Child malnutrition and mortality among families not utilizing adequately iodized salt in Indonesia.
BACKGROUND
Salt iodization is the main strategy for reducing iodine deficiency disorders worldwide. Characteristics of families not using iodized salt need to be known to expand coverage.


OBJECTIVE
The objective was to determine whether families who do not use iodized salt have a higher prevalence of child malnutrition and mortality and to identify factors associated with not using iodized salt.


METHODS
Use of adequately iodized salt (>or =30 ppm), measured by rapid test kits, was assessed between January 1999 and September 2003 in 145 522 and 445 546 families in urban slums and rural areas, respectively, in Indonesia.


RESULTS
Adequately iodized salt was used by 66.6% and 67.2% of families from urban slums and rural areas, respectively. Among families who used adequately iodized salt, mortality in neonates, infants, and children aged <5 y was 3.3% compared with 4.2%, 5.5% compared with 7.1%, and 6.9% compared with 9.1%, respectively (P < 0.0001 for all), in urban slums; among families who did not use adequately iodized salt, the respective values were 4.2% compared with 6.3%, 7.1% compared with 11.2%, and 8.5% compared with 13.3% (P < 0.0001 for all) in rural areas. Families not using adequately iodized salt were more likely to have children who were stunted, underweight, and wasted. In multivariate analyses that controlled for potential confounders, low maternal education was the strongest factor associated with not using adequately iodized salt.


CONCLUSIONS
In Indonesia, nonuse of adequately iodized salt is associated with a higher prevalence of child malnutrition and mortality in neonates, infants, and children aged <5 y. Stronger efforts are needed to expand salt iodization in Indonesia.
Semba
Richard D
RD
Johns Hopkins School of Medicine, Baltimore, MD, USA. rdsemba@jhmi.edu
de Pee
Saskia
S
Hess
Sonja Y
SY
Sun
Kai
K
Sari
Mayang
M
Bloem
Martin W
MW
D046688:Child Mortality; D015362:Child Nutrition Disorders / Q000453:epidemiology* / Q000401:mortality; D002675:Child, Preschool; D004522:Educational Status; D005220:Fathers; D005260:Female; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007455:Iodine / Q000008:administration & dosage*; D016015:Logistic Models; D008297:Male; D009035:Mothers; D015999:Multivariate Analysis; D009752:Nutritional Status; D011159:Population Surveillance; D011204:Poverty Areas; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage*; D013851:Thinness / Q000453:epidemiology*; D014505:Urban Population / Q000706:statistics & numerical data
D017673:Sodium Chloride, Dietary; C034024:iodized salt; D007455:Iodine