Limits to commercially iodized salt to address dietary iodine deficiency in rural Papua New Guinea.

BACKGROUND AND OBJECTIVES: Fortifying commercial table salt with iodine is the principal strategy used globally to prevent dietary iodine deficiency. However, the costs of providing fortified salt to remote communities may result in it not being locally available or too expensive for many households. This study shows that barriers to consuming adequately iodized salt remain significant for remote rural households in Papua New Guinea (PNG). METHODS AND STUDY DESIGN: Using data from a rural household survey conducted in four areas of PNG in 2018, two issues are examined. First, we contrast the characteristics of households that reported consuming or not consuming iodized table salt, respectively. Second, the adequacy of the iodine content of samples of table salt consumed was assessed in the laboratory. RESULTS: Nine percent of the 1,026 survey households reported not consuming iodized table salt. These households tend to live in remote communities, are among the poorest households, have received no formal education, and have experienced recent food insecurity. Second, 17 percent of the 778 salt samples tested had inadequate iodine. The brand of salt most commonly consumed had the highest share of samples with inadequate iodine levels. CONCLUSIONS: Particularly in remote communities, ensuring that individuals consume sufficient iodine will require going beyond salt iodization to use other approaches to iodine supplementation. To ensure that the iodine intake of those using commercial table salt is adequate, closer monitoring of the iodine content in table salt produced or imported into PNG and enforcement of salt iodization regulations is required.

Predictors of Essential Health and Nutrition Service Delivery in Bihar, India: Results From Household and Frontline Worker Surveys.

BACKGROUND: In Bihar, India, coverage of essential health and nutrition interventions is low. These interventions are provided by 2 national programs--the Integrated Child Development Services (ICDS) and Health/National Rural Health Mission (NRHM)--through Anganwadi workers (AWWs) and Accredited Social Health Activists (ASHAs), respectively. Little is known, however, about factors that predict effective service delivery by these frontline workers (FLWs) or receipt of services by households. This study examined the predictors of use of 4 services: (1) immunization information and services, (2) food supplements, (3) pregnancy care information, and (4) general nutrition information. METHODS: Data are from a 2012 cross-sectional survey of 6,002 households in 400 randomly selected villages in 1 district of Bihar state, as well as an integrated survey of 377 AWWs and 382 ASHAs from the same villages. For each of the 4 service delivery outcomes, logistic regression models were specified using a combination of variables hypothesized to be supply- and demand-side drivers of service utilization. RESULTS: About 35% of households reported receiving any of the 4 services. Monetary immunization incentives for AWWs (OR = 1.55, CI = 1.02-2.36) and above-median household head education (OR = 1.39, CI = 1.05-1.82) were statistically significant predictors of household receipt of immunization services. Higher household socioeconomic status was associated with significantly lower odds of receiving food supplements (OR = 0.87, CI = 0.79-0.96). ASHAs receiving incentives for institutional delivery (OR = 1.52, CI = 0.99-2.33) was marginally associated with higher odds of receiving pregnancy care information, and ASHAs who maintained records of pregnant women was significantly associated with households receiving such information (OR = 2.25, CI = 1.07-4.74). AWWs receiving immunization incentives was associated with significantly higher odds of households receiving general nutrition information (OR = 1.92, CI = 1.08-3.41), suggesting a large spillover effect of incentives from product- to information-oriented services. CONCLUSION: Product-oriented incentives affect delivery of both product- and information-oriented services, although household factors are also important. In India, existing government programs can mitigate supply- and demand-side constraints to receiving essential interventions by optimizing existing incentives for FLWs in national programs, helping FLWs better organize their work, and raising awareness among groups who are less likely to access services.