Coverage of Adequately Iodized Salt Is Suboptimal and Rice Fortification Using Public Distribution Channels Could Reach Low-Income Households: Findings from a Cross-Sectional Survey of Anganwadi Center Catchment Areas in Telangana, India

Wirth JP, Leyvraz M, Sodani PR, Aaron GJ, Sharma ND, Woodruff BA

July 2016 – PLOS ONE

To assess the coverage of adequately iodized salt and the potential for rice fortification, we conducted a cross-sectional survey of children 0–35 months of age residing in the catchment areas of anganwadi centers in the state of Telangana, India. Iodine concentration of salt samples was tested using iodometric titration, and information on household rice consumption and Telangana’s rice sector was collected and interpreted. In households of selected children, 79% of salt samples were found to be adequately iodized. Salt brand and district were significant predictors of inadequately iodized salt. Daily rice consumption among children and women averaged 122 grams and 321 grams per day, respectively. Approximately 28% of households reported consuming rice produced themselves or purchased from a local farmer, 65% purchased rice from a market or shop, 6% got rice from a public distribution system site, and 2% obtained it from a rice mill. Due to the significant variation in the coverage of adequately iodized salt by district and brand, increasing the adequacy of iodization of smaller salt manufacturers will help achieve universal salt iodization in Telangana. Despite high consumption of rice, our findings suggest that large-scale market-based rice fortification is not feasible in Telangana. Distributing fortified rice via Telangana’s public distribution system may be a viable approach to target low-income households, but would only reach a small proportion of the population.