Salt Iodization Program Research Articles

Knowledge and practices of iodized salt consumption among pregnant women in Galle district

Introduction: Sri Lanka introduced national salt iodization programme in 1995 to control iodine deficiency disorders (IDD) as iodized salt is the main source of iodine in the population. Although Sri Lanka achieved a satisfactory control of IDD in 2005, a recent study showed that iodine nutrition in pregnant women in Sri Lanka is far below the WHO recommendation. Lack of knowledge on iodized salt and improper practices of its usage may cause iodine deficiency during pregnancy. Methods: Study was conducted in Bope-Poddala health division of Galle District in the Southern province. Pregnant women (n=425) with gestational age = Results : Forty percent of pregnant women in the sample had poor knowledge on iodized salt and the importance of iodine in the diet. Less than 50% of subjects were aware of bad consequences of maternal iodine deficiency on their babies and about 50% of them had improper practices on iodized salt usage. A poor correlation between the good knowledge and proper practices, were observed. Conclusion: Overall knowledge about iodine and iodized salt is not satisfactory and the health educational programmes expressing the importance of eliminating IDD at various levels is important to prevent iodine deficiency during pregnancy. Galle Medical Journal 2015 20(1): 10-16

Prevalence and Factors Associated with Goitre among 6-12-year-old Children in a Rural Area of Karnataka in South India.

In India, endemic goitre is present in sub-Himalayan region and in pockets in states of Andhra Pradesh, Karnataka and Gujarat. Being a public health problem amenable for prevention, the assessment of prevalence of endemic goitre in an area helps in understanding whether the preventive strategies under National Iodine Deficiency Disorder Control Program (NIDDCP) have any impact on the control of endemic goitre. Hence, the current study was carried out to determine the prevalence, distribution and factors associated with iodine deficiency goitre among 6-12-year-old children in a rural area in south Karnataka. A cross-sectional study was conducted among 838 children, using a questionnaire adopted from Iodized Salt Program Assessment Tool and the tools prescribed by WHO for goitre survey. The prevalence of goitre in the study area was 21.9% (95% CI 19.2-24.8). There was higher prevalence of goitre among those having salt iodine <15 ppm than those with >15 ppm (P = 0.01; OR 1.59; 95% CI 1.10-2.29). In 10% of the children, urinary iodine excretion (UIE) was assessed and prevalence was higher among those with <100 μg/l of UIE than those with normal UIE, which was not statistically significant (P = 0.8, OR 1.36; 95% CI 0.62-2.96). Multiple logistic regression revealed that gender (P = 0.002; OR 1.7; 95% CI 1.21-2.35) was an independent variable associated with goitre. The study area was found to be moderately endemic for goitre based on the WHO criteria. Higher prevalence of goitre was found to be still associated with consumption of low iodized salt (<15 ppm) necessitating emphasis on monitoring of salt iodine levels in the study area. Though NIDDCP is being implemented since five decades in India, the burden of iodine deficiency disorders (IDDs) is still high demanding further impetus to the monitoring systems of the programme.

Iodine nutrition status in lactating mothers residing in countries with mandatory and voluntary iodine fortification programs: an updated systematic review.

