title: Household Coverage with Adequately Iodized Salt Varies Greatly between Countries and by Residence Type and Socioeconomic Status within Countries: Results from 10 National Coverage Surveys.
abstract: Background:Household coverage with iodized salt was assessed in 10 countries that implemented Universal Salt Iodization (USI).Objective:The objective of this paper was to summarize household coverage data for iodized salt, including the relation between coverage and residence type and socioeconomic status (SES).Methods:A review was conducted of results from cross-sectional multistage household cluster surveys with the use of stratified probability proportional to size design in Bangladesh, Ethiopia, Ghana, India, Indonesia, Niger, the Philippines, Senegal, Tanzania, and Uganda. Salt iodine content was assessed with quantitative methods in all cases. The primary indicator of coverage was percentage of households that used adequately iodized salt, with an additional indicator for salt with some added iodine. Indicators of risk were SES and residence type. We used 95% CIs to determine significant differences in coverage.Results:National household coverage of adequately iodized salt varied from 6.2% in Niger to 97.0% in Uganda. For salt with some added iodine, coverage varied from 52.4% in the Philippines to 99.5% in Uganda. Coverage with adequately iodized salt was significantly higher in urban than in rural households in Bangladesh (68.9% compared with 44.3%, respectively), India (86.4% compared with 69.8%, respectively), Indonesia (59.3% compared with 51.4%, respectively), the Philippines (31.5% compared with 20.2%, respectively), Senegal (53.3% compared with 19.0%, respectively), and Tanzania (89.2% compared with 57.6%, respectively). In 7 of 8 countries with data, household coverage of adequately iodized salt was significantly higher in high- than in low-SES households in Bangladesh (58.8% compared with 39.7%, respectively), Ghana (36.2% compared with 21.5%, respectively), India (80.6% compared with 70.5%, respectively), Indonesia (59.9% compared with 45.6%, respectively), the Philippines (39.4% compared with 17.3%, respectively), Senegal (50.7% compared with 27.6%, respectively) and Tanzania (80.9% compared with 51.3%, respectively).Conclusions:Uganda has achieved USI. In other countries, access to iodized salt is inequitable. Quality control and regulatory enforcement of salt iodization remain challenging. Notable progress toward USI has been made in Ethiopia and India. Assessing progress toward USI only through household salt does not account for potentially iodized salt consumed through processed foods.
authors.affiliation: Global Alliance for Improved Nutrition, Geneva, Switzerland; jknowles@gainhealth.org.
authors.forename: Jacky M
authors.initials: JM
authors.lastname: Knowles
authors.affiliation: Global Alliance for Improved Nutrition, Geneva, Switzerland.
authors.forename: Greg S
authors.initials: GS
authors.lastname: Garrett
authors.affiliation: Sajilo Solutions International, Seattle, WA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gorstein
authors.affiliation: Nutrition Section, UNICEF, New York, NY; and.
authors.forename: Roland
authors.initials: R
authors.lastname: Kupka
authors.affiliation: Nutrition Section, UNICEF, New York, NY; and.
authors.forename: Ruth
authors.initials: R
authors.lastname: Situma
authors.affiliation: Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi.
authors.forename: Kapil
authors.initials: K
authors.lastname: Yadav
authors.affiliation: Global Alliance for Improved Nutrition, Geneva, Switzerland.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Yusufali
authors.affiliation: Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi.
authors.forename: Chandrakant
authors.initials: C
authors.lastname: Pandav
authors.affiliation: Global Alliance for Improved Nutrition, Geneva, Switzerland.
authors.forename: Grant J
authors.initials: GJ
authors.lastname: Aaron
mesh_terms: D000349:Africa; D001208:Asia; D004032:Diet; D005191:Family Characteristics; D006296:Health Services / Q000592:standards*; D006801:Humans; D007455:Iodine / Q000008:administration & dosage*; D009752:Nutritional Status; D012923:Social Class; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage*
chemical_list: D017673:Sodium Chloride, Dietary; C034024:iodized salt; D007455:Iodine
keywords: USI; coverage survey; elimination of IDD; iodine; iodine deficiency; micronutrient; salt iodization