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Baffa LD, Angaw DA, Abriham ZY, Gashaw M, Agimas MC, Sisay M, Muhammad EA, Mengistu B, Belew AK. Prevalence of iodine deficiency and associated factors among school-age children in Ethiopia: a systematic review and meta-analysis. Syst Rev 2024; 13:142. [PMID: 38816755 PMCID: PMC11138098 DOI: 10.1186/s13643-024-02567-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 05/17/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Currently, iodine deficiency has become a significant burden globally; where 2 billion people and 29.8% of school-age children are iodine deficient. It is a leading cause of preventable brain damage among children, resulting in impaired cognitive and motor development. Even though salt iodization was started to be implemented to alleviate this burden in Ethiopia, primary studies assessing iodine deficiency in the country show highly variable findings, and no systematic review was conducted to determine the pooled prevalence of the problem which makes it difficult to assess the effect of the intervention as well as to design appropriate and timely measures. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of iodine deficiency and the common factors affecting its occurrence among school-age children in Ethiopia. METHOD To obtain the eligible studies, databases (EMBASE, Scopus, Hinari, and PubMed), websites (Google and Google Scholar), and references of the eligible studies were searched systematically. Data were extracted using an Excel spreadsheet and analyzed using the STATA 17 version. The I2 test was used to assess heterogeneity between the studies. A DerSimonian and Laird random-effects model was used to estimate the pooled prevalence and pooled odds ratio. A funnel plot and Egger's test were used to detect publication bias. RESULT A total of 15 eligible studies, representing 15,611 school-age children, were included in the systematic review and meta-analysis. The pooled prevalence of iodine deficiency among school-age children in Ethiopia was found to be 58% (95%CI 44.00-77.00), while the highest prevalence was recorded in the Oromia Region, which was 64% (95% CI 49-79). Goitrogenic food consumption (adjusted odds ratio (AOR) 2.93, 95% CI 1.60-5.35) and being female (adjusted odds ratio (AOR) 1.87, 95% CI 1.43-2.44) showed a significant association with the prevalence of iodine deficiency. CONCLUSION Iodine deficiency among school-age children in Ethiopia was noticeably high. Goitrogenic food consumption and the sex of the child were determinant factors for the occurrence of iodine deficiency among the children. Therefore, appropriate advice should be given to households to limit goitrogenic foods in the diet of their children by giving due attention to their female children.
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Affiliation(s)
- Lemlem Daniel Baffa
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zufan Yiheyis Abriham
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Moges Gashaw
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muluken Chanie Agimas
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mekonnen Sisay
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Esmael Ali Muhammad
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhanu Mengistu
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Aysheshim Kassahun Belew
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Terefe B, Jembere MM, Assimamaw NT. Iodized household salt utilization and associated factors among households in East Africa: a multilevel modelling analysis using recent national health surveys. BMC Public Health 2023; 23:2387. [PMID: 38041025 PMCID: PMC10690974 DOI: 10.1186/s12889-023-17296-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023] Open
Abstract
INTRODUCTION Iodine deficiency disorders (IDDs) are a significant global public health issue that affects the physical and mental development of every age group, with children and nursing mothers being the most vulnerable. Approximately 50 million of approximately 2 billion people with iodine deficiency (ID) globally exhibit clinical symptoms. Identifying iodine levels using various techniques is important when considering treatment choices. Screening programs and early ID diagnostics are crucial for the follow-up of pregnant women, especially in iodine-deficient nations. There have been calls for universal salt iodization programs, but only approximately 71% of people have access to them. The problem is more common in developing nations; however, there is a shortage of literature on the individual-, family-, and community-level factors influencing iodized salt use in East Africa. This study aimed to investigate individual- and community-level factors of household iodized salt usage in East Africa. METHODS Using Stata 17, this study used the most recent demographic and health survey datasets from twelve East African countries. The survey included a weighted sample of 154,980 households. To assess factors related to iodized salt use in the region, bivariable and multivariable multilevel logistic regressions were used. P values less than or equal to 0.2, and < 0.05 were used in the binary regression, and to deem variables statistically significant in the final model respectively. RESULTS About 87.73% (95% CI = 87.56,87.89) households have utilized iodized household salt. Secondary and above education (AOR = 1.23, 95% CI = 1.17-1.30), household heads with ages of 25-35 years, 36-45 years (AOR = 1.20, 95% CI = 1.12,1.28), 36-45 years (AOR = 1.16, 95% CI = 1.09,1.24), and more than 45 years (AOR = 1.18, 95% CI = 1.11,1.25), lower and middle wealth (AOR = 0.89, 95% CI = 0.76,0.89) and (AOR = 0.97, 95% CI = 0.81,0.93), media exposure (AOR = 1.10, 95% CI = 1.07-1.14), female household leaders (AOR = 1.08, 95% CI = 1.04-1.12), access to improved drinking water and better toilet facility (AOR = 2.26, 95% CI = 2.18-2.35) and (AOR = 1.50, 95% CI = 1.44,1.56), larger than five family members (AOR = 0.96, 95% CI = 0.93-0.99), high community level wealth (AOR = 1.54, 95% CI = 1.27-1.87), and low community education(AOR = 0.40, 95% CI = 0.33,0.49) were statistically associated with utilization of iodized household salt in East Africa respectively. CONCLUSION In East Africa, household salt iodization is moderately good. To expand the use of iodized salt in the region, access to improved drinking water and toilet facilities, participating family leaders, using the opportunity of family planning services, media sources, and the improvement of the community's socioeconomic level are all needed.
