Lymphatic filariasis (LF) is truly a national disease in Haiti, present in 118 of 140 communes, making 84% of the country a potential risk zone. World Health Organization models suggest that Mass Drug Administration (MDA) of approximately 80% of the eligible population in endemic areas is needed to stop transmission and eliminate the disease. However, in Haiti, distribution is hampered by the effects of a transient population, illiteracy and the need to educate the people regarding the transmission of the disease.
Research reveals that adding coverage via fortified food-grade salt in highly endemic region is an effective method to halt LF transmission and address areas of non-compliance. Therefore, since 2006, the Haiti Program has been producing and distributing iodized salt with DEC to supplement on-going MDA programs.
The salt is marketed as “Bon Sel Dayiti+," which translates as “The Good Salt of Haiti.” It is available in one pound and 25 kg bags as both fine and coarse-grade salt. Pricing is competitive with unrefined local raw salt.
The Haiti Program uses salt domestically fortified at a production plant in Port-au-Prince. Both local and imported raw salt is purchased for further processing and subsequent distribution. Raw salt is cleaned, sized, fortified and packaged. Technical assistance is provided by Cargill Salt to ensure high standards of product and worker safety. Distribution is done through a Haiti Program direct sales force in Leogane and nationally through Carribex SA, the largest food company in Haiti and producer of the well known “Ti Malice” branded food products.
Salt fortified with DEC avoids the barriers associated with annual tablet-based mass treatment. For instance, DEC-fortified salt is not 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.
However, when properly implemented, the efficacy of co-fortified salt is striking. A community-wide 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
The mission statement of the Haiti Program Salt Project is: “Ministering in Christ’s name, we will eliminate lymphatic filariasis and achieve universal salt iodization in Haiti through the production and distribution of food-grade salt with DEC."
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.