Iodized salt makes a difference

Tantri Yuliandini, The Jakarta Post, Jakarta

"Consuming iodized salt will help me become a university graduate, if not I will get goiter," said Ingka Fitra Sunar, 10, from Bone, South Sulawesi eloquently.

Ingka was one of seven elementary school children from seven provinces across Indonesia who won a drawing contest on iodized salt organized by the United Nations Children's Fund (Unicef).

His prize-winning picture, a watercolor painting showing new graduates in black robes and mortarboards on one side, and what appears to be a farmer with a goitrous neck on the other, had a quality that not many elementary school students could produce.

Other winners also produced more or less the same themes -- that iodized salt will make people smarter and eating non-iodized salt will produce goiter.

"Salt is produced from seawater, and when combined with iodine produces iodized salt," another winner, Andrea Tyas Sari Putri from Surakarta, Central Java, explained. Despite drawing sacks of salt stacked on a beach, the 11-year-old does not know how it could be obtained from saltwater.

"We are continually educating children on the benefits of iodized salt, and the winners of this competition were chosen in part because of their knowledge of the matter," said Ati Muchtar Sjarief, Unicef's communication officer, during a recent ceremony announcing the competition's winners.

The program to erase iodine deficiency in Indonesia began prior to independence, but Unicef's involvement only started in the 1970s, she said.

Winners of the competition received a scholarship of Rp 5 million each, a three-day tour package in Jakarta and a Unicef trophy.

Iodine deficiency is known as the single most common cause of preventable mental retardation and brain damage. It decreases the chances of a child's survival, causes goiter and impairs growth and development.

"Most people only look at gondok (goiter) as the effect of iodine deficiency, now that they don't see it anymore they think it's not a problem. But most of the damage you can't see immediately," Unicef project officer for nutrition Ernest Schoffelen said, explaining that 90 percent of damage from iodine deficiency could not be seen.

Iodine deficiency in pregnant women, for example, causes miscarriage and stillbirth, while children with iodine deficiency disorder (IDD) can grow up stunted, apathetic, mentally retarded, and incapable of normal movements, speech, or hearing.

The International Council for the Control of Iodine Deficiency Disorders (ICCIDD) predicts some 2.2 billion people, or 38 percent of the world's population, live in areas with iodine deficiency and are at risk of experiencing complications caused by the deficiency.

"Some regions in Indonesia risk these complications, such as West Nusa Tenggara, East Nusa Tenggara, Sulawesi, Aceh, and Maluku. And even in Java there are pockets that don't get enough iodine," Schoffelen said.

Only 65 percent of Indonesian people consume enough iodine, 15 percent of people do not get enough, while the other 20 percent do not get iodine at all, he said.

Iodine is a chemical element that can be found in fairly constant amounts in seawater, but its distribution over land and fresh water is uneven.

It is an essential part of the chemical structure of thyroid hormones, which are released into the bloodstream and carried to target organs, particularly the liver, kidneys, muscles, heart, and developing brain. The body needs proper levels of thyroid hormones to work well.

Most of the iodine we consume comes from food and drink, Ati said, with seafood being a good source because the ocean contains considerable iodine.

Other sources include freshwater fish, vegetables and meat, depending on the amount of iodine it is produced in, which may not be adequate if they are grown in iodine deficient areas.

"Jakartans are OK because they get enough variety of foods, but other areas in Indonesia do not have enough sources of food," Ati said, adding that most processed food also contains iodized salt.

Iodized salt is special produced, and except for a few isolated cases, edible salt does not naturally contain iodine, Schoffelen said, explaining that iodine is added deliberately to salt as one of the most efficient ways of improving iodine nutrition.

He recommended the consumption of about 10 grams of iodized salt per day. About 30 milligrams of iodine is contained in a kilogram of table salt.

"The problem arises because raw salt that is locally produced is often leaked into the market without being properly processed with iodine," Schoffelen said, adding that in the meantime about 50 percent of the country's raw salt supplies are imported from India, Australia and Jordan, and are not well controlled.

"If control of imported salt in improved and there is enforcement of the law and a committed government, the problem of iodine deficiency would easily be solved," he said.

Before 1995, less than 50 percent of the population consumed iodized salt which increased to 65 percent in 1996, but this figure remains stagnant until present because of a lack of commitment, Schoffelen explained.

Unicef monitors iodine deficiency in seven provinces in Indonesia, namely Banten, West Java, Central Java, East Java, West Nusa Tenggara, East Nusa Tenggara and South Sulawesi.