Background. There are laws to enforce the universal iodization of salt to check the consequences of iodine deficiency in Ghana. These laws are to ensure that there are production and sales of iodized salt in the country. Yet, the availability of iodized salt in the county's households is still not encouraging, with data indicating that 93.8% of children have urine iodine <100 μg/dl. Hence, the study investigated the iodine content of salt in retail shops and knowledge of iodized salt among retailers in the Wa East District. The study will help the informed decision on strengthening and enforcing laws to achieve the universal salt iodization and the consumption of adequate iodized salt. Method. The study was a descriptive cross-sectional survey. We used a questionnaire to collect quantitative data from participants and a rapid field test kits to determine the iodine content of salt. STATA version 14.2 was used to analyse data. Chi-squared and logistic regression models were used to examine the association between the dependent and independent variables and considered value <0.05 as statistically significant. Findings. The retailers’ primary source of information about iodized salt was health workers (46.2%), with the majority (52.8%) of them having low knowledge of iodized salt. Notwithstanding the high knowledge of iodized salt, as high as 53.8% of the salts do not have adequate iodine (<15 ppm). Retailer’s sex (), educational level (), primary source of information about iodized salt (), texture of salt being sold (), and mode of displaying salt in the shop () were associated with knowledge of iodised salt. Again, retailer’s educational level (), knowledge of iodized salt (), texture of salt being sold (), and method of displaying the salt being sold () were associated with an iodine content of the salt in the shop. Conclusions. Though policies have been implemented to promote production and consumption of iodized salt, the iodine content of salt in retail shops in the Wa East are not encouraging. We recommend the establishment of checkpoints along the production and distribution chain to ensure salt with adequate iodine reaches the consumer. Again, traders of iodized salt should have regular training on ways to preserve salt to maintain its iodine content.
Iodized Salt has been credited with preventing about 750 million cases of goitre over the past years, with Iodine Global Network and UNICEF estimating that globally about 6.1 billion people are currently consuming iodised salt representing a significant achievement of large-scale food fortification . However, studies in Tunisia and Tanzania showed that salt in wholesale and retail shops are inadequately iodised [2, 3].
Ghana has, since 1996, passed laws, including the Food and Drugs (Amendment) Act 523, the Provisional National Defence Council Law (PNDCL) 3058, and the Public Health Act 851 aimed at promoting universal salt iodization to check the consequences of iodine deficiency. Despite this, studies in the country indicate that 93.8% of children have low urine iodine (<100 μg/dl) levels  and 36.6% of women are living in households with no iodized salt . Again, a study conducted in the Volta Region of Ghana revealed that only 30.9% and 24.5% of salt in the retail shops and households, respectively, have adequate iodine (>15 ppm) . Also, iodine concentration levels in salt in retail shops in Accra do not meet the standards of the Ghana Standard Authority . Though Volta Region and Accra are closer to the iodized salt production sites, transporting iodized salts to these areas might have less effect on iodine content than to the Wa East District.
Aware of the consequences of iodine deficiency on the general population, especially women and children including abortion, miscarriage, brain damage, congenital abnormalities, and perinatal deaths , we investigated the iodine content of salt in retail shops and knowledge of iodized salt among retailers in the Wa East District to help inform the decision on strengthening and enforcing laws to achieve the universal salt iodization and the consumption of adequate iodized salt.
2. Materials and Methods
2.1. Study Site
The total land size of Wa East District is about 4,279.1 km², forming approximately 17.3% of the total landmass of the Upper West Region. It is located in the South-Eastern part of the region and has one-hundred and forty-five (145) communities that are completely rural with no urban settlements. The district had an estimated population of eighty-nine thousand one-hundred and eighty-two (89,182) with an annual fertility rate of 3.9 and crude birth rate (CBR) of 25 per 1,000 populations. Males constitute 50.5%, while females represent 49.5%. The distance between the study area and salt production sites on the coast of Ghana is about 713.1.3 km. About 68.6% of the people who are 11 years or older are uneducated, with the proportion of females (53.4%) higher than that of males (46.6%). About 76.0% of the people who are 15 years or older are economically active, while 24.0% are not active. Of the economically active ones, 97.8% of them are employed while 2.2% are unemployed . There are nine health centres, a clinic, and twenty-eight Community-Based Health Planning and Services (CHPS) compounds providing healthcare services to the people in the district. The area also has some secondary and elementary schools providing formal education to people in the area including two senior high secondary schools, fifty-four junior high secondary schools, eighty-one primary schools, and seventy-seven nursery schools .
