Somalia Vitamin A

South Africa

Iodine

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EPIDEMIOLOGICAL DATA
Goiter  
Most Recent Goiter Survey  
Date: National IDD survey conducted during 1998
Groups Surveyed: Primary school learners
Sample Size: 2,333 children (49 schools surveyed)
Sampling Method: Random sampling method, whereby 10,000 children, 200 schools  (representative of rural and urban populations and to provide a cross-section of socio-economic status in each province) and 50 children per school were selected for the survey.
Estimated Goiter Prevalence:

Group

Sample size

Prevalence in sample (%)

Est. Pop. with Goiter

Grade 1

Grade 2

Total goiter rate
Primary school

2,333

20 - 68%

   NR

 
         

 

NR = Not Reported
 
Urinary Iodine
Most Recent Urinary Iodine Survey
    National IDD survey conducted during 1998 among primary school learners in 9 provinces (same as above).
 
Estimated Prevalence of IDD:  Indicator < 100 microgram/L
 

Region/Group

Sample size

Prevalence in Sample

Population with Low Urinary Iodine

Median Urinary Iodine Level
Primary school learners 8524 children (179 schools) 89.4% (=100 µg/) NR NR

NR = Not Reported
 
 

POLICY AND LEGISLATION
 

Legislation on IDD
    

IDD legislation in South Africa was passed in 1995.  Iodization of salt is mandatory at the level of 40 - 60 ppm at the level of packaging.  The government of South Africa has published documents regarding IDD.  Regulations in the Act on Foodstuffs, Cosmetics and Disinfectants (Act 54 of 1972) for the mandatory iodation of all food grade salt.
 
Government Agency to Address IDD
    

The government agency that deals with IDD is the Department of Health.
    

Contact information:  Director: Nutrition, Private Bag X828, Pretoria, 0001, South Africa.
   
     

PROGRAM DATA
Supplementation
     Oral supplementation with iodized oil capsules is not currently used.
Fortification
Production and Importation of Salt
    

There is iodized salt production.
    

Voluntary iodation started in 1954 at a level of 10 to 20 ppm.  However, only 30% of the salt was iodated.  Regulations for the mandatory iodation of food grade salt came into effect in December 1995.
    

There are about 74 registered salt companies.
    

About 12 companies are producing iodized salt, some representing groups of salt companies are currently iodating salt for human consumption.
    

Potassium iodate is used to iodize salt.
    

Regarding packaging methods, the regulations stipulate impermeable packaging material, e.g., low density polyethylene, high density polyethylene, woven polypropylene or similar materials and includes polycoated cardboard.
     Salt is imported from Botswana and Namibia.
    

The salt is imported from India at the intended level of iodization of 30 PPM.
    

The regulations regarding iodine content at the production level stipulate that food grade salt or other salt intended for use in or on foodstuffs shall contain between 40 and 60 ppm iodine on entering the Republic of South Africa.
    

*   Manufacturers conduct quality control checks, Environmental Health Practitioners use salt test kits and in the event of non-compliance take samples for titration analyses.  Evaluation is also done by means of surveys.
    

*  About 25,6% of salt producers comply with the legal requirement of 40 - 60 ppm.  While 46.8% of salt contains more than 30 ppm, but 44,4% of salt contains less than 20 ppm at the production level.
Retail
   

*  The average retail cost of salt is as follows:

Iodized:  Approximately $0.25
Un-iodized salt:  Un-iodated salt which in packaging of 1kg or less and which is labeled  "un-iodated" may only be sold by pharmacies.  The cost is higher than for iodated salt.
    Other:  Agricultural salt is not iodated. Furthermore salt intended for use in the manufacture of compound foodstuffs which is packaged in bags of 20 kg is exempted from iodation.  Vulnerability to under-iodated or non-iodated salt appears to be the greatest in the three northern provinces in the country, in households belonging to low socio-economic categories and among people living in rural areas.
 
Household Consumption
     The estimated daily per capita consumption of salt is 5 - 10g.
     The estimated percent of adequately iodized salt consumed by all people is 62.4%.*                                      
  * Source: Jooste, P.L., Weight, M.J. Lombard, C.J.  Iodine concentration in household salt in South Africa.  Bullletin of the World Health Organization. 2001.  79 (6).  534 - 40
 
Iodized Salt Surveys

    

Iodine concentration in household salt in South Africa (conducted in 1998) - household level.
     National IDD Survey (conducted in 1998) - household level.
     Annual salt retail surveys: 1996/1997; 1997/1998; 1998/1999; 2001/2002.
     Iodine Deficiency Disorders:  South African salt producers' practices and perceptions (conducted in  2001) - producer level.
      
Survey Results

 

Survey Level

(producer/ retail/ household)

 

Date of Survey

 

Geographic area/ other grouping

 

Sample size

 

Sampling Method

%  of samples with > 15 ppm

% of samples with  > 30 ppm

Average and/or Range of Iodine Content

Household

1998

National

2043

Multistage stratified cluster

 62,4%

45,3%

Mean: 27mg/kg

Retail

2001

National

429

Random

78%

57% (>40ppm)

 -

Producer

2001

National

169

Triplicate samples per brand name produced on day of visit

Legal req:

40-60ppm:

25,6%

 

46,8%

(>30ppm)

 

-

(Note:  The retail survey results exclude data of 2 provinces i.e. Western and Eastern Cape and the will be incorporated in the data set by mid-March 2002)
Other Programs Related to Control of IDD
Mass Media Campaigns
    

IEC materials, i.e., pamphlets for the public, booklet for health workers and producers and a poster have been developed to promote a good iodine status.

Community-Based Programs
     Awareness programs are implemented by district health workers, in particular in identified or at-risk areas for IDD.
   
 
 
MONITORING
 
Salt Iodine
Current monitoring activities for iodine levels in salt
     Monitoring of salt by Environmental Health Practitioners and the evaluation of salt iodation at producers level , regular annual retail salt surveys and surveys to evaluate the iodine content of household salt.
     The surveys described above are being repeated. 
     Monitoring of household/facility salt (e.g. used by creches) is done with UNICEF field test kits.
    

IDD Indicators
     Lab facilities are available at academic and research institutions, e.g. Medical Research Council (MRC) and the South African Institute of Medical Research.
     There will be monitoring of the goiter rate via repeating the afore-mentioned surveys.  This is planned for 2004/2005.
     
     
PROGRAM RESOURCES
 
Donor and Implementing Agencies Involved in IDD Programs
     UNICEF and Kiwanis International provide techinical support, support for training, capacity-building IEC materials and field test kits.  They are a source of available funds for fortification.