Trends in iodine nutrition in Uganda since the inception of the Universal Salt Iodization programme

Deficiency of iodine in humans leads to a range of health defects, referred to as iodine deficiency disorders (IDD). Since 1994, a universally recognised strategy of mass fortification of edible salt with iodine, codenamed USI Programme, has been implemented in Uganda to ensure optimal human iodine intake. Evidence on the impact of this intervention remains fragmented. The objective of this review is to assess the impact of the Ugandan USI Programme on the population since its inception. We used data from surveys that assessed iodized salt coverage and the prevalence of IDD and iodine deficiency for the period of 1994-2019.Findings revealed that over 90% households used iodized salt after five years of implementation of the programme. This progress translated into dramatic reduction of goiter rate, but led to excessive iodine intake due to over-iodization in the first 10 years. Although updated national data on iodine nutrition status is lacking, recent findings from a sub-regional study revealed a high prevalence of iodine deficiency, suggesting a likely recurrence of inadequate iodine intake in the country, despite wide practice of salt iodization. From this review, it is clear that high iodization coverage does not necessarily translate into expected optimal iodine intake. The review reveals the importance of rigorous and regular monitoring of iodine use to minimise incursion of latent IDDs among communities. Keywords: Edible salt, Iodine deficiency disorders, iodization, Uganda