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Ferede A, Abera Wordofa M, Belachew T. Behavior change intervention to sustain iodide salt utilization in households in Ethiopia and study of the effect of iodine status on the growth of young children: community trial. PeerJ 2024; 12:e16849. [PMID: 38549782 PMCID: PMC10977086 DOI: 10.7717/peerj.16849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/07/2024] [Indexed: 04/02/2024] Open
Abstract
Background Monitoring systems in a broad range of countries are a notable effort to eliminate iodine deficiency disorders (IDDs). This study aimed to gather data on the amount of iodide present in table salt and how household consumption patterns affect children's iodine status and its effect on their growth. Methods A single treatment arm community trial study design was designed. Lower community units (LCUs) were chosen at random from districts assigned either intervention or control. From a list of LCUs, 834 mothers and their paired children were chosen randomly. Urine and table salt samples were collected and examined in the national food and nutrition laboratory. The deference between arms was determined using a t test, and the generalized estimating equation (GEE) was used to forecast parameters. Results The mean iodide content in the table salt samples of 164 (98.1%) was 45.3 ppm and a standard deviation (SD) of 14.87, which were above or equal to the recommended parts per million (ppm). Between the baseline survey and the end-line survey, the mean urine iodine concentration (UIC) was 107.7 µg/L (+/- 8.64 SD) and 260.9 µg/L (+/- 149 SD). Children's urine iodine excretion (UIE) had inadequate iodine in 127 (15.2%) children at the beginning of the study, but only 11 (2.6%) of the intervention group still had inadequate iodine at the end. The childrens' mean height (Ht) was 83.1 cm (+/-10 SD) at baseline and 136.4 cm (+/-14 SD) at the end of the survey. Mothers knew a lot (72%) about adding iodized salt to food at the end of cooking, and 183 (21.9%) of them did so regularly and purposefully. A total of 40.5% of children in the intervention group had stunted growth at baseline, which decreased to 15.1% at the end of the study but increased in the control group to 51.1%. The mean difference (MD) of urine iodine concentration (UIC) between intervention and control groups was 97.56 µg/L, with a standard error (SE) of 9.83 (p = 0.001). The end-line Ht of children in the intervention group was increased by 7.93 cm (β = 7.93, p = 0.005) compared to the control group. Conclusions Our research has shown that mothers who embraced healthy eating habits had perceived improvements in both the iodine status and height growth of their children. In addition to managing and using iodine salt, it has also introduced options for other healthy eating habits that will also play a significant role in their children's future development. This sort of knowledge transfer intervention is essential for the sustainability of society's health. Therefore, this trial's implications revealed that the intervention group's iodine status and growth could essentially be improved while the control group continued to experience negative effects. Trial registration ClinicalTrials.gov Identifier: NCT048460 1.
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Affiliation(s)
- Abebe Ferede
- Department of Public Health, Arsi University, Asella, Ethiopia
| | | | - Tefera Belachew
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
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Abdalla AE, Altahir AM, Hasabo EA, Alrawa SS, Elazrag AM, Ahmed HA, Ali HA, Abdelrazig IM, Ahmed MY, Alagib MA, Siddig MM, Asmally RS, Mohamedelrasheed SM, Elnaiem WA, Malik EM. Prevalence and determinants of goitre among children of South Kordofan state, Sudan, 2021: an urgent need for effective implementation of universal salt iodisation. Public Health Nutr 2023; 27:e18. [PMID: 38095122 PMCID: PMC10830365 DOI: 10.1017/s1368980023002744] [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: 02/02/2022] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE This study aimed to determine the prevalence and determinants of goitre among children aged 6-12 years at South Kordofan state. DESIGN This was a cross-sectional facility-based study. SETTING The study was conducted in twenty villages of South Kordofan state during a medical mission. PARTICIPANTS All 575 school-age children (6-12 years) who attended the medical day were examined for clinical assessment of goitre. RESULTS The prevalence of goitre among children of South Kordofan was 42·8 % (grade 1: 15·7 %, grade 2: 27·1 %). Only 24·2 % of caregivers reported using iodised salt. Mothers working as farmers (OR: 3·209, CI 95 % 1·437, 7·167; P = 0·004) and children of Darforian tribes (OR: 21·799, CI 95 % 2·566, 185·226; P = 0·005) were found to be significantly associated with higher prevalence of goitre among children. This contrasts with children of African tribes, where they were found to have less goitre prevalence (OR: 0·432, CI 95 % 0·213, 0·875; P = 0·02). Iodised salt utilisation (OR = 0·523, CI 95 % 0·320, 0·854; P = 0·01) was found associated with a lower prevalence of goitre. CONCLUSION Even though National Iodine Deficiency Disorders control programs were initiated in Sudan more than 25 years ago, the prevalence of goitre among children in South Kordofan state was alarming (42·8 %). Efforts to improve access to iodised salt, increase utilisation and raise awareness are urgently needed.
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Affiliation(s)
- Azza Elfadil Abdalla
- Khartoum Medical Student’s Association, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Anfal Mahmoud Altahir
- Khartoum Medical Student’s Association, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Elfatih A. Hasabo
- Khartoum Medical Student’s Association, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
- CORRIB Research Centre for Advanced Imaging and Core Laboratory, Clinical Science Institute, University of Galway, Galway, Ireland
- Discipline of Cardiology, Saolta Healthcare Group, Health Service Executive, Galway University Hospital, Galway, Ireland
| | - Salma Salah Alrawa
- Khartoum Medical Student’s Association, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Amna Mutasim Elazrag
- Khartoum Medical Student’s Association, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Hayat Abdoallah Ahmed
- Khartoum Medical Student’s Association, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Hiba Abubakr Ali
- Khartoum Medical Student’s Association, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Ibrahim Mysara Abdelrazig
- Khartoum Medical Student’s Association, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Mohamed Yaser Ahmed
- Khartoum Medical Student’s Association, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Mohamed Alsiddig Alagib
- Khartoum Medical Student’s Association, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Musab Mohammed Siddig
- Khartoum Medical Student’s Association, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Rofida Salah Asmally
- Khartoum Medical Student’s Association, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | - Walaa Abdulgadir Elnaiem
- Khartoum Medical Student’s Association, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Elfatih Mohammed Malik
- Community Medicine Department, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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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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Asfaw A, Behailu M, Oumer A, Gebremariam T, Asefa K. Factors associated with recent iodine intake level among household food handlers in Southwest Ethiopia: a cross-sectional study. BMC Womens Health 2023; 23:354. [PMID: 37403023 DOI: 10.1186/s12905-023-02516-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 06/29/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Iodine deficiency is a global public health threat, affecting an estimated two billion people. The median urinary iodine concentration is more reliable in determining recent iodine intakes and the risks of iodine deficiency. Therefore, this study was aimed to identify the factors associated with recent iodine intake level using median urinary iodine concentration as an indicator among household food handlers in southwest Ethiopia. METHODS A community-based survey was conducted with selected households using a pretested interviewer-administered questionnaire in southwest Ethiopia. A 20-gram sample of table salt and a 5 ml causal urine samples were also collected and analyzed using rapid test kit and a Sandell-Kolthoff reaction, respectively. A salt iodine concentration above 15 ppm was classified as adequately iodized and a median urinary iodine concentration between 100 and 200µgl- 1 was considered as adequate iodine intake. A bivariable and multivariable logistic regression model was fitted. Crude and adjusted odds ratios with their 95% confidence levels were reported. Associations with a p-value ≤ 0.05 were used to declare statistical significance. RESULTS A total of 478 women were included, with a mean age of 33.2 (± 8.4 years). Only 268 (56.1%) of the households had adequately iodized salt (> 15 ppm). The median urinary iodine concentration (interquartile range) was 87.5 µg l- 1 (45.6-107.6). In a fitted multivariable logistic regression model (p-value = 0.911), illiterate women (AOR = 4.61; 95% CI: 2.17, 9.81), poorly iodized salt in the household (AOR = 25.0; 95% CI: 13-48), salt purchased from open market (AOR = 1.93; 95% CI: 1.0, 3.73) and women who do not read the label during purchasing the salt (AOR = 3.07; 95% CI: 1.31, 7.17) were important predictors of the risk of Iodine deficiency. CONCLUSION Despite public health efforts to improve iodine intake, its deficiency is still a major public health problem among southwest Ethiopian women.
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Affiliation(s)
- Agize Asfaw
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Welkite, P.O. Box: 07, Ethiopia.
| | - Mifta Behailu
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Welkite, P.O. Box: 07, Ethiopia
| | - Abdu Oumer
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Welkite, P.O. Box: 07, Ethiopia
| | - Tigist Gebremariam
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Welkite, P.O. Box: 07, Ethiopia
| | - Kenzudin Asefa
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Welkite, P.O. Box: 07, Ethiopia
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Bourassa MW, Atkin R, Gorstein J, Osendarp S. Aligning the Epidemiology of Malnutrition with Food Fortification: Grasp Versus Reach. Nutrients 2023; 15:2021. [PMID: 37432175 DOI: 10.3390/nu15092021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 07/12/2023] Open
Abstract
Large-scale food fortification (LSFF) has been recognized as one of the most cost-effective interventions to improve the intake of vitamins and minerals and decrease the burden of micronutrient deficiency. Indeed, the simple addition of micronutrients to staple foods, such as wheat, maize and rice, or condiments, including salt and bouillon, has tremendous potential to impact malnutrition. However, most LSFF programs have been poorly designed and have not taken into consideration critical inputs, including current levels of nutrient inadequacy and per capita consumption of different food vehicles when deciding which nutrients to add and at what concentrations. LSFF programs, like some other nutrition interventions, also tend to have low coverage and reach and lack monitoring to measure this and course correct. These program design flaws have resulted in limited effectiveness and have made it difficult to determine how best to harmonize LSFF with other interventions to reduce micronutrient deficiencies, including efforts to enhance dietary diversity, biofortification and supplementation. Furthermore, LSFF has often been touted as a population-based intervention, but in fact has heterogenous effects among sub-groups, particularly those with limited access to or inability to afford fortified foods, as well as those with higher physiological requirements, such as pregnant and lactating women. This article focuses on these limitations and the concerted efforts underway to improve the collection, analysis, and use of data to better plan LSFF programs, track implementation, and monitor coverage and impact. This includes a more sophisticated secondary analysis of existing data, innovations to increase the frequency of primary data collection and programmatically relevant visualizations of data of sub-national estimates. These improvements will enable better use of data to target resources and programmatic efforts to reach those who stand to benefit most from fortification.
