Iodine-deficiency disorders (IDDs) are some of the public health problems that confront 118 countries worldwide, and approximately 1.5 billion people are at risk of preventable IDDs [1
]. The vulnerable groups particularly at risk include pregnant women, infants and children. In some cases, the developing foetus is affected in the womb [3
]. Iodine is required to synthesize thyroid hormones which control the body's metabolic rate, and its deficiency results in problems such as abortions, stillbirths, congenital abnormalities, cretinism, goitre and impaired mental function, squinting and mutism [6
In Ghana, it is estimated that 120,000 children born each year are at risk of intellectual impairment because of iodine deficiency. Approximately 15,600 (13%) of these babies are severely impaired and are unable to develop properly, which results in an average of 22 million dollars loss in productivity each year in Ghana. Most of these affected children are also held back by reduced intelligence and mental dullness which are enormous negative educational implications of iodine deficiency [11
It has been recommended that most developing countries battling with IDD can address the problem in a cost effective way by adding iodine to universally consumed products such as common salt, as done in most industrialized countries [12
In Ghana, the first baseline survey on the state of IDDs in 27 districts was conducted between 1991 and 1994, and the findings revealed a varying degree of endemicity ranging from mild to severe Total Goitre Rates (TGR) [17
]. On the basis of a baseline survey conducted in 1994, it was found out that IDD was serious in 33% of the 110 surveyed districts [19
]. In most of the surveys conducted, the method employed to measure the thyroid volume of subjects was thyroid palpation.
A survey conducted in 2001 revealed that the median urinary iodine level was 77 mcg/L with a range of 28 mcg/L to183 mcg/L [20
]. Another study conducted among school children revealed that the median urinary iodine concentration was 67.9 ug/L [21
]. Similarly, a study conducted in two districts in the Upper East region in 2007 showed that while there was a drop in overall total goitre rates in the two districts, the median urine iodine levels were below the satisfactory threshold of 100 ug/L. The median urine iodine levels were 51.6 ug/L and 62.56 ug/L in Jirapa and Bongo respectively. The study also found out that only 38.5% and 36.3% of households in Jirapa and Bongo districts respectively were using iodized salt adequately [22
A market survey conducted in the Western Region in 2007 revealed that the level of patronage of iodized salt was 95.7%. However, this figure dropped to 52% in 2010 [23
]. In addition, the market survey showed that 58% of salt sold in markets was iodized, yet below 20 ppm, compared with the mandated iodization level of between 25 and 45 ppm [20
]. Consequently, it was concluded that the National Salt Iodization Committee and the United Nations' target of 90 per cent plus of Universal Salt Iodization has not been achieved.
A re-analysis of the 1994 baseline data conducted in 2007 indicated that 51.8% rather than 33.3% of Ghana's 1,194 districts were afflicted with IDD, deserving public health attention [19
]. Another study conducted in 1998 in the northern parts of Ghana revealed that 68.8% of 1061 subjects had goitre. The subjects were examined for goitre by the palpation method, and every tenth subject examined provided urine for urinary iodine determination. The median urinary iodine level for the subjects was 1.6 micrograms/dl. Seventy two percent (72%) of the subjects had urinary iodine level less than 2 micrograms/dl, 24% had urinary iodine levels in the range 2-5 micrograms/dl and the remainder had urine iodine in the range 5-10 micrograms/dl. The researchers suggested that further studies should be conducted to determine the cause(s) of the IDD endemic [24
]. The ignorance of people regarding the importance and sources of iodine to the body could be a contributory factor to this public health problem.
Fortification of salt with iodine has been the most widespread, long-term and effective preventive measure against IDDs since 1920 [25
]. To improve consumption of iodized salt, the Universal Salt Iodization (USI) programme was launched in Ghana in 1995. However, in Ghana it has been estimated that approximately 50% of households use iodized salt exclusively [26
]. Surveys conducted by the Ghana Health Service to assess consumption levels of iodized salts in households revealed that, only 49.1%, 41.5%, 74.1% and 50.8% of households in the country consumed iodized salt solely in 2002, 2003, 2005 and 2006 respectively [28
]. The survey conducted in 2006 revealed that only 32.4% of household salt samples were adequately iodized [28
]. In addition, only 74% of households consumed iodized salt in Ghana as at 2008, below the national target of 90% which was to have been attained by the end of 2005 and sustained by 2011 [29
The Medium Term Health Strategy for Ghana towards 'Vision 2020' revised in August 2000, still maintained and emphasized that levels of IDDs were high, especially in the northern part of the country and some parts of the Western Region [30
]. It has also been indicated that though the IDD control programme is in place, there are doubts with regard to how the general populace especially in rural communities utilize iodized salt [31
In the Western Region, surveys carried out to assess household utilization of iodized salt showed that, 53.2%, 67.5% and 78.1% of households consumed iodized salt in 2003, 2005 and 2007 respectively. It was also revealed that, 51.7% of households consumed iodized salt in Bia district (formerly Juaboso-Bia) in 2003, which rose to 76.7% and 77.4% in 2005 and 2007 respectively [32
]. The last survey conducted in 2007 showed that 78.1% of households consumed iodized salt in the region, with Bia, the district with the lowest reported iodized salt consumption rate in the Western Region, recording 77.4%, (in a range of 77.4% to 80.8%) [32
]. Findings of the 2007 survey further revealed that the goitre rate stood at 18.8% which, according to the study, was quite high [32
Apart from a survey which was conducted in 2007 to assess household utilization of iodized salt, no other survey has been conducted in the district. Hence the need to undertake this survey to provide current information regarding the utilization of iodized salt in Bia District.
The main objectives of the study, then, were to assess the perceptions, knowledge and practices of people in respect of the use of iodized salt, and to ascertain the current consumption rate of iodized salt in the district. The survey also assessed the iodine concentrations of salt consumed in households in the district.
The findings of this study would be useful to District Health Management Teams (DHMT) which plan promotional and educational programmes on the utilization of iodized salt in Ghana, and to other countries grappling with the problem of IDDs, mainly because of the low utilization of iodized salt.