The term iodine deficiency disorders (IDD) refers to all the effects of iodine deficiency on growth and development in human and animal populations that can be prevented by correction of the iodine deficiency . IDD in the most severe form includes cretinism, stillbirth and miscarriage, and increased infant mortality . In developing countries about 38 million newborns every year remain unprotected from the lifelong consequences of brain damage associated with IDD . A recent study estimated that 266 million school-age children and two billion of the general population worldwide have insufficient iodine intake .
In the Middle East and North Africa region the situation of IDD control varies considerably between countries. Only the Islamic Republic of Iran and Tunisia have achieved IDD control goals . Iraq, Afghanistan and Pakistan were classified as suffering from severe IDD while Morocco, Sudan and the Kingdom of Saudi Arabia (KSA) were considered as suffering from moderate IDD problems [4, 5].
Universal Salt Iodization (USI) is a strategy to ensure sufficient intake of iodine by all individuals was recommended by the WHO and UNICEF Joint Committee on Health Policy in 1994 . Some experts believe that universal salt iodization may be the most successful public health effort of the past two decades  and a remarkably cost-effective public health goal .
UNICEF estimates that less than 20% of households in the developing world were using iodized salt in the early 1990s, and by 2000, the average had jumped to some 70%. By 2006, around 120 countries were implementing salt iodization programs . In 2007, worldwide 12 countries have optimal iodine status and iodine intake is more than adequate, or even excessive, in 34 countries , an increase from 27 in 2003 . In the Middle East and North Africa region, 64% of households consume adequately iodized salt with wide variation between countries .
The targets for sustainable IDD elimination include process and impact indicators. The process indicators are; (1) 100% of all salt produced and imported is iodized; (2) 95% of all iodized salt imported and produced is adequately iodized; (3) 90% of households are using adequately iodized salt; and (4) 100% of all districts have reached the goal of USI, i.e. > 90% of households are using adequately iodized salt. The impact indicators are: (1) population median urinary iodine concentration (UIC) is 100–300 μg/L; (2) proportion of samples with UIC levels below 100 μg/L is < 50%; and (3) proportion of samples with UIC levels below 50 μg/L .
In the KSA a national cross-sectional epidemiological survey for studying iodine status was conducted among Saudi schoolchildren aged 8–10 years in 1997 . The median national UIC was 180 μg/L and the total goiter rate (TGR) ranged from 8% to 30%. Nationally the proportion of the population with UIC less than 100 was 23%. The southern province of Jazan had the lowest median UIC (110 μg/L) and the highest percentage (45%) of subjects with a UIC < 100 μg/L . The IDD control program using the USI strategy started in 1997, and the Saudi Standards, Metrology and Quality Organization (SASO) recommend that iodine content of salt must be 70–100 ppm in all food salt . Since the national survey in 1997, no follow up survey or monitoring system has taken place  to assess the iodine nutrition status in the population neither nationally or in the Jazan region.
The objective of this paper is to determine the iodine nutrition status among schoolchildren in the Jazan Region of the KSA, by measuring the UIC and by clinical assessment of the goiter rate.