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Affiliation(s)
| | - Reed Atkin
- Micronutrient Forum, Washington, DC 20005, USA
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Muluneh AG, Merid MWM, Kassa GM. Hotspots of un-iodized salt availability among Ethiopian households, evidence from the national survey data. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:20. [PMID: 36927806 PMCID: PMC10021937 DOI: 10.1186/s41043-023-00359-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/01/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Universal salt iodization was started before decades but there are communities using the un-iodized salt till now. More than one-tenth of the Ethiopian community uses un-iodized salt. OBJECTIVE This study aimed to identify the hotspots and associate factors of un-iodized salt availability in Ethiopia based on Ethiopian national household survey data. METHODS We conducted an in-depth analysis of the Ethiopian Demographic and Health Survey 2016 data. A total of 15,567 households were included in the final analysis. We cleaned and weighed the data using Stata version 16 software and descriptive outputs were reported in graphs and tables. We computed the weighted prevalence of un-iodized salt and prepared it for spatial analysis. Global-level spatial autocorrelation, hotspot analysis using the Getis-Ord Gi* statistics, and spatial interpolation using empirical Bayesian interpolation were executed using ArcGIS 10.3 to predict the magnitude of un-iodized salt at the national level. The binary logistics regression model was used to identify the contributing factors of un-iodized salt utilization. Model goodness of fit was tested with Hosmer and Lemeshow goodness-of-fit test (P = 0.96). Finally, the adjusted odds ratio (AOR) with 95% CI was reported to identify significant factors. RESULTS The magnitude of un-iodized salt availability was 14.19% (95% CI: 13.65, 14.75) among Ethiopian households. Un-iodized salt hotspots were found in Afar, Somalia, and Benishangul Gumuz regions. Compared to poorest wealth index: poorer (AOR = 0.55, 95% CI: 0.48, 0.64), middle (AOR = 0.51, 95% CI: 0.44, 0.60), richer (AOR = 0.55, 95% CI: 0.47, 0.64), and richest (AOR = 0.61, 95% CI: 0.50, 0.75); compared to uneducated household head: heads with secondary (AOR = 0.72, 95% CI: 0.60, 0.67) and above secondary (AOR = 0.54, 95% CI: 0.43, 0.67) education reduced the odds of un-iodized salt viability, while households living in highland (AOR = 1.16, 95% CI: 1.05, 1.29) had increased the odds of un-iodized salt availability. CONCLUSION More than a tenth of the households in Ethiopia uses un-iodized salt. Hotspots of un-iodized salt availability were found in Somali and Afar regions of Ethiopia. Better wealth index and education of the household heads reduces the odds of un-iodized salt availability while living in a high altitude above 2200 m increases the odds of un-iodized salt availability in Ethiopia.
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Affiliation(s)
- Atalay Goshu Muluneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia.
| | - Mehari W Mariam Merid
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Getahun Molla Kassa
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
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Foroozanfar Z, Moghadami M, Mohsenpour MA, Houshiarrad A, Farmani A, Akbarpoor MA, Shenavar R. Socioeconomic determinants of nutritional behaviors of households in Fars Province, Iran, 2018. Front Nutr 2022; 9:956293. [PMID: 36225881 PMCID: PMC9549329 DOI: 10.3389/fnut.2022.956293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionHouseholds' dietary habits are affected by their environment and socioeconomic status (SES). This study aims to investigate eating behaviors and determine the factors affecting nutritional status in households in Fars Province in 2018.MethodIn this cross-sectional study, urban and rural households were selected using the multistage sampling method. A questionnaire was employed to interview the mother or householder to record the demographic, SES, and dietary habits of the family for major food items commonly used. A logistic regression model was used to analyze the data. The p-value less than 0.05 was considered significant.ResultsIn total, 6,429 households participated in the study. The majority of households use traditional flatbread, low-fat milk, and liquid/cooking oil. Frying was the most prevalent method of cooking. Parents' level of education and SES were associated with type of consumed bread, milk and dairy, methods of food preparation, adding salt at the table, eating out, and fast-food usage. Parents' higher level of education was significantly associated with salt storage in optimal conditions and not using salt before tasting the meal.ConclusionMost of the households had healthy practices, especially in consumption of certain oils and methods of preparing their food as well as keeping salt in an optimal condition and using iodized salt. The most important unhealthy nutritional behavior was high consumption of fast food and outdoor food, especially in urban regions. Unhealthy dietary habits were more prevalent in households with low household and regional SES. Both households and regions with higher SES had better dietary habits.
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Affiliation(s)
- Zohre Foroozanfar
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Moghadami
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Mohsenpour
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Anahita Houshiarrad
- Nutrition Research Department, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azam Farmani
- Department of Community Nutrition, Shiraz University of Medical Science, Shiraz, Iran
| | - Mohsen Ali Akbarpoor
- Department of Community Nutrition, Shiraz University of Medical Science, Shiraz, Iran
| | - Razieh Shenavar
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Community Nutrition, Shiraz University of Medical Science, Shiraz, Iran
- *Correspondence: Razieh Shenavar ;
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Ewunie TM, Kabthymer RH, Hailu S, Mareg M, Mengie T, Sisay D, Arage G. Iodine concentration level of iodized dietary salt and its associated factors: a systematic review and meta-analysis. Eur Thyroid J 2022; 11:e220066. [PMID: 35635801 PMCID: PMC9254272 DOI: 10.1530/etj-22-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Iodine deficiency disorder (IDD) is a major public health problem in Ethiopia. The availability of adequate iodized dietary salt at the household level is immensely important. Hence, this review aimed to estimate the pooled prevalence of adequate iodine concentration level of iodized dietary salt at the household level and its associated factors in Ethiopia. Methods We searched the literature using electronic databases (PubMed/Medline, Google Scholar, Science Direct, and Embase) and gray literature from January 9, 2022, to February 25, 2022. The rapid test kit was used to measure the adequacy of iodine level of dietary salt. The quality of studies was assessed using Joanna Briggs Institute critical appraisal tool. Heterogeneity between studies was checked using I2 test statistics and publication bias was checked using funnel plot and Egger's statistical test at a 5% significance level. A random-effects model was employed to estimate the pooled prevalence of the outcome variable and its determinants in Ethiopia. Results The search identified 149 studies of which 18 studies were included with a total of 10,556 participants. The pooled prevalence of adequate iodine levels of iodized salt in Ethiopia was 44.37% (95% CI: 35.85-52.88). Women who had formal education (adjusted odds ratio (AOR) = 1.99 (95% CI: 1.47-2.48)), good knowledge of women (AOR = 2.14, 95% CI: 1.36-3.36), packed iodized salt (AOR = 3.85 (95% CI: 1.88-7.87)) and storage of iodized salt at home for less than 2 months (AOR = 2.66 (95% CI: 2.11-3.35) were the significant factors. Conclusion This review suggests that the pooled prevalence of adequate iodine levels was low. Our finding highlights the need for considering the educational status, knowledge, and duration of salt storage to enhance the prevalence of adequate levels of iodized salt at the national level.
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Affiliation(s)
- Temesgen Muche Ewunie
- Department of Human Nutrition, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Robel Hussen Kabthymer
- Department of Human Nutrition, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Samrawit Hailu
- Department of Reproductive Health, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Moges Mareg
- Department of Reproductive Health, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Tesfa Mengie
- Amhara Regional Health Bureau, CDC Project Zonal Monitoring and Evaluation Officer, Dessie, Ethiopia
| | - Daniel Sisay
- Epidemiology-Biostatistics Unit, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Getachew Arage
- Department of School of Public Health, College of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
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Barnett-Itzhaki Z, Ehrlich D, Troen AM, Rorman E, Groismann L, Blaychfeld-Magnazi M, Endevelt R, Berman T. Results of the national biomonitoring program show persistent iodine deficiency in Israel. Isr J Health Policy Res 2022; 11:18. [PMID: 35346362 PMCID: PMC8960077 DOI: 10.1186/s13584-022-00526-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Adequate iodine intake is essential for human health, for normal thyroid function, and for attainment of full intellectual potential in children. In light of Israel's lack of a mandatory salt fortification policy, heavy reliance on desalination and low iodine intake from dairy products and seafood, there is concern in Israel that the population is iodine deficient. Indeed, the first Israeli National Iodine Survey in 2016 found a median urinary iodine concentration (UIC) of 83 µg/L among school age children, falling below the WHO’s adequacy range of 100–299 µg/L for children.
Methods
In the framework of the National Human Biomonitoring Program in Israel, spot urine samples and questionnaire data were collected from 166 healthy children aged 4–12 years in 2020–2021. Urinary iodine concentrations were measured at the Ministry of Health National Biomonitoring Laboratory, using mass spectrometry. An international comparison of median urinary iodine concentrations (UIC) was performed taking into consideration the levels of desalinated water per capita, and fortification policies.
Results
The overall median (interquartile range [IQR]) UIC was 80.1 µg/L (44.7–130.8 µg/L) indicating that the population’s iodine status has not improved in the five years that have passed since inadequacy was first identified. When comparing 13 countries with population size above 150,000, whose desalinated water per capita was at least 1 m3, Israel and Lebanon were the only countries with median UIC below the WHO adequacy range.
Conclusions
There is an urgent need for mandatory salt fortification in Israel. Based on our international comparison, we conclude that the potential impact of desalination on iodine intake can be compensated for using the implementation of salt fortification policy. This study highlights the critical need for public health surveillance of nutritional and environmental exposures using human biomonitoring, with emphasis on vulnerable populations such as pregnant women and children.
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Saha A, Guariso D, Mbuya MN, Ebata A. Firm's compliance behaviour towards food fortification regulations: Evidence from oil and salt producers in Bangladesh. FOOD POLICY 2021; 104:102143. [PMID: 34720344 PMCID: PMC8546459 DOI: 10.1016/j.foodpol.2021.102143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 06/13/2023]
Abstract
Impact of national food fortification programs is contingent on the extent to which there is compliance with national standards. However, this compliance is often sub-optimal and is not consistently measured. One of the challenges to more regular measurement is an over-reliance on quantitative assessments of micronutrient levels for compliance, which are costly. In resource constrained environments, this contributes to weaknesses in regulatory monitoring. We offer an alternative, systems-based approach to determine compliance, presenting a unique score that can capture firms' compliance behaviour, based on whether and how firms actually carry out stages of the fortification process. The key utility of such a measure being its use to monitor fortification propensity and assess changes in response to interventions. Further, we present an empirical application of this measure, providing novel evidence on firms' compliance towards food fortification regulations in Bangladesh, investigating the institutional and firm-level factors that correlate with compliance behaviour towards food fortification regulations among edible oil and salt producers.
