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. 2020 Oct;16 Suppl 2(Suppl 2):e12827.
doi: 10.1111/mcn.12827. Epub 2020 Aug 24.

Universal Salt Iodisation: Lessons learned from Cambodia for ensuring programme sustainability

Karen Codling  1 , Arnaud Laillou  2 , Christiane Rudert  3 , Mam Borath  4 , Jonathan Gorstein  5
Affiliations

Universal Salt Iodisation: Lessons learned from Cambodia for ensuring programme sustainability

Karen Codling et al. Matern Child Nutr. 2020 Oct.

Abstract

Iodine deficiency is the leading cause of preventable intellectual disability in the world, but it has been successfully prevented in most countries through universal salt iodization (USI). In 2011, Cambodia appeared to be an example of this success story, but today, Cambodian women and children are once again iodine deficient. In 2011, Cambodia demonstrated high-household coverage of adequately iodized salt and had achieved virtual elimination of iodine deficiency in school-age children. However, this achievement was not sustained because the USI programme was dependent on external funding, and the national government and salt industries had not institutionalized their implementation responsibilities. Recent programmatic efforts, in particular the establishment of a regulatory monitoring and enforcement system, are turning the situation around. Although Cambodia has not yet fully regained the achievements of 2011 (only 55% of tested salt was adequately iodized in 2017 compared with 67% in 2011), the recent steps taken by the government and the salt industry point to greater sustainability of the USI programme and the long-term prevention of iodine deficiency in children, women, and the general population.

Keywords: Cambodia; iodine deficiency; program sustainability; regulatory monitoring and enforcement; salt iodization.

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Conflict of interest statement

All authors are proponents of mandatory salt iodization as the most effective intervention for the prevention of iodine deficiency, and Arnaud Laillou, Christiane Rudert, and Borath Mam have all been directly involved in supporting and implementing the salt iodization programme in Cambodia.

Figures

Figure 1
Figure 1
Household use of iodized salt in Cambodia (2000 – 2017). Ref: 2000, 2005, and 2010 Cambodia Demographic Health Survey, 2004 and 2009 Cambodia Socio Economic Survey, 2008 and 2011 Cambodia Survey on Iodine Nutrition, 2014, 2016 and 2017 market survey. All surveys used a rapid test kit to test for the presence of iodine (blue colour appeared) except for the 2014, 2016 and 2017 market surveys which used a quantitative assessment of iodine content; results here reflect salt with'any iodine’ (>0 ppm)
Figure 2
Figure 2
Cambodia's new iodized salt certification logo
Figure 3
Figure 3
Iodine content of salt in Cambodia (2008 – 2017). Ref: 2008 and 2011 Cambodia Survey on Iodine Nutrition and 2014, 2016, and 2017 market surveys. Results are based on a quantitative assessment of iodine level (sample sizes: 2008:2,329; 2011:2,310; 2014:1,862; 2016:506; 2017:457)
Figure 4
Figure 4
MUIC of mothers of children under 5 (2014). Ref: Laillou A., Sophonneary P., Kuong K., Hong R., Un S., Chamnan C. et al. (2016) Low urinary iodine concentrations among mothers and children in Cambodia. Nutrients, 8. Reference for iodine status categories: WHO, 2013
Figure 5
Figure 5
MUIC of children 6‐59 months (2014). Ref: Laillou a., Sophonneary P., Kuong K., Hong R., Un S., Chamnan C. et al. (2016) Low urinary iodine concentrations among mothers and children in Cambodia. Nutrients, 8. Reference for iodine status categories: WHO, 2013
Figure 6
Figure 6
MUIC of non‐pregnant women in 5 provinces (2016). Ref: Ministry of Planning & UNICEF. (2016) monitoring the iodine status of pregnant and non‐pregnant women in 5 provinces of Cambodia, Ministry of Planning, Phnom Penh. Reference for iodine status categories: WHO, 2013
Figure 7
Figure 7
MUIC of pregnant women in 5 provinces (2016). Ref: Ministry of Planning & UNICEF. (2016) monitoring the iodine status of pregnant and non‐pregnant women in 5 provinces of Cambodia, Ministry of Planning, Phnom Penh. Reference for iodine status categories: WHO, 2013
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