Power from below: enabling communities to ensure the provision of iodated salt in Kyrgyzstan.
BACKGROUND
In Kyrgyzstan, as in many countries around the world, progress in universal salt iodization has been slow because of difficulties in enforcing existing national regulations.


OBJECTIVE
To study the effects of community testing of the iodine content of salt in households, at local retailers, and at wholesale markets on the percentage of households using iodized salt in Naryn Oblast, a region of Kyrgyzstan.


METHODS
In response to a stated community priority to address iodine deficiency in Naryn Oblast, volunteers from village health committees and personnel of Primary Health Care units living in the communities were trained in testing salt using test kits. A phased introduction of two testing components was conducted in 2002-2003 in two areas with a combined population of 160,000. The two components included testing of salt for iodine content by community members in as many households as possible (Component 1) and testing of retail salt for iodate content by community members and by retailers at wholesale markets (Component 2). Results from these two components provided the data for this study.


RESULTS
For Component 1, salt testing reached 65% of households; coverage of iodized salt increased from 87.6% to 96.8% within 5 to 7 months (averages of the two areas; p < .001), mostly owing to a great decrease in the variation among settlements. For Component 2, in area 1, the percentage of households using iodated salt increased from 71.0% to 90.3% within 5 to 7 months, whereas the percentage of households using iodinated salt decreased from 18.6% to 5.6%. In area 2, the percentage of households using iodated salt increased from 65.2% to 76.2% within 5 to 7 months, with no change in the percentage of households using iodinated salt (21.7% and 20.8%). The differences between areas I and 2 are highly significant (p < .001). At 18 to 21 months, the percentage of households using iodated salt was 97.5% in area 1 and 90.2% in area 2. The intervention cost around U.S. dollars 1500.


CONCLUSIONS
Testing salt in a large percentage of households is an effective, low-cost approach to increasing the percentage of households using iodized salt to satisfactory levels in a very short time. Empowering community members to check salt at retailers and retailers to check salt at wholesale markets with test kits for iodated salt can rapidly ensure almost exclusive consumption of iodated salt in households.
Schüth
Tobias
T
Kyrgyz-Swiss Health Reform Support Project in Bishkek, Kyrgyzstan, Swiss Red Cross. tobias@elcat.kg
Jamangulova
Tolkun
T
Janikeeva
Shaken
S
Tologonov
Temir
T
D003906:Developing Countries; D006043:Goiter, Endemic / Q000517:prevention & control*; D006801:Humans; D007455:Iodine / Q000008:administration & dosage / Q000032:analysis* / Q000172:deficiency / Q000592:standards; D007707:Kyrgyzstan; D011634:Public Health; D011640:Public Policy; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage* / Q000032:analysis* / Q000592:standards*
D017673:Sodium Chloride, Dietary; C034024:iodized salt; D007455:Iodine