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Affiliation(s)
- Amrita Saha
- Institute of Development Studies, University of Sussex. BN19RE, United Kingdom
| | - Daniele Guariso
- Department of Economics, Jubilee Building, University of Sussex, BN19SL, United Kingdom
| | - Mduduzi N.N. Mbuya
- The Global Alliance for Improved Nutrition (GAIN), 1701 Rhode Island Ave NW, Washington, DC 20036, United States
| | - Ayako Ebata
- Institute of Development Studies, University of Sussex. BN19RE, United Kingdom
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11
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Consumption of multiple micronutrients or small-quantity lipid-based nutrient supplements containing iodine at the recommended dose during pregnancy, compared with iron and folic acid, does not affect women's urinary iodine concentration in rural Malawi: a secondary outcome analysis of the iLiNS DYAD trial. Public Health Nutr 2021; 24:3049-3057. [PMID: 33054890 PMCID: PMC9884741 DOI: 10.1017/s1368980020003250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Inadequate iodine intake during pregnancy increases the risk of neonatal morbidity and mortality. We aimed to evaluate whether prenatal supplements containing iodine affect urinary iodine concentrations (UIC) of pregnant women in Malawi. DESIGN A randomised controlled trial. Pregnant women (n 1391) were assigned to consume 60 mg/d Fe and 400 µg/d folic acid (IFA) or 18 vitamins and minerals including 250 µg/d iodine (MMN) or 20 g/d small-quantity lipid-based nutrient supplements (SQ-LNS) with similar nutrient contents as MMN group, plus macronutrients (LNS) until childbirth. In a sub-study (n 317), we evaluated group geometric mean urinary iodine concentration (UIC) (µg/L) at 36 weeks of gestation controlling for baseline UIC and compared median (baseline) and geometric mean (36 weeks) UIC with WHO cut-offs: UIC < 150, 150-249, 250-499 and ≥500 reflecting insufficient, adequate, above requirements and excessive iodine intakes, respectively. SETTING Mangochi District, Malawi. PARTICIPANTS Women ≤20 weeks pregnant. RESULTS Groups had comparable background characteristics. At baseline, overall median (Q1, Q3) UIC (319 (167, 559)) suggested iodine intakes above requirements. At 36 weeks, the geometric mean (95 % CI) UIC of the IFA (197 (171, 226)), MMN (212 (185, 243)) and LNS (220 (192, 253)) groups did not differ (P = 0·53) and reflected adequate intakes. CONCLUSIONS In this setting, provision of supplements containing iodine at the recommended dose to pregnant women with relatively high iodine intakes at baseline, presumably from iodised salt, has no impact on the women's UIC. Regular monitoring of the iodine status of pregnant women in such settings is advisable. Clinicaltrials.gov identifier: NCT01239693.
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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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Marakis G, Katsioulis A, Kontopoulou L, Ehlers A, Heimberg K, Hirsch-Ernst KI, Langerholc T, Adamska H, Matyjaszczyk E, Silva KDR, Madumali KAC, Yeh TS, Chiou LJ, Lin MJ, Karpetas G, Weissenborn A. Knowledge, attitude and behaviour of university students regarding salt and iodine: a multicentre cross-sectional study in six countries in Europe and Asia. ACTA ACUST UNITED AC 2021; 79:68. [PMID: 33947465 PMCID: PMC8097851 DOI: 10.1186/s13690-021-00593-5] [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: 02/09/2021] [Accepted: 04/21/2021] [Indexed: 11/25/2022]
Abstract
Background Strategies to reduce salt intake are encouraged to be implemented in parallel with those that aim to ensure iodine adequacy at the population level. The aim of the present study was to assess and compare knowledge, attitudes and behaviours related to salt and iodine among students in Europe and Asia. Methods A multicentre cross-sectional study was conducted with 2459 university students in total (42.7% males, median age 21 years) from four countries in Europe and two countries in Asia. Data were collected with the use of a self-administered questionnaire, and univariate and multivariate statistical analyses were performed to explore any association between variables. Results Only 6.5% of all participants knew the correct salt recommendations. Nearly a quarter of them (24.4%) found salt recommendations confusing and/or contradictory. There were significant differences between European and Asian participants, with those from Europe being better informed about salt recommendations, but significantly less knowledgeable about iodine. The reported frequency of use of salt and salt-containing sauces either at the table or for cooking, as well as knowledge about ways to reduce salt intake among those who indicated to make conscious efforts to do so, differed significantly between countries. Significant differences between countries were also observed with respect to the type of salt used, with about one third of all participants (34%) not being aware of the kind of salt they used. Conclusion The results of this survey highlight serious salt- and iodine-related knowledge gaps among university students in Europe and Asia. Raising awareness and conducting information campaigns is needed to promote changes in behaviour that would result in a reduction of salt intake and conscious use of iodised salt at the individual level. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00593-5.
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Affiliation(s)
- Georgios Marakis
- Nutrition and Food Standards Unit, Directorate of Risk Assessment and Nutrition, Hellenic Food Authority, Athens, Greece
| | | | | | - Anke Ehlers
- Department of Food Safety, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Katharina Heimberg
- Department of Food Safety, German Federal Institute for Risk Assessment, Berlin, Germany
| | | | - Tomaž Langerholc
- Department of Microbiology, Biochemistry, Molecular Biology and Biotechnology, University of Maribor, Maribor, Slovenia
| | - Hanna Adamska
- Institute of Economic Sciences, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
| | - Ewa Matyjaszczyk
- Institute of Plant Protection-National Research Institute, Poznan, Poland
| | - K D Renuka Silva
- Department of Applied Nutrition, Wayamba University of Sri Lanka, Gonawila, Kuliyapitiya, Sri Lanka
| | - K A Chathurika Madumali
- Department of Applied Nutrition, Wayamba University of Sri Lanka, Gonawila, Kuliyapitiya, Sri Lanka
| | - Tai-Sheng Yeh
- Department of Food Science and Nutrition, Meiho University, Neipu, Pingtung, Taiwan
| | - Ling-Jan Chiou
- Department of Health Business Administration, Meiho University, Neipu, Pingtung, Taiwan
| | - Mei-Jen Lin
- Department of Animal Science, National Pingtung University of Science and Technology, Neipu, Pingtung, Taiwan
| | | | - Anke Weissenborn
- Department of Food Safety, German Federal Institute for Risk Assessment, Berlin, Germany.
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Kumorowulan S, Nurcahyani YD, Latifah L. Household Iodized Salt, Iodine Intake, and Thyroid Dysfunction in Reproductive Age Women in Different Regions of Iodine Adequacy. J Nutr Sci Vitaminol (Tokyo) 2021; 66:S468-S473. [PMID: 33612643 DOI: 10.3177/jnsv.66.s468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Iodine deficiency affects people of all age groups and yields detrimental health effects known as Iodine Deficiency Disorders (IDD). Universal Salt Iodization (USI) where above 90% household use iodized salt became the main program to optimized population iodine status. This study aimed to analyze iodine in salt, iodine status and thyroid functions from three different IDD endemic regions. METHODS This was a cross-sectional study, with women of reproductive age (15 to 45 y old) as subjects, conducted in plain area (Yogyakarta) city (n=250), mountainous area (Bukit Tinggi city) (n=249), and combination of mountaneous and plain area (Purworejo regency) (n=249). Urinary iodine (UIE), prevalence of hyperthyroidism, and hypothyroidism (diagnostic based on combination of TSH and fT4 level), also the presence or absence and level of iodine in salt were assessed. RESULT Iodized salt coverage have reached >90% household in all three region, while titration found 75.6% with adequate level of iodine in salt (>30 ppm), with wide range of iodine level in salt (0.00-218.2 ppm). With that condition, population in plain and combination of plain and mountainous area have more than adequate iodine status (218 μg/L and 224 μg/L), while population in mountaneous area still in mild iodine deficiency status (UIE median of 88 μg/L). Most population is in euthyroid condition. Hyperthyroidism, subclinical hyperthyroidism, secondary hyperthyroidism, subclinical hypothyroidism, and hypothyroidism were found in 0.7%, 4.8%, 0.4%, 8.9%, and 0.9% population consecutively. There were no relationship between iodine status and prevalence of hyperthyroidism and hypothyroidism, but subclinical hypothyroidism most prevalent in excess UIE population (12.5% vs 8.3%). CONCLUSION All three regions have achieved USI target. But the risk of iodine deficiency still found in mountaneous area. Household iodized salt coverage discrepancy between rapid test and titration strengthen the need of more accurate but efficient test of iodine level in salt.
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Alamneh AA, Leshargie CT, Desta M, Birhanu MY, Assemie MA, Denekew HT, Alamneh YM, Ketema DB. Availability of adequately iodized salt at the household level in Ethiopia: A systematic review and meta-analysis. PLoS One 2021; 16:e0247106. [PMID: 33592066 PMCID: PMC7886221 DOI: 10.1371/journal.pone.0247106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/01/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Iodine deficiency disorder (IDD) is a global, regional, and national public health problem that is preventable. Universal salt iodization is a worldwide accepted strategy to prevent IDD. The level of iodine in the salt should be adequate at the household level (≥15ppm). Though there was fragmented evidence on the proportion of adequately iodized salt at the household level in Ethiopia, the national level proportion of adequately iodized salt at the household level was remaining unknown. Therefore, this systematic review and meta-analysis estimated the pooled proportion of adequately iodized salt at the household level in Ethiopia from 2013-2020. METHOD We systematically searched the databases: PubMed/MEDLINE, Google Scholar, and Science Direct for studies conducted in Ethiopia on the availability of adequately iodized salt at the household level since 2013. We have included observational studies, which were published between January first, 2013, and 10 August 2020. The report was compiled according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The quality of included studies was scored based on the Newcastle Ottawa quality assessment scale adapted for cross-sectional studies. The data were extracted in Microsoft excel and analyzed using Stata version 14.1 software. We employed a random-effects model to estimate the pooled proportion of adequately iodized salt at the household level in Ethiopia. The presence of statistical heterogeneity within the included studies was evaluated using the I-squared statistic. We used Egger's regression test to identify evidence of publication bias. The pooled proportion with a 95% confidence interval (CI) was presented using tables and forest plots. RESULTS We screened a total of 195 articles. Of these, 28 studies (with 15561 households) were included in the final systematic review and meta-analysis. In Ethiopia, the pooled proportion of adequately iodized salt at the household level was 37% (95% CI: 28, 46%). The subgroup analyses of 28 studies by residence revealed that the pooled proportion of adequately iodized salt at the household level was 32% (95% CI: 29, 35%) and 48% (95% CI: 31, 66%) in rural and urban areas, respectively. Based on geographic location, the highest proportion was found in Addis Ababa (81%; 95%CI: 78, 83), and the lowest proportion found in Dire Dawa (20%; 95%CI: 17, 22). Besides, the proportion of adequately iodized salt at the household level was significantly increased during 2017-2020 (42%; 95% CI: 30, 53%) as compared with 2013-2016 (27%; 95% CI: 17, 39%). CONCLUSIONS In Ethiopia, the pooled proportion of adequately iodized salt at the household level was very low as compared to the world health organization's recommendation. Thus, the Federal Ministry of Health of Ethiopia and different stakeholders should give more attention to improve the proportion of adequately iodized salt at the household level.
