Iodization of village water supply in the control of endemic iodine deficiency in rural Sarawak, Malaysia

A simple water iodizing system, which incorporates the Venturi principle in combination with the controlled release mechanism of a silicone-sodium iodide elastomer, for the iodization of rural piped-water supply in the control of endemic iodine deficiency has been developed and its effectiveness evaluated in three Iban longhouse villages in the iodine-deficient district of Lubok Antu, Sarawak. Urines were collected for iodine assays from women aged 15-40 years before and at 6 and 12 months after the connection of the iodinating device; goiter assessment was performed on the women at the start and end of the 1-year study. Water samples were collected for iodine assays at 2-weekly intervals. In all three villages, significant and sustained increases in median urinary iodine excretions, reaching levels recommended for an iodine-sufficient population, were observed; goitre prevalences were reduced in all the villages (by 22.6% to 35.8%). The iodine levels in the water ranged from 34 micrograms/l to 212 micrograms/L. In the control village, median urinary iodine excretions remained essentially unchanged but a small increase in goiter prevalence was observed. The iodized water was well received by the villagers and no adverse effects of water iodization were observed. The system functioned unattended throughout the one year period. The cost of providing supplemental iodine via the iodizing device is approximately 60 cents (U.S.) per family per year which is affordable by either the Government or the villagers. It is concluded that the iodizing system offers a new cost-effective strategy for the control of endemic iodine deficiency in Sarawak and may have applications in other areas with similar water sources.