Omar Dary, Ph.D. Food Fortification Advisor MOST/The USAID Micronutrient Program
Origin and Evolution:
pidemiological studies, carried out by the Institute of Nutrition of Central America and Panama (INCAP) in 1952, revealed that 38% of the Guatemalan population was suffering of some degree of goiter. Inorder to improve the iodine status of the population, the government of Guatemala made mandatory the addition of iodine to salt by means of a decree in 1954 (Decree # 115), whose regulation was enacted in 1955. It established a fortification level of 67 to 100 mg iodine/kg from potassium iodate. The same decree made responsible of the iodization supervision to the Association of Salt Producers.The salt iodization program started in 1959. Goiter prevalence was reduced from 38% in 1952, to 14% in 1962, to 8% in 1964 and to 5% in 1967. In 1967, urinary iodine was determined as 400-µg/L. Guatemala became one of the first countries in the developing world to demonstrate that the goiter and the other iodine deficiency disorders can be prevented by means of consumption of iodized salt. The saltiodization program was very successful because sea salt was produced by a reduced number of producers; only one company (“salinas Santa Rosa”) was responsible for more than 90% of the national salt production. However, at the end of the 70´s the country initiated the construction of its pacific port (“Puerto Quetzal”), which caused the destruction of the sea salt production fields of thatcompany. As consequence, hundreds of small sea salt collectors originated to all length of the Pacific shore of the country. Concomitantly, the salt iodization program was ruined. By 1979, goiter prevalence raised to 11%, and to 20% in 1987. The mean of urinary iodine decreased to 32 µg/L in 1979 and, although increased to 75 µg/L in 1999, it is still lower than the recommended level of 100 µg/L. Theneighboring countries of El Salvador, Honduras and Nicaragua also have hundreds of small sea salt collectors, but at difference of Guatemala, salt is ground and packaged in a reduced number of facilities (10 to 20), which are subjected to continuous governmental inspection. This practice, although inefficient because the
intense use of human and financial resources of the public sector — inmost cases depending on UNICEF donations — has achieved acceptable coverage and quality of the salt iodization programs. The same has not happened in Guatemala, where advocacy, workshops, meetings, household monitoring, and social marketing aimed to salt producers, technical functionaries and consumers for the last 10 years, have been unable to improve the situation.
Efforts Aimed atResurrecting the Salt Iodization Program
In 1991, the program of oral health of the Ministry of Health, with the support of the Professional Association of Dentists, the school of Dentistry of the National University, and other institutions proposed to add fluoride to salt to reduced tooth decay in the Guatemalan population, which is the worst in the Western hemisphere. The “average” 12 year-child has 13teeth decayed, filled or lost. As comparison, only 1 to 3 teeth are affected in children of the same age from Jamaica and Costa Rica where the program of salt fluoridation has been established. This initiative of the public health dentists of Guatemala was visualized as a good opportunity to recover the quality of the salt iodization program, because addition of fluoride requires good quality saltthat should be produced in a few centers with a minimum industrial development. First, the Congress passed a new Food Fortification Law in 1992 (Decree 44-92 on July 23rd, 1992), which later was accompanied by regulations specific for each type of food, one of which was salt (Governmental Accord 496-93 on September 24th, 1993), which fixed the iodine level at 30100 mg/kg, and made mandatory the...