Dataset Information

Coverage of Adequately Iodized Salt Is Suboptimal and Rice Fortification Using Public Distribution Channels Could Reach Low-Income Households: Findings from a Cross-Sectional Survey of Anganwadi Center Catchment Areas in Telangana, India.

ABSTRACT: Food fortification is a cost-effective approach to prevent and control of micronutrient deficiencies in India. A cross-sectional survey of children 0-35 months of age residing in the catchment areas of anganwadi centers in the state of Telangana was conducted to assess the coverage of adequately iodized salt and the potential for rice fortification. Salt samples were collected and tested for iodine concentration using iodometric titration. Information on demographics, household rice consumption, and Telangana's rice sector was collected and interpreted. In households of selected children, 79% of salt samples were found to be adequately iodized. Salt brand and district were significant predictors of inadequately iodized salt. Daily rice consumption among children and women averaged 122 grams and 321 grams per day, respectively. Approximately 28% of households reported consuming rice produced themselves or purchased from a local farmer, 65% purchased rice from a market or shop, 6% got rice from a public distribution system site, and 2% obtained it from a rice mill. In the catchment areas of Telangana's anganwadi centers, there is significant variation in the coverage of adequately iodized salt by district. Future surveys in Telangana should measure the coverage of salt iodization in the general population using quantitative methods. Nonetheless, increasing the adequacy of iodization of smaller salt manufacturers would help achieve universal salt iodization in Telangana. Despite high consumption of rice, our findings suggest that large-scale market-based rice fortification is not feasible in Telangana due to a large proportion of households producing their own rice and highly fragmented rice distribution. Distributing fortified rice via Telangana's public distribution system may be a viable approach to target low-income households, but would only reach a small proportion of the population in Telangana.

SUBMITTER: Wirth JP

PROVIDER: S-EPMC4957802 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Coverage of Adequately Iodized Salt Is Suboptimal and Rice Fortification Using Public Distribution Channels Could Reach Low-Income Households: Findings from a Cross-Sectional Survey of Anganwadi Center Catchment Areas in Telangana, India.

Wirth James P JP Leyvraz Magali M Sodani Prahlad R PR Aaron Grant J GJ Sharma Narottam D ND Woodruff Bradley A BA

PloS one 20160722 7

Food fortification is a cost-effective approach to prevent and control of micronutrient deficiencies in India. A cross-sectional survey of children 0-35 months of age residing in the catchment areas of anganwadi centers in the state of Telangana was conducted to assess the coverage of adequately iodized salt and the potential for rice fortification. Salt samples were collected and tested for iodine concentration using iodometric titration. Information on demographics, household rice consumption, ...[more]

PMID: 27447925

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Project description:Introduction:Adequate iodine fortified salt is the most common and effective method of preventing iodine deficiency. Studies showed households using iodized salt (15 Parts Per Million (PPM) to 80 PPM) of iodine at household level were low in Tigray region and other regions of Ethiopia. Limited studies have conducted on utilization of iodized salt at the household level and none of them did not addressed on factors affecting to proper iodized salt utilization. The aim of this study was to determine the iodine concentration in the collected salt samples, adequately iodized salt consumption coverage and identify factors affecting to proper iodized salt utilization amongst the households of Northern Ethiopia. Methods:Community based cross-sectional designs on selected 318 household food caterers were interviewed and salt samples were accordingly collected. Data was analyzed by the SAS-9.2 statistical software package. The iodine concentrations of the salt samples were determined by using the golden standard iodometric titration technique. Logistic Generalized Estimating Equation (GEE) statistical analysis method was used to assess factors affecting proper iodized salt utilization at household level. Results:Adequately iodized salt coverage among the households was only 51 (17.5%). About 42 (14.38%) had 15?ppm (ppm) - 80?ppm, 9 (3.08%) had >?80?ppm, 188 (64.4%) had 1.1?ppm to 14.9?ppm and 53 (18.2%) had no iodine in the salt (0?ppm). Only 26 (8.9%) of the households had used iodized salt properly. Family size with Adjusted Odds Ratio (AOR) (0.82) and 95%CI [0.67, 0.92], residency of the household with AOR (2.83) and 95%CI [1.48, 5.40], the availability of iodized salt with AOR (3.90) and 95% CI [1.74, 8.7] and affordability to iodized salt with AOR (3.33) and 95% CI [1.41, 7.34] was strong predictors to proper iodized salt utilization. Conclusions:Coverage of adequately iodized salt was low. Family size, residency, availability and affordability of iodized salt were the predictors of proper iodized salt utilization. To enhance USI utilization effective inspection and regulatory measures should be taken to prevent the production and distribution of under/ over iodized salt in the market.

Project description:Background: Globally, iodine deficiency has been drastically reduced since the introduction of salt iodization programs; nonetheless, many populations remain at-risk for iodine deficiency. This study aimed to assess the iodine status among women of reproductive age in Uzbekistan and to identify factors associated with iodine deficiency, including the availability of adequately iodized salt at the household level. Methods: A cross-sectional household survey was conducted to produce region-specific estimates of the household coverage with adequately iodized salt and iodine status among women for each of the 14 regions in Uzbekistan. Other information, such as socioeconomic status, lactation and pregnancy, residence, age, and consumption of iodine supplements, was also collected. Results: Overall, 36% of 3413 households had adequately iodized salt (iodine concentration >15 ppm [parts per million (mg I/kg salt)]), 20% had inadequately iodized salt (5-14 ppm), and 44% had salt without detectable iodine (<5 ppm). Adequate iodization was found in 33.2% of the 2626 salt samples taken from retail packages labeled as "iodized," 36.5% of the 96 samples taken from retail packages without mention of iodization, and 50.5% of the 674 samples without the original packaging (p < 0.001). The median urinary iodine concentration (UIC) of 140.9 μg/L (95% confidence interval [CI 132.4-150.7]) in nonpregnant nonlactating women indicated adequate iodine status, while for nonpregnant lactating and pregnant women, the median UIC of 112.9 μg/L [CI 99.3-128.4] and 117.3 μg/L [CI 101.8-139.9], respectively, indicated borderline adequacy. Significant differences in UIC (p < 0.001) were found between nonpregnant nonlactating women living in households with adequately iodized salt (UIC 208.9 μg/L), inadequately iodized salt (UIC 139.1 μg/L), and noniodized salt (UIC 89.9 μg/L). Conclusions: Coverage with adequately iodized salt is low in Uzbekistan, and women in households with poorly iodized salt have substantially worse iodine status; claims on packaging about salt iodization do not reflect salt iodine content. This highlights the importance and effectiveness of salt iodization and the need to strengthen this program in Uzbekistan.

Project description:Universal salt iodization is the most cost-effective, safe and sustainable strategy to eliminate iodine deficiency disorders. However, little is known about the availability of adequately