Excess dietary iodine intake in long-term African refugees

Objective: To assess the iodine status of long-term refugees dependent on international food aid and humanitarian assistance. Design: A series of cross-sectional two-stage cluster or systematic random sample surveys which assessed urinary iodine excretion and the prevalence of visible goitre. Salt samples were also collected and tested for iodine content by titration. Setting: Six refugee camps in East, North and Southern Africa. Subjects: Male and female adolescents aged 10-19 years. Main results: The median urinary iodine concentration (UIC) ranged from 254 to 1200 mu g l(-1) and in five of the camps exceeded the recommended maximum limit of 300 mu g l(-1), indicating excessive iodine intake. Visible goitre was assessed in four surveys where it ranged from 0.0 to 7.1%. The camp with the highest UIC also had the highest prevalence of visible goitre. The iodine concentrations in 11 salt samples from three camps were measured by titration and six of these exceeded the production-level concentration of 20 to 40 ppm recommended by the World Health Organization (WHO), but were all less than 100 ppm. Conclusions: Excessive consumption of iodine is occurring in most of the surveyed populations. Urgent revision of the level of salt iodisation is required to meet current WHO recommendations. However, the full cause of excessive iodine excretion remains unknown and further investigation is required urgently to identify the cause, assess any health impact and identify remedial action.