Friday, June 30, 2017

A ‘nimbler’ approach to tackling Cambodia’s salt iodization concerns

By Sam Oeurn Un and Arnaud Laillou

Teng and his son with their new package and testing their daily production;
©UNICEF Cambodia/2017/Laillou

Kampong Speu and Phnom Penh, Cambodia, June 2017 – The consequences of nutritional iodine deficiency are well known in Cambodia. Adequate iodine intake during pregnancy, lactation and early childhood is critical for optimal brain development of the foetus and of children aged 6 months to 2 years old. Failure to do so can lead to intellectual disability and goitres. Though Cambodia achieved universal salt iodization in 2010, the situation has regressed to an alarming degree.

A recent government-led analysis found that only 1 of 10 salt samples tested in markets across Cambodia were adequately iodized. It also showed that approximately 30 per cent of pregnant and non-pregnant women had a urinary iodine concentration below the minimum threshold of 50µg/L. This puts children at risk of losing as many as 13 IQ points, potentially thwarting the trajectory of their entire lives; it also jeopardizes national goals to improve the population’s educational outcomes.

New strategies are needed to stem this looming public health crisis and improve salt iodization in Cambodia.

UNICEF Cambodia has a long-term commitment to achieving universal salt iodization that began in the early 2000s. Facing a deteriorating situation, in May 2016 UNICEF hired an international consultant to work with Cambodia’s National Sub-Committee for the Control of Iodine Deficiency Disorders to analyze the challenges and develop guidelines on production, monitoring, quality control and assurance at different levels.

One solution proposed was a small piece of equipment called ‘The Nimble’, an iodization machine developed specifically for small- to medium-sized salt producers. “The Nimble was designed to operate in areas with or without access to electricity, who want to iodize small quantities of salt on a continuous basis to meet the needs of their local communities,” says Lorenzo Locatteli-Rossi, one of the machine’s founders. This criteria is a good fit for many Cambodian salt producers, who often run small-scale operations in remote areas and electricity comes at a premium.

With USAID funding, UNICEF has been able to invest in six Nimbles, which were sold to local salt boilers or re-packers via the Ministry of Planning. Buyers repay the ministry in monthly instalments.

One of the first salt boilers to invest in the device was Teng Vannak from Kandol Dom commune in Kampong Speu Province. “I produce 800 to 1,000 kilogrammes of boiled salt to sell for around 750 to 800 riels (US$0.20),” he explains. “I am very dedicated to salt iodization and I welcome this new equipment as mine was getting rusty and old. This project allowed me to buy this new device and to pay back on a monthly basis. This device is so simple to use and I’m improving my production”.

The Nimble with one of its creators, Lorenzo Locatteli-Rossi;
©UNICEF Cambodia/2017Laillou

UNICEF also provides a quality control test kit that allows the producer to track the quality of the salt he is selling on a daily basis.

“As requested by the Ministry of Industry, I have changed my packaging so that my brand, 2 Lions, is recognized for reliable quality,” Teng explains. “I hope that the Government will help promote companies like mine that are in line with the iodization standards. It is vital for us to eliminate the bad producers.”

Koy Rithya, a re-packer from Phnom Penh’s Russey Keo district, is also aware of Cambodia’s iodization challenges. He relies on product from boilers and the iodization cooperative in Kampot and Kep, where quality and control had been slipping. He developed a manual process that involved spraying the salt with iodine before repackaging. In early 2017, he purchased a Nimble, taking advantage of the UNICEF/Ministry revolving fund.

“The Government told me my process was not suitable for future registration, so I decided to invest in the Nimble. The possibility to pay in instalments over time was an incentive and very useful,” Koy says. “I have made small modifications on the Nimble to ease my daily work and I am very happy with this new system that UNICEF promoted. Now we need the Government to enforce the legislation so all producers are on the same level.”

UNICEF and involved line ministries are working together to develop a more appropriate certification process for salt producers and re-packers to ensure fair competition. Senior Minister of Industry and Handicraft H.E. Cham Prasidh has continued to show his support by opening the National Salt Producers’ Meeting in late 2016. He made it clear that the situation of iodine deficiency in Cambodia was serious and persistent, even after years of work. In the future, the Government would not tolerate any shortfalls and issues with iodine deficiency must be eliminated, he said.

Thanks to the support of several UNICEF National Committees (Korean, Canadian and Hong Kong) and mainly USAID, UNICEF has been able to restart its important iodization work with government leadership. It’s still a long road ahead, but with simple innovations like the Nimble, UNICEF can continue its full commitment to achieving universal salt iodization and thus protecting more Cambodian lives from unnecessary hardships.

UNICEF Cambodia Representative Debora Comini and Senior Minister of Industry and Handicraft Cham Prasidh discuss strategies to tackle salt iodization; ©UNICEF Cambodia/2017Laillou

Recent news articles on iodine deficiency in Cambodia:
New York Times:

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