Role of Effective Enforcement of Salt Iodization Legislation in Improving the Supply and Distribution of Adequately Iodized Salt.

Objectives: The production and distribution of non iodized salt is banned by the legislation in Senegal and the Ministry of Trade (MoT) supported by the police forces and the Department of Hygiene of the Ministry of Health is mandated to enforce this legislation. However, household use of iodized salt remains <70%. We undertook this survey to compare apparent governmental commitment to enforcing salt iodization legislation and production of iodized salt. Methods: Technical and logistical support were provided to regional offices of MoT covering salt producing regions and Five year data trends were collected from regional MoT offices in two salt producing regions. Analyses included: number and frequency of enforcement activities in productions sites, fines paid by defaulters and total production of adequately iodized salt in comparison to changes in leadership at these offices. Results: Between 2008 and 2012, the level of enforcement/ field controls decreased sharply in region 1 (from 138 to 35) and increased in region2 (from 30 to 140). Fines paid by defaulters between 2008 and 2012 were 600,000FCFA in region1 against 4,075,000FCFA in region2. In region 1, the production and distribution of adequately iodized salt declined from 20,000 to 12,000 MT per year in 2008 and2012, while in region2it steady increased from 6,000 to 25,000 MT per year in2008 and 2012, respectively. Conclusions: Whatever the resources used in training small salt producers, and communicating for their behavior change, Universal Salt Iodization will be difficult to achieve without a commitment of the authorities responsible for enforcing regulations.

Feasibility of Using Electronic Rapid Testing Kits for Improved Monitoring of Salt Processors.

Objectives: Quality control is a process to detect and correct production default from specified standards during actual processing. In salt iodization units, iodized salt samples are collected and tested through iodometric titration, in a laboratory attached to the production unit. Small and medium-scale producers do not have these adjacent laboratories. The time-lag between sample collection, testing, and incorporation of corrective guidance increases the risk of producing non-standard iodized salt. The objective of this study was to assess real-world accuracy of a recently developed electronic Rapid Testing kit (eRTK, Innovative design) as a more rapid method of controlling iodine levels in salt, particularly in small-scale production sites. Methods: 3198 iodized field salt samples were tested using 15 eRTKs, in accordance to the standard operating protocol of the instrument and compared with results from standard iodometric titration. Sample types included free flow salt, washed and crushed salt, crushed salt and crystal salt from eight different geographical areas, representing each type of salt produced in India. Results: The instrument is accurate to ±3 ppm in salt iodization between 15 – 55 ppm. Results from the study report a sensitivity of 76.3%, specificity of 81.9%, positive predictive value of 79.5% and negative predictive value 79%. The cost of testing iodized salt samples using eRTK is 25% of that of iodometric titration. Conclusions: eRTK was found to be a rapid, accurate and portable alternative to titration testing that is suitable for salt traders, retailers and enforcement agencies to ensure the iodization levels of salt.