Assessment of the sustainability of the iodine-deficiency disorders control program in Lesotho.
BACKGROUND
Evaluation of the sustainability of iodine-deficiency disorders control programs guarantees successful and sustained virtual elimination of iodine deficiency. The Lesotho universal salt iodization legislation was enacted in 2000 as an iodine-deficiency disorders control program and has never been evaluated.


OBJECTIVE
To assess the sustainability of the salt iodization program in Lesotho, 2 years after promulgation of the universal salt iodization legislation.


METHODS
The proportion to population size method of sampling was used in 2002 to select 31 clusters in all ecological zones and districts of Lesotho. In each cluster, 30 women were selected to give urine and salt samples and 30 schoolchildren to give urine samples. The salt samples were analyzed by the iodometric titration method, and the ammonium persulfate method was used to analyze the urine samples. The chairperson of the iodine-deficiency disorders control program was interviewed on programmatic indicators of sustainability. SAS software was used for statistical analysis of the data.


RESULTS
The urinary iodine concentrations of very few children (10.1% and 21.5%) and women (9.8% and 17.9%) were lower than 50 microg/L and 100 microg/L, respectively. At the household level, 86.9% of the households used adequately iodized salt. Only four indicators of sustainability have been attained by the salt iodization program in Lesotho. CONCLUSIONS; Iodine-deficiency disorders have been eliminated as a public health problem in Lesotho, but this elimination is not sustainable. Effective regular monitoring of salt iodine content at all levels, with special attention to iodization of coarse salt, is recommended, together with periodic evaluation of the iodization program.
Sebotsa
Masekonyela Linono Damane
ML
Food and Nutrition Coordinating Office, P/Bag A78, Maseru 100, Lesotho. sebotsa@ananzi.co.za
Dannhauser
André
A
Jooste
Pieter L
PL
Joubert
Gina
G
D000293:Adolescent; D000328:Adult; D002648:Child; D016000:Cluster Analysis; D005260:Female; D006042:Goiter / Q000453:epidemiology / Q000517:prevention & control; D006306:Health Surveys; D006801:Humans; D007037:Hypothyroidism / Q000453:epidemiology / Q000517:prevention & control; D007455:Iodine / Q000008:administration & dosage / Q000032:analysis / Q000172:deficiency* / Q000652:urine; D007927:Lesotho / Q000453:epidemiology; D008297:Male; D015596:Nutrition Assessment; D009752:Nutritional Status; D010043:Outcome and Process Assessment, Health Care; D015995:Prevalence; D015397:Program Evaluation; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage* / Q000032:analysis
D017673:Sodium Chloride, Dietary; C034024:iodized salt; D007455:Iodine