Fortified Salt

Bon Sel

Mass drug administration (MDA) is not without its challenges.  A primary impediment to this tablet-based distribution method is that it must be administered annually for six years.  To offset such hurdles, Notre Dame and its partners have instituted a salt co-fortification program to complement the drug administration.  Salt fortified with DEC to address LF and iodine, a vital nutrient for brain development in children is being manufactured and distributed in endemic regions of Haiti. The current strategy for elimination is to use MDA plus salt in the hyperendemic zones, and salt alone in urban settings and areas of low to moderate prevalence.

 

The Haiti Program uses salt domestically fortified at a production plant in Port-au-Prince.  It costs 26 cents to make each bag of salt, but given the severe price sensitivity of the Haitian economy, it must be sold at a loss, for 10 cents, to compete with the grimy local salt.  As such, until a sufficient economy of scale is reached, the production cannot sustain itself.  The operation can only hope to move forward and expand coverage with support.  The Haitian business economy is given particular consideration throughout this process, so as to cause as little disruption of the economic environment as possible.

 

Salt fortified with DEC avoids the barriers associated with annual tablet-based mass treatment. For instance, DEC-fortified salt does not require a dedicated distribution infrastructure, nor is it associated with the adverse side effects caused by rapid death of the parasite during tablet-based mass treatment.   Moreover, DEC-fortified salt can easily be incorporated into salt iodization programs, thus eliminating both lymphatic filariasis and addressing iodine deficiency disorders.  Haiti is one of 19 nations left in the world with iodine deficiency problems.  Without salt iodization legislation, this program’s efforts achieving significant results in offsetting these issues will continue to be a challenge for the country.

 

However, when properly implemented, the efficacy of co-fortified salt is striking.  A communitywide pilot using co-fortified iodized DEC salt in Miton, Haiti dramatically halted the transmission of LF, reducing microfilaremia by 95%, and eliminated iodine deficiency within just months—each of which returned the following year when co-fortified salt was discontinued in the community.1

 

DEC fortification is unlike iodine fortification in that it will not need to be continued indefinitely.  Yet it is essential to reaching the nationwide coverage for the elimination of this disease.

 

1. Freeman A, Lammie PJ, Houston R, LaPoint MD, Streit TG, Jooste PL, Brissau JM, Lafontant JG, Addiss DG. A community-based trial for the control of lymphatic filariasis and iodine deficiency using salt fortified with diethylcarbamazine and iodine. Am. J. Trop. Med. 65(6);2001:865-871.

 

 

 

 

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