F&N Bulletin Vol 23 No 1b - United Nations University

Letter to the editor
Dear Sir,
Community-based salt iodization program
administered by hand sprayers: A trial in Mongolia
since 1999
Salt iodization is the most commonly accepted strategy
for the control of iodine-deficiency disorders in more
than 100 countries that have launched salt iodization
programs [1]. WHO/UNICEF/International Council
for Control of Iodine-Deficiency Disorders (ICCIDD)
recommends a national usage rate of iodized salt of
at least 90% for the effective prevention of iodinedeficiency
disorders [2]. Mongolia began its salt iodization
program in 1996 with nine salt companies, and
by 1998, its national coverage had only reached the
42% level [3], in spite of nearly 100% coverage in the
capital, Ulaanbaatar.
We figured that the high price of iodized salt in
comparison with natural salt and its poor distribution
in rural areas were the main obstacles to popularizing
the use of iodized salt. The price of the iodized salt
was twice that of natural salt in Ulaanbaatar and three
to seven times in outlying areas. Out of 3,660 tons of
iodized salt produced in 1998, we found that less than
40% was consumed in rural areas, which have 75% of
the population.
We also inferred that the program would not make
much progress under current economic and political
constraints. Therefore, it was time to develop and
introduce a new program, supplementary to the
current salt iodization program, which focused on
community ownership. We developed the safe-spray
method, which iodized 1 kg of salt to 30 ppm with
three sprays of a measured solution of potassium
iodate (KIO 3
) by using durable hand sprayers. The
procedure was to measure 1 kg of salt into a plastic
bag, put the sprayer nozzle into the plastic bag with
the tightly closed mouth of the bag around the nozzle,
spray once and shake well, and then repeat the same
procedure two more times. In 10 random samplings
of 1 kg of the sprayed salt, the iodine content was constant,
ranging only from 29.6 to 32.8 ppm (n=300).
Uyanga, Taragt, and Zuiil, three villages with a high
prevalence of goiter (31.1% to 41.3%) in Uvurkhangai
Province 430 km southwest of the capital, agreed to
participate in the program. The spray-method community
initiative program (SMEP) in the three villages
was approved by the Ministry of Health, which
agreed to provide potassium iodate until 2002. The
village committees then registered with the provincial
government as iodized salt production sites. The SMEP
officially started in August of 1999.
Quality control of iodization was done by a field
test kit (MBI company, India) to check the iodine
content in 10 random samples per day. We established
a laboratory for a titrimetric method in the Provincial
Health Center, which examined 30 samples per month
from each village.
The local iodized salt was sold in the village hospitals
for Tg. 120 (US$1.00 = Tg. 1,087, 1999) per kilogram
of salt, and the prices of natural salt and iodized salt
from Ulaanbaatar in retail shops were Tg. 100 to 130
and Tg. 350 to 400, respectively. When the hospital
staff visited remote areas, they brought the sprayers
and iodized natural salt to each household; the charge
was Tg. 20 per kg.
A baseline survey to assess iodine-deficiency disorder
status and the use of salt was carried out in 1999. One
hundred fifty-eight children aged 8 to 12 years and 64
women aged 15 to 45 years were selected randomly
and examined. The median values of urinary iodine
excretion indicated that they were at moderate risk for
iodine-deficiency disorders. Iodized salt coverage in
three villages increased from 10% in 1999 to 30% in
2000. Although iodine intake among the 300 children
and 300 women was not yet adequate, those in village
centers showed greater usage rates and urinary iodine
excretion values than those in remote units. We found
the reasons that residents in remote units did not use
108 Food and Nutrition Bulletin, vol. 23, no. 1 © 2002, The United Nations University.