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Affiliation(s)
- Alehegn Aderaw Alamneh
- Department of Human Nutrition and Food Sciences, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Cheru Tesema Leshargie
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.,Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Melaku Desta
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | | | - Moges Agazhe Assemie
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Habtamu Temesgen Denekew
- Department of Human Nutrition and Food Sciences, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Yoseph Merkeb Alamneh
- Departments of Biomedical Sciences, Schools of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Daniel Bekele Ketema
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Factors associated with the consumption of table salt with inadequate iodine concentrations: a population analysis at a Peruvian household level. Public Health Nutr 2021; 24:5498-5505. [PMID: 33500009 DOI: 10.1017/s1368980021000380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Iodine deficiency is a public health problem, especially in Peru, where it affects women of childbearing age and school-age children. The objective of the study was to conduct a household-level analysis of the factors associated with the consumption of table salt with inadequate amounts of iodine in Peru. DESIGN Analytical cross-sectional study using Peruvian household-level data from the Demographic and Family Health Survey. Table salt iodine concentrations were considered as the dependent variable ('inadequate' with iodine levels <30 PPM and 'adequate' with levels ≥30 PPM). The association between iodine concentrations in salt and independent variables was evaluated using crude and adjusted log-binomial regression models. SETTING Peru. PARTICIPANTS A total of 25 007 households were included. RESULTS In Peru, 21·8 % households had inadequate table salt iodine concentrations. Belonging to the poorer and poorest wealth index, living in the Highlands natural region, and living with women of childbearing age with native mother tongue were identified as factors associated with inadequate iodine concentrations in table salt. CONCLUSIONS There is an urgent need to ensure that table salt with adequate iodine concentrations is available for poor populations, residents of the Highlands and households with ethnic presence. Likewise, it is necessary to promote good storage practices, greater regulation/law enforcement and better monitoring of the companies that manufacture or sell this product. Furthermore, the population needs to be informed of the disorders associated with iodine deficiency.
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Mridha MK, Hossain MM, Khan MSA, Hanif AAM, Hasan M, Mitra D, Hossaine M, Ullah MA, Sarker SK, Rahman SMM, Bulbul MMI, Shamim AA. Prevalence and associated factors of depression among adolescent boys and girls in Bangladesh: findings from a nationwide survey. BMJ Open 2021; 11:e038954. [PMID: 33455924 PMCID: PMC7813352 DOI: 10.1136/bmjopen-2020-038954] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To assess the prevalence of and factors associated with depression among adolescent boys and girls. DESIGN We conducted a nationwide cross-sectional study. SETTING This study was carried out in 82 randomly selected clusters (57 rural, 15 non-slum urban and 10 slums) from eight divisions of Bangladesh. PARTICIPANTS We interviewed 4907 adolescent boys and 4949 adolescent girls. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was 'any depression' and the secondary outcome measures were types of depression: no or minimal, mild, moderate, moderately severe and severe. RESULTS The overall prevalence of no or minimal, mild, moderate, moderately severe and severe depression was 75.5%, 17.9%, 5,4%, 1.1% and 0.1%, respectively. Across most of the sociodemographic, lifestyle and anthropometric strata, the prevalence of any depression was higher among adolescent girls. In both sexes, depression was associated with higher age, higher maternal education, paternal occupation e.g., business, absence of a 6-9-year-old member in the household, food insecurity, household consumption of unfortified oil, household use of non-iodised salt, insufficient physical activity (adjusted odds ratio, AOR: 1.24 for boys, 1.44 for girls) and increased television viewing time e.g., ≥121 minute/day (AOR: 1.95 for boys, 1.99 for girls). Only among boys, depression was also associated with higher paternal education e.g., complete secondary and above (AOR: 1.42), absence of another adolescent member in the household (AOR: 1.34), household use of solid biomass fuel (AOR: 1.39), use of any tobacco products (AOR: 2.17), and consumption of processed food (AOR: 1.24). Only among girls, non-slum urban residence, Muslim religion, and household size ≤4 were also associated with depression. CONCLUSION The prevalence of depression among adolescent boys and girls is high in Bangladesh. In most sociodemographic, lifestyle and anthropometric strata, the prevalence is higher among girls. In this age group, depression is associated with a number of sociodemographic and lyfestyle factors. The government of Bangladesh should consider these findings while integrating adolescent mental health in the existing and future programmes.
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Affiliation(s)
- Malay Kanti Mridha
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Mokbul Hossain
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Showkat Ali Khan
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Abu Abdullah Mohammad Hanif
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mehedi Hasan
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Dipak Mitra
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Moyazzam Hossaine
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mohammad Aman Ullah
- National Nutrition Services (NNS), Directorate General of Health Services, Dhaka, Bangladesh
| | - Samir Kanti Sarker
- National Nutrition Services (NNS), Directorate General of Health Services, Dhaka, Bangladesh
| | - S M Mustafizur Rahman
- National Nutrition Services (NNS), Directorate General of Health Services, Dhaka, Bangladesh
| | - Md M Islam Bulbul
- National Nutrition Services (NNS), Directorate General of Health Services, Dhaka, Bangladesh
| | - Abu Ahmed Shamim
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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A review of species differences in the control of, and response to, chemical-induced thyroid hormone perturbations leading to thyroid cancer. Arch Toxicol 2021; 95:807-836. [PMID: 33398420 DOI: 10.1007/s00204-020-02961-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022]
Abstract
This review summarises the current state of knowledge regarding the physiology and control of production of thyroid hormones, the effects of chemicals in perturbing their synthesis and release that result in thyroid cancer. It does not consider the potential neurodevelopmental consequences of low thyroid hormones. There are a number of known molecular initiating events (MIEs) that affect thyroid hormone synthesis in mammals and many chemicals are able to activate multiple MIEs simultaneously. AOP analysis of chemical-induced thyroid cancer in rodents has defined the key events that predispose to the development of rodent cancer and many of these will operate in humans under appropriate conditions, if they were exposed to high enough concentrations of the affecting chemicals. There are conditions however that, at the very least, would indicate significant quantitative differences in the sensitivity of humans to these effects, with rodents being considerably more sensitive to thyroid effects by virtue of differences in the biology, transport and control of thyroid hormones in these species as opposed to humans where turnover is appreciably lower and where serum transport of T4/T3 is different to that operating in rodents. There is heated debate around claimed qualitative differences between the rodent and human thyroid physiology, and significant reservations, both scientific and regulatory, still exist in terms of the potential neurodevelopmental consequences of low thyroid hormone levels at critical windows of time. In contrast, the situation for the chemical induction of thyroid cancer, through effects on thyroid hormone production and release, is less ambiguous with both theoretical, and actual data, showing clear dose-related thresholds for the key events predisposing to chemically induced thyroid cancer in rodents. In addition, qualitative differences in transport, and quantitative differences in half life, catabolism and turnover of thyroid hormones, exist that would not operate under normal situations in humans.
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Dinka AW, Kebebe T, Nega G. Iodine Level of Salt and Associated Factors at Household Level in Gidami District, Oromia Region, Ethiopia: A Cross-Sectional Study. NUTRITION AND DIETARY SUPPLEMENTS 2021. [DOI: 10.2147/nds.s284944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Yeshaw Y, Alem AZ, Tesema GA, Teshale AB, Liyew AM, Tesema AK. Spatial distribution and determinants of household iodized salt utilization in Ethiopia: a spatial and multilevel analysis of Ethiopian demographic and Health survey. BMC Public Health 2020; 20:1421. [PMID: 32943046 PMCID: PMC7500019 DOI: 10.1186/s12889-020-09538-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Iodine deficiency disorder is a significant public health problem, affecting both developed and developing nations worldwide. It is associated with poor body growth and irreversible mental retardation. However, little is known about the spatial distribution and determinants of household iodized salt utilization in Ethiopia. Therefore, this study aimed to explore the spatial distribution and determinants of iodized salt utilization at national level. METHODS Ethiopian Demographic and Health Survey 2016 data was used to investigate the spatial distribution and determinants of household iodized salt utilization in Ethiopia. ArcGIS 10.6 and SaTScan™ version 9.6 software were used to explore the spatial distribution and detect significant clusters, respectively. The odds ratio with its 95% confidence interval (CI) was determined for potential determinants included in the multivariable multilevel logistic regression model. RESULTS Household iodized salt utilization was spatially clustered in Ethiopia (Moran's Index = 0.076, p-value = 0.01). The significant hotspot areas with high iodized salt utilization were located in Benishangul, Amhara, Gambella, Tigray and Northwest Oromia regions. Significant cold spot areas (areas with low iodized salt utilization) were found in Somali, and East Afar regions. Those households with higher education level ((Adjusted Odds Ratio [AOR] =1.49, 95% CI =1.14-1.93), high community level education (AOR = 1.51, 95% CI = 1.03-2.20), middle wealth index (AOR = 1.31, 95% CI = 1.04-1.65) and high community media exposure (AOR = 1.52, 95% CI = 1.07-2.17) had higher odds of iodized salt utilization. CONCLUSIONS Household iodized salt utilization had significant spatial variation across the country. Both household and community level variables were found to be associated with household iodized salt utilization in Ethiopia. Therefore, increasing the education level, wealth status and community media exposure is recommended to improve iodized salt utilization in a country. A targeted intervention is also needed for those regions with low household iodized salt utilization.
