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

Difference in goiter rates between regular and
occasional users of iodized salt in Mongolia
Chieri Yamada and Dalphjabin Oyunchimeg
Editorial introduction
This paper was accepted for publication not only for its
positive findings but also for a negative observation. On
the positive side, it is of interest there was no difference
in goiter and urinary iodine excretion between families
that regularly used iodated salt and those that used it
only half of the time. The former constituted 20% of
the families and the latter 30%. The possibility must be
recognized that the five groups differed in other factors
in addition to iodated salt consumption. Ultrasound
examination is not needed to determine iodine-deficiency
disorder status when urinary iodine excretion is available.
However, since it was used in this study, it would
have been desirable to determine the relative size of the
goiters and not just their presence or absence.
On the negative side is the observation that the consumption
of iodated salt was limited by a price that was
three to seven more than noniodated salt. When salt was
first fortified with potassium iodate in Guatemala in
1956, iodated salt was being sold in the United States
at the same price as noniodated salt. When it was ascertained
that the cost of iodizing salt with potassium
iodate in Guatemala was so small per kilogram that it
did not justify an increase in the retail cost of salt, the
decree requiring universal iodation of salt for human
consumption so specified. Potassium iodate was used
for the first time instead of potassium iodide because
studies of the Institute of Nutrition of Central America
and Panama (INCAP) demonstrated that its iodine
was equally available [1] and that it could be added
with only a small loss, even under unprotected tropical
conditions [2]. This meant that there was no need to dry
and refine it and sell it in moisture-proof packages or
to increase the price.
Chieri Yamada is affiliated with the Department of Nursing,
School of Health Sciences, Hirosaki University, Hirosaki,
Japan. Dalphjabin Oyunchimeg is affiliated with the Department
of Public Health, Ministry of Health, in Ulaanbaatar,
Mongolia
Mention of the names of firms and commercial products
does not imply endorsement by the United Nations University.
Today the water-insoluble potassium iodate is the
basis for salt iodation in developing countries, since
the quality and packaging of the salt are unimportant
to its correction of iodine deficiency. Salt with iodine
should not cost the consumer significantly more than salt
without iodine, but there are complicating circumstances.
In Mongolia refined iodated salt must reach rural areas
through a geographically difficult supply chain, and
it cannot be expected to be sold at the same price as
crude local salt. Nevertheless, there is no justification
for the huge price differential observed by the authors.
This violates the human rights of the population and is
unacceptable. There should be no economic obstacle to
substituting iodated salt for noniodated salt.
There is clearly a need for any agency that promotes
the national iodation of salt in countries to ensure it
is not made a pretext for price-gouging of those most
in need. Unfortunately, governments sometimes do not
recognize the importance of having salt with iodine
available at the lowest possible cost and impose valueadded
taxes and other taxes on it, as is currently the
case in Mongolia. Locally gathered salt can be cheaper,
therefore, because producers do not pay these taxes. The
recent initiative by the Asian Development Bank and
UNICEF to promote the universal iodation of salt in
the countries of Central Asia and Mongolia calls for the
removal of all tariff barriers to the production and sale
of iodated salt. This has been accepted as a requirement
for financial support by all of the participating countries,
and when implemented, should improve the prospects
for affordable salt in Mongolia.
Remarkably, soon after this editorial was first drafted,
the same authors submitted a Letter to the Editor (page
108) that provides an excellent response to it. Recognizing
that a high price for iodated salt was inhibiting its use,
particularly in rural areas, they initiated a pilot study
using a simple method of adding potassium iodate to
the local crude salt at the village and family level in
three villages. The resulting salt sold for a price similar
to that for noniodized salt. It is clear that this approach
is labor intensive, and, as they note, it would require a
strong communication and education program. For these
Food and Nutrition Bulletin, vol. 23, no. 1 © 2002, The United Nations University. 89