Unsatisfactory results of the Tunisian universal salt iodization program on national iodine levels

Unbalanced intakes of sodium and potassium among Tunisian adults: A cross-sectional study

The prevention and management of hypertension are untimely associated with a lowering of sodium intake. The present study aimed to evaluate the sodium and potassium intake levels of Tunisian population through measurement of 24-hr urinary sodium excretions. A randomly, multistage, cross-sectional study was conducted in an urban region (Bizerte) in Tunisia during 2015. The target population involved adults aged from 25 to 64 years. Sodium, potassium, and creatinine concentrations were determined in each urine sample using indirect potentiometric method. From the 420 selected participants, only 194 gave urine samples complying completeness criteria. A multivariate regression model was used to assess the variables related to sodium and potassium excretion. The daily mean excretion of sodium and potassium was 138.3 ± 46.5 mmol/d (corresponding to 8.1 ± 2.7 g/d of salt intake) and 61.0 ± 22.7 mmol/d, respectively. More than 87.1% of the participants (89.8% for men vs. 84.9% for women; p = .31) exceeded the WHO recommendation of 5 g/d. The upper limit of 10 g salt intake per day was still exceeded by 26.3%. After adjusted analysis, sex (for women, coef = -1.6; (95% CI: -2.4, -0.7)), level of instruction (≥30 kg/m2, coef = +1.1; (95% IC: 0.4-2.0)), and body mass index (≥30 kg/m2, coef = +1.1; (95% CI: 0.1, 2.0)) were associated with the sodium excretion. High sodium intake and inadequate potassium intake were found among participants. This consumption profile complies with the diet westernization context occurring in Tunisia. The initiated strategy focused on the downward of sodium in bread (the main source of salt intake) seems to be promising.

Trend of Iodine Status in the Eastern Mediterranean Region and Impact of the Universal Salt Iodization Programs: a Narrative Review

Recognizing the importance of iodine deficiency as a single most important preventable cause of brain damage, World Health Organization (WHO) urged all countries to scale up salt iodization since 1991 where iodine deficiency was declared as a global public health problem. All countries committed to report on the national iodine status of school-aged children (6-12 years), every 3 years. This paper aims to evaluate the progress of countries in Eastern Mediterranean Region (EMR) toward the eradication of iodine deficiency disorders (IDD) and recommend operational action to support implementation of the WHO Regional Nutrition Strategy (2020-2030). Salt iodization in EMR has been scaled up with significant progress in increasing the proportion of dietary salt which is adequately iodized. As a result, many countries such as Qatar, Kuwait, Bahrain, Jordan, Oman, and Iran have achieved, or are now on the threshold of achieving IDD elimination. The WHO in coordination with United Nations Children's Fund is working with member states to ensure suitability of these achievements. Hence, efficient monitoring will help member states to measure the magnitude of IDD as a public health problem and to monitor the effects of the intervention on the iodine status of a population. Policy makers should take proactive steps to enforce mandatory regulatory measures for USI, through a multi-sectoral coordination, and careful assessments and estimates of iodine nutritional status. Coordination between the two national programs of USI and salt reduction intake is necessary.

Iodine Content of Salt in Retail Shops and Retailers’ Knowledge on Iodized Salt in Wa East District, Upper West Region, Ghana

Background. There are laws to enforce the universal iodization of salt to check the consequences of iodine deficiency in Ghana. These laws are to ensure that there are production and sales of iodized salt in the country. Yet, the availability of iodized salt in the county's households is still not encouraging, with data indicating that 93.8% of children have urine iodine <100 μg/dl. Hence, the study investigated the iodine content of salt in retail shops and knowledge of iodized salt among retailers in the Wa East District. The study will help the informed decision on strengthening and enforcing laws to achieve the universal salt iodization and the consumption of adequate iodized salt. Method. The study was a descriptive cross-sectional survey. We used a questionnaire to collect quantitative data from participants and a rapid field test kits to determine the iodine content of salt. STATA version 14.2 was used to analyse data. Chi-squared and logistic regression models were used to examine the association between the dependent and independent variables and considered p value <0.05 as statistically significant. Findings. The retailers’ primary source of information about iodized salt was health workers (46.2%), with the majority (52.8%) of them having low knowledge of iodized salt. Notwithstanding the high knowledge of iodized salt, as high as 53.8% of the salts do not have adequate iodine (<15 ppm). Retailer’s sex (p=0.014), educational level (p=0.006), primary source of information about iodized salt (p=0.012), texture of salt being sold (p=0.023), and mode of displaying salt in the shop (p=0.003) were associated with knowledge of iodised salt. Again, retailer’s educational level (p=0.036), knowledge of iodized salt (p=0.034), texture of salt being sold (p=0.021), and method of displaying the salt being sold (p=0.004) were associated with an iodine content of the salt in the shop. Conclusions. Though policies have been implemented to promote production and consumption of iodized salt, the iodine content of salt in retail shops in the Wa East are not encouraging. We recommend the establishment of checkpoints along the production and distribution chain to ensure salt with adequate iodine reaches the consumer. Again, traders of iodized salt should have regular training on ways to preserve salt to maintain its iodine content.