title: Adequacy Assessment of a Universal Salt Iodization Program Two Decades after Its Implementation: A National Cross-Sectional Study of Iodine Status among School-Age Children in Tunisia.
abstract: In the framework of a worldwide policy to eliminate iodine deficiency (ID) disorders, universal salt iodization was adopted in Tunisia two decades ago. The present study aims to evaluate this strategy, using both performance and impact indicators. A total of 1560 children, aged 6-12 years, were randomly sampled using a national, two-stage, stratified, cross-sectional cluster survey in 2012. Urinary iodine concentration (UIC) of the subjects, and household salt iodine content, were analyzed. The national median UIC was 220 µg/L (95% confidence interval (CI): 199-241), indicating an acceptable iodine status at the population level. Only 11.4% (95% CI: 8.6-14.9) of the children had UIC <100 µg/L, but with large regional disparities (4.3% to 25.5%,p< 0.01); however, more than a quarter of the subjects were at risk of adverse health consequences due to iodine excess. Children from households of low socio-economic levels were more prone to inadequate UIC. The national median iodine concentration of household salt was 22 mg/kg (95% CI: 21-23). Only half of the households used adequately iodized salt (15-25 ppm), with large regional disparities. National ID rates are now well below the target criteria of WHO (World Health Organization) certification (<20% of children with UIC <50 µg/L and <50% with UIC <100 µg/L). The coverage of adequately iodized salt fell short in meeting the goals of USI (Universal Salt Iodization), i.e., >90% of households. Regular monitoring of iodized salt production lines must be strengthened with involvement by producers.
authors.affiliation: INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 Rue Jebel Lakhdar, babSaadoun, Tunis 1007, Tunisia. doggui.radhouene@gmail.com.
authors.forename: Radhouene
authors.initials: R
authors.lastname: Doggui
authors.affiliation: Institut Préparatoire aux Etudes Scientifiques et Techniques, Toxicology Research and Environment Research Laboratory, 10, Rue Abou El KacemChabbi, Montfleury, Tunis 1008, Tunisia. mfh22002@yahoo.fr.
authors.forename: Myriam
authors.initials: M
authors.lastname: El Ati-Hellal
authors.affiliation: IRD (Institut de Recherche pour le Développement), NUTRIPASS Unit, IRD-UM-SupAgro, 911, Av Agropolis, 534394 Montpellier CEDEX, France. pierre.traissac@ird.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Traissac
authors.affiliation: Hôpital d'Enfants, Pediatric Radiology Department, Bab Saadoun, Tunis 1007, Tunisia. lilialahmar@hotmail.com.
authors.forename: Lilia
authors.initials: L
authors.lastname: Lahmar
authors.affiliation: INNTA (National Institute of Nutrition and Food Technology), SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 Rue Jebel Lakhdar, babSaadoun, Tunis 1007, Tunisia. jalila.elati@rns.tn.
authors.forename: Jalila
authors.initials: J
authors.lastname: El Ati
mesh_terms: D002648:Child; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007455:Iodine / Q000008:administration & dosage / Q000172:deficiency / Q000652:urine*; D016015:Logistic Models; D008297:Male; D015596:Nutrition Assessment; D009752:Nutritional Status; D012959:Socioeconomic Factors; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage*; D014416:Tunisia
chemical_list: D017673:Sodium Chloride, Dietary; C034024:iodized salt; D007455:Iodine
keywords: Tunisia; adequacy assessment; children; evaluation; iodine deficiency disorders; iodine status; universal salt iodization