Sustainable universal salt iodization in low-income countries - time to re-think strategies?
OBJECTIVE
Sustained iodine deficiency control requires sustainable mechanisms for iodine supplementation. We aim to describe the status of salt iodation machines, salt producers' experiences and quality of salt produced in Tanzania.


METHODS
Qualitative and quantitative data was collected from the factory sites, observations were made on the status of UNICEF-supplied assisted-iodation machines and convenience samples of salt from 85 salt production facilities were analysed for iodine content.


RESULTS
A total of 140 salt works visited had received 72 salt iodation machines in 1990s, but had largely abandoned them due to high running and maintenance costs. Locally devised simple technology was instead being used to iodate salt. High variability of salt iodine content was found and only 7% of samples fell within the required iodation range.


CONCLUSIONS
Although iodine content at factory level is highly variable, overall iodine supply to the population has been deemed largely sufficient. The need for perpetual iodine fortification requires reassessment of salt iodation techniques and production-monitoring systems to ensure sustainability. The emerging local technologies need evaluation as alternative approaches for sustaining universal salt iodation in low-income countries with many small-scale salt producers.
Assey
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VD
IDD Control Program, Tanzania Food and Nutrition Centre (TFNC), Dar-Es-Salaam, Tanzania. vincentassey@yahoo.co.uk
Peterson
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S
Greiner
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D004864:Equipment and Supplies / Q000191:economics / Q000592:standards; D005260:Female; D019649:Food Industry / Q000191:economics / Q000592:standards*; D005527:Food, Fortified / Q000032:analysis / Q000592:standards; D006042:Goiter / Q000517:prevention & control; D006801:Humans; D007455:Iodine / Q000008:administration & dosage* / Q000032:analysis / Q000172:deficiency* / Q000592:standards; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011203:Poverty; D015397:Program Evaluation; D011786:Quality Control; D017673:Sodium Chloride, Dietary / Q000032:analysis* / Q000592:standards*; D013636:Tanzania / Q000453:epidemiology
D017673:Sodium Chloride, Dietary; C034024:iodized salt; D007455:Iodine