Ethiopian Review

NEDJO, Ethiopia (AP) - Rome Berihun barely remembers Ethiopia's deadly border war with Eritrea, but she feels its effects in her shortness of breath, trouble swallowing and a tumor-like growth in her neck.

The 16-year-old is among some 80 percent of Ethiopians suffering from an easily preventable deficiency of iodine, an essential nutrient that was readily available from Eritrea until the 1998-2000 war halted all trade between the countries.

"It suffocates me," said Rome, who has developed a lemon-sized goiter, or enlarged thyroid gland, in her neck a common symptom of iodine-low diets. "I can't breathe. I can't swallow."

Iodine deficiency and its largely irreversible effects _ the most severe is brain damage can be devastating. Most children born to iodine-deficient mothers appear normal but have difficulty learning and staying in school. Other symptoms include deafness, speech defects and goiters.

Dr. Iqbal Kabir, head of UNICEF's Nutrition and Food Security section in Ethiopia, said only 4 percent of Ethiopia's 77 million people consume iodized salt among the lowest percentages in the world.

"I have never seen any other country like this," said Kabir, who has worked in the nutrition field since 1983, and in that time has worked in three or four countries that used to have iodine deficiency problems, including Bangladesh and Tanzania. Both have since improved their lot.

In Ethiopia, Kabir said, «If this problem continues, a generation will suffer. Most countries protect against iodine deficiency, simply by adding iodine to salt at a cost of about 4 US cents; 2 euro cents per kilogram (2 US cents;one euro cent per pound). Most people get enough iodine simply by eating plants grown in iodine-rich soil or seafood that also carries the trace amounts of the nutrient.

But Ethiopia is landlocked and its soil is iodine-poor. The country used to get its salt from the Eritrean port of Aseb, where iodization factories added the nutrient. But since the war, most Ethiopian salt comes uniodized from the salt flats of northern Ethiopia.

Eritrea and Ethiopia have been feuding over their border since Eritrea gained independence from the Addis Ababa government in 1993 after a 30-year guerrilla war.

Ethiopia is among the world's 13 most iodine-poor countries, including India, Pakistan, Ghana and Burkina Faso, Kabir said. Nearly 64 percent of Pakistanis suffer from iodine deficiency, according to the International Council for the Control of Iodine Deficiency Disorders.

In Africa, Burkina Faso reports nearly 48 percent iodine deficiency rates, and Ghana tops 71 percent.
The United Nations estimates that up to 80 percent of Ethiopians suffer from the deficiency.

Ethiopia is working to fix the problem. Belaynesh Yifru, a nutrition expert in the Ministry of Health, expects newly purchased iodization machines to be operating within three months in northern Ethiopia.

But for those already suffering the effects particularly developmental problems this promised solution comes too late. And for those with goiters, the only treatment is surgery, a faraway option for the rural poor.

Dinke Baja, 13, blinked away tears as she touched her bulging neck in the remote village of Kelay.

"I don't like it," said Dinke, who has not seen a doctor because her family hopes the goiter will go away on its own. "I don't know what causes it."

Doctors in the area say they're doing their part to spread awareness, but often, it's too late. Dr. Fekede Jara, one of three doctors for Nedjo's 20,000 residents, says he sees eight to 10 patients a day with a goiter.
In the bustling surgery ward of the largest hospital in nearby Nekemte, Dr. Adam Lemma prepared to operate on Hanmbissa Farada, a farmer who decided he was ready to shed his goiter after 25 years. The goiter, the size of a small melon, dwarfs Hanmbissa's thin frame.

Adam, who like many Ethiopians goes by his first name, is the hospital's main general surgeon and performs up to four goiter-removal surgeries a week. At his hospital, which is government-run and where surgeries are subsidized, the most expensive goiter removal surgery costs about US$5.50 (€3.50) a considerable sum in a country where average per capita income is US$180 (€116).

«We have to concentrate more on prevention than on surgery,» Adam said. «It is a preventable disease.

But for those in the remote areas, prevention seems as far away as that distant war so many years ago.
In Nedjo, schoolteacher Negesse Olana, 36, clutched a plastic bag that held the remains of what was a pound of iodized salt. Doctors in Nekemte gave him the salt for his two children, both of whom have begun to develop goiters.

«Six, seven years ago, it did not exist around here,» he said. «But now most of the children have it. There is a difference between them. They are not as clever in the class, those who have this illness.

With less than a few teaspoons left in the bag and nowhere to buy more, Negesse says he has little hope. His 11-year-old daughter is already starting to struggle in school, and he said he's certain the iodine deficiency is causing it.

"This is a national disaster," said Mesfin Namarra, a lawmaker who represents Nedjo in far western Ethiopia, some 300 miles (480 kilometers) from the capital, Addis Ababa. «I don't know why nobody is scared about this.

Source: World Health Organization on iodine deficiency
www.who.int/nutrition/topics/idd/en.