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Affiliation(s)
- Yigizie Yeshaw
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Alemneh Mekuriaw Liyew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Ayenew Kassie Tesema
- Department of Health Education and Behavioral Science, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
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Ba DM, Ssentongo P, Na M, Kjerulff KH, Liu G, Du P, Song W, Richie JP, Gao X. Factors Associated with Urinary Iodine Concentration among Women of Reproductive Age, 20-49 Years Old, in Tanzania: A Population-Based Cross-Sectional Study. Curr Dev Nutr 2020; 4:nzaa079. [PMID: 32462108 PMCID: PMC7236838 DOI: 10.1093/cdn/nzaa079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/14/2020] [Accepted: 04/25/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Universal salt iodization (USI) is the most feasible and cost-effective, and equitable, approach to prevent iodine deficiency. Severe maternal iodine deficiency during pregnancy is associated with serious adverse gestational and birth outcomes. OBJECTIVES The aim was to assess iodine status and identify independent factors associated with urinary iodine concentration (UIC) among women of reproductive age in Tanzania. METHODS This was a weighted, population-based, cross-sectional study in 2985 women of reproductive age (20-49 y) in Tanzania who participated in the Demographic and Health Surveys in 2015-2016 (DHS 2015-2016) and had measured UIC. Multivariable generalized linear regression was used to identify potential factors that were associated with UIC. RESULTS The median UICs among women consuming inadequately iodized salt (93.6 μg/L; 25th and 75th percentiles: 43.1, 197.9 μg/L) and women in the lowest socioeconomic status (92.3 μg/L; 45.6, 194.4 μg/L) were below the WHO-recommended ranges (≥150 μg/L for pregnant women and ≥100 μg/L for nonpregnant women). The results of multivariable models indicated that pregnant women had 1.21 μg/L lower UIC than nonpregnant women (β = -1.21; 95% CI: -3.42, -0.12), breastfeeding women had 1.02 μg/L lower UIC than nonbreastfeeding women (β = -1.02; 95% CI: -2.25, -0.27), and women with no education had a 1.88 μg/L lower UIC compared with those with secondary/highest education (β = -1.88; 95% CI: -4.58, -0.36). Women consuming inadequately iodized salt had 6.55 μg/L lower UIC than those consuming adequately iodized salt (β = -6.55; 95% CI: -9.24, -4.33). The median UIC varied substantially across geographic zones, ranging from 83.2 μg/L (45.9, 165.3) in the Western region to 347.8 μg/L (185.0, 479.8) in the Eastern region. CONCLUSIONS Our findings indicated a great heterogeneity in median UIC across regions of Tanzania among women of reproductive age. Poverty, consuming inadequately iodized salt, and lack of education appeared to be the driving factors for lower UIC in Tanzania.
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Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Muzi Na
- Department of Nutritional Sciences, Penn State University, State College, PA, USA
| | - Kristen H Kjerulff
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Ping Du
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Won Song
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA
| | - John P Richie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Xiang Gao
- Department of Nutritional Sciences, Penn State University, State College, PA, USA
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Ajema D, Bekele M, Yihune M, Tadesse H, Gebremichael G, Mengesha MM. Socio-demographic correlates of availability of adequate iodine in household salt: a community-based cross-sectional study. BMC Res Notes 2020; 13:125. [PMID: 32131883 PMCID: PMC7057523 DOI: 10.1186/s13104-020-04983-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/26/2020] [Indexed: 11/22/2022] Open
Abstract
Objective This study aimed to assess the availability of adequately iodized salt at a household level and associated factors in Arba Minch town, South Ethiopia using the gold standard technique, the iodometric titration. Results 41.8% (95% CI (confidence interval) 38.6 to 45.1) of households had inadequately iodized salt, and 9.3% (95% CI 7.5 to 11.4) had an iodine content below 10 ppm (parts per million). Compared to households with a monthly income of greater than 2000 ETB (Ethiopian Birr), households with a monthly income between 1000 ETB to 2000 ETB (adjusted odds ratio (AOR) = 0.52, 95% CI 0.390.36 to 00.77) and main food handlers aged 30 years or above compared to those aged less than 20 years of age (aOR = 0.55, 95% CI 0.34 to 0.91) had higher odds of having adequately iodized salt. Food handler’s knowledge and practice were not found to be correlated with the availability of adequately iodized salt in household salt.
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Affiliation(s)
- Dessalegn Ajema
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
| | - Muluken Bekele
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Manaye Yihune
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Hiwot Tadesse
- Department of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Gebrekiros Gebremichael
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Melkamu Merid Mengesha
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Mkambula P, Mbuya MNN, Rowe LA, Sablah M, Friesen VM, Chadha M, Osei AK, Ringholz C, Vasta FC, Gorstein J. The Unfinished Agenda for Food Fortification in Low- and Middle-Income Countries: Quantifying Progress, Gaps and Potential Opportunities. Nutrients 2020; 12:nu12020354. [PMID: 32013129 PMCID: PMC7071326 DOI: 10.3390/nu12020354] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 12/18/2022] Open
Abstract
Large-scale food fortification (LSFF) is a cost-effective intervention that is widely implemented, but there is scope to further increase its potential. To identify gaps and opportunities, we first accessed the Global Fortification Data Exchange (GFDx) to identify countries that could benefit from new fortification programs. Second, we aggregated Fortification Assessment Coverage Toolkit (FACT) survey data from 16 countries to ascertain LSFF coverage and gaps therein. Third, we extended our narrative review to assess current innovations. We identified 84 countries as good candidates for new LSFF programs. FACT data revealed that the potential of oil/ghee and salt fortification is not being met due mainly to low coverage of adequately fortified foods (quality). Wheat, rice and maize flour fortification have similar quality issues combined with lower coverage of the fortifiable food at population-level (<50%). A four-pronged strategy is needed to meet the unfinished agenda: first, establish new LSFF programs where warranted; second, systems innovations informed by implementation research to address coverage and quality gaps; third, advocacy to form new partnerships and resources, particularly with the private sector; and finally, exploration of new fortificants and vehicles (e.g. bouillon cubes; salt fortified with multiple nutrients) and other innovations that can address existing challenges.
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Affiliation(s)
- Penjani Mkambula
- Global Alliance for Improved Nutrition, Rue de Varembé 7, 1202 Geneva, Switzerland; (V.M.F.); (F.C.V.)
- Correspondence: (P.M.);
| | - Mduduzi N. N. Mbuya
- Global Alliance for Improved Nutrition, Rue de Varembé 7, 1202 Geneva, Switzerland; (V.M.F.); (F.C.V.)
- Correspondence: (P.M.);
| | - Laura A. Rowe
- Food Fortification Initiative, 1518 Clifton Road, Atlanta, GA 30322, USA;
| | | | - Valerie M. Friesen
- Global Alliance for Improved Nutrition, Rue de Varembé 7, 1202 Geneva, Switzerland; (V.M.F.); (F.C.V.)
| | - Manpreet Chadha
- Nutrition International 180 Elgin St., Suite 1000, Ottawa, ON K2P 2K3, Canada;
| | - Akoto K. Osei
- Helen Keller International, Regional Office for Africa, Dakar BP 29.898, Senegal;
| | - Corinne Ringholz
- World Food Programme, Via Cesare Giulio Viola, 68, 00148 Rome, Italy;
| | - Florencia C. Vasta
- Global Alliance for Improved Nutrition, Rue de Varembé 7, 1202 Geneva, Switzerland; (V.M.F.); (F.C.V.)
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Non-iodized salt consumption among women of reproductive age in sub-Saharan Africa: a population-based study. Public Health Nutr 2020; 23:2759-2769. [PMID: 31915084 DOI: 10.1017/s1368980019003616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify countries in sub-Saharan Africa (SSA) that have not yet achieved at least 90 % universal salt iodization and factors associated with the consumption of non-iodized salt among women of reproductive age. DESIGN A cross-sectional study using data from Demographic and Health Surveys (DHS). The presence of iodine in household salt (iodized or non-iodized), which was tested during the survey process, was the study outcome. Multivariable logistic regression models were used to determine independent factors associated with the consumption of non-iodized salt among women of reproductive age. SETTING There were eleven countries in SSA that participated in the DHS since 2015 and measured the presence of iodine in household salt. PARTICIPANTS Women (n 108 318) aged 15-49 years. RESULTS Countries with the highest rate of non-iodized salt were Senegal (29·5 %) followed by Tanzania (21·3 %), Ethiopia (14·0 %), Malawi (11·6 %) and Angola (10·8 %). The rate of non-iodized salt was less than 1 % in Rwanda (0·3 %), Uganda (0·5 %) and Burundi (0·8 %). Stepwise multivariable logistic regression showed that women were more likely to be using non-iodized salt (adjusted OR; 95 % CI) if they were poor (1·62; 1·48, 1·78), pregnant (1·16; 1·04, 1·29), aged 15-24 years (v. older: 1·14; 1·04, 1·24) and were not literate (1·14; 1·06, 1·23). CONCLUSIONS The use of non-iodized salt varies among SSA countries. The higher level of use of non-iodized salt among poor, young women and pregnant women is particularly concerning.
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Goris JM, Temple VJ, Sumbis J, Zomerdijk N, Codling K. Iodine status of non-pregnant women and availability of food vehicles for fortification with iodine in a remote community in Gulf province, Papua New Guinea. PLoS One 2019; 14:e0224229. [PMID: 31730622 PMCID: PMC6858069 DOI: 10.1371/journal.pone.0224229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/08/2019] [Indexed: 12/03/2022] Open
Abstract
Adequate iodine status of women of childbearing age is essential for optimal growth and development of their offspring. The objectives of the current study were to assess the iodine status of non-pregnant women, availability and use of commercial salt, extent to which it is iodised, and availability of other industrially processed foods suitable for fortification with iodine. This prospective cross-sectional study was carried out in 2018 in a remote area in Gulf province, Papua New Guinea. Multistage cluster sampling was used to randomly select 300 women visiting local markets. Of these, 284 met study criteria of being non-pregnant and non-lactating. Single urine samples were collected from each of them. Discretionary salt intake was assessed; salt samples were collected from a sub-sample of randomly selected households. A semi-structured, pre-tested questionnaire to assess use and availability of commercial salt and other processed foods was modified and used. Salt was available on the interview day in 51.6% of households. Mean iodine content in household salt samples was 37.8 ± 11.8 ppm. Iodine content was below 30.0 ppm in 13.1% and below 15.0 ppm in 3.3% of salt samples. Mean iodine content of salt available at markets was 39.6 ± 0.52 ppm. Mean discretionary intake of salt per capita per day was 3.9 ± 1.21 g. Median UIC was 34.0 μg/L (95% CI, 30.0-38.0 ppm), indicating moderate iodine deficiency. For women with salt in the household, median UIC was 39.5 μg/L (95% CI, 32.0-47.0 μg/L), compared to median UIC of 29.0 μg/L (95% CI, 28.0-32.0 μg/L) for those without salt. This community has low consumption of iodised salt, likely due to limited access. Investigation of other industrially processed foods indicated salt is the most widely consumed processed food in this remote community, although 39.8% of households did use salty flavourings.
