LF & Fortified Salt
Lymphatic filariasis (LF) truly has been a national disease in Haiti. When Notre Dame Haiti program first began, LF was present in 84 percent of communes (118 of 140) and is still present in 22 communes as of 2019.
World Health Organization models suggest that Mass Drug Administration (MDA) of 80% of the eligible population in endemic areas is needed to stop transmission and eliminate the disease. However, in Haiti, pill distribution is hampered by the effects of a transient population and illiteracy.
Research reveals that adding MDA 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, CSC in Haiti has been producing and distributing iodized salt co-fortified with diethyl carbamazine citrate (DEC) to
address LF and potassium iodate (KIO3) to prevent Iodine Deficiency Disorders (IDD).
The fortified salt is marketed as “Bon Sel Dayiti+," which translates as “The Good Salt of Haiti.” It is available in half-kilo and 25-kg bags as both fine and coarse-grade salt. Pricing is competitive with unrefined local raw salt.
The fortified salt is processed and produced at the CSC salt facility at Delmas-2 in Port-au-Prince. Both local and imported raw salt is purchased for further processing and subsequent distribution. Technical assistance is provided by Cargill Salt to ensure high standards of product and worker safety. Distribution is achieved through a direct sales force as well as a variety of distributors in the retail, foodservice, and food-processing segments.
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 be easily 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).
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 CSC salt project is: “Ministering in Christ’s name, we will eliminate lymphatic filariasis and prevent iodine deficiency disorders in Haiti through the production and distribution of fortified salt."
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.