Universal Salt Iodization (USI) - FTP Directory Listing

FEATURESwww.unsystem.org/scn 13to continue efforts toward sustained elimination of iodine deficiency by 2005 (UNICEF 2002a).In the early 1990s, adults and children with goitres would have been common sights in the rural areas ofcountries such as China, Indonesia, Nepal and Zimbabwe. Individuals suffering from severe neurologicaldeficits affecting hearing, speech and gait would not have been unusual. These clinical signs and symptomsof IDD were well-documented, but they represented only the most visible forms of the disorders. This resultedin a vast underestimate of the real problem: the loss of intellectual capacity in newborns due to an inadequateintake of iodine (Hetzel 1983). The shift to USI in the early 90s resulted in progress towards the goal ofelimination of IDD as a public health problem.Over the past decades UNICEF has advocated among policy makers, supported consultations, preparedguidelines, assisted countries with iodised salt plants, and worked with salt producers in quality monitoring. Incoordination with many other partners, UNICEF has been working in more than 100 countries to ensure theelimination of IDD around the world. It is a testament to the strong commitment of governments, the saltindustry, international nutrition groups, the UN system and other agencies that the most severemanifestations of IDD have nearly disappeared today and that in most countries the clinical manifestations ofiodine deficiency are becoming rare.Although the story is not yet over, the history and evolution of the global fight to eliminate IDD offers manylessons that could be applied to other public health efforts. A review of the progress made in the eliminationof IDD reveals the importance of partnerships with salt producers, the evolution of national policies, therefinement in monitoring, and many other factors that are contributing to this global success.Remarkable progressUNICEF estimates that only 20% of households in the developing world were using iodized salt in early1990s (UNICEF 2001). By 2000, following intensified efforts to eliminate iodine deficiency, this figure hadjumped to 70%. This is a remarkable achievement considering that salt iodization did not become the mainintervention to combat iodine deficiency in Asia until the mid-1980s, and that in much of Africa programmeswere not even started until the early 1990s.The most recent UNICEF global database of the State of the World’s Children 2007 indicated that the proportionof households in the developing world consuming adequately iodized salt officially remains at about 70%(UNICEF 2006). While this lack of change reveals the challenges that some countries face, it also reflectsprogramme maturation, which is significant but less visible. In addition, data limitations make it difficult to generatea picture of global trends over short periods of time.Progress since 1995 can be illustrated by the increase in the number of countries implementing salt iodizationprogrammes and achieving the USI goal of over 90% of households consuming adequately iodized salt(WHO 1996). By 2005, about 120 countries were implementing salt iodization programmes compared to 90 in2000. With more new countries reporting, our global database reflects a larger number of countries initiatingUSI programmes, and the global average may not well capture the achievements. The most recent estimatesindicate that 33 developingFigure 1. Countries by proportion of households consuming iodized salt in the last five yearscountries have now reached3533the USI goal, up from 21 in3028 272000, and that an additional252227 developing countries are212120well on their way to reaching17 1713this goal, having achieved1512about 70% household10coverage (Figure 1).Countries (N)50=90Household iodized salt consumption (%)UNGASS 2002SOWC 2007UNGASS 2002: Database 1997-2000 (N=90); SOWC 2007: Database 1998-2005 (N=121)WHO estimated that thenumber of countries withIDD as a public healthproblem is down by half fromback to contents SCN NEWS # 35