Ethiopia Eyes Double Fortified Salt to Prevent Neural Tube Defects

ADDIS ABABA – A new joint initiative plans to replicate an innovative way to reduce the incidence of Neural Tube Defects (NTDs) in Ethiopia.

The Ethiopian Public Health Institute (EPHI) and Ottawa-based Nutrition International (NI) jointly launched the project on Tuesday.

It will enable the sample production and market testing of table salt fortified with folic acid and iodine, and reduce the incidence of NTDs, the duo said.


Studies indicate that, in Ethiopia, the live birth rate of babies affected by NTDs may reach up to 13.8 per 1,000 births.

This rate is significantly higher than the African average of 1 – 2.5, resulting in devastating individual, economic, and social costs.

NTDs, a group of congenital anomalies, form within the first 18 days of a pregnancy, often before a woman knows she is pregnant.

The defects include anencephaly – a baby is born without parts of the brain and skull – and spina bifida – a birth defect of the spine – in a fetus.

While anencephaly always results in early death, experts say lucky survivors of spina bifida may adjust to a life-long disability through rehabilitation and surgery.

For many populations, it is very difficult to get enough folic acid in a regular diet and prevent NTDs.

To supply the required dose, fortifying foods routinely consumed such as steples or salt with folic acid is an alternative.

Many countries have implemented mandatory folic acid fortification programs – including Canada, Oman, and South Africa.

And the incidence of NTDs consistently declined to 0.5-0.6 per 1,000 live births, as per reports.

New Initiative

The newly launched project, designed by Nutrition International, aims at fortifying Ethiopian-produced table salt with folic acid and iodine.

The three-year project involves a research plan and its implementation to make sure quality evidence and system-based findings

“(This is) to make sure quality evidence and system-based findings will be produced and goes to policymakers and program developers,” said Dr. Mesay Hailun EPHI’s Director General.

The project plans to reach approximately 25.3 million women of reproductive age and over 11.65 million adolescent girls.

The Project plans to conduct product development and market testing of a table salt fortified with iodine and folic acid.

Table salt is selected due to its relatively huge potential of being used in almost all foods, officials say, adding it is also mostly sourced from a single source in Ethiopia offering an opportunity to centralize the processing, thus at a potentially low cost.

EPHI is now tasked to produce a sample product through its laboratory.

It will also conduct a study on a number of parameters: taste, market acceptability, safety, and economic viability.

The other partner of the Project, the University of California – Davis, will offer oversight in the scientific process of the research.

Officials say the findings of research and market testing are expected to be published at the end of the three-year period.

The research is also expected to produce recommendations to the Government of Ethiopia to adopt legislative and policy measures including the development of a mandatory standard of an iodine-folic acid fortified table salt.

“NI is committed to support the Government of Ethiopia’s effort in the prevention and control of all forms of malnutrition and in particular Neural Tube Defect,” said Girma Mamo, Deputy Country Director of the global Nutrition organization.