Population

Population:  24.0 million
Population growth rate:  2.9%
Population < 15 years:  51 %
Birth rate:  48 per 1000
Life expectancy at birth:  43 years
Infant mortality:  91 per 1000

Prevalence of Goiter/ UIE

Median urinary iodine: 310 mcg/L. A survey published in 4/00 assessed six districts from different parts of the country:  (1) Apac (lowland, northern); (2) Hoima (lowland, Midwestern); (3) Lowero (lowland, central); (4) Kisoro (highland, southwestern); (5) Kabale (highland, western); and (6) Kapchorwa (highland, eastern). 

The overall median urinary iodine was 310 mcg/L, range 156 (Kisoro) to 517 (Luwero).  The overall range was 15-795 mcg/L; 5% were < 50 mcg/L. 

The total goiter rate was 60.2%, ranging from 42.6% in Luwero to 76.3% in Kapchorwa.  The visible goiter rate 30.9%.  Rates were similar in boys and girls.  Results from a 1991 survey conducted in four endemic districts (Kisoro, Bundibugyo, Hoima and Kapchorwa) indicated TGR prevalence of 75%, gathered from a sample of 1523 schoolchildren. In 1992, a survey in Masindi district of 2032 schoolchildren (11-13 yrs) found a mean TGR of 44%, and the goiter rate was highly correlated with cassava preparation. A 1993 integrated micronutrient survey found TGR > 5% in 37 of 39 districts surveyed, and a national TGR of 15.7%.

Iodized salt Coverage

Salt Situation Analysis

Production

90% of the salt is imported from Kenya , the rest is from small producers, mostly in Kasese.  This is the source of much of the country's cattle salt, which is also frequently used by people and is currently not iodized (2002).  The government and UNI C EF have submitted a project request to provide effective salt iodization in Hoima and the lake Katewe in the west. 

Consumption

• Estimated daily per capita salt consumption: no data
• Estimated % of all salt consumed by people which is adequately iodized (household level):   (1997) 65%; C entral 91%, East 59%, North 38%, West 62% (considered adequate if 20-50 ppm at household).  A 1997 survey of 165 salt samples from Kampala and from several outlying districts reported that 60% of samples contained at least 50 ppm iodine.  A DHS survey was finished (2002) and data analysis is awaited. 

Iodine Procurement and Utilization

Universal Salt Iodization Program

Information, Education, Communication (IEC) Activities

First Lady, Janet Musaveni launched Uganda 's USI campaign during a one-day IDD/USI workshop held in Kampala . Workshop participants included ministers and commissioners of various ministries, representatives of salt producers' associations, the National Bureau of Standards, the Revenue Authorities, and WHO and UNI C EF country representatives. The purpose of the workshop was to inform, sensitize, and update policy makers on IDD in Uganda and to discuss a plan of action for IDD control. Recommendations included establishing multi-sectoral coordination committee for IDD control, establishing quality control facilities, training of health care workers and salt importers on the importance of iodized salt. (UNI C EF USI Update- Vol. 2 - 1995).  Following the government ban in 1993 outlawing the importation into Uganda of non-iodized salt intended for human consumption, administrative measures were taken in order to implement the government directive.  They included the following: conducting a national rapid assessment micro-nutrient survey; formulating the regulations for iodized salt, on the basis of an already existing "Food and Drugs Act;" formulating a national standard for food grade salt; conducting national information dissemination seminars on the IDD situation in Uganda and adoption of national strategies to combat IDD in the country; developing and implementing a national plan of action on control of IDD through USI in Uganda.

Legislation

• Legislation: Statutory regulations under the Food and Drugs Act were passed, and the Uganda standards US 203:  1994 (standards specification for food grade salt) operates.
• Legislation for Animals: Status uncertain; 1993 C abinet resolution that all salt entering Uganda for human and livestock consumption must be iodized
• Year Enacted: 1994

Program Monitoring and Evaluation

Ministry of Health, Division of Nutrition. Active program is integrating IDD and vitamin A programs, conducting awareness campaigns, developing databases and monitoring systems.  A plan of action, based on iodized salt, launched in 1995.  An interagency nutrition committee meets every two months.  It includes salt retailers and is chaired by the Ministry of Health.

Iodine nutrition:   The 2000 survey was carried out by the Institute of Public Health at Makerere University .  It assessed goiter by palpation and urinary iodine by Method E. 

Other Interventions

None

Key Lessons Learned

Challenges and Constraints

Future Plans for Sustained IDD Elimination

The careful 2000 report from Makerere raised the issues of possible iodine excess, the continued presence of goiter, uneven distribution of iodized salt in the country, and standards of salt iodization.  The authors recommend a surveillance system for both salt iodization and urinary iodine, to include sentinel districts, assessment every three years, with introduction of ultrasonography for survey monitoring, and expert assessment from I C C IDD and WHO in five years, strengthening of the control program to clarify the role of the national multisectoral committee, advocacy, education of the population, studies to determine average daily per capita consumption and cooking losses, encouragement for local salt producers.

Sources:

IDD NL 18(1):    (2002)

IDD NL 13(2):23 (1997)

Lwamafa, country paper, Harare conference (4/96)

UNI C EF USI Update, as above