The aim of this review is to assess data available on iodine nutrition status in lactating mothers residing in countries with mandatory and voluntary iodine fortification programs and/or iodine supplementation. A systematic review was conducted by searching articles published between 1964 and 2013 in Pub Med, ISI Web, and Cochrane Library using iodine nutrition, lactation, iodine supplementation, and iodine fortification as keywords for titles and/or abstracts. Relevant articles were included if they reported urinary iodine concentration (UIC) in lactating mothers and, if determined, the type of iodine fortification program and/or iodine supplementation. Forty-two studies met the inclusion criteria. Among these, 21 studies assessed lactating mothers in countries with a mandatory iodine fortification program, 17 studies were from countries with voluntary and/or without iodine fortification programs, and four studies assessed iodine nutrition status in lactating mothers undergoing iodine supplementation. Among countries with mandatory iodine fortification programs, the range of salt iodization level in lactating mothers with a UIC <100 μg/L was between 8 and 40 ppm, whereas among lactating mothers with UIC >100 μg/L, it was between 15 and 60 ppm. Levels of UIC <100 μg/L were observed among lactating women in India, Denmark, Mali, New Zealand, Australia, Slovakia, Sudan, and Turkey, whereas in countries such as Chile, Iran, Mongolia, New Guinea, and Nigeria, the median or mean of UIC was >100 μg/L. There was a median or mean UIC <100 μg/L in nearly all lactating mothers residing in countries where implementation of universal salt iodization program was voluntary, including Switzerland, Australia, New Zealand, Ireland, and Germany. However, in some countries with voluntary iodine fortification programs, such as the United States, Spain, and Japan, a mean or median UIC of >100 μg/L has been reported. Although universal salt iodization is still the most feasible and cost-effective approach for iodine deficiency control in pregnant and lactating mothers, UIC in lactating mothers of most countries with voluntary programs and in areas with mandatory iodine fortification is still within the iodine deficiency range, indicating that iodine supplementation in daily prenatal vitamin/mineral supplements in lactating mothers is warranted. However, further investigations are still recommended in this regard.

Breast Milk Iodine Concentration Correlated with Urinary Iodine Concentration of Infants from Southern Ethiopia

Breast milk from iodine‐sufficient mothers is considered an adequate source of iodine for the exclusively breastfed infant until the age of 6 months. A national policy requiring salt iodization was initiated in Ethiopia in 2011, but reports indicate high variability in salt iodine concentration (SIC) at the community level. Although the recommended household SIC should be 15‐40 ppm, salt from 102 rural households of lactating women in southern Ethiopia ranged from 0 to 39 ppm. Only about 20% of households had SIC &gt;15 ppm. Mean ± SD age of mothers was 23 ± 3.9 y. Maternal BMI was 21.3 ± 2.5 and MUAC was 23.1 ± 1.9 cm. Goiter was observed in 75 of the mothers. Breast milk and urine samples were collected from these mothers and urine samples were collected from their 6 day old infants. Breast milk iodine (BMIC) and urinary iodine (UIC) were analyzed by inductively coupled plasma mass spectrometry (ICP‐MS). Median (Interquartile range) BMIC was 1551 (495, 2487) µg/L. Median maternal UIC was 106 (71, 160), but 47 had UIC below 100 µg/L. Median infant UIC was 212 (109, 348) µg/L. UIC of the mother correlated with BMIC (r=0.26, p&lt; 0.007). BMIC and infant UIC were correlated (r=.34, p&lt;0.0001) as were UIC of mother and infant (r=.63, p &lt;0.0001). UIC of the mother and iodine of the household salt predicted 15% of the variation in BMIC while UIC of the mother and BMIC predicted 41% of the variability in UIC of the infant. Despite the fact that the study population was getting variable amounts of iodine from the recently implemented salt iodization program, BMIC at 6 days after delivery was high. (Supported by Néstle Foundation and Oklahoma Agricultural Experiment Station).

Iodized Salt Improves Child's Iodine Status, Mental Development, and Physical Growth in a Cluster Randomized Trial in Ethiopia

The effectiveness of iodized salt programs to improve mental development and physical growth has not been studied in children &lt; 36 months. Using a cluster randomized design, 1835 infants 5‐11 mo old were enrolled in 60 villages in Amhara, Ethiopia. Following salt iodization legislation, iodized salt was forced early into the markets of 30 villages (intervention, I) before it became available in the 30 control (C) villages. The two groups were similar at baseline. Children (85% of the baseline sample) were re‐assessed at age 20‐29 mo. Treatment effects were analyzed using linear mixed models. The median endline urinary iodine concentration (UIC) was significantly higher in group I (161.6 vs 124.0 µg/L; p&lt;0.001). Group I had significantly higher scores at reassessment on three of the four Bayley‐III subscales: cognitive (std mean 6.40 vs 6.14; p&lt;0.05), receptive language (std mean 7.19 vs 6.92; p&lt;0.05), and fine motor (std mean 7.97 vs 7.59; p&lt;0.05). Moderator analysis indicated that length‐for‐age in children was higher in group I for those with high household assets. UIC was higher in I vs C children with an unschooled mother, unimproved water, and no recent illness. These results support universal salt iodization to improve children's life. [Funded by Micronutrient Initiative, Canada]

Iodine deficiency during pregnancy: a national cross-sectional survey in Latvia.