2.2. Study Population
The study involves retailers of salt who had stayed in the district for three or more months. However, only those who signed informed consent forms were allowed to participate in the study. Foreign nationals and severely ill people were excluded from the study.
2.3. Study Design
We used a descriptive cross-sectional study and a qualitative and quantitative data collection procedure to collect data on iodine concentration levels in salt in retail shops and knowledge of iodized salt among retailers in the district from October to November 2019.
2.4. Sample Size and Sampling Procedure
A total of 197 salt retail shops and retailers were involved in the study. A total population purposive sampling method was used to include all the 197 registered salt retail shops and retailers in the study area.
2.5. Data Collection Tools and Procedure
Semistructured questionnaires and the Rapid Field Iodine Test kits manufactured by MBI KITS INTERNATIONAL supplied to Ghana Health Service by UNICEF were the tools used to collect data on iodine concentration levels of salts in retail shops, knowledge on iodized salt, and demographic characteristics of the retailers. Face-to-face interview technique and collection of a sample of salt for the iodine test were the methods used to collect study data. The Rapid Field Iodine Test kits used were part of kits tested and approved for Ghana Health Service to use for routine services by the Ghana Standard Board and Food and Drugs Authority.
Iodine concentration levels of salt in each retail shop were tested by adding two drops of the test solution to each sample using the Rapid Field Test kits and the testing procedure was followed as specified by the manufacturer of the kits. After sixty seconds, the colour of the salt was cross-checked with the colour chart of the kits to determine the iodine content.
A verification test was performed on salts that did not show colour change after sixty-seconds by adding five drops of the recheck solution and two drops of the test solution to a fresh sample as specified in the user instructions. When no colour change appeared after the retest, it was assumed and concluded that the salt does not contain iodine. Due to differences in an individual’s eyesight and to reduce errors, two individuals were recruited to perform double iodine tests on each sample separately and independently.
Ages of the retailers were assessed using their Baptismal Certificates, Birth Certificates, Health Insurance Cards, Marriage Certificates, and events calendars for participants who do not possess any certificate or document.
2.6. Data Analysis
The statistical software STATA 14.2 version was used to analyse data and display them in tables and charts as frequencies and proportions to delineate the characteristics of the study population. Chi-squared and logistic regression analytical tests were used to investigate the associations between the predictor and outcome variables, and the value <0.05 was recognized as exhibiting significant association. The retailers’ knowledge on iodized salt was appraised on 11 points, and those who scored 0 to 5 points were described as having low (poor) knowledge, while those who scored 6 to 11 points were described as having high (good) knowledge on iodized salt.
3.1. Background Characteristics of Retailers
A total of one-hundred and ninety-seven (197) salt retailers in Wa East District were involved in the study. The mean age of the retailers was 39.5 years (±2.6 sd), with a comparative majority (47.2%) of them being 40 years or older. The majority (63.5%) of them was females, and a comparative majority (45.2%) of the salt retailers had no formal education. Again, the majority (73.1%) of them was married, and 78.2% were Moslems. Also, a comparative majority (48.2%) of them were Waalas. About 1% of the retailers’ tested the salt for iodine content before purchasing from the wholesale shops and distributors. Fine-texture salt (38.1%) was the comparative majority found in the shops in the district, while 44.2% of the retailers had placed salt directly under the Sun. About 37.6% of salts were in the original package from the producer (Table 1).
Frequency (n = 197)
Age group (years)
Type of marriage (n = 144)
Salt from wholesale shop tested for iodine
Texture of salt in shop
How salt was displayed for sale
In handy polythene bag
In large polythene bag
In original package
Where salt was displayed for sale
Placed directly in sun
Placed under shade