Iodisation in displaced African populations [Letter]

In their excellent Seminar on iodine-deficiency disorders (Oct 4, p 1251),1 Michael Zimmermann and colleagues highlight the growing problem of excess iodine intake in some sub-Saharan African countries. However, they do not address concerns regarding excessive iodine intake in refugee and displaced populations within the region. Sub-Saharan Africa has an estimated 16 million refugees and displaced people, many of whom rely on iodised salt provided through food aid from regional governments and international aid agencies.2 A survey in refugee settlements across several African countries including Kenya, Ethiopia, Uganda, Zambia, and Algeria revealed excessive dietary iodine associated with overiodisation of salt supplies.3 A similar situation was reported in Sudanese children dependent on humanitarian food assistance.4 These reports call for urgent monitoring of iodisation in displaced African populations. Vigilance is particularly required where migrant flows arise from severely deficient areas. As noted by Zimmermann and colleagues, precipitous increases in iodine can be harmful in individuals with pre-existing thyroid autonomy (ie, thyroids that can function in the absence of thyroid-stimulating hormone). The recorded deaths in Zimbabwe in the 1990s should serve as a reminder that iodine-induced hyperthyroidism is not always benign in poor communities with limited access to health-care facilities.5 Nevertheless, the risks of iodisation should in no way deter from the ultimate goal of eliminating iodine deficiency. Rather, the task ahead must focus on developing sustainable systems for systematic collection of iodine nutrition data in African populations. Such information will allow appropriate correction of iodine deficiency with safe levels of iodisation