Low iodine intake during pregnancy may cause thyroid dysfunction, which results in inadequate fetal brain development. In the absence of a universal salt iodization programme, we conducted a nationwide survey of iodine deficiency in pregnant women in Latvia. A countrywide twenty-cluster survey, with at least twenty women per cluster. Participants completed a questionnaire on dietary habits concerning iodine intake (n 739). Thyroid function (thyroid-stimulating hormone, free thyroxine and thyroperoxidase antibodies) was measured (n 550). Urinary iodine was measured using the ammonium persulfate method (n 696). The survey was performed in all regions of Latvia during the spring and autumn seasons in 2013. Pregnant women (n 829). The median creatinine (Cr)-standardized urinary iodine concentration (UIC) was 80·8 (interquartile range (IQR) 46·1-130·6) µg/g Cr or 69·4 (IQR 53·9-92·6) µg/l during pregnancy, and 81% of pregnant women had UIC levels below the WHO recommended range of 150-250 µg/g Cr. The UIC was lowest during the first trimester of pregnancy, 56·0 (IQR 36·4-100·6) µg/g Cr, reaching higher concentrations of 87·5 (IQR 46·4-141·7) µg/g Cr and 86·9 (IQR 53·8-140·6) µg/g Cr in the second and third trimesters, respectively. Women taking supplements containing ≥150 µg iodine (6·8% of respondents) had non-significantly higher UIC than did women without supplementation (96·2 v. 80·3 µg/g Cr, respectively, P=NS). Thyroperoxidase antibody concentration did not correlate significantly with UIC: Spearman's ρ=-0·012, P=0·78. The median UIC indicates iodine deficiency in pregnant women in Latvia. Iodine supplementation (150 µg daily) and regular UIC monitoring should be suggested to overcome iodine deficiency and to reach the recommended levels without inducing autoimmune processes.

The Proportion of Households with Adequately Iodized Salt in Ethiopia

Objectives: According to the Ethiopia Demographic and Health Survey 2011, the proportion of households using iodized salt (>15 parts per million [PPM]) was 15.4%. The 2014 Ethiopia National Micronutrient Survey (ENMS) will estimate the national and regional proportions of households using adequately iodized (>15 ppm) salt in Ethiopia. Methods: The ENMS is a cross-sectional household survey designed to produce national and regionally representative estimates. Samples of salt (20 gram) usually consumed will be collected from approximately 4,000households for qualitative testing using the rapid test kit. Salt samples will be sent to the Ethiopian Health and Nutrition Institute Laboratory where iodometric titration will be conducted. Results: The national and regional proportions of households with adequately iodized (>15 ppm) salt will be presented. Conclusions: This survey will provide national and regional data for monitoring and evaluating the progress of the Universal Salt Iodization (USI) program in Ethiopia. © 2015 Zerfu et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Conference Abstract

Enhancing Salt Iodization Programs in Africa through the Establishment of Financially Viable Potassium Iodate (KIO3) Supply Systems

Enhancing Salt Iodization Programs in Africa through the Establishment of Financially Viable Potassium Iodate (KIO3) Supply Systems

Overview of Universal Salt Iodization Program as Main Strategy on Combating IDD in Afghanistan

Overview of Universal Salt Iodization Program as Main Strategy on Combating IDD in Afghanistan

A reliable and accurate portable device for rapid quantitative estimation of iodine content in different types of edible salt.

