Household Knowledge of Iodized Salt and Iodine Content of Dietary Salt in Morocco Further 25 Years of Universal Salt Iodization: A National Cross-Sectional Study
Copyright © 2026 Anass Rami, Souad Benaich, Mohammed El Mzibri, Assia Elouari, Imane Saha, Siham Hattad, Mohamed Idrissi, Laila El Ammari, Hassan Aguenaou, Khalid El Kari, Naima Saeid
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Background: At the global level, iodine deficiency (ID) has been significantly reduced since the widespread implementation of salt iodization programs; nevertheless, numerous populations worldwide remain at risk of insufficient iodine intake. In Morocco, the Universal Salt Iodization (USI) strategy was formally adopted in 1995 as a national public health measure to address this nutritional challenge. However, to date, no comprehensive national study has been conducted to evaluate the impact of this strategy on iodine adequacy at the household level.
Aims: This cross-sectional study aims to assess the iodine content of dietary salts at the household level in Morocco on a national scale.
Methods: A national cross-sectional study was conducted in 2019 among Moroccan households (n = 1963). Dietary salt samples were systematically collected from surveyed households to estimate household coverage of adequately iodized salt and to evaluate consumer awareness of iodization labelling. Iodine content analysis was performed employing the standardized iodometric titration method.
Results: At the national level, the majority of households predominantly consumed packaged salt (89%), whilst bulk salt accounted for only 8.1% of total consumption. Packaged salt was significantly more prevalent in urban areas (93.3%), whereas bulk salt was more frequently consumed in rural areas (14%) (p < 0.05). Consistently, the majority of surveyed households (71%) were unaware of the "iodized salt" designation on product labelling. The median iodine content of salt samples collected from the 1,963 households was 7.40 ppm (CI: 7.4–8.0), indicating that only 7.5% (95% CI: 6.4–8.7) of the surveyed population consumed adequately iodized salt (15 – 40 ppm). Furthermore, 65.6% (95% CI: 63.5–67.7) consumed inadequately iodized salt (5–14.9 ppm); 25.7% (95% CI: 23.8–27.6) consumed non-iodized salt (< 5 ppm); and 1.2% (95% CI: 0.8–1.8) consumed over-iodized salt (> 40 ppm).
Conclusion: Household coverage of adequately iodized salt remains critically low in Morocco, 25 years following the adoption of the USI strategy, underscoring the limited effectiveness of current program implementation. These findings highlight the urgent to reinforce and comprehensively revise the national salt iodization strategy through enhanced regulatory oversight, strengthened supply chain monitoring, improved consumer awareness campaigns, and targeted interventions in rural and nutritionally vulnerable populations, in order to fulfil the public health objectives of sustainable iodine deficiency elimination.
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Andersson, M., Takkouche, B., Egli, I., Allen, H. E., & de Benoist, B. (2005). Current global iodine status and progress over the last decade towards the elimination of iodine deficiency. Bulletin of the World Health Organization, 83 (4), 518-525. .
Arrêté conjoint de la ministre de la santé et du ministre de l'agriculture et de la pêche maritime n° 1486-09 du 19 octobre 2009 fixant la concentration de l'iode dans le sel à la fabrication et à la distribution. (2009). Bulletin Official, 5792, 1598. http://81.192.52.100/BO/fr/2009/bo_5792_fr.pdf
Asfaw, A., Tamiru, D., & Belachew, T. (2022). Mandatory versus voluntary implementation of salt iodization program for the last two decades in Ethiopia: A comparative review of existing literatures. Food and Nutrition Bulletin. https://doi.org/10.1177/03795721221114523 . DOI: https://doi.org/10.1177/03795721221114523
Bousliman, Y., Eljaoudi, R., Zahidi, A., Idrissi, M. O. B., Draoui, M., Abouqal, R., et al. (2011). Consommation du sel iodé et la prévalence du goitre chez les enfants d'âge scolaire dans la province de Larache, Maroc. Médecine du Maghreb, 189. .
Chaouki, N., Ottmani, S., & Saad, A. (1996). Etude de prévalence des troubles dues à la carence en iode chez les enfants âgés de 6 à 12 ans. Bulletin Epidémiologique du Maroc, 17, 2-19.
Charlton, K. E., Yeatman, H. R., & Houweling, F. (2010). Poor iodine status and knowledge related to iodine on the eve of mandatory iodine fortification in Australia. Asia Pacific Journal of Clinical Nutrition, 19 (2), 250-255. .
De Benoist, B., & Delange, F. (2002). La carence iodée: bilan et perspectives pour le futur Iodine deficiency: Current situation and future prospects. Santé, 12 (1), 9-17. .
De Benoist, B., McLean, E., Andersson, M., & Rogers, L. (2008). Iodine deficiency in 2007: Global progress since 2003. Food and Nutrition Bulletin, 29 (3), 195-202. https://doi.org/10.1177/156482650802900305 . DOI: https://doi.org/10.1177/156482650802900305
Dearth-Wesley, T., Makhmudov, A., Pfeiffer, C. M., & Caldwell, K. (2004). Fast and reliable salt iodine measurement: Evaluation of the WYD Iodine Checker in comparison with iodometric titration. Food and Nutrition Bulletin, 25 (2), 130-136. https://doi.org/10.1177/156482650402500204 . DOI: https://doi.org/10.1177/156482650402500204
Doggui, R., et al. (2017). Unsatisfactory results of the Tunisian universal salt iodization program on national iodine levels. Journal of Food Composition and Analysis, 64, 163-170. https://doi.org/10.1016/j.jfca.2017.09.001 . DOI: https://doi.org/10.1016/j.jfca.2017.09.001
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