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Affiliation(s)
| | - Victor J. Temple
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Joan Sumbis
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Nienke Zomerdijk
- School of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Karen Codling
- Iodine Global Network—Southeast Asia and the Pacific, Bangkok, Thailand
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Yadav K, Pandav CS. National Iodine Deficiency Disorders Control Programme: Current status & future strategy. Indian J Med Res 2019; 148:503-510. [PMID: 30666977 PMCID: PMC6366256 DOI: 10.4103/ijmr.ijmr_1717_18] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Iodine deficiency disorders (IDDs) constitute a significant public health problem globally. In India, the entire population is prone to IDDs due to deficiency of iodine in the soil of the sub-continent and thus both animal and plant source food grown on the iodine-deficient soil. IDDs encompass the spectrum of disability and disease and include goitre, cretinism, hypothyroidism, abortion, stillbirth, brain damage, learning disabilities, mental retardation, psychomotor defects, hearing and speech impairment. Iodine deficiency is known to be the single largest cause of preventable brain damage. IDDs with their causal association with brain development, cognition, and learning disabilities impair the human resource development and progress of the country. The children born in iodine-deficient regions on an average have 13.5 intelligence quotient (IQ) points lesser than children born in iodine-sufficient regions. IDD control programme in India is a public health success story, with 92 per cent of the population consuming iodized salt. The partnership between government agencies, academic institutions, salt industry, development agencies and civil society has been key to achieve this success story. The sustainable elimination of iodine deficiency in India is within reach, what is required is accelerated and coordinated effort by all key stakeholder at national and State level.
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Affiliation(s)
- Kapil Yadav
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrakant S Pandav
- Indian Coalition for Control of Iodine Deficiency Disorders, All India Institute of Medical Sciences, New Delhi, India
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Keats EC, Neufeld LM, Garrett GS, Mbuya MNN, Bhutta ZA. Improved micronutrient status and health outcomes in low- and middle-income countries following large-scale fortification: evidence from a systematic review and meta-analysis. Am J Clin Nutr 2019; 109:1696-1708. [PMID: 30997493 PMCID: PMC6537942 DOI: 10.1093/ajcn/nqz023] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/25/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Micronutrient malnutrition is highly prevalent in low- and middle-income countries (LMICs) and disproportionately affects women and children. Although the effectiveness of large-scale food fortification (LSFF) of staple foods to prevent micronutrient deficiencies in high-income settings has been demonstrated, its effectiveness in LMICs is less well characterized. This is important as food consumption patterns, potential food vehicles, and therefore potential for impact may vary substantially in these contexts. OBJECTIVES The aim of this study was to determine the real-world impact of LSFF with key micronutrients (vitamin A, iodine, iron, folic acid) on improving micronutrient status and functional health outcomes in LMICs. METHODS All applicable published/unpublished evidence was systematically retrieved and analyzed. Studies were not restricted by age or sex. Meta-analyses were performed for quantitative outcomes and results were presented as summary RRs, ORs, or standardized mean differences (SMDs) with 95% CIs. RESULTS LSFF increased serum micronutrient concentrations in several populations and demonstrated a positive impact on functional outcomes, including a 34% reduction in anemia (RR: 0.66; 95% CI: 0.59, 0.74), a 74% reduction in the odds of goiter (OR: 0.26; 95% CI: 0.16, 0.43), and a 41% reduction in the odds of neural tube defects (OR: 0.59; 95% CI: 0.49, 0.70). Additionally, we found that LSFF with vitamin A could protect nearly 3 million children per year from vitamin A deficiency. We noted an age-specific effect of fortification, with women (aged >18 y) attaining greater benefit than children, who may consume smaller quantities of fortified staple foods. Several programmatic/implementation factors were also reviewed that may facilitate or limit program potential. CONCLUSIONS Measurable improvements in the micronutrient and health status of women and children are possible with LSFF. However, context and implementation factors are important when assessing programmatic sustainability and impact, and data on these are quite limited in LMIC studies.
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Affiliation(s)
- Emily C Keats
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | | | - Greg S Garrett
- Global Alliance for Improved Nutrition, Geneva, Switzerland
| | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada,Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,Address correspondence to ZAB (e-mail: )
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Raghavan R, Aaron GJ, Nahar B, Knowles J, Neufeld LM, Rahman S, Mondal P, Ahmed T. Household coverage of vitamin A fortification of edible oil in Bangladesh. PLoS One 2019; 14:e0212257. [PMID: 30943194 PMCID: PMC6447147 DOI: 10.1371/journal.pone.0212257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 01/24/2019] [Indexed: 12/24/2022] Open
Abstract
Mandatory fortification of edible oil (soybean and palm) with vitamin A was decreed in Bangladesh in 2013. Yet, there is a dearth of data on the availability and consumption of vitamin A fortifiable oil at household level across population sub-groups. To fill this gap, our study used a nationally representative survey in Bangladesh to assess the purchase of fortifiable edible oil among households and project potential vitamin A intake across population sub-groups. Data is presented by strata, age range and poverty-the factors that potentially influence oil coverage. Across 1,512 households, purchase of commercially produced fortifiable edible oil was high (87.5%). Urban households were more likely to purchase fortifiable oil (94.0%) than households in rural low performing (79.7%) and rural other strata (88.1%) (p value: 0.01). Households in poverty were less likely to purchase fortifiable oil (82.1%) than households not in poverty (91.4%) (p <0.001). Projected estimates suggested that vitamin A fortified edible oil would at least partially meet daily vitamin A estimated average requirement (EAR) for the majority of the population. However, certain population sub-groups may still have vitamin A intake below the EAR and alternative strategies may be applied to address the vitamin A needs of these vulnerable sub-groups. This study concludes that a high percentage of Bangladeshi population across different sub-groups have access to fortifiable edible oil and further provides evidence to support mandatory edible oil fortification with vitamin A in Bangladesh.
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Affiliation(s)
- Ramkripa Raghavan
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America
| | - Grant J. Aaron
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Baitun Nahar
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Jacky Knowles
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | | | | | - Prasenjit Mondal
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Factors associated with the availability of iodized salt at household level: a case study in Bangladesh. Public Health Nutr 2019; 22:1815-1823. [PMID: 30755282 DOI: 10.1017/s1368980018003907] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The availability of iodized salt in households remains low in Bangladesh, which calls for improving the salt iodization quality and its coverage. The present study assessed the socio-economic disparity in Bangladesh to characterize the availability of iodized salt at household level. DESIGN Associations between different socio-economic factors and availability of iodized salt at household level were explored using Bayesian mixed-effects logistic models after adjusting the district- and cluster-level random effects. SETTING Bangladesh Multiple Indicator Cluster Survey (MICS), 2012-13.ParticipantsHouseholds (sample size, n 50981). RESULTS Results showed that 73·15 % of household salt samples were iodized to some extent although iodization level varied. According to the regression model, houses with young (adjusted odds ratio of posterior mean (OR) = 1·31; 95 % credible interval (CI) 1·09, 1·64) and educated (OR = 3·66; 95 % CI 3·25, 4·23) household heads had significantly higher likelihood of availability of iodized salt. In addition, iodized salt was less likely be found in poor and rural households, as urban households were 2·88 times (95 % CI 2·41, 3·34) more likely have iodized salt. Moreover, the regional locations of the households were an important component that contributed to the local iodized salt coverage. As per the district-wise distribution, the north-west part of Bangladesh and Cox's Bazar in the far south seemed to lack household-level iodized salt. CONCLUSIONS Our findings suggest that iodized salt intervention should be promoted considering the area variations, which could potentially help policy makers to design interventions in the context of Bangladesh.
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Prevention of Iodine Deficiency Disorders in Children in India - the Way Forward. Indian J Pediatr 2019; 86:113-115. [PMID: 30637676 DOI: 10.1007/s12098-018-02849-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
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Shetty A, Rao CR, Kamath A, Sp V, Reddy T SK. Goiter Prevalence and Interrelated Components from Coastal Karnataka. Indian J Pediatr 2019; 86:159-164. [PMID: 30105567 DOI: 10.1007/s12098-018-2757-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess prevalence of goiter and associated factors among school going children in Udupi district. METHODS A school based cross-sectional survey was conducted among 6-12 year old children. A sample of 30 villages was selected from the entire district by probability proportionate to size. One school was then randomly selected from each of the 30 villages. Goiter was assessed clinically and was graded as per the recommended criteria of World Health Organization (WHO)/ United Nations Children's Fund (UNICEF)/ International Council for the Control of Iodine Deficiency Disorders (ICCIDD). Salt and urine samples were collected from a subsample for iodine estimation. RESULTS A total of 2703 children were examined. The mean (±SD) age of the participants was 9.6 y (±1.9). The overall prevalence of goiter in Udupi district was found to be 9.3% with 7.0% and 2.3% having grade 1 and grade 2 goiter respectively. Prevalence of goiter was significantly higher among females [153(11.1%)] as compared to males [98(7.4%)] (p = 0.001). Of the 543 salt samples analyzed, 379 (69.8%) salt samples had adequate salt iodine content (> 15 ppm); while among the children with goiter 32 (8.4%) had inadequate salt iodine. Median iodine value was 202.12 mcg/l among the 270 urine samples tested for iodine levels. CONCLUSION Goiter prevalence at 9.3% in the coastal district contributes to the endemicity of the public health problem. The district had adequate iodine nutrition based on median urinary iodine levels. Hence, other contributing factors for the persistence of endemic goiter need to be explored.