Continuous monitoring of salt iodization to ensure the success of the Universal Salt Iodization (USI) program can be significantly strengthened by the use of a simple, safe, and rapid method of salt iodine estimation. This study assessed the validity of a new portable device, iCheck Iodine developed by the BioAnalyt GmbH to estimate the iodine content in salt. Validation of the device was conducted in the laboratory of the South Asia regional office of the International Council for Control of Iodine Deficiency Disorders (ICCIDD). The validity of the device was assessed using device specific indicators, comparison of iCheck Iodine device with the iodometric titration, and comparison between iodine estimation using 1 g and 10 g salt by iCheck Iodine using 116 salt samples procured from various small-, medium-, and large-scale salt processors across India. The intra- and interassay imprecision for 10 parts per million (ppm), 30 ppm, and 50 ppm concentrations of iodized salt were 2.8%, 6.1%, and 3.1%, and 2.4%, 2.2%, and 2.1%, respectively. Interoperator imprecision was 6.2%, 6.3%, and 4.6% for the salt with iodine concentrations of 10 ppm, 30 ppm, and 50 ppm respectively. The correlation coefficient between measurements by the two methods was 0.934 and the correlation coefficient between measurements using 1 g of iodized salt and 10 g of iodized salt by the iCheck Iodine device was 0.983. The iCheck Iodine device is reliable and provides a valid method for the quantitative estimation of the iodine content of iodized salt fortified with potassium iodate in the field setting and in different types of salt.

Australian midwives’ understanding and experience of routine enquiry for intimate partner violence during pregnancy

Introduction: Insufficient iodine intake during pregnancy is the leading cause of preventable mental impairment worldwide. Iodine supplementation during pregnancy and lactation is recommended in countries with low soil iodine and without a universal salt iodisation programme, including Australia, to prevent the deficiency. Even mild iodine deficiency during pregnancy has been associated with reduced cognitive outcomes of children of primary school age. Pregnant women do not appear to bewell advised about its role and requirements, in contrast to folic acid forwhichpregnant women appear well informed. Aim: To present the knowledge and practices of childbearing women related to iodine and folic acid supplementation. Methods: A survey of pregnant women at 22 weeks gestation was undertaken. Pregnant women were recruited from antenatal clinic of the major public hospital in the Illawarra area of New SouthWales. In addition to other aspects of the study, participants completed a survey at 22 weeks gestation which asked questions related to nutrition. Results: A total of 39 participants have been recruited to date. Most participants (85%) reported taking a supplement during pregnancy, 74% and 77% reported taking a supplement containing iodine and folic acid respectively. Just under two thirds (62%) of participants felt they had received adequate information about iodine, compared to 87% for folic acid. Conclusion: Over two thirds of participants (69%) knew that the recommended period to take folic acid supplements was prior to conception and during the first trimester, whereas only 38.5% knew that iodine should be taken throughout the entire pregnancy. Although these findings only represent a small number of participants, they add to the existing literature which highlights that pregnant women are poorly informed about iodine. Antenatal care providers should ensure that their pregnant clients are well educated about supplementation recommendations during pregnancy.

Iodine supplementation during pregnancy: Are pregnant women aware of its importance?