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Affiliation(s)
- Bewuketu Terefe
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Mahlet Moges Jembere
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nega Tezera Assimamaw
- Department of Pediatric and Child Health, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Maldey H, Tadesse S, Alem AZ, Hagezom HM, Hagos Gufue Z. Time to Euthyroidism and Its Determinants Among Thyrotoxicosis Patients on Anti-Thyroid Drug Who Attend to Medical and Ambulatory Clinics of South Tigrai General Hospitals. Ther Clin Risk Manag 2021; 17:1091-1101. [PMID: 34703238 PMCID: PMC8527101 DOI: 10.2147/tcrm.s312810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/22/2021] [Indexed: 01/19/2023] Open
Abstract
Purpose To determine the time to euthyroidism and its determinants among thyrotoxicosis patients on anti-thyroid drug attending the medical and ambulatory clinics of South Tigrai General Hospitals, Ethiopia, 2015–2020. Methods A multi-center retrospective cohort study was conducted from March 30, 2020, to July 30, 2020, among adult thyrotoxicosis patients who received anti-thyroid medications in the medical and chronic ambulatory clinics of South Tigrai General Hospitals, Ethiopia. Epi-data manager version 3.1 software was used for data entry and then exported to STATA version 15 for windows for analysis. Cox proportional hazards regression model was used to determine the determinants of time to euthyroidism and the summary measures of the adjusted hazard ratio with a 95% CI were presented, and P-value < 0.05 used to declare the statistical significance. Results One hundred and seventy-five (51.9%) thyrotoxicosis patients become euthyroid with the median time to euthyroidism of 9 months, IQR (6–12) months, with a total of 5542 person-months of observation. Age greater than 40 years (AHR = 0.7; 95% CI 0.54–0.96), toxic multi-nodular goiter (AHR = 0.69; 95% CI 0.60–0.87), World Health Organization goiter size three (AHR = 0.78; 95% CI 0.54–0.82) and baseline free thyroxin (AHR = 0.96; 95% CI 0.80–0.99) were the independent determinants of delayed time to euthyroidism. Conclusion The time to euthyroidism was longer than the expected time. High baseline free thyroxin, toxic multinodular goiter, elderly patients, and patients with World Health Organization goiter size three were determinants of delayed time to euthyroidism.