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Affiliation(s)
- Avinash Shetty
- Department of Community Medicine, Kasturba Medical College (KMC), Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Chythra R Rao
- Department of Community Medicine, Kasturba Medical College (KMC), Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - Asha Kamath
- Department of Statistics, PSPH, MAHE, Manipal, Karnataka, India
| | - Vibha Sp
- Department of Community Medicine, Kasturba Medical College (KMC), Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Sravan Kumar Reddy T
- Department of Community Medicine, Kasturba Medical College (KMC), Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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Randremanana RV, Bastaraud A, Rabarijaona LP, Piola P, Rakotonirina D, Razafinimanana JO, Ramangakoto MH, Andriantsarafara L, Randriamasiarijaona H, Tucker-Brown A, Harimanana A, Namana S. First national iodine survey in Madagascar demonstrates iodine deficiency. MATERNAL AND CHILD NUTRITION 2018; 15:e12717. [PMID: 30315611 DOI: 10.1111/mcn.12717] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/27/2018] [Accepted: 10/02/2018] [Indexed: 11/28/2022]
Abstract
Universal salt iodization (USI) was adopted in Madagascar in 1995 within the framework of a worldwide policy to eliminate iodine deficiency disorders. Despite early USI adoption, there are no representative data on the iodine status of the Malagasy population. The aims of this study were to determine the iodine status of the Malagasy population and to assess the use of adequately iodized salt among households. We randomly sampled women of reproductive age (WRA) using a national, two-stage, stratified cross-sectional survey in 2014. Casual urine from WRA and salt samples from the household containing WRA were collected to measure urinary iodine concentration (UIC) and to assess household salt iodine content. Data from 1,721 WRA in 1,128 households were collected and analysed. The national median UIC was 46 μg L-1 (interquartile range [IQR]: 13-98 μg L-1 ), indicating a moderate iodine deficiency. The median UIC was 53 μg L-1 (IQR: 9-89 μg L-1 ) in pregnant women and 46 μg L-1 (IQR: 13-98 μg L-1 ) in non-pregnant women. The national median iodine concentration of household salt was 10 mg kg-1 (IQR: 6.3-15.8 mg kg-1 ) and 26.2% (95% CI [22.1, 31.0]) of households containing WRA used adequately iodized salt (≥15 mg kg-1 ). Women living in households with adequately iodized salt had higher median UIC (72 vs. 50 μg L-1 ). Iodine status was significantly lower among women from low socio-economic households. Madagascar's USI program needs to be revitalized. Implementing strategies to provide adequately iodized salt and enhancing iodized salt legislation to prevent severe complications resulting from iodine deficiency in the Malagasy population are essential.
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Affiliation(s)
| | - Alexandra Bastaraud
- Laboratoire d'Hygiène des Aliments et de l'Environnement, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Patrice Piola
- Unité épidémiologie, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | | | | | | | | | | | - Aina Harimanana
- Unité épidémiologie, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Simeon Namana
- Maison Commune des Nations Unies, UNICEF, Antananarivo, Madagascar
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Serafico ME, Ulanday JRC, Alibayan MV, Gironella GMP, Perlas LA. Iodine Status in Filipino Women of Childbearing Age. Endocrinol Metab (Seoul) 2018; 33:372-379. [PMID: 30229576 PMCID: PMC6145958 DOI: 10.3803/enm.2018.33.3.372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/11/2018] [Accepted: 06/17/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Iodine deficiency (ID) has become a concern not only among pregnant women, but in women of childbearing age as well. In fact, a recent report suggested that women with moderate to severe ID may experience a significantly longer time to conceive. This study aimed to investigate iodine status in Filipino women of childbearing age. METHODS The iodine status of 6,194 Filipino women aged 15 to 45 years old was assessed through urinary iodine analysis. A casual spot urine sample was collected from women in households participating in the eighth National Nutrition Survey conducted by the Food and Nutrition Research Institute. The sample was analyzed using ammonium persulfate digestion followed by the Sandell-Kolthoff colorimetric reaction. A median urinary iodine concentration (UIC) of less than 100 μg/L was used to define ID. RESULTS The median UIC was 123 μg/L, indicative of adequate iodine nutrition; however, 21.5% of participants had a UIC below 50 μg/L. The median UIC of women who lived in urban areas (142 μg/L), belonged to the middle to richest class (>124 μg/L), had reached a college education (136 μg/L), and used iodized salt (15 ppm and above; 148 to 179 μg/L) reflected adequate iodine nutrition. ID was found to have been eliminated in the regions of Central Luzon, Eastern Visayas, Calabarzon, Mimaropa, and the National Capital, while mild ID was identified in Western Visayas, Southern and Western Mindanao, and in the Autonomous Region in Muslim Mindanao. CONCLUSION Pockets of ID among women of childbearing age exist in the Philippines. Proper information through education and the use of adequately iodized salt are key measures for improving the iodine status of the studied population.
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Affiliation(s)
- Michael E Serafico
- Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI), Taguig, Philippines.
| | - Joselita Rosario C Ulanday
- Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI), Taguig, Philippines
| | - Marites V Alibayan
- Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI), Taguig, Philippines
| | - Glen Melvin P Gironella
- Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI), Taguig, Philippines
| | - Leah A Perlas
- Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI), Taguig, Philippines
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Regression Analysis to Identify Factors Associated with Urinary Iodine Concentration at the Sub-National Level in India, Ghana, and Senegal. Nutrients 2018; 10:nu10040516. [PMID: 29690505 PMCID: PMC5946301 DOI: 10.3390/nu10040516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 11/21/2022] Open
Abstract
Single and multiple variable regression analyses were conducted using data from stratified, cluster sample design, iodine surveys in India, Ghana, and Senegal to identify factors associated with urinary iodine concentration (UIC) among women of reproductive age (WRA) at the national and sub-national level. Subjects were survey household respondents, typically WRA. For all three countries, UIC was significantly different (p < 0.05) by household salt iodine category. Other significant differences were by strata and by household vulnerability to poverty in India and Ghana. In multiple variable regression analysis, UIC was significantly associated with strata and household salt iodine category in India and Ghana (p < 0.001). Estimated UIC was 1.6 (95% confidence intervals (CI) 1.3, 2.0) times higher (India) and 1.4 (95% CI 1.2, 1.6) times higher (Ghana) among WRA from households using adequately iodised salt than among WRA from households using non-iodised salt. Other significant associations with UIC were found in India, with having heard of iodine deficiency (1.2 times higher; CI 1.1, 1.3; p < 0.001) and having improved dietary diversity (1.1 times higher, CI 1.0, 1.2; p = 0.015); and in Ghana, with the level of tomato paste consumption the previous week (p = 0.029) (UIC for highest consumption level was 1.2 times lowest level; CI 1.1, 1.4). No significant associations were found in Senegal. Sub-national data on iodine status are required to assess equity of access to optimal iodine intake and to develop strategic responses as needed.
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Regression Analysis to Identify Factors Associated with Household Salt Iodine Content at the Sub-National Level in Bangladesh, India, Ghana and Senegal. Nutrients 2018; 10:nu10040508. [PMID: 29671774 PMCID: PMC5946293 DOI: 10.3390/nu10040508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/02/2018] [Accepted: 04/12/2018] [Indexed: 11/25/2022] Open
Abstract
Regression analyses of data from stratified, cluster sample, household iodine surveys in Bangladesh, India, Ghana and Senegal were conducted to identify factors associated with household access to adequately iodised salt. For all countries, in single variable analyses, household salt iodine was significantly different (p < 0.05) between strata (geographic areas with representative data, defined by survey design), and significantly higher (p < 0.05) among households: with better living standard scores, where the respondent knew about iodised salt and/or looked for iodised salt at purchase, using salt bought in a sealed package, or using refined grain salt. Other country-level associations were also found. Multiple variable analyses showed a significant association between salt iodine and strata (p < 0.001) in India, Ghana and Senegal and that salt grain type was significantly associated with estimated iodine content in all countries (p < 0.001). Salt iodine relative to the reference (coarse salt) ranged from 1.3 (95% CI 1.2, 1.5) times higher for fine salt in Senegal to 3.6 (95% CI 2.6, 4.9) times higher for washed and 6.5 (95% CI 4.9, 8.8) times higher for refined salt in India. Sub-national data are required to monitor equity of access to adequately iodised salt. Improving household access to refined iodised salt in sealed packaging, would improve iodine intake from household salt in all four countries in this analysis, particularly in areas where there is significant small-scale salt production.
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Dold S, Zimmermann MB, Jukic T, Kusic Z, Jia Q, Sang Z, Quirino A, San Luis TOL, Fingerhut R, Kupka R, Timmer A, Garrett GS, Andersson M. Universal Salt Iodization Provides Sufficient Dietary Iodine to Achieve Adequate Iodine Nutrition during the First 1000 Days: A Cross-Sectional Multicenter Study. J Nutr 2018; 148:587-598. [PMID: 29659964 DOI: 10.1093/jn/nxy015] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/16/2018] [Indexed: 12/14/2022] Open
Abstract
Background Dietary iodine requirements are high during pregnancy, lactation, and infancy, making women and infants vulnerable to iodine deficiency. Universal salt iodization (USI) has been remarkably successful for preventing iodine deficiency in the general population, but it is uncertain if USI provides adequate iodine intakes during the first 1000 d. Objective We set out to assess if USI provides sufficient dietary iodine to meet the iodine requirements and achieve adequate iodine nutrition in all vulnerable population groups. Methods We conducted an international, cross-sectional, multicenter study in 3 study sites with mandatory USI legislation. We enrolled 5860 participants from 6 population groups (school-age children, nonpregnant nonlactating women of reproductive age, pregnant women, lactating women, 0-6-mo-old infants, and 7-24-mo-old infants) and assessed iodine status [urinary iodine concentration (UIC)] and thyroid function in Linfen, China (n = 2408), Tuguegarao, the Philippines (n = 2512), and Zagreb, Croatia (n = 940). We analyzed the iodine concentration in household salt, breast milk, drinking water, and cow's milk. Results The salt iodine concentration was low (<15 mg/kg) in 2.7%, 33.6%, and 3.1%, adequate (15-40 mg/kg) in 96.3%, 48.4%, and 96.4%, and high (>40 mg/kg) in 1.0%, 18.0%, and 0.5% of household salt samples in Linfen (n = 402), Tuguegarao (n = 1003), and Zagreb (n = 195), respectively. The median UIC showed adequate iodine nutrition in all population groups, except for excessive iodine intake in school-age children in the Philippines and borderline low intake in pregnant women in Croatia. Conclusions Salt iodization at ∼25 mg/kg that covers a high proportion of the total amount of salt consumed supplies sufficient dietary iodine to ensure adequate iodine nutrition in all population groups, although intakes may be borderline low during pregnancy. Large variations in salt iodine concentrations increase the risk for both low and high iodine intakes. Strict monitoring of the national salt iodization program is therefore essential for optimal iodine nutrition. This trial was registered at clinicaltrials.gov as NCT02196337.
