Introduction

Over the years, the Bangladesh Universal Salt Iodization (USI) strategy has achieved significant progress.  The National Micronutrient Survey of 2011-12 indicates that the population in Bangladesh is iodine sufficient (>100 μg/L) with 80 percent of households consuming iodized salt with any iodine. Nevertheless, The last National Salt Iodization survey 2015 reported that 64.7% of households are using salt with any iodine, and which is a reversion from prior years.

 

Current Status of IDD Elimination

 Evidence on population iodine status: The National Micronutrient Survey of 2011-12 revealed that the Bangladeshi population was iodine sufficient. This status was indicated by the median Urinary iodine concentrations (UICs), with some concerns for the poorest and poor strata of the population still consuming open salt. The median urinary iodine concentration in school-age children and NPNL women was 145.7 μg/l and 122.6 μg/l, respectively. According to the Asset Index, the bottom two quintiles had a median urinary iodine concentration among NPNL women below 100 μg/l, the “poorest (99.3 μg/l) ” and “poorer (92.7 μg/l)”, indicating that these women were milk iodine-deficient in adequate. The school-age children living in poorer quintiles (93.6 μg/l)  were also mild iodine-deficient in adequate.

Household use of iodized salt: According to the National Micronutrient Survey 2011-2012, the national estimate of the usage of iodized salt (≥5 ppm) at the household level was 80.3%, which was similar to the estimate in the preceding National IDD/USI Survey 2004-5 (81.4%). The usage of iodized salt was lower in the rural households than in the urban or slum clusters (rural, 76.7%; urban, 91.7%, slums, 91.1%) due to more consumption of open salt among the rural households than the urban (29.2% against 7.7%). 57.6% of the households used iodized salt, which was a slight improvement from the 2004-5 estimate (51.2%). Three out of four households in the urban and slum areas used appropriately iodized salt, while the percentage was just over 50% in the rural area. According to the Asset Index, appropriately iodized salt consumption is below the national level among the bottom two quintiles (poorest 51.9% and poorer 56.3%)

 

Situation of the National IDD Elimination program

Salt Iodization Policies: In 1989, the Government of Bangladesh endorsed the Iodine Deficiency Disease Prevention Law making it mandatory that all edible salt should be iodized and also endorsed under the implementation rules of 1994. To ensure quality iodized salt for all, the government is mandated to implement the Iodine Deficiency Disease Prevention Law 1989, Regulation of Salt Law 1994, and the Bangladesh Standards and Testing Institution (BSTI) Ordinance 1985. However, enforcing legislation remains a continuous challenge for the USI project. There are also limitations of the existing salt law that does not support achieving USI objectives. In Bangladesh, the existing salt legislation guides the iodization of salt but does not emphasize that all salt within the scope of the legislation must be iodized. Within the salt market in Bangladesh, open salt is sold for animal feeds, however, it is also purchased for human consumption due to its low price. The price differences between packet iodized salt and open non-iodized salt for animal feed from the traditional mills 2-3 Bangladeshi taka (<1 cent). The price difference is more if the iodized salt is produced in vacuum or mechanical factories ranging from 15-20 Bangladeshi Taka (BDT) (18 cents). As such, if the salt used for animal feeds is not covered under the existing legislation, it is difficult to control leakage of non-iodized salt in the iodized salt market. Similarly, to prevent the leakage of other types of non-iodized salt, including industrial salt, in the iodized edible salt market with low price, the GoB should increase focus on a clear demarcation in policy for selling and transportation of industrial salt. Considering all these factors, the GoB prioritized the following key revisions in the new salt law with an emphasis on stopping the trade of open salt in the edible salt market:

• Inhibit selling of open salt
• Inclusion of imported salt
• Increase in penalties to strengthen legislative enforcement
• Clear implementation procedure and
• Inclusion of salt used for processed foods and animal feeds