Academic journal article Bulletin of the World Health Organization

Assessment of the Iodine Concentration in Table Salt at the Production Stage in South Africa. (Research)

Academic journal article Bulletin of the World Health Organization

Assessment of the Iodine Concentration in Table Salt at the Production Stage in South Africa. (Research)

Article excerpt

Void page 520 le resume en francais. En la pagina 520 figura un resumen en espanol.


Salt iodization is considered the most effective long-term public health intervention for achieving optimal iodine nutrition. Effective salt iodization is a prerequisite for the sustainable elimination of iodine deficiency disorders, e.g. retarded mental and physical development, hypothyroidism, endemic goitre, reproductive failure and childhood mortality (1).

In South Africa, direct and indirect evidence of continued endemic goitre and iodine deficiency led, in 1995, to the introduction of mandatory iodization of table salt at an iodine concentration of 40-60 ppm. Salt iodization had previously been voluntary. As in other African countries, the regulations require potassium iodate to be used for this purpose. After the introduction of mandatory iodization, increased iodine concentrations were reported in retailed salt (2) and the iodine status of primary-school children improved (3-4). Nevertheless, there continued to be shortcomings in the accuracy of salt iodization. There was considerable variation in the iodine content of retailed salt, and evidence of endemic goitre and iodine deficiency persisted in some areas.

Recent monitoring of the iodine concentration of household salt indicated that 62.4% of households used adequately iodized salt containing at least 15 ppm iodine (5), considerably below the international goal of 90% coverage (1). A possible reason for this is that salt is underiodized at the production stage. The main aim of the present study was to extend the monitoring of table salt that takes place in retail outlets and households to all the production sites in the country. A secondary aim was to determine the perceptions and knowledge of salt producers about the prevention and control of iodine deficiency disorders and to investigate the internal quality control practices adopted during the iodization process.


A register was created of all salt producers iodizing salt in South Africa on the basis of data from a situation analysis on iodized salt in East Africa and southern Africa (6), a directory of salt producers collated by the country's Department of Minerals and Energy, and additional information obtained from local producers. Producers were visited and information was obtained during interviews with chief executive officers or senior managers closely involved in salt iodization.

Salt producers' perceptions and knowledge about iodine deficiency disorders were assessed by means of a questionnaire (Box 1) completed during personal interviews. Information was also collected on internal quality control practices (Box 2).

Box 1. Matters covered in questionnaire on salt producers'
perceptions and knowledge

 1. Why is table salt being iodized? In other words, what is the
    effect of iodized salt on people's health?

 2. What is the legal requirement for salt iodization in South Africa
    (mandatory iodization, iodate levels, packaging, labelling)?

 3. What is your understanding of the term "universal salt iodization"

 4. How long will the iodization of salt continue in South Africa?
    -- Until iodine deficiency is eliminated?
    -- 5 years?
    -- 10 years?
    -- 20 years?

 5. What does IDD (a) stand for?

 6. What are the most important examples of IDD?

 7. What is the aim of WHO, UNICEF and ICCIDD? What percentage of
    households in the country should be consuming iodized salt

 8. What are the most important impact/outcome criteria in the
    assessment of IDD? In other words, what should be measured in
    order to assess the effect of iodized salt on children?

 9. What is the potential health consequence of overiodized salt?

10. What is likely to happen to the iodine concentration in iodized
    salt during its transportation, storage and distribution, i. … 
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