Iodine deficiency is regarded as the single most common cause of preventable mental impairment in communities with suboptimal intake of iodine. Universal Salt Iodization is the most effective and sustainable intervention strategy for prevention, control and elimination of iodine deficiency. Urinary iodine concentration is the biochemical indicator for assessing the iodine status of a population. This study was prompted by reports showing evidence of cretinism in Karimui-Nomane district in Simbu province. The major objectives were therefore to assess the availability of adequately iodized salt in households, the per capita discretionary intake of salt per day and the iodine status of school children (age 6–12 years) in Karimui-Nomane, the district of concern, and Sina Sina Yonggomugl, a comparison district in Simbu province. Iodine level was assessed in salt samples collected from randomly selected households in both districts. The head of each household completed a questionnaire on knowledge, attitudes and practices related to salt iodization. Urinary iodine concentrations were measured in spot urine samples collected from randomly selected 6 to 12 years old children from selected primary schools in the two districts. 82.4% and 63.8% of salt samples from Karimui-Nomane and Sina Sina Yonggomugl respectively were adequately iodized above the national standard of 30ppm. The mean per capita discretionary intake of salt in households in Karimui-Nomane district was 4.62 ± 0.42 g/day, and in Sina Sina Yonggomugl district was 6.0 ± 2.61g/day. At measured levels of iodization (mean iodine content 34.7ppm and 32.7ppm respectively), this amount of salt would provide the recommended intake of iodine (150ug/day). However, for children in Karimui-Nomane the median UIC was 17.5μg/L and the interquartile range (IQR) was 15.0 – 43.0μg/L. and in Sina Sina Yonggomugl, the median UIC was 57.5μg/L and the IQR was 26.3–103.0μg/L, indicating severe and mild iodine deficiency respectively. These apparently conflicting findings may be explained by the fact that only 34% of households in Karimui-Nomane and 72% of households in Sina Sina Yonggomugl had salt on the day of the survey. The results indicate that iodine deficiency is a significant public health problem in Karimui-Nomane and Sina Sina Yonggomugl districts in Simbu province, potentially because of lack of access to salt, rather than inadequate implementation of salt iodization. Further studies are needed to quantify access to salt for communities in areas that are not easily accessible like Karimui-Nomane district in Papua New Guinea and, if inadequate salt access is confirmed, to develop alternative or complementary strategies to salt iodization