Combating iodine deficiency: lessons from China, Indonesia, and Madagascar

This study investigated the factors contributing to a successful and sustainable elimination of iodine-deficiency disorders, drawing from salt fortification experiences in China, Indonesia, and Madagascar. Government officials, salt farmers, salt producers, and wholesalers were interviewed to collect data during field visits. Analyses used in the study include simple correlation, and wherever data permit, regression. The study found that measures crucial for combating iodine deficiency include raising public awareness of the disorders, ensuring easy access to iodated salt, promoting compliance in the salt industry, and monitoring and enforcement. Factors that ensure a reliable supply of iodated salt are equally important as those that create the demand for it. Governments must ensure that surveillance and enforcement mechanisms are functioning right from the time that salt iodation is made compulsory. For sustainability during later years, the adequacy of iodine in iodated salt must be monitored, and incentives must be modified as needed to increase compliance rates in the salt industry. Once national coverage of iodated salt reaches over 90%, the government can concentrate on fine-tuning and targeting resources at areas with a low consumption of iodated salt. Elimination of micronutrient deficiencies has a long-term impact on public health; moreover, poorer segments of the population, who are more vulnerable to such deficiencies, have more to gain from fortification programs. Thus, lessons from the successful elimination of iodine-deficiency disorders are valuable for future similar micronutrient activities.