Deficiency of the micronutrient iodine is a major cause of preventable brain damage and learning disabilities. The deficiency is easily prevented if all family members consume salt that has been adequately iodized.
By Sandra Bisin
Only a few decades ago, iodine deficiency impaired the growth and mental development of large numbers of children. Now, thanks to a simple solution – salt iodization – this disorder can be easily prevented. UNICEF estimates that 75 per cent of all households globally have adequately iodized salt, compared with fewer than 20 per cent in 1990.
With a strategy that spans farm to salt shaker, community to government, Zanzibar is on track to eliminate the hidden, but devastating, problem of iodine deficiency.
PEMBA ISLAND, United Republic of Tanzania, 8 November 2013 – Mbarouk Hamad Yussaf, a salt farmer in Pemba Island, Zanzibar, sighs with relief. He has just received a year’s worth of potassium iodate and a manual sprayer. The equipment was distributed through Zanzibar’s Ministry of Health programme that aims for universal salt iodization on the island, with support from UNICEF.
“One kg of potassium iodate would cost me 70,000 Tanzanian shillings [US$44] – it’s a fortune!” he says. “Nearly every two years, I have to buy a manual sprayer, which costs me another 50,000 Tanzanian shillings. This is more than I can afford.”
A ‘hidden hunger’ with grave consequences
The initiative supporting farmers like Mr. Yussaf is part of a government effort to combat Zanzibar’s ‘hidden hunger’ – iodine deficiency, particularly in small children and pregnant women.
A visible symptom of the deficiency is goitre. But iodine deficiency is also a major cause of preventable brain damage and learning disabilities. It has an invisible impact on brain development, reducing intellectual capacity at school and in working life, even among those with mild or moderate deficiency. One report showed that even mild deficiency can cause a significant loss of learning ability – about 13.5 intelligence quotient points, at population level.
“Goitre is only the tip of the iceberg,” says Zanzibar’s Minister of Health, Hon. Dr. Juma Duni Hajj. “The consequences of insufficient iodized salt consumption will impact generations of children in terms of their intellectual development and economic performance.”
Salt farmers like Mbarouk Hamad Yussaf of Pemba Island receive training and support from Zanzibar's Ministry of Health in a push towards universal salt iodization. The programme has multiple focuses, from community to government level.
Problem identified, legislation enacted
“Iodine deficiency is easily prevented if every family member uses salt that has been properly treated,” says UNICEF Representative in the United Republic of Tanzania Dr. Jama Gulaid. But, in Zanzibar, only one in two families has access to adequately iodized salt. In Pemba Island, use of iodized salt is even lower – only one in four families.
In the 1980s and 1990s, iodine deficiency disorders (IDD) control interventions were implemented. Pemba Island produces approximately 2,000 tonnes of salt every year, mostly for local consumption. But the islands of Zanzibar did not start implementing the IDD interventions based on the assumption that the population living there had frequent access to sea foods that are rich in iodine.
In 2001, UNICEF supported a study in Zanzibar that indicated that iodine deficiency was a problem. A year later, the organization started supporting the Ministry of Health to train salt producers on the adverse effects of non-iodized salt consumption and on proper salt iodization.
In 2011, the government introduced the Food Security and Nutrition Act, legislation that promotes the use of iodized salt.
Ensuring iodine reaches the table
Like other salt farmers in Pemba, Mr. Yussaf started iodizing salt in 2005. His farm produces up to 50 kg of salt per year. “We can still see the consequences of decades of using non-iodized salt in our communities,” he says. “There are a lot of miscarriages among women and many children with low weight at birth.”
UNICEF’s support for the programme has multiple focuses. It aims to strengthen the technical and managerial capacity of salt plants, support salt farmers like Mr. Yussaf with training and distribution of potassium iodate, provide farmers with manual sprayers, train traders and food inspectors and sensitize local authorities and farmers on the importance of iodizing salt. Recently, all salt producers in Pemba received training on quality assurance for iodized salt.
According to Dr. Gulaid, inspections are also key to ensuring iodine is reaching families: “To ensure compliance with the legislation on salt production, we need inspectors to regularly check the quality of salt in the market and stop the sale of non-iodized salt.” All health inspectors from the Ministry of Health and the Zanzibar Food, Drugs and Cosmetics Board received training on quality control.
Treatment of salt reserves and enforcement of legislation are lagging behind.
Towards eliminating iodine deficiency in Zanzibar
Head of UNICEF’s field office in Zanzibar Francesca Morandini says that, moving forward, “We need to sustain our efforts – continue working with the Association of Zanzibar Salt Farmers to inform communities and train farmers to efficiently adapt simple fortification and proper packing technologies.
“We are currently facing issues, as iodized salt is still not properly packed and stored, which can cause iodine to evaporate,” she continues. “Salt farmers also need to control the level of iodine in salt using rapid test kits.”
According to Dr. Gulaid, “Zanzibar can eliminate iodine deficiency. But, this task needs vigilance and a strong partnership among stakeholders – the government, salt producers, retailers, inspectors, public health officials and communities.”