Population

Population:   9.8 million
Population growth rate:   1.93%
Population < 15 years:   47.4%
Birth rate:   41.5 per 1000
Life expectancy at birth:   37.3 years
Infant mortality:   90.9 per 1000

Prevalence of Goiter/ UIE

Median urinary iodine: No recent surveys.

1971 national prevalence survey of 49,322 school children from 6-12 years and 5,518 adults in 37 districts showed a high prevalence of 50.5% goiter. Data from 1989 in Livingstone of 1163 children from 3-14 was 18%. In 1992 a survey in C homa showed a 68% goiter among 105 children aged 8-12 years. (Gutekunst, R., 1993) 1993 National survey of schoolchildren noted a TGR of 32%. Multicenter Study (1996) showed following decreases in TGR since 1993: Livingstone, 82% to 4.3%; C homa, 59% to 16%; Katete, 31% to 4%.

Urine survey done in 1993 found a median value of 60 mcg/L. Multicenter Study (1996) showed UI of 180, 264, and 175 mcg/L for above 3 regions.

Iodized salt Coverage

Salt Situation Analysis

Production

Almost all salt is imported into Zambia , mainly from Botswana , some from Namibia , and South Africa . Botswana supplies both fine and coarse salt and Namibia only coarse. There are four main importers, with National Milling C ompany being the largest, importing 10,000-15,000 MT of the total annual requirement of 30,000 MT for human consumption. Salt imported by the National Milling C ompany was previously iodized at 40 pp, and now iodized at 80 ppm (1997). 

Local production of salt takes place in the northern and northwestern provinces. It provides less than 10% of the total requirement. It is produced from a special grass growing in the salt pans and soil scraped from the pans.  Reports from the Food and Drug Laboratory described 76 salt samples in 1997, with a range of 2-779 ppm, of which 22 were below 50 ppm as KIO3, and 10 were > 168 ppm.  Data from 1998 of locally produced salt ranged in iodine content from 0-107 ppm as KIO3; of 54 imported samples, only one was in the acceptable legal limit and the rest were < 50 ppm KIO3.

Consumption

• Estimated daily per capita salt consumption: 10g
• Estimated % of all salt consumed by people which is adequately iodized (household level):   37%.  Utilization was reported as 93% in urban communities in 1995, but declined to 65% by December 1997.  Kaputa was lowest (4%) with Kasempa 24% and Mufumbde, 36%. 

Iodine Procurement and Utilization

Universal Salt Iodization Program

Information, Education, Communication (IEC) Activities

Legislation

• Legislation: Yes
• Legislation for Animals: no data
• Year Enacted: 1978; revised in 1994 with review scheduled in 1998.  Salt regulations under Food and Drugs Act, administered by MOH, with mandatory review every four years

Program Monitoring and Evaluation

MOH is responsible, with National Food and Nutrition C ommission and its National IDD C ontrol Task Force.

Zambia Food and Drug Laboratory carries out iodine analysis, but funding inadequate and laboratory future uncertain.  No reliable facility for measuring

urinary iodine.  Initial dramatic increase in use of iodized salt, peaking around 1995.  Since, use has declined, and current estimate down to 37% (2000).

Other Interventions

Uncertain; some use of oral iodized oil in hyperendemic areas in 1993.

Key Lessons Learned

Challenges and Constraints

Future Plans for Sustained IDD Elimination

Sources:

IDD NL 15(1):7, 1999.