Population

Population:  70.678 millions
Population < 18 years:  36.987 millions ; <5 yrs: 12.453 millions
Population annual growth rate:  2.8%
Crude birth rate:   4 2 per 1000
Life expectancy at birth:  46 years



Current Iodine Nutrition Situation

Prevalence of Goitre/ Urinary Iodine Concentration

In the late 1990s, the Ethiopian Health and Nutrition Research Institute, Addis Ababa, undertook a cross-sectional study selecting 2,485 elementary school children belonging to ten villages from four administrative regions of Ethiopia. The study revealed that Urinary iodine measurements showed moderate iodine deficiency in 70% of the samples, and mild iodine deficiency in 30% of the samples.

The prevalence rate of goitre (average of male and female values) among school children was 53.3%. The prevalence was higher in girls (56.1%) than in boys (50.8%). The highest prevalence was observed in the villages of Lotte (82%) and Kodowono (91%) and the lowest in the village of Abossara (31%).

The earliest published report about IDD in Ethiopia (1976) indicated area-specific goitre rates as high as 71%. The first and only nationally representative IDD survey was conducted in 1981-82. This household and school-based survey included 38 of the 85 provinces, which had a total population of about 19 million. (Household study: n-19,158 and School Study: n-35,635) The findings revealed that the overall male and female goitre rates were 30.6% and 18.7% respectively (visible goitres of 1.6% and 3.2% respectively).

Iodized salt Coverage

Household consumed iodized salt 1 : 28 %.

Salt Situation Analysis

Production

The total salt requirement for Ethiopia is 350,000 tons per year (320,000 TPA for consumption and about 30,000 TPA for the canning industry).

In spite of having its own sources, Ethiopia has been importing most of its needs. Production of salt by solar evaporation of inland brines is a relatively recent phenomenon in Ethiopia. Till 1998 Ethiopia used to import salt from Eritrea. Later, about 80% of the Ethiopian salt needs began to be met by imports from Djibouti. The latter was producing small quantities of salt at Lake Assal till 1998 and the demand from Ethiopia resulted in increased production. From 1998 to 2001, the number of companies producing salt at Lake Assal rose from 4 to 12 ( Banque Central de Djibouti , Undated). However, when Ethiopia started producing its own salt, it started levying 53% tax on imported salt since October 2003. As the salt produced in Ethiopia is naturally cheaper than that brought from Djibouti, the demand for Djibouti salt fell down drastically.

Though imports from Djibouti have not stopped altogether, Ethiopia's own sources have started producing salt in increasing quantities. The following Table gives the figures of production of salt in Eritrea, Ethiopia and Djibouti during the years 1998 to 2002.

Salt production in Ethiopia, Eritrea and Djibouti (in Tons)

( Source : Thomas R. Yager, The Mineral Industries of Djibouti, Eritrea, Ethiopia and Somalia,

http://minerals.usgs.gov/minerals/pubs/country/2002/djeretsomyb02.pdf .)

There are two main iodisation plants in Ethiopia, one at Mekelle in the Tigray region and another near Addis Ababa but h undreds of small-scale units are functioning along the shores of Lake Afdera, each with an individual production varying between 3,000 to 5,000 tons. Figures of the actual number of such units and their total production are not available.

Consumption

• Households consumed adequately iodized salt (2000):   28%

Universal Salt Iodization Program

Information, Education, Communication (IEC) Activities

Awareness of IDD problems and the benefits of iodised salt by the Ethiopian public are low. Following research carried out by a UNICEF consultant in 1999, it was evident that consumers were aware of the link between goitre and lack of iodine. However, they were not aware of the wider consequences of IDD in mental capacity 2 .

Legislation

The National Guideline for Control and Prevention of Micronutrient Deficiencies formulated by the Federal Ministry of Health, Family Health Department (June 2004) states that "in Ethiopia an iodine content of 80-100 ppm is required as KIO­ 3 at the Port of entry or at the packaging factory. Iodine content for a level of 80 ppm or 80 mg/kg KIO­ 3 in one ton of salt = 80 grams KIO­­ 3 in one ton of salt."

