Tuesday, December 29, 2015

The salt of life: Ensuring table salt provides a vital mineral for good health

By Samoeurn Un and Arnaud Laillou

Salt producers in Kampot Province. Local salt producers are facing a challenging environment.
© UNICEF Cambodia/2015/Arnaud Laillou

Iodine is an essential component of a proper daily diet, contributing to healthy thyroid function. Iodine deficiency is the leading preventable cause of intellectual and development disabilities. In many countries, iodine is efficiently delivered into food via table salt. But in Cambodia, as recently as 10 years ago only one in four households were using iodized salt, missing out on this vital mineral.

Intensive UNICEF work since then toward universal salt iodization, coupled with government initiatives, has brought about dramatic improvements, but recent information demonstrates the need to renew efforts on this important issue.
Since the 2003 sub-decree on mandatory iodization of salt and several related regulations, Cambodia’s supply of iodized salt has increased greatly. In 2011, 70 per cent of households were using iodized salt. Cambodian schoolchildren’s median urinary iodine levels remained steady at 200 micrograms per litre in 2008 and 2011 studies, a level considered satisfactory.

In light of this success, in 2011 UNICEF and development partners stopped providing premix support (free potassium iodate) to local salt producers. However, the iodization of salt was not fully maintained by producers once this support had come to an end. Alarmingly, 2014 UNICEF data shows a substantial decrease in appropriately iodized salt on the Cambodian market.

With funding from the Australian, Hong Kong, Korean, and Czech Committees for UNICEF, UNICEF and the Ministry of Planning’s National Sub-Committee for Control of Iodine Deficiency Disorders collected and analyzed over 1,800 salt samples sold in local markets. Only 8 per cent met national iodine requirements.

Iodized salt tested during a UNICEF field visit to Kampot Province
© UNICEF Cambodia/2015/Arnaud Laillou

The impact on the population is evident: the latest micronutrient survey shows that more than 40 per cent of tested children and women exhibit extremely low iodine concentration in their urine (less than 50 micrograms per litre), reintroducing serious potential health concerns.

“The high level of non-iodized salt not only questions local manufacturers’ current iodization practices, but also the quality of imported iodized salt,” says Borath Mam, Director of the Ministry of Planning’s Department of Improving Nutrition.

He believes the problem is both economic and regulatory: at US$65 per metric ton, domestic salt is more expensive than salt imported from neighbouring countries (US$30–$40 per metric ton), encouraging producers outside of Cambodia to export products that do not comply with local legislation. Limited routine government monitoring at borders and in markets exacerbates the situation. “By domino effect, several local producers decided to reduce or stop the iodization process.” added Mr. Mam. 

UNICEF is leveraging new donor support to ensure that salt is iodized, working with government to reinforce testing. In the coming months, UNICEF will test all branded salt and publish the names of improperly iodized products in the newspaper. Government testing capacity at the border and in markets will also be reinforced.

Using the market study findings, solutions are now being discussed with the Government, such as better enforcement of legislation on both local and imported salt and increasing awareness among the public. Several actions will be undertaken in 2015–2016 to ensure producers are following the rules.

For their part, Cambodian salt producers understand the positive impact of their work. Forty-seven-year-old Bun Bariang, Executive Director of the Salt Producers Community of Kampot and Kep since June 2005, says, “Our dedication to iodizing salt and our daily investment are helping Cambodians regardless of age or generation. Salt is one of the main condiments used in Cambodia and therefore provides a significant proportion of iodine needed to prevent or eliminate related health issues.”

Bun Bariang, executive director of the Salt Producers Community of Kampot and Kep
© UNICEF Cambodia/2015/Samoeurn Un  

New players with bigger production capacity are investing in salt in Cambodia, preparing for the future. “Locally produced salt in 2015 exceeds the market requirement in Cambodia, but the quality is low. As such, we can’t compete against cheaper exported salt,” says Bariang. “To prepare for the upcoming ASEAN free trade agreement by end 2015, I am investing in modern technology to produce high-quality salt. Even though my new product is very good and iodized, we need the government to invest in more adequate external quality control to avoid unfair competition.”

In the coming months, UNICEF will intensify its efforts to stabilize universal salt iodization in Cambodia. Six key interventions will take place:

  1. Test the stability of iodine in Cambodian salt and in market settings;
  2. Assess how low iodization is impacting levels of urinary iodine concentration in the general population;
  3. Advocate for appropriate national budgets to enforce legislation;
  4. Establish standards and regulation for iodized salt across the region (ASEAN), including penalties;
  5. Integrate fortification standards, including iodization, in the annual industry licensing and registration; and 
  6. Raise community awareness of adequately iodized brands of domestic salt with a media campaign.

With these measures, UNICEF hopes that Cambodia will soon return to the road toward universal salt iodization, allowing its population to benefit from this important aspect of a healthy diet. 

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