Nutrition

52

Table NU.9: Bottle feeding

Percentage of children aged 0-23 months who were fed with a bottle with a nipple during
the previous day, Ghana, 2011
Background
Characteristics

Percentage of children
age 0-23 months fed
with a bottle with a
nipple [1]

Number of children
age 0-23 months:

Male

12.1

1495

Female

15.2

1500

Sex

Age
0-5 months

18.6

818

6-11 months

20.4

725

12-23 months

7.5

1453

Western

5.8

315

Central

11.4

309

Greater Accra

35.4

477

Volta

8.2

220

Eastern

17.9

352

Ashanti

14.3

518

Brong Ahafo

4.1

259

Northern

3.5

334

Upper East

5.1

123

Upper West

3.1

87

Urban

20.8

1276

Rural

8.4

1719

Region

Residence

Mother's education
None

4.6

877

Primary

10.8

665

Middle/JSS

15.1

1050

Secondary +

34.3

403

4.1

656

Second

7.1

649

Middle

11.2

592

Fourth

16.0

541

Richest

32.9

557

13.7

2995

Wealth index quintiles

Poorest

Total
[1] MICS indicator 2.11

Salt Iodization
Iodine Deficiency Disorders (IDD) is the worlds leading cause of preventable mental retardation and
impaired psychomotor development in young children. In its most extreme form, iodine deficiency causes
cretinism. It also increases the risk of stillbirth and miscarriage in pregnant women. Iodine deficiency is
most commonly and visibly associated with goitre. IDD takes its greatest toll in impaired mental growth and
development, contributing in turn to poor school performance, reduced intellectual ability, and impaired
work performance. The indicator is the percentage of households consuming adequately iodized salt (>15
parts per million).

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53

The Universal Salt Iodisation (USI) regulations mandate salt for human and animal consumption to be
iodized. In Ghana, non-iodized salt is banned from sale when it is intended for consumption and people
found selling or using non-iodized salt are liable to arrest. Campaigns on iodized salt consumption have
also been on-going for several years and iodized salt is readily accessible, at least, in all urban areas.
In the Ghana MICS 2011 testing for iodine content in salt used for cooking was done in two ways: using
Rapid Test Kits (RTKs), and through Titration in a lab. In the case of titration, a sample of salt was collected in
5 out of 15 households in each cluster, and a titration test was carried out by the Department of Nutrition
and Food Science, University of Ghana. The results of the two tests are highlighted below. Additionally, the
results from titration were compared to those obtained through the Rapid Test Kits.
Rapid Test Kits results
In 89 percent of households, salt used for cooking was tested for iodine content by using salt test kits to
test for the presence of potassium iodate. Table NU.10 shows that in 10 percent of households there was
no salt available. In 35 percent of households, salt was found to be adequately iodated (i.e. 15+ ppm). Use
of adequately iodized salt was lowest in Northern (15%), followed by Volta (18%), and Upper East (18%)
regions, and was highest in Greater Accra (56%), followed by Brong Ahafo (45%) and Western (44%). Also,
households in urban areas are more likely to use adequately iodated salt (45%), compared to households
in rural areas (23%).
There is a marked variation by household wealth in terms of adequately iodized salt consumption. About
66 percent of the households in the richest wealth quintile use adequately iodated salt compared to 37
percent of households in the fourth wealth quintile, 24 percent for the households in middle wealth quintile,
19 percent households in the second wealth quintile, and 15 percent for households in the poorest wealth
quintile. It is also interesting to note that more than one in five households (22%) use salt that was not
iodized, and 34 percent used inadequately iodated salt (>0 and <15 ppm). Households in Volta (59%) and
those in Northern (56%) are also more likely to use inadequately iodated salt, compared to households in
the other regions.

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54

Table NU.10: Iodized salt consumption

Percent distribution of households by consumption of iodized salt, Ghana, 2011
Percent of households with salt test result

Background
Characteristics

Percent of
households
with no salt

Not iodized
0 PPM

>0 and <15

PPM

Percent of
households
in which salt
was tested

Number of
households

Percent of
households
with no salt

Not iodized
0 PPM

>0 and <15

PPM

15+ PPM [1]

Total

Number of
households
in which salt
was tested
or with no
salt

86.6

1116

12.8

14.5

28.6

44.0

100.0

1108

15+ PPM [1]