Abstract of a poster presentation at ACM 2015 Conference, Gold Coast, 5-8 October. Disciplines Medicine and Health Sciences | Social and Behavioral Sciences Publication Details Baafi, M., Lucas, C., Charlton, K., Townsend, M. & Grenyer, B. (2016). Iodine supplementation during pregnancy: are pregnant women aware of its importance?. Women and Birth, 28 (Suppl. 1), S39-S39. This journal article is available at Research Online: http://ro.uow.edu.au/smhpapers/3613 ACM2015 Poster Presentations Abstract Iodine supplementation during pregnancy: Are pregnant women aware of its importance? Mercy Baafi*, Catherine Lucas, Karen Charlton,Michelle Townsend, Brin Grenyer University of Wollongong, Wollongong, Australia *Corresponding author. Introduction Insufficient iodine intake during pregnancy is the leading cause of preventable mental impairment worldwide. Iodine supplementation during pregnancy and lactation is re commended in countries with low soil iodine and without a universal salt iodisation programme, including Australia, to prevent the deficiency. Even mild iodine deficiency during pregnancy has been associated with reduced cognitive outcomes of children of primary school age. Pregnant women do not appear to be well advised about its role and requirements, in contrast to folic acid for which pregnant women appear well informed. Aim To present the knowledge and practices of childbearing women related to iodine and folic acid supplementation. Methods A survey of pregnant women at 22 weeks gestation was undertaken. Pregnant women were recruited from antenatal clinic of the major public hospital in the Illawarra area of New South Wales. In addition to other aspects of the study, participants completed a survey at 22 weeks gestation which asked questions related to nutrition. Results A total of 39 participants have been recruited to date. Most participants (85%) reported taking a supplement during pregnancy, 74% and 77% reported taking a supplement containing iodine and folic acid respectively. Just under two thirds (62%) of participants felt they had received adequate information about iodine, compared to 87% for folic acid. Conclusion Over two thirds of participants (69%) knew that the recommended period to take folic acid supplements was prior to conception and during the first trimester, whereas only 38.5% knew that iodine should be taken throughout the entire pregnancy. Although these findings only represent a small number of participants, they add to the existing literature which highlights that pregnant women are poorly informed about iodine. Antenatal care providers should ensure that their pregnant clients are well educated about supplementation recommendations during pregnancy.

Thyroid and iodine nutritional status: a UK perspective

Iodine is an essential component of the thyroid hormones, which play a crucial role in brain and neurological development. At least one-third of the world's population is estimated to be iodine deficient predominantly in developing countries. Recently concern had also been expressed about the iodine status in industrialised countries such as the UK. A recent survey of the UK iodine status found that that more than two-thirds of schoolgirls aged 14-15 years were iodine deficient due to the reduced milk intake. Maternal iodine deficiency in pregnancy is correlated with cognitive outcomes such as intelligence quotient and reading ability in offspring. No randomised trial data exist for iodine supplementation in mild-moderate iodine-deficient pregnant women. It is possible to combine population interventions to reduce population salt intake with salt iodisation programmes in order to maintain adequate levels of iodine nutrition.

Incidence of congenital hypothyroidism in the Autonomous Province of Bolzano: benefit of increased iodine intake.

Although a nation-wide salt iodization program on voluntary basis was implemented in 2005, many areas in our country are still characterized by mild iodine deficiency. Differently from the rest of Italy, an efficient program of iodine prophylaxis was implemented in 1981 in the Autonomous Province of Bolzano. The aim of this study was to investigate whether an adequate iodine intake in the population may affect the incidence of permanent congenital hypothyroidism (CH). The incidence trends of permanent CH between 1987 and 2006 in Bolzano Province and in the rest of Italy were estimated. Over the years, the CH incidence has remained steadily lower in Bolzano than in the rest of the country. Primary prevention of permanent CH may be possible by assuring an adequate nutritional iodine intake in the population. However, the time needed to observe a decrease in the incidence of CH is about a decade under conditions of iodine sufficiency.

Iodine Deficiency Disorders After Sixteen Years of Universal Dietary Salt Iodization in a Severe Iodine Deficiency Village in Niger

Introduction: Since 1996, Niger has officially adopted the universal dietary salt iodization program (UDSI). Objective: It is a before‑after trial study conducted to determine the impact of UDSI program in Tiguey 16 years after. Subjects and methods: The study was centered on 371 volunteers whose thyroid gland was palpated and urinary iodine concentration (UIC) determined in 319 of them. Results: The total goitre rate (TGR) was 13.20% with 9.70% invisible but palpable goitre (G1) and 3.50% visible goitre (G2). In 1987, the TGR was 77.15%, with 25.25% G1 and 51.90 % G2. The median UIC was 166.00 μg/L, the 20th percentile 66.40 μg/L and the 80 percentile was 300 μg/L. 68.34 % of the volunteers had a UIC ≥ 100 μg/L, 2.51% &lt;20 μg/L, 10.97% between 20 and 49 μg/L and 18.18% between 50 and 99 μg/L. In 1987, only 3.96% of the studied sample had a UIC ≥ 100 μg/L, 45 % had a UIC &lt;20 μg/L, 35% between 20 and 49 μg/L and 16% from 50 to 99 μg/L. No significant relationship was found between UIC and age and gender or goitre prevalence and gender (P&gt; 0.05). However, goitre prevalence increases significantly with age (p &lt; 0.05). Conclusion: The implementation of the UDSI program in Niger decreased goitre prevalence and significantly improved the nutritional iodine status of the populations of Tiguey. However a slight endemic goitre and mild to moderate iodine deficiency persists.

