Mandatory Versus Voluntary Implementation of Salt Iodization Program for the Last Two Decades in Ethiopia: A Comparative Review of Existing Literatures

Background: Ethiopian government was implementing mandatory salt iodization program for the last decade to eliminate iodine deficiency disorders, but several recent studies reported mixed findings. Objective: This review aimed to assess the difference in implementation of iodized salt program 10 years before and after mandatory salt iodization being implemented in Ethiopia since 2011. Methods: In Ethiopia, legislation that enforces salt producers to iodize all salts used for human consumption started in February 2011. All studies about iodine deficiency and iodized salt conducted in Ethiopia in the last 2 decades were searched. Searches were performed in PubMed database. Google Scholar, Iodine Global Network, and Ethiopian Public Health Institute websites were also searched. Results: A total of 235 titles and abstracts were identified. After scanning the abstracts and full papers, 43 articles were remained for final data synthesis. In this review, all studies conducted before 2011 reported a urinary iodine concentration (UIC) value of < 100 μg/L and 66.7% of them reported a goiter prevalence of > 30%. On the other hand, among studies conducted after 2011, 88.9% reported UIC value < 100 μg/L and 73.7% reported goiter prevalence of > 30%. Household availability of adequately iodized salt increased from nearly 20% in pre 2011 to more than 50% in post 2011 period. Conclusion: Despite the efforts made by the Ethiopian government on mandatory salt iodization for the last decade, iodine deficiency is sustained in the country. Moreover, the goal of universal salt iodization program is offtrack and needs urgent revision. Registration: Registered on PROSPERO register with reg. no CRD42021251124.