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Affiliation(s)
- Hiluf Maldey
- Department of Clinical Pharmacy, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Sumeya Tadesse
- Department of Clinical Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Haftamu Mamo Hagezom
- Department of Psychiatry, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Zenawi Hagos Gufue
- Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
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Tareke AA, Zerfu TA. Magnitude, Trends, and Determinants of Iodized Salt Availability among Households in Ethiopia: Analysis of Ethiopian Demographic and Health Surveys (2000-2016). Nutr Metab Insights 2021; 14:11786388211025342. [PMID: 34188487 PMCID: PMC8212372 DOI: 10.1177/11786388211025342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 05/27/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Iodine deficiency causes various health problems such as mental defects,
goiter, reproductive damage, hypo and hyperthyroidism, stillbirth, abortion,
congenital abnormalities, cretinism, mental retardation, muscle anomalies,
and reduced work output. Although the adverse effects on health and
socio-economic development are well known, they persisted as a public health
problem worldwide. Salt iodization is recommended as a simple cost-effective
method to prevent iodine deficiency disorders. This study aimed to determine
the magnitude, trends, and determinants of iodized salt availability in the
household in Ethiopia. Methods: The current study used the Ethiopian Demographic and Health Surveys conducted
from 2000 to 2016 with a total of 57 939 households. Descriptive statistics
were performed on selected background characteristics to provide an overall
picture of the sample after considering sample weights. To ensure the
representativeness of the sample we applied a complex sample design
considering household weights, primary sampling units, and the strata
associated with it. The Cochran–Armitage test was performed to assess the
trend of iodized salt availability in the household. Multivariate logistic
regression was used to determine the association between the dependent
variable and independent variables. A significance level of .05 was chosen
for all analyses. Results: The magnitude of iodized salt availability in the household was 28.45% in
2000, 54.34% in 2005, 15.42% in 2011, and 89.28% in 2016. Iodized salt
availability increased from 28.45% [95% CI: 27.69-29.21] in 2000 to 89.28%
[95% CI: 88.79-89.75] in 2016. Despite the decline from 2005 to 2011 in the
percentage of households with iodized salt, overall, there was a significant
increment from 2000 to 2016 in Ethiopia (P-value <.001).
There were differences in the status of salt iodization in the
administrative region, wealth, family size, and ownership of radio or
television. Conclusion: Remarkable progress has been made in Ethiopia regarding iodized salt
availability in recent years. Besides the current efforts to achieve
universal salt iodization, future interventions should prioritize specific
groups like those with lower socioeconomic status and geographic areas with
lower availability of iodized salt in the household.
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Affiliation(s)
- Amare Abera Tareke
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Taddese Alemu Zerfu
- College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia.,Global Academy of Agriculture and Food Security, University of Edinburgh, Edinburgh, UK
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Adequately Iodized Salt Utilization and Associated Factors among Households in Tach Armachio District, Northwest Ethiopia: A Community-Based Cross-Sectional Study. J Nutr Metab 2021; 2021:6630450. [PMID: 33953976 PMCID: PMC8064771 DOI: 10.1155/2021/6630450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/03/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022] Open
Abstract
Background For the synthesis of thyroid hormones, iodine is a crucial trace element. Iodine deficiency disorders affect all groups particularly: pregnant, young women and children. Iodine deficiency disorder has been recognized as a serious public health issue in Ethiopia. Therefore, this study planned to assess iodized salt utilization and associated factors at the household level. Methods A community-based cross-sectional study was conducted from January 25 to February 24, 2019, in Tach Armachio district, Northwest Ethiopia. A single population proportion formula was used to calculate the sample size and a total of 555 households were sampled. A multistage sampling technique was conducted to select the household. An iodometric titration method was performed. A structured, pretested, and face-to-face interview questionnaire was used to collect data; then, it was entered in Epi Info 7 and exported to SPSS version 25 for analysis. Bivariable and multivariable analyses were done to identify predictor variables. A 95% confidence interval and adjusted odd ratio were reported. P values less than 0.05 were considered statistically significant in the multivariable analysis. Results This study showed that iodized salt was adequately utilized by 61.1% (CI = 57%–65%) of households. Good knowledge of iodine deficiency disorder (AOR = 2.25, 95% CI = (1.44, 3.50)), keeping salt in the kitchen house away from fire (AOR = 5.09, 95% CI = (3.25, 7.98)), buying packed salt [AOR = 1.89, 95% CI = (1.12, 3.19)), keeping salt in a covered container (AOR = 2.18, 95% CI = (1.24, 3.81)), and exposing salt to sunlight (AOR = 0.39, 95% CI = (0.23, 0.65)) were significantly associated. Conclusion In the district, adequately iodized salt utilization was low. Therefore, it is necessary to enforce the current law for merchants to sell iodized packed salt and teach the community how to handle it.
