Non-iodized salt consumption among women of reproductive age in sub-Saharan Africa: a population-based study

Iodized household salt utilization and associated factors among households in East Africa: a multilevel modelling analysis using recent national health surveys

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.

An assessment of Individual, community and state-level factors associated with inadequate iodised salt consumption among pregnant and lactating women in Nigeria

BACKGROUND

Iodine deficiency is the most common cause of thyroid disease, and in its severe form can result in cretinism; the impairment of the brain development of a child. Pregnant and breastfeeding women's daily iodine requirement is elevated due to physiological changes in iodine metabolism, requiring up to double the iodine intake of other women. Although Nigeria was the first African country to be declared iodine sufficient in 2007, recent evidence has shown that only about seven in ten households consume salt with adequate iodine content (≥ 15 ppm), with variation across states. The study aimed to assess the Individual- and household-, community- and state-level factors associated with inadequate iodised salt consumption among pregnant women and breastfeeding mothers in Nigeria.

METHODS

This study utilised the Multiple Indicator Cluster Survey to assess factors associated with inadequate iodised salt consumption among 4911 pregnant women and breastfeeding mothers in Nigeria. The descriptive analysis was presented using frequencies and percentages. The prevalence of adequate and inadequate iodised salt consumption with their 95% confidence interval were computed. Several multi-level mixed effect log-binomial logistic regressions were used to explore the factors associated with inadequate iodised salt consumption. The Loglikelihood, Akaike Information Criterion and Bayesian Information Criterion were used to assess the goodness of fit of the models. All analyses were adjusted for the complex survey design and analysed using Stata 15.0 at p < 0.05.

RESULTS

The prevalence of inadequate iodised salt consumption among pregnant and breastfeeding mothers was 35.2% (95% CI: 33.1-37.5). Inadequate consumption of iodised salt was highest among pregnant and breastfeeding women aged 45-49 years (48.2%; 95%CI: 37.8-58.8), as well as those with non-formal education (52.7%; 95%CI: 47.7-57.6) and no education (34.6%; 95%CI: 31.3-38.1). Our findings revealed that pregnant and breastfeeding women living in the poorer, middle, richer and richest quintiles were 32%, 47%, 35% and 62% less likely to consume salt with inadequate iodine compared to those in the poorest households. Those with non-formal education were 1.8 times (95%CI: 1.36-2.42) more likely to consume salt with deficient iodine than those without education. Pregnant and breastfeeding mothers residing in moderately and most deprived communities were 3.5 (95%CI: 2.57-4.73) and 4.7 times (95%CI: 3.38-6.55) more likely to consume salt with inadequate iodine than those from least deprived communities. Women in the Northwestern region and those from the Southwestern region were 4.0 and 3.5 times, respectively, more likely to consume salt with inadequate iodine compared to pregnant and breastfeeding women residing in the North-Central region.

CONCLUSIONS

The study has shown that inadequate consumption of iodised salt dominates among older pregnant and breastfeeding women. Also, women with non-formal education have higher prospects of consuming salt with lesser iodine. There is a need to enhance women's economic opportunities and empowerment as well as sensitisation on their nutritional requirements during pregnancy and breastfeeding. Both formal and non-formal educational initiatives on nutrition are extremely important and should be prioritised by the Nigerian government in its efforts to encourage the consumption of iodised salt among pregnant and lactating mothers. Additionally, health promotion interventions that seek to advocate iodised salt intake must be prioritised by the actors in the health sector.

Aligning the Epidemiology of Malnutrition with Food Fortification: Grasp Versus Reach

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.

Hotspots of un-iodized salt availability among Ethiopian households, evidence from the national survey data

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.

Individual and community level factors associated with use of iodized salt in sub-Saharan Africa: A multilevel analysis of demographic health surveys

Introduction

Iodine deficiency disorder a common problem in sub-Saharan Africa (SSA). It affects not only the health of the affected individual but also the economic development of the country. However, to the best of our knowledge, there is a scarcity in literature about the associated factors of iodized salt utilization in sub-Saharan Africa. Therefore, this study aimed to identify both individual and community level determinants of iodized salt utilization in sub-Saharan Africa.

Methods

This study used the appended datasets of the most recent demographic and health survey from 31 sub-Saharan countries. A total weighted sample of 391,463 households was included in the study. Both bivariable and multivariable multilevel logistic regression were done to determine the associated factors of iodized salt utilization in SSA. P value ≤ 0.05 was used to declare statistically significant variables.

Results

Those households with primary (AOR  =  1.53, 95% CI  =  1.50–1.57), secondary (AOR  = 1.81, 95% CI  =  1.76–1.86) and higher education level (AOR  =  2.28, 95% CI  =  2.17–2.40) had higher odds of iodized salt utilization. Households with middle (AOR  =  1.05, 95% CI  =  1.02–1.08), richer (AOR  = 1.13, 95% CI  =  1.09–1.17) and richest wealth index (AOR  =  1.23, 95% CI  =  1.18–1.28) also had an increased chance of using iodized salt. Households from high community media exposure (AOR  =  2.07, 95% CI  =  1.71–2.51), high community education level (AOR  =  3.78, 95% CI  =  3.14–4.56), and low community poverty level (AOR = 1.29, CI  =  1.07–1.56) had higher odds of using salt containing iodine.

Conclusion

Both individual and community level factors were found to be associated with use of salt containing iodine in sub-Saharan Africa. Education level, media exposure, community poverty level, wealth index, community education, and community media exposure were found to be associated with use of salt containing iodine in SSA. Therefore, to improve the use of iodized salt in the region, there is a need to increase access to media sources and develop the socioeconomic status of the community.

Global, regional and national epidemiology and prevalence of child stunting, wasting and underweight in low- and middle-income countries, 2006-2018

In 2016, undernutrition, as manifested in childhood stunting, wasting, and underweight were estimated to cause over 1.0 million deaths, 3.9% of years of life lost, and 3.8% of disability-adjusted life years globally. The objective of this study is to estimate the prevalence of undernutrition in low- and middle-income countries (LMICs) using the 2006-2018 cross-sectional nationally representative demographic and health surveys (DHS) data and to explore the sources of regional variations. Anthropometric measurements of children 0-59 months of age from DHS in 62 LMICs worldwide were used. Complete information was available for height-for-age (n = 624,734), weight-for-height (n = 625,230) and weight-for-age (n = 626,130). Random-effects models were fit to estimate the pooled prevalence of stunting, wasting, and underweight. Sources of heterogeneity in the prevalence estimates were explored through subgroup meta-analyses and meta-regression using generalized linear mixed-effects models. Human development index (a country-specific composite index based on life expectancy, literacy, access to education and per capita gross domestic product) and the United Nations region were explored as potential sources of variation in undernutrition. The overall prevalence was 29.1% (95% CI 26.7%, 31.6%) for stunting, 6.3% (95% CI 4.6%, 8.2%) for wasting, and 13.7% (95% CI 10.9%, 16.9%) for underweight. Subgroup analyses suggested that Western Africa, Southern Asia, and Southeastern Asia had a substantially higher estimated prevalence of undernutrition than global average estimates. In multivariable meta-regression, a combination of human development index and United Nations region (a proxy for geographical variation) explained 54%, 56%, and 66% of the variation in stunting, wasting, and underweight prevalence, respectively. Our findings demonstrate that regional, subregional, and country disparities in undernutrition remain, and the residual gaps to close towards achieving the second sustainable development goal-ending undernutrition by 2030.

Factors associated with the consumption of table salt with inadequate iodine concentrations: a population analysis at a Peruvian household level

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.