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Affiliation(s)
- Susanne Dold
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, ETH Zurich, Zurich, Switzerland
| | - Michael B Zimmermann
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, ETH Zurich, Zurich, Switzerland.,Iodine Global Network, Ottawa, Ontario, Canada
| | - Tomislav Jukic
- Department of Nuclear Medicine and Oncology, Sestre Milosrdnice University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia.,Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, Osijek, Croatia
| | - Zvonko Kusic
- Department of Nuclear Medicine and Oncology, Sestre Milosrdnice University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia.,Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Qingzhen Jia
- Shanxi Institute for Prevention and Treatment of Endemic Disease, Linfen, China
| | - Zhongna Sang
- Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Antonio Quirino
- Technological Institute of the Philippines, Manila, Philippines
| | | | - Ralph Fingerhut
- Swiss Newborn Screening Laboratory, Division of Metabolism and Children's Research Centre (CRC), University Children's Hospital Zurich, Zurich, Switzerland
| | | | - Arnold Timmer
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Greg S Garrett
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Maria Andersson
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, ETH Zurich, Zurich, Switzerland.,Iodine Global Network, Ottawa, Ontario, Canada
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van der Haar F, Knowles J, Bukania Z, Camara B, Pandav CS, Mwai JM, Toure NK, Yadav K. New Statistical Approach to Apportion Dietary Sources of Iodine Intake: Findings from Kenya, Senegal and India. Nutrients 2018; 10:nu10040430. [PMID: 29596369 PMCID: PMC5946215 DOI: 10.3390/nu10040430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/13/2018] [Accepted: 03/27/2018] [Indexed: 01/13/2023] Open
Abstract
Progress of national Universal Salt Iodization (USI) strategies is typically assessed by household coverage of adequately iodized salt and median urinary iodine concentration (UIC) in spot urine collections. However, household coverage does not inform on the iodized salt used in preparation of processed foods outside homes, nor does the total UIC reflect the portion of population iodine intake attributable to the USI strategy. This study used data from three population-representative surveys of women of reproductive age (WRA) in Kenya, Senegal and India to develop and illustrate a new approach to apportion the population UIC levels by the principal dietary sources of iodine intake, namely native iodine, iodine in processed food salt and iodine in household salt. The technique requires measurement of urinary sodium concentrations (UNaC) in the same spot urine samples collected for iodine status assessment. Taking into account the different complex survey designs of each survey, generalized linear regression (GLR) analyses were performed in which the UIC data of WRA was set as the outcome variable that depends on their UNaC and household salt iodine (SI) data as explanatory variables. Estimates of the UIC portions that correspond to iodine intake sources were calculated with use of the intercept and regression coefficients for the UNaC and SI variables in each country’s regression equation. GLR coefficients for UNaC and SI were significant in all country-specific models. Rural location did not show a significant association in any country when controlled for other explanatory variables. The estimated UIC portion from native dietary iodine intake in each country fell below the minimum threshold for iodine sufficiency. The UIC portion arising from processed food salt in Kenya was substantially higher than in Senegal and India, while the UIC portions from household salt use varied in accordance with the mean level of household SI content in the country surveys. The UIC portions and all-salt-derived iodine intakes found in this study were illustrative of existing differences in national USI legislative frameworks and national salt supply situations between countries. The approach of apportioning the population UIC from spot urine collections may be useful for future monitoring of change in iodine nutrition from reduced salt use in processed foods and in households.
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Affiliation(s)
- Frits van der Haar
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Jacky Knowles
- Large Scale Food Fortification Initiative, Global Alliance for Improved Nutrition, 1211 Geneva, Switzerland.
| | - Zipporah Bukania
- Center for Public Health Research, Kenya Medical Research Institute, 00202 Nairobi, Kenya.
| | - Boubacar Camara
- Comité Scientifique de l'Ecole Doctorale, Université Cheikh Anta Diop de Dakar, B.P. 5005 Dakar-Fann, Sénégal.
| | - Chandrakant S Pandav
- All India Institute of Medical Sciences, Iodine Global Network, New Delhi 110029, India.
| | - John Maina Mwai
- Ministry of Health, Nutrition and Dietetics Unit, P.O. Box 43319-00100, Nairobi, Kenya.
| | - Ndeye Khady Toure
- Cellule de Lutte contre la Malnutrition, B.P. 45001 Dakar-Fann, Sénégal.
| | - Kapil Yadav
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi 110029, India.
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Adu-Afarwuah S, Young RT, Lartey A, Okronipa H, Ashorn P, Ashorn U, Zeilani M, Dewey KG. Supplementation during pregnancy with small-quantity lipid-based nutrient supplements or multiple micronutrients, compared with iron and folic acid, increases women's urinary iodine concentration in semiurban Ghana: A randomized controlled trial. MATERNAL AND CHILD NUTRITION 2017; 14:e12570. [PMID: 29210520 PMCID: PMC5900724 DOI: 10.1111/mcn.12570] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/24/2017] [Accepted: 11/01/2017] [Indexed: 12/12/2022]
Abstract
There is little information on whether prenatal multiple micronutrient (MMN) supplements containing iodine affect women's iodine status. In the International Lipid‐based Nutrient Supplements DYAD‐Ghana trial, we aimed to assess women's urinary iodine concentration (UIC, μg/L) during pregnancy, as one of the planned secondary outcomes. Women (n = 1,320) <20 weeks of gestation were randomized to consume 60 mg iron and 400 μg folic acid per day (iron and folic acid [IFA]); 18 vitamins and minerals including 250 μg iodine per day (MMN); or 20 g/day of small‐quantity lipid‐based nutrient supplements (LNS) with the same and additional 4 vitamins and minerals as the MMN (LNS). In a subsample (n = 295), we tested differences in groups' geometric mean UICs at 36 weeks of gestation controlling for baseline UIC and compared the geometric means (approximately median UICs) with the World Health Organization (WHO) cut‐offs: median UIC <150, 150–249, and ≥500 reflecting low, adequate, and excessive iodine intakes, respectively. At baseline, overall median UIC was 137. At 36 weeks of gestation, controlling for baseline UIC, geometric mean (95% confidence interval) UICs of the MMN (161 [133, 184]) and LNS (158 [132, 185]) groups did not differ; both values were significantly greater (overall p = .004) than that of the IFA group (116 [101, 135]). The median UICs of the MMN and LNS groups were within the WHO “adequate” range, whereas that of the IFA group was below the WHO adequate range. In this setting, supplementation during pregnancy with small‐quantity LNS or MMN providing iodine at the WHO‐recommended dose, compared with IFA, increases the likelihood of adequate iodine status.
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Affiliation(s)
- Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Rebecca T Young
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, California, USA
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Harriet Okronipa
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Per Ashorn
- Centre for Child Health Research, University of Tampere Faculty of Medicine and Life Sciences, and Tampere University Hospital, Department of Pediatrics, Tampere, Finland
| | - Ulla Ashorn
- Centre for Child Health Research, University of Tampere Faculty of Medicine and Life Sciences, and Tampere University Hospital, Department of Pediatrics, Tampere, Finland
| | | | - Kathryn G Dewey
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, California, USA
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Neufeld LM, Baker S, Garrett GS, Haddad L. Coverage and Utilization in Food Fortification Programs: Critical and Neglected Areas of Evaluation. J Nutr 2017; 147:1015S-1019S. [PMID: 28404835 PMCID: PMC5404214 DOI: 10.3945/jn.116.246157] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 12/22/2016] [Accepted: 02/16/2017] [Indexed: 12/04/2022] Open
Abstract
The need for evidence to inform nutrition program design and implementation has long been recognized, yet the generation and use of evidence for program decision making has lagged. The results of the coverage surveys reported in this supplement highlight some of the strengths and areas for improvement of current population-based (i.e., staple foods and condiments) and targeted (e.g., foods for infants and young children) fortification programs. Among other topics, the results identify a few striking successful fortification programs whereby the majority of the food vehicle used is fortifiable and fortified, and coverage is equitable among those classified as vulnerable and not. Other programs have great potential based on very high use of a fortifiable food vehicle, including in most cases among the vulnerable, but that potential is not currently reached because of low compliance with fortification requirements. Programs were also identified whereby the food vehicle has limited potential to make public health contributions to micronutrient intake, given the low proportions of the population who consume the food vehicle in general or who consume the fortifiable food vehicle. Four key lessons were learned: 1) the potential for impact of food fortification depends on the appropriate choice of food fortification vehicle but also on the proportion of the food vehicle consumed that is fortifiable; 2) the design of fortification programs should be informed by the magnitude and distribution of inadequate intake and deficiency and consumption of fortifiable foods, and part of micronutrient deficiency control strategies to ensure coordination with other programs; 3) effective quality control of fortification levels in foods urgently needs strengthening, including the many governance and other policy factors that influence the capacity, resources, and commitment to do this; 4) periodic review of the assumptions related to dietary patterns that underpin food fortification is needed to ensure continual safe and impactful programs.
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Affiliation(s)
| | - Shawn Baker
- Bill & Melinda Gates Foundation, Seattle, WA
| | - Greg S Garrett
- Global Alliance for Improved Nutrition, Geneva, Switzerland; and
| | - Lawrence Haddad
- Global Alliance for Improved Nutrition, Geneva, Switzerland; and
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Friesen VM, Aaron GJ, Myatt M, Neufeld LM. Assessing Coverage of Population-Based and Targeted Fortification Programs with the Use of the Fortification Assessment Coverage Toolkit (FACT): Background, Toolkit Development, and Supplement Overview. J Nutr 2017; 147:981S-983S. [PMID: 28404838 PMCID: PMC5404211 DOI: 10.3945/jn.116.242842] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/02/2016] [Accepted: 01/04/2017] [Indexed: 11/14/2022] Open
Abstract
Food fortification is a widely used approach to increase micronutrient intake in the diet. High coverage is essential for achieving impact. Data on coverage is limited in many countries, and tools to assess coverage of fortification programs have not been standardized. In 2013, the Global Alliance for Improved Nutrition developed the Fortification Assessment Coverage Toolkit (FACT) to carry out coverage assessments in both population-based (i.e., staple foods and/or condiments) and targeted (e.g., infant and young child) fortification programs. The toolkit was designed to generate evidence on program coverage and the use of fortified foods to provide timely and programmatically relevant information for decision making. This supplement presents results from FACT surveys that assessed the coverage of population-based and targeted food fortification programs across 14 countries. It then discusses the policy and program implications of the findings for the potential for impact and program improvement.
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Affiliation(s)
| | - Grant J Aaron
- Global Alliance for Improved Nutrition, Geneva, Switzerland; and
| | - Mark Myatt
- Brixton Health, Llawryglyn, United Kingdom
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