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Current Iodine Deficiency Disorder Situation
Population
Population: 30.7 million
Population growth rate: 1.27%
Population < 15 years: 42 %
Birth rate: 28 per 1000
Life expectancy at birth: 47 years
Infant mortality: 68 per 1000
Prevalence of Goiter/ UIE
Median urinary iodine: 113 mcg/L (1994). A 1994 National Micronutrient Survey conducted in 45 districts found total goiter rate 16%. Three had no goiter problems, while 30 had mild IDD with goiter prevalence between 5 and 19%, 7 had moderate problem (TGR 20-29%) and 5 districts were noted to have goiter prevalences greater than 30%. Limited survey data from Mombasa , Nairobi & Rift Valley collected in 1984 indicated TGR prevalence around 20%. The national prevalence was 16.3%. Multicenter study (1995) 3 sites: TGR 14% (Kericho), 11% (Kiambu), 9.5% ( Nairobi ).
Mean urinary iodine of 62 mcg/L (also reported as 26-95 mcg I/g creatinine and elsewhere as 113 mcg/L) was observed in a sub-sample of the survey population in the National Micronutrients Survey (1994). Multicenter study (1995) reported for above 3 sites: 125, 378, and 580 mcg/L.
Iodized salt Coverage
Household iodized salt use: 90%
Salt Situation Analysis Production
Kenya is a major salt producer, of which 85% (235,000 tons per year) comes from the sea. Most is processed in Malindi and Mombasa by five major salt companies, one of which is a refiner. Iodization is carried out by manual or continuous spraying and subsequent mixing is not done by the small packaging companies.
Analysis of salt samples in the Multicenter Study by titration showed about 60 ppm at the household level, 39 ppm at the retail level, and 51 ppm at the production level. The higher levels of the household were attributed to excessive iodization by small packaging companies that are poorly monitored. An older study (East African Medical Journal 71:611, 1994) with data from 1991 confirmed wide variations in iodine content of salt, with some samples as high as 8,000 ppm.
Insignificant amount of salt is imported from Holland and Italy
Consumption
- Estimated daily per capita salt consumption: 5-10
- Estimated % of all salt consumed by people which is adequately iodized (household level): 90%
Iodine Procurement and Utilization
KIO3 at 100 ppm.
Universal Salt Iodization Program
Information, Education, Communication (IEC) Activities
Legislation
- Legislation: Yes. Note: The level of iodine in salt can be changed by the Bureau of Standards without new legislation
- Legislation for Animals: No, but most cattle salt is iodized
- Year Enacted: 1978, revised in 1988
Program Monitoring and Evaluation
Nutrition Program, MOH, in collaboration with Kenya Bureau of Standards is responsible for salt iodine monitoring. An IDD Laboratory was set up with support from UNICEF. In 1987 a National Council for the Control of Iodine Deficiency Disorders was established to create a proposal to prevent IDD. Currently there is a micronutrient project, started in 1990, working on iodine, iron and vitamin A.
Several studies have used goiter by palpation. Capacity for urinary iodine analysis exists in the laboratories for the Ministry of Health, set up with UNICEF funding in 1990. Plans are underway for a national survey in 2002 using urinary iodine.
Other Interventions
None recently
Key Lessons Learned
Challenges and Constraints
Future Plans for Sustained IDD Elimination Major needs are better quality control with iodized salt, more data on urinary iodine and participation in regional discussions about harmonization of salt iodine levels. The current iodization level, 100 ppm as iodine, is one of the highest in the world, and concern exists about its being excessive. Results of the planned survey are being awaited before lowering iodine levels.
Sources:
IDD NL 13(2):21 (1997), multicenter study (1995)
IDD NL 18(1): (2002) |
