IODINE IN INDONESIA

SALT OF THE EARTH – AND BODY. © Duncan Graham 2006

If you’re reading this paper during a meal, pause a moment and reach for the condiments.

Is the salt on your table iodised? If bought already packaged from a supermarket the answer is probably yes; nonetheless check the label’s small print. (In Indonesian iodine is yodium).

However if it came in bulk from the local market the chances are it won’t have the essential additive – but may include some unwanted nasties.

“The problem is that although salt is cheap at around Rp 2,000 (US 20 cents) a kilo, the iodised product is marginally more expensive,” said Sinung Kristanto of the United Nations Children’s Fund (UNICEF) in Surabaya.

“Offsetting this is the fact that the iodised salt is cleaner and tastes saltier. That’s because it’s more concentrated through processing. Unfortunately people don’t know this and their shopping is driven by price alone.”

Mineral trace element deficiencies in the diet have long been known to cause serious health problems. A lack of iodine affects the thyroid gland that in turn can lead to goitre (swelling of the gland) and mental deficiencies. (See sidebar)

Indonesia introduced a salt iodisation policy in 1979 and is widely regarded a world leader in eliminating iodine deficiency. Despite this it’s not difficult to find examples of the problem in isolated parts of the archipelago.

“The East Java government estimates that less than 40 per cent of the population is using the additive in at least two areas - Probolingo on the north coast of East Java and Sampang on the south coast of Madura Island,” said Kristanto, UNICEF’s project officer for East Java and West Nusa Tenggara (NTB).

“So we’re concentrating our efforts there as part of our health and nutrition program. This isn’t a cosmetic issue – it’s extremely serious. But getting the message across isn’t easy.

“Some people think goitre is a condition inflicted on them by God for their sins.

“Much of the salt sold in the markets is made by farmers in Madura who evaporate sea water. It’s known as kerosok. It’s not washed and has a high moisture content. Better quality salt is made in Lombok by boiling and distilling water.

“Salt can be bought cheaper in bulk from Australia. It’s cleaner and more than 99 per cent dry. But local producers object to imports for fear they’ll lose income.

“Farmers also eat the salt they buy for their cattle, or pick up salt from the seashore for the kitchen. Of course that hasn’t been iodised.”

The Australian salt isn’t iodised. It’s mainly produced for industry where it’s used for the manufacture of plastics and chemicals. So imports are iodised locally.

The addition of only 30 to 80 parts per million of iodine in salt is needed to prevent health problems.

Attempts by this reporter to visit a Surabaya salt factory to see the process were thwarted by staff. They feared the request was a ploy to steal the technology and get the salt treated in Australia.

The East Java public health information campaign includes promoting a logo of a smart kid in a mortarboard with a purple sash (the color of iodine vapour). This is to emphasise that iodised salt aids intellectual development. The other tactic is legislative.

The local and international import and export of non-iodised salt has been banned by administrations in NTB but not in East Java. This isn’t the total answer as people can still make or gather their own salt.

UNICEF has just celebrated its first ten years in Surabaya. It’s an advocacy and technical assistance agency with only 14 staff to run operations. It works with government and non-government organisations to implement programs in health and nutrition, education, HIV /Aids prevention and child protection.

UNICEF’s annual budget for East Java and NTB is Rp 20 billion (US $ 2.2 million) and includes funds from government aid agencies in Australia, the US and Japan.

Promoting iodised salt through UNICEF is also backed by a Canadian not-for-profit organisation called the Micronutrient Initiative, run by nutritionists and scientists. The global goal is to eliminate malnutrition through the lack of vitamins and essential minerals.

Kristanto said that to ensure corruption was minimised projects were audited ahead of implementation to decide a unit cost of delivery. This meant the number of people who would be expected to benefit had to be determined and all purchases monitored.

Where flaws had been detected and corruption identified funding was cut for a year.

“We have to be tough,” he said. “We cry for the children who suffer as a result, but we have no choice. If we continue with the funding the corruption continues. It’s better to stop for a while so people know we’re serious.”


NOT TOO LITTLE, NOT TOO MUCH

“I’m strong to the ‘finich / ‘cause I eats me spinach” sang the American cartoon character Popeye the Sailor Man with grating and memorable diction.

He was right to advocate spinach – it’s one of the few foods with a significant amount of iodine. It’s also present in seafoods and excessively so in the edible seaweed known as dulse.

The lack of these foods in mountain areas is probably a reason for the higher level of goitre in the uplands.

Iodine is a non-metallic element and an overdose can also lead to problems, particularly for pregnant mums. Introducing the additive in an area that’s suffered years of deficiency has to be handled carefully to avoid hyperthyroidism.

While extreme cases of goitre are obvious as a major swelling below the Adam’s Apple, early cases can be detected using ultrasound and through urine tests.

International agencies reckon about one billion people – that’s a sixth of the world population don’t get enough iodine in their diets.

The result can include infant deaths and damage to the brain. Intelligence quotient (IQ) levels have been recorded at 50 points below average among children whose diet lacked iodine.

Developed countries often add iodine to bread and milk, though salt is the food most used to get the element into the body. Where public water supplies are potable iodine is sometimes dissolved – a system impossible to apply in Indonesia where many use wells and tap water is unsafe to drink.

(First published in The Jakarta Post 18 October 2006)
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