The Government of Ethiopia made salt iodization mandatory in 2011. The country is self-sufficient in salt production and most of the population currently consumes adequately iodized salt regularly.
Folate insufficiency, however, is very high. Most people in Ethiopia do not regularly eat food that is rich in folate or vitamin B9, and between 60% to 100% of women have insufficient folate – with wide disparities across regions – putting them at greater risk for pregnancy impacted by neural tube defects (NTDs). Consequently, NTD rates in Ethiopia are very high, with hospital-based studies reporting a prevalence up to eight times greater than other African countries.
Children with NTDs are often critically ill and may have severe disabilities, which causes stigma for both children and caregivers. The burden of care often falls on mothers or female caregivers, and results in financial distress and psychological pain and stigma for the families and the affected child.
Large-scale food fortification provides an opportunity to reach large numbers of a population, especially those in vulnerable situations, with essential micronutrients to which they may not otherwise have access. Double-fortified salt with iodine and iron is currently used in other countries, such as India, and has proven effective in reducing rates of iron-deficiency anaemia.