt consumed in Burundian households (94%) contained iodine, only half of the salt tested contained adequate levels of it.
Drinking water was also collected and analyzed for iodine content, and had negligible iodine content.
Driving change with evidence
All of this tells us that the salt iodization program is not making the desired impact. While the legislation mandating adequately iodized salt for import is in place, these survey results suggest that a likely culprit is insufficient control of imports.
The good news is that imported salt is easy to control at border entry points, similar to what is implemented by neighboring country Rwanda. Moreover, the majority of salt is imported from just a few producers in Tanzania, which makes control easier at the production stage. Salt regulations need to be disseminated widely and enforcement enhanced.
That should go hand in hand with the creation of public awareness to create consumer demand for iodized salt. Low literacy rates pose a challenge to this effort, and communication campaigns should be explored to overcome this.
Gathering data is the first step, and in Burundi’s case the legislation is already in place. Now, let’s refine the salt iodization program to protect Burundi from iodine deficiency and its newborns from brain damage. IGN will continue working with our country partners and advocating for change
About the Authors
Dr. Vincent Assey
, a native of Tanzania, received his PhD in Public Health Nutrition from Bergen University (Norway). He is Head of Nutrition Services at the Ministry of Health and Social Welfare in Tanzania and the Iodine Global Network Regional Coordinator for Eastern & Southern Africa
Dr. Festo Kavishe
has an MD from the University of Dar es Salaam (Tanzania), and an MSc in Human Nutrition from the University of London (UK), among his degrees. He is former Managing Director of the Tanzania Food and Nutrition Centre, Deputy Regional Director of UNICEF in East Asia & Pacific, and the Iodine Global Network Regional Coordinator for Eastern & Southern Africa