Iodine Global Network (IGN)

31.05.2015   IDD Newsletter 2/2015

In this issue:
  • Ethiopia’s long road to USI
  • Iodized salt in the U.S.
  • Papua New Guinea
  • Basil Hetzel: History of IDD
  • Bhutan
  • India Salt Summit
  • Middle East (Gulf States)
  • Madagascar
  • Bok choy diet
  • CEE/CIS sustainability workshops


Ethiopia’s long road to USI

(Tesfaye Chuko, Jack Bagriansky)
The history of Ethiopia’s Universal Salt Iodization (USI) program is closely linked to the dramatic changes in the nation’s salt industry and supply. As a signatory to the World Summit for Children in 1990, the Government of Ethiopia banned the production and sale of non iodized salt in 1996. At the time almost all edible salt in Ethiopia was produced in large, industrial-scale plants on the Red Sea, and progress towards USI was rapid, with coverage of iodized salt reaching 80% just two years later.

Only half of U.S. household salt is iodized

(Excerpted from: Maalouf J et al. Nutrients. 2015; 7: 1691-1)
Iodization of salt is a global public health strategy for addressing iodine deficiency. Iodine is particularly important during pregnancy, when severe deficiency can cause cretinism, congenital abnormalities, and increased neonatal and infant mortality. Recent observational studies suggest that even mild to moderate iodine deficiency during pregnancy can lead to reduced IQ and educational achievement among offspring.

Papua New Guinea’s commitment to USI pays off

(Victor J. Temple, Karen Codling)
Severe consequences of iodine deficiency, including endemic cretinism, were identified in Papua New Guinea (PNG) as early as in the 1950s. The situation was so serious that ethical clearance was given for the first ever trials using iodized oil injections for the management of IDD to be conducted in the country in 1957 (1). The trials resulted in a drastic decline in the goiter rate, however a national program to provide iodized oil injections to the population was not initiated. Surveys in the 1980s and 1990s showed widespread iodine deficiency, with goiter rates in women and school-age children ranging from 0.5 to 54.2% across different regions.

Basil Hetzel reflects on his pioneering IDD studies in Papua New Guinea

In the recently published Global Iodine Scorecard, Papua New Guinea joined the growing number of countries that achieved optimal iodine nutrition at the national level. As we are nearing the target of virtual IDD elimination, PNG’s achievement seems particularly poignant. It was 50 years ago in the highland villages of Papua New Guinea that a team of researchers, which included Dr. Basil Hetzel, found evidence that endemic cretinism (a condition of severe mental impairment) could be prevented by correcting iodine deficiency before pregnancy.

Steadfast efforts to sustain the elimination of IDD in Bhutan

(The IGN South Asia Team)
The dragon kingdom of Bhutan is a landlocked, mountainous country in the Himalayas with a total land area of 38,394 km2 and a population of 750,000. Within this small area, the elevation varies dramatically from 97 m in the south to 7570 m in the north. Bhutan is an IDD endemic country. A survey in 1983 reported a total goiter rate of 65%, which gave rise to a multisectoral IDD Control Program (IDDCP) established in 1984.

Spurring the salt industry to achieve the last mile of USI in India

(Kuchibhotla Srinivas, Arijit Chakrabarty)
Melinda Gates in one of her TED talks (“What non-profits can learn from Coca- Cola,” filmed in September 2010) makes a provocative case for non-profits taking cue from corporations such as Coca-Cola, whose plugged-in, global network of marketers and distributors ensures that every remote village wants—and can get—a Coke. Besides sanitation, condoms, and vaccinations that she makes a case for, one wonders why shouldn’t this approach work for iodized salt in order to reach the unreached? What would make the markets (for edible salt) work for the poor?

Four Gulf States move toward IDD elimination

Already in 1997, a nationally-representative survey reported optimal iodine nutrition among school-age children (SAC) in Kuwait: the median urinary iodine concentration (UIC) was 147 µg/L, with 9.7% of the UIC values below 50 µg/L. In 2013, a survey was conducted to assess whether the adequate iodine status of the population had been sustained.

Consensus on salt iodization and sodium reduction in Madagascar

(Simeon Nanama)
Madagascar is an island off the south-east coast of Africa with a population of 21 million and an annual growth rate of 2.7%. The number of infants born each year is about 840,000. Almost all salt consumed in the country is produced locally with about two-thirds produced by medium-to-large salt producers. The remainder is produced by multiple small-scale producers in the southern regions of Atsimo Andrefana and Androy.

Severe hypothyrodism due to high intakes of goitrogenic raw bok choy

(Excerpted from: Chu, M and Seltzer, N Engl J Med. May 20, 2010. 362(20): 1945-1946.)
An 88-year-old Chinese woman was brought to the emergency department by her family, who reported that she had been lethargic and unable to walk or swallow for 3 days. She had been eating an estimated 1.0 to 1.5 kg of raw bok choy daily for several months in the belief that it would help control her diabetes. She had no previous history of thyroid disease.

Sustaining USI achievements in Central and Eastern Europe

(Gregory Gerasimov)
By 2000, only 26% of households across the CEE/CIS region had access to adequately iodized salt. As political turmoil and military conflicts receded, USI strategies gained momentum, and national coalitions were activated country after country. By the end of 2009, 55% of the region’s population had access to adequately iodized salt. At the same time, several countries had already officially achieved optimal iodine nutrition, others were approaching this target and, importantly, the effective national ability to pursue USI had been established in almost all CEE/CIS countries.