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Tekalegn Y, Bekele K, Sahiledengle B, Woldeyohannes D. Prevalence of Goiter Among School-Aged Children in Ethiopia: Update of Systematic Review and Meta-analysis. Glob Adv Health Med 2021; 10:2164956120988660. [PMID: 33598366 PMCID: PMC7863155 DOI: 10.1177/2164956120988660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 11/23/2022] Open
Abstract
Background Iodine deficiency is a major public health concern throughout the world. Goiter is the most visible sign of iodine deficiency. In Ethiopia, a study finding regarding the prevalence of goiter among school-age children is inconsistent and highly variable. Objectives To estimate the pooled prevalence of goiter among school-age children in Ethiopia. Methods Three international databases (MEDLINE/Pub-Med, Google Scholar and Science Direct) were systematically searched. Besides, the reference sections of identified articles were searched to increase the chance of detecting missed articles in gray literature. STATA Version 14 statistical software was used to conduct a meta-analysis. The pooled prevalence with a 95% confidence interval was displayed using the forest plot. A random-effect meta-analysis model was used to compute the pooled prevalence, and The Cochrane Q test statistics and I2 test were used to assess the heterogeneity of the studies. Results A total of 14 studies fulfilled the inclusion criteria and included in this systematic review and Meta-analysis, with a total sample size of 26,282. The finding of this systematic review revealed that the pooled prevalence of goiter among school-age children was 42.9% (95% CI: 38.8–46.9). The highest prevalence of goiter (46.7%) was observed in Oromia region and the lowest (26.3%) was observed in Benishangul-Gumuz region. Conclusions This review finding revealed that more than two in five of the school children in Ethiopia suffer from iodine deficiency disorder as manifested by the goiter rate.
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Affiliation(s)
- Yohannes Tekalegn
- Department of Public Health, School of Health Science, Goba Referral Hospital, Madda Walabu University, Bale Robe, Ethiopia
| | - Kebebe Bekele
- Department of Surgery, School of Medicine, Goba Referral Hospital, Madda Walabu University, Bale Robe, Ethiopia
| | - Biniyam Sahiledengle
- Department of Public Health, School of Health Science, Goba Referral Hospital, Madda Walabu University, Bale Robe, Ethiopia
| | - Demelash Woldeyohannes
- Department of Public Health, School of Health Science, Goba Referral Hospital, Madda Walabu University, Bale Robe, Ethiopia
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Elias E, Tsegaye W, Stoecker BJ, Gebreegziabher T. Excessive intake of iodine and low prevalence of goiter in school age children five years after implementation of national salt iodization in Shebedino woreda, southern Ethiopia. BMC Public Health 2021; 21:165. [PMID: 33468112 PMCID: PMC7816433 DOI: 10.1186/s12889-021-10215-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Iodine is a trace element required for the synthesis of thyroid hormones. The multiple effects of iodine deficiency on human health are called iodine deficiency disorders (IDDs). IDDs have been common nutritional problems in Ethiopia. In 2012, Ethiopia launched a national salt iodization program to address IDDs. The objective of this study was to assess the effects of this program after 5 years by measuring urinary iodine concentration (UIC) and prevalence of goiter in school age children as well as household salt iodine concentration (SIC). Methods A school-based cross-sectional design was employed. After ethical approval, 408 children from eight randomly selected primary schools provided urine samples. UIC was analyzed by inductively coupled plasma mass spectrophotometry (ICP-MS). A 10 g salt sample was collected from each household of a sampled child. SIC was analyzed with a digital electronic iodine checker (WYD, UNICEF) and goiter was assessed by palpation. Results The mean (±SD) age of the children was 9 ± 2 years. The prevalence of goiter was 4.2% and no child had grade 2 goiter. The median (IQR) UIC was 518 (327, 704) μg/L and UIC ranged from 3.1 to 2530 μg/L. Of the salt samples, 15.6% were not adequately iodized (< 15 ppm), 39.3% were adequately iodized (≥15 to ≤40 ppm), and 45.1% were > 40 ppm. SIC ranged from 4.2 to 195 ppm. Of the mothers, 92% said iodized salt prevents goiter and 8% mentioned prevents mental retardation. Conclusions In 2017 iodine deficiency was no longer a public health problem in the study area. However, the high variability in UIC and SIC and excessive iodine intake are of great concern. It is vital to ensure that salt is homogenously iodized at the production site before being distributed to consumers.
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Affiliation(s)
- Elilta Elias
- School of Nutrition, Food Science and Technology, Hawassa University, P.O. Box 5, SNNPR, Hawassa, Ethiopia
| | - Workneh Tsegaye
- Department of Nutritional Sciences, Oklahoma State University, 421 Human Sciences, Stillwater, OK, 74078, USA
| | - Barbara J Stoecker
- Department of Nutritional Sciences, Oklahoma State University, 421 Human Sciences, Stillwater, OK, 74078, USA
| | - Tafere Gebreegziabher
- School of Nutrition, Food Science and Technology, Hawassa University, P.O. Box 5, SNNPR, Hawassa, Ethiopia. .,Department of Health Sciences, Central Washington University, 400 E University way, Ellensburg, WA, 98926, USA.
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