Challenges and Enabling Environments of Universal Salt Iodization in Eastern and Southern Africa Countries

Abstract

Objectives: There has been reasonable progress in the universal salt iodization (USI) programmes in the Eastern and Southern Africa Region with 6 countries achieved USI and 11 have coverage between 50-89%.  However regional coverage remains at 50% with 5.6 million infants born every year unprotected against iodine deficiency.  The bottleneck and determinants of USI programmes remain unclear.  This review aims to investigate challenges and enabling environments of USI programmes at different stages of country progress. Methods: A systematic review using data from Demographic Health Surveys and UNICEF's Household Iodized Salt database, and technical reports/studies from 21 countries in the region.  Analyses were done through stratifying countries based on their progress within the last decades. Results: (i) Countries achieved USI generally have strong government and salt industry commitments, improved political and regulatory environment, effective monitoring, strategic advocacy and communications and strong public-private partnership, (ii) Countries on tract have reasonable government commitment, established systems for production/importation and monitoring but remain vulnerable to programmes sustainability, (iii). Countries with stagnated or declined coverage have initiated programmes but unable to increase coverage because of issues related to capacity of small producers, quality assurance/control and enforcement, (iv). Countries with low coverage are either in conflict/emergency or have poorly developed salt industries. Conclusions: Political and regulatory environment, monitoring systems, partnership, advocacy and communication are key enabling environments to attain USI.  Issues related to quality assurance/control, capacity of small producers and enforcement remain as bottlenecks in some countries. These evidence-based findings are keys to enabling a sustainable approach to eliminating iodine deficiency.