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Salt iodisation from mill to home

© UNICEF Bangladesh\2009\Shakil Noorani
Women fill packets with salt by hand in the BRAC salt crushing mill in Islampur Union, Cox's Bazar.
By Sophie McNamara

Cox’s Bazar, Bangladesh: Inside a rickety wooden building surrounded by rice paddies, men carry heavy baskets of wet salt balanced on their heads, while women scoop up salt with their hands and fill packets to be sold at markets.

This salt crushing mill, in Islampur union in Cox’s Bazar district, is a typical Bangladeshi salt factory that relies almost entirely on manual labour. Almost the only machine in the building is the salt iodisation plant, provided by UNICEF and Bangladesh Small and Cottage Industries Corporation (BSCIC ), as part of the national salt iodisation project aimed at eliminating iodine deficiency disorders (IDD).

The seaside district of Cox’s Bazar has the lowest level of iodised salt consumption in the country, at only 20 per cent. It is also the site for 80 per cent of Bangladesh’s salt production because the ocean provides the raw materials to create it. The problem is that many people eat the crude salt straight off the field.

The prevalence of iodine deficiencies in Bangladesh, including intellectual impairment and goitre, remains high. The world’s largest river delta flushes through Bangladesh, and much of the country floods every year, washing out the naturally occurring iodine from the soil.

Improving national health
Mr Md. Alamgir Khan, Production and Purchase Manager at the salt mill, which is run by the NGO BRAC, has attended several UNICEF/ BSCIC workshops about the importance of salt iodisation.

“This mill is committed to providing iodised salt. I’m proud to be able to contribute to the health of my country,” Mr Khan says.

The use of iodised salt has dramatically increased, from 20 per cent of households in the early 1990s to 84 per cent in 2006. As a result, the prevalence of goitre has reduced significantly, from 49.9 per cent of children in the mid-90s to 6.2 per cent in 2005. The main challenge now is ensuring that salt is adequately iodised. A recent national survey found that only 51 per cent of the salt samples tested contained adequate iodine.

UNICEF is working with salt mill owners and managers like Mr Khan to encourage adequate iodisation, by holding orientations and workshops that explain the health implications of the lack of iodine.

Despite Mr Khan’s enthusiasm, barriers remain to adequate iodisation. Salt mills operate on slim profit margins and adequate iodisation is not seen as profitable. The BRAC salt mill is one of only two in the upazila (sub district) with an on-site lab to accurately test iodine levels, out of a total of 35 mills.

BSCIC, UNICEF’s government counterpart, and other partner organisations conduct random salt testing at both the market and the mill to ensure that iodine levels are sufficient.

© UNICEF Bangladesh\2009\Shakil Noorani
Abul Hasnaf, 27 and his niece, Fazila Tunnesa Kartica, 22, from Mohripara village, demonstrate the local method of testing for iodine in salt.
Challenging myths
UNICEF is also working on the other side of the equation, to increase demand for iodised salt, partly by combating inaccurate myths about iodine.

“Many salt producers believe the myth that iodine is contained in the sea fish that we eat, so we don’t have to eat iodised salt,” says Mr Kaiser Idrish, secretary of the Salt Producers Association, an organisation that represents crude salt producers in Cox’s Bazar.

“The awareness of iodisation is increasing, but we have to work at it. I now know that fish contains minimal amounts of iodine. At a UNICEF workshop I heard that you would have to eat many kilograms of fish or a tiny pinch of iodised salt to get the same amount of iodine.”
Rumi Dey, age 22, is a part of Sat Rong, a theatre group that has created a 20-minute drama about the importance of iodised salt, with support from UNICEF.

The play will be performed 24 times in three upazilas in the Cox’s Bazar district, in locations that are convenient for salt producers. One of the play’s characters is a salt producer who eats salt straight off the field and who believes that salt water contains enough iodine for health.

“The play also shows the problems of not having enough iodine, such as goitre and IQ problems, and how to test iodised salt at home. I’m happy to be part of this mass awareness and demand creation programme. It will help Bangladeshis live healthily and peacefully,” says Rumi.

Empowering locals to test salt
People can test for the presence of iodine in salt using locally available materials. First one teaspoon of salt is mixed with five grains of cooked rice, then two drops of lime juice are squeezed on top. Iodine is present if the salt turns purple. UNICEF provides information to community nutrition workers to raise awareness of this method.

Abul Hasnaf, 27, is a teacher from Cox’s Bazar who uses this method everytime he buys a new packet of salt and encourages his class three students to do the same. “If the salt doesn’t contain iodine, we take it back to the market,” says Abul. While this method is useful for household-level testing, it does not show the amount of iodine in the salt.



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