Region
Western
Central

88.4

1236

10.7

37.3

27.9

24.1

100.0

1225

Greater Accra

87.9

2321

11.5

12.5

19.9

56.1

100.0

2304

Volta

95.6

992

3.8

20.0

58.5

17.7

100.0

986

Eastern

89.4

1533

10.0

32.3

30.4

27.3

100.0

1523

Ashanti

88.8

2321

10.5

25.6

33.8

30.0

100.0

2304

Brong Ahafo

87.3

1011

12.3

10.2

32.2

45.3

100.0

1007

Northern

95.4

727

4.4

23.8

56.4

15.4

100.0

725

Upper East

88.2

414

5.3

29.2

47.3

18.2

100.0

386

Upper West

95.7

253

3.4

21.7

42.9

32.0

100.0

250

Urban

87.7

6358

11.6

16.6

26.9

44.9

100.0

6303

Rural

91.4

5567

7.7

28.6

41.1

22.5

100.0

5516

Nutrition

55

the Rapid Test Kits. The method of Sullivan et al3 was used for the titrimetry. The results of salt titration are
not provided by any other background characteristics in this report (regional, area of residence, education
of head of household and wealth index quintile). A stand-alone report will be prepared and this will provide
more details of the results and comparisons between the two methods for iodine testing.
Table NU.11 provides results of salt iodine content using Titrimetry for Ghana. In line with Pieters
recommendation, non-iodised salt was that with 0-2 ppm4. Accordingly, results reveal that no salt was
found to be totally devoid of iodine (i.e 0-2 ppm iodine). The results also reveal that 29 percent of households
had adequately iodised salt ( 15 ppm), while the remaining 71 percent of households used inadequately
iodated salt (<15 ppm).
Considering that the recommended level of salt iodisation at the factory in Ghana is 50 ppm, and the
recommended cut-off for human consumption is 15 ppm, the optimum or desirable range of iodised salt
concentration in Ghana is 15 -50 ppm. Table NU.11 shows that 20 percent of the titrated salt is in this range.
However, 5 percent of the salt used for cooking had very high levels of iodine concentration ( 60 ppm),
which points to excessive iodisation.

Residence

Table NU.11: Iodized salt consumption using Titration Method

Percent distribution of households by consumption of iodized salt, Ghana, 2011

Wealth index quintiles

Percent of households with salt test result

Poorest

94.8

1763

4.3

32.6

48.4

14.6

100.0

1746

Second

89.8

2244

9.4

29.5

42.2

18.9

100.0

2226

Middle

87.6

2450

11.6

28.0

36.9

23.5

100.0

2429

Fourth

86.3

2639

13.1

19.2

30.4

37.3

100.0

2620

Richest

90.3

2829

8.8

7.8

17.3

66.1

100.0

2799

89.4

11925

9.8

22.2

33.5

34.5

100.0

11819

Total

[1] MICS indicator 2.16

Salt Titration
Salt sample for analysis
Among the 11,925 households interviewed in the MICS 2011, 10 percent had no salt at the time of survey
(Table NU.10). About 90 percent of households provided salt samples for iodine testing using the Rapid Test
Kits. As indicated above, one-third of households in each cluster were requested to provide an additional
salt sample for further iodine testing using the titration method. A total of 3,439 of these salt samples were
delivered to the Department of Nutrition and Food Science, University of Ghana, for titrimetric analysis,
and this was equivalent to one in three of all salt samples, which had earlier been tested using the Rapid
Test Kits.
Some of these salt samples were insufficient in quantity (< 20 or <10gm) and could not be analysed, leaving
3,325 for the titrimetric analysis. After analysis, 62 of the results were identified as duplicates from some
households where two different salt samples were collected at the time of survey. Since only one salt sample
was to be analysed per household, these 62 extra results were dropped by random sampling, leaving a total
of 3,263 samples for the titration analysis. This number is equivalent to 30 percent of the samples tested by

Total

Percent of
households
in which salt
was tested
89.4

Number of
households

Percent of
households
with no
salt

Salt with
no
iodine
(0 ppm)

11,925

9.8

0.0

>0 and15
ppm
Inadequately
Iodized salt

15 ppm
Adequately
Iodized salt

70.7

29.3

15 and 50
ppm
Optimum
Iodized salt
Concentration
range for
Ghana
20.3

>60
ppm
Excessive
Iodine.
5.0

Number of
households
in which salt
was tested for
iodine using
Titration
method
3,263

Results of the Rapid Test Kits with matching titration results were identified and extracted for comparison
with the titration results (Table NU.12). The percent efficiency of the Rapid Test Kits in correctly identifying
adequately iodised salts was examined by comparing its results with the titration results. The following
results were compared between the two methods:
% salt without iodine (0 ppm)
% inadequately iodised salt (> 0 and < 15 ppm)
% adequately iodised salt ( 15 ppm)
For salt without iodine, the Rapid Test Kits identified 25 percent of the salt samples as non-iodised, while
the titration method found no salt samples as devoid of iodine.
The Rapid Test Kits reported 62 percent of salt as inadequately iodised (< 15 ppm) in this case, 25
percent of salt without iodine (0 ppm), and 37 percent of inadequately iodated salt ( >0 and <15 ppm)
were combined to give 62 percent. The titration method, on the other hand, identified 71 percent of salt
3 UNICEF, PAMM, MI, ICCIDD, WHO. Sullivan KM et al., eds. Monitoring universal salt iodization programmes. Atlanta, PAMM, MI, ICCIDD, 1995.
4 Pieter L.J, Emmerentia S.( 2010): Methods for determining Iodine in Urine and Salt. Best Practice & Research Clinical Endocrinology & Metabolism 24 (2010), 77-88