The Efficacy of Double-Fortified Salt in Reducing Iodine Deficiency and Anemia

Abstract

About 1.6 billion people in more than one hundred countries including Ghana suffer the consequences of micronutrient deficiencies, namely iron, iodine and Vitamin A. A thousand million people were estimated to be at risk of iodine deficiency alone in 1990. Two hundred million have goiters, 20 million are mentally retarded; six million of these being cretins. Iron deficiency anemia is the most widespread nutritional deficiency in the world today. Two billion people are affected by anemia, more than half being preventable and treatable anemia. Prevalence rates are higher in developing countries. The most affected are women of child-bearing age, and preschool children (six months to five years of age). The purpose of this study were to assess the efficacy of the double fortified salt in preventing anemia and iodine deficiency disorders. A total of 289 children aged between 1- 5 years old whose parents gave their consent and also qualified to participate in the study were initially screened at baseline for hemoglobin. Out of this, a total of 150 children had their hemoglobin ≥ l0g/dL. The selected children were assigned to one of the three intervention salt groups in a randomized controlled double-blind design for four months. One group was assigned to the red-labelled salt (R) suspected, by virtue of its color, to be double fortified and the other two groups on green- labelled salt (G) and yellow-labelled salt (Y) -both believed to be iodized salt. Salt was supplied constantly to ensure that the study subjects do not run short. They were also asked not to buy or use any salt from the market. They were monitored weekly to ensure compliance of the usage of the salt as well as its acceptability. Urine and blood samples were collected at the baseline and the fourth month to estimate the amount of iodine and iron nutrition status of the children. Malaria parasite, sickle cell and serum ferritin were also determined. Seventy-one (71) percent of the children screened at the baseline were found to be anemic (Hb<11g/dL) and 80% found to be iodine deficient (i.e. UI< l0μg/dL). Mild anemia was found to decrease by 27% for children on the double fortified salt. Mild anemia (i.e Hb≥10g/dL and <11g/dL) among the children on the ‘Y’ and ‘G’ salts were also found to decrease by 20% and 8% respectively. However, there was no significant difference (p = 0.4) between the mean hemoglobin of the children on the three different salts. Prevalence of malaria was found to be low (5.5%), probably due to the time the research was conducted (dry season). Twenty one per cent of the children were found to have sickle cell anemia but this could not be the cause of the high rate of anemia found among the children. This is because, 50% of those with sickle trait had their hemoglobin higher than l0g/dL. The median ferrtin concentration of the children on the double fortified salt was found to have performed better (increased by 25.8μg/L at the end of the 4-month period) than that of those on the other two salts (Y=17.8 and G=22.3) but there was no statistical difference (p = 0.2) between the salt groups. The rate of iodine deficiency found among the children at the baseline was 71.4%. Out of this, 29.6% were found to have mild deficiency, 17.4% had moderate deficiency and 24.6% also had severe iodine deficiency. The iodine status of the children improved at the end of the study. Only 20.3% were still found iodine deficient. This may be due to the very low urine iodine levels (0.09μg/dL) of some of the children at the baseline. Hence the period of study (4th months) may not be enough for such children to catch-up. Again, those on the double fortified salt was found to have performed better than the other two salts. Those on the double fortified salt had an improvement of 67%, those on the Y-labelled salt was also improved by 39.4% whereas those on the G-labelled salt was increased by 41%. The double fortified salt could therefore be said to be effective or efficacious in alleviating iodine deficiency.