Prevalence of goiter and thyroid nodules before and after implementation of the universal salt iodization program in mainland China from 1985 to 2014: a systematic review and meta-analysis.

ObjectivesWe comprehensively estimated the prevalence of goiter and thyroid nodules (TNs) before and after the implementation of the Universal Salt Iodization (USI) program in mainland China and provided information for creating effective health policies.MethodsPubMed, Google Scholar, CNKI, Chinese Wanfang and Chongqing VIP databases were searched for relevant studies from Jan 1985 to Feb 2014. Data from eligible citations were extracted by two independent reviewers. All analyses were performed with Stata 11.0 and SPSS 17.0.ResultsEligible articles (N = 31; 4 in English and 27 in Chinese) included 52 studies (15 about goiter rates made before 1996 and 14 afterwards, and 23 about TNs). Our meta-analysis suggests a pooled prevalence for goiter before and after 1996 and for TNs of 22.8% (95% CI: 15.3%, 30.3%), 12.6% (95% CI: 9.4%, 15.8%) and 22.7% (95% CI: 18.3%, 27.0%), respectively. Egger's test of three independent categories revealed no evidence of publication bias (p = 0.101, 0.148 and 0.113, respectively).ConclusionsThe prevalence of goiter was reduced by almost half after 1996 in mainland China, so the USI program was considered beneficial. However, subgroup analysis suggests that both insufficient and excess iodine may be associated with goiter. The prevalence of goiter and TNs increased significantly after 2002, suggesting a risk of excessive iodine intake. Thus, salt iodization standardizations should be set according to local conditions.

Concept of double salt fortification; a tool to curtail micronutrient deficiencies and improve human health status

Fortification of food with micronutrients such as vitamins and minerals is one of the main strategies used to combat micronutrient deficiencies. Fortification in common salt is a fruitful strategy because of the daily consumption of 5-12 g salt per person globally. Therefore double fortification of salt with iodine and iron could be a reasonable approach to prevent both iodine and iron deficiencies. It is reckoned that about two billion people are iodine-deficient worldwide. Iodine deficiency during pregnancy may affect the health status of both mother and fetus and increase infant mortality. Deficiencies of both these micronutrients during childhood affect somatic growth and cognitive and neurological function. Thyroid metabolism is negatively affected by iron deficiency and reduced effectiveness of iodine prophylaxis in areas of endemic goiter. High prevalence of iron deficiency among children may be reduced by the application of effective iodized salt programs. However, ensuring the stability and bioavailability of both iron and iodine as double-fortified salt is difficult. Iodine present in iodide or iodate form in dual-fortified salt is oxidized to free iodine in the presence of ferrous ions and oxygen and consequently loses its characteristics. Moreover, ferrous iron is more bioavailable but is readily oxidized to the less bioavailable ferric form. However, both forms of iron may lead to discoloration of the final product, which can be reduced by providing a physical barrier around the iron. Salt encapsulation is one of the best tools to provide a physical barrier for undesirable reactions and interactions during storage. In this review the concept of dual salt fortification, the impact of fortification on curing various life-threatening maladies, latest assessments of mineral deficiencies and the choice of fortificants are discussed.

Variation in iodine concentration of salt at the local level following national salt iodization in Ethiopia (804.31)

Ethiopia launched a salt iodization program in 2011. The objective of this study was to evaluate the concentration of iodine in salt 2 years after the national proclamation that all salt for human consumption should be iodized. Salt samples were collected from 193 randomly selected households in Sidama zone, southern Ethiopia. The study participants were from farming communities where more than two‐thirds of the families were subsistence farmers. Iodine concentration of salt was analyzed using a portable digital electronic iodine checker (WYD, UNICEF) and by inductively coupled plasma mass spectrometry (ICP‐MS). Correlation between the analyses was 0.69 (p&lt;0.001). Mean (±SEM) iodine concentration using the digital iodine checker was 7.8 (8.0) ppm and by ICP‐MS was 9.8 (8.6) ppm. The recommended salt iodine concentration at the household level should be 15 to 40 ppm, but in this survey varied from 0 to 41.1 ppm; only 21% of households had &gt;15 ppm. Salt samples from 10 retail shops and open markets had a mean iodine concentration of 5.3 (4.0) ppm with a range from 0 to 10.9 ppm which was far below the recommended retail level of 20‐40 ppm. The results indicate that salt may not be homogenously or adequately iodized and/or storage and handling may not be appropriate. Hence a strong monitoring strategy from production to household level for Ethiopia’s salt iodization program is of great importance.Grant Funding Source: Supported by Nestlé Foundation and Oklahoma State University

Iodized salt benefits infant mental development: preliminary results from a cluster randomized trial in Ethiopia (389.4)

Iodine deficiency is thought to contribute to delayed mental development. The effectiveness of iodized salt programs to eliminate this delay has not been studied in children under 36 months. Using a cluster randomized design, 1880 infants 6 to 10 mo old were administered Bayley Scales of Infant and Toddler Development (BSID‐III) in 60 villages in Amhara, Ethiopia. Following salt iodization legislation, iodized salt was forced early into the markets of 30 villages (intervention group) before it became available in the 30 control villages. The two groups had similar socioeconomic, nutrition, and mental development scores at baseline. The same children (86% of the baseline sample) were re‐assessed with the BSID‐III when 20 to 29 mo of age. Analysis was done with a linear mixed model. The intervention group had significantly higher scores at reassessment on three of the four subscales: cognitive (std mean 6.4 vs 6.1, p&lt;0.05), receptive language (std mean 7.2 vs 6.9, p&lt;0.05), expressive language (std mean 6.4 vs 6.2, ns), and fine motor (std mean 7.94 vs 7.63, p&lt;0.05). Effect sizes were small (d=0.11), possibly due to the low socioeconomic status, diet diversity, and stimulation as well as high prevalence of stunting and access to iodized salt in some control areas that may have hampered greater benefits that iodine alone could provide.Grant Funding Source: Supported by Micronutrient Initiative, Canada

Iodized salt benefits children school readiness: preliminary results from a cluster randomized trial in Ethiopia (635.2)

Iodine deficiency is thought to contribute to delayed mental development. The effectiveness of iodized salt programs in reducing this delay has not been studied in children 6 years and under. Using a randomized cluster design, 1835 children 54 to 60 mo old were sampled from 60 villages in the Amhara region of Ethiopia. The iodized salt and control groups were comparable on all baseline variables, including maternal schooling (89.6% had none) and child dietary diversity (mean: 2.2 out of 7 food categories). Once national production of iodized salt began, the project facilitated early delivery to intervention village marketplaces; iodized salt arrived to control village marketplaces approximately 6 months later. The same children (92% of the original sample) were re‐assessed at 69 to 78 mo of age. Intervention group children had a significantly higher score on the 25‐item school readiness test (mean: 8.3 vs 7.8, respectively, p&lt;0.05). No significant differences were found on the two Wechsler tests of reasoning, analyzing raw or standardized scores (0‐19); standardized mean values were very low: Matrix Reasoning (4.0) and Similarities (5.5). In conclusion, along with the exposure to iodized salt, the school readiness skills of 5‐ and 6‐year‐old children benefited possibly because they had exposure to older siblings' literacy and math skills but not to cognitive and verbal reasoning.Grant Funding Source: Supported by Micronutrient Initiative, Canada