Program Monitoring and Evaluation

Responsible parties are the Ministry of Health, Micronutrient Deficiency Control Task Force comprised of the Ethiopian Health and Nutrition Research Institute, Ministry of Trade and Industry, Ethiopian Authority of Standards, Ethiopian Mineral Resource Development Enterprise, Ministry of Information and Ministry of Education.

At present, there is no monitoring system. The program has been at a stand-still and previous progress with iodized salt from Eritrea has now been lost.  There are current indications of renewed interest on the part of the government.

Currently, the Ministry of Health is involved in the coordination and monitoring of implementation of the legislation. Due to competing priorities of health inspectors within local governments, there is lack of consistent public health inspection of salt production facilities system in place 2 .

Other Interventions

Oral iodized oil was administered to about 255,000 people in the severely affected areas.

Key Lessons - no data

Challenges and Constraints 2

In the mid-1990s Eritrea started iodised salt production, but the border conflict between Eritrea and Ethiopia resulted in Ethiopia 's salt supply being cut off. Currently, much of Ethiopia 's salt is imported from Djibouti and is not iodised, although producers in Djibouti have the capacity to iodise it. Ethiopia has legislation requiring that salt for sale for human consumption should be iodised but this is currently not being enforced due to the non-availability of nationally produced iodised salt.

Future Plans for Sustained IDD Elimination 2

Government in coordination with UNICEF 2005 has planned the following strategies for achievement of virtual elimination of iodine deficiency disorders by the year 2015 through USI in Ethipoia.

•  Formation of a national committee. The current micronutrient committee will be re-vitalised and the mandate of the committee will be enlarged under the leadership of the MOH.

•  Enable Industry Ownership and Capacities. Beyond provision of legislation regulating salt production, the gaps in knowledge and skills of salt producers will be addressed. The salt industry needs technical support and skills to improve production efficiency, reduce production costs, provide operational and professional guidelines for quality salt production, iodisation and handling of iodised salt. Revolving funds for the procurement of potassium iodate will be established.

•  Information, Education and Communication (IEC) activities are being planned to raise awareness among the community should be on a continuous basis and is yet to be realised.

•  Monitoring Mechanism and Quality Control. Federal and regional laboratories for testing and QC of iodised salt will be established. Salt monitoring will be undertaken at sites of production and packaging, at wholesale and retail levels, and at the household level. Multiple strategies for improvement of salt iodisation monitoring at the factory and community level will be identified and implemented.

•  Commercial viability and sustainability of elimination of IDD by iodisation of salt is a win-win situation for all partners involved, such as the business communities, consumers and public health professionals. USI of edible salt, including animal salt and salt used for food processing, is the principal strategy which will be adopted in Ethiopia for sustainable elimination of iodine deficiency.

•  Targeted activities in 3 major salt producing regions. The regions: Afar, Tigray and Somalia . The package of activities will include: (i) creating awareness on benefits of iodated salt to producers, local leaders and consumers; (ii) improving knowledge and skills on salt iodisation by training producers on salt iodation, QC and proper handling of iodated salt; (iii) provision of simple, user-friendly equipment and supplies for salt iodation; (iv) strengthening salt monitoring by training and sensitising salt inspectors, loal leaders, police and magistrates on monitoring of salt iodation; and (v) provision of micro-credit facilities.

References

•  UNICEF. The State of the World's Children. 2005

•  UNICEF. Control and Prevention of Iodine Deficiency Disorders (IDD) in Ethiopia . UNICEF Addis Ababa . May 2005.

•  IDD NL 17(2):26, 2000

•  IDD NL 16(2):25, 2000

•  IDD NL 15(2):26, 1999

•  IDD NL 13(2):20, 1997

•  IDD NL 10(3):30, 1994

•  UNICEF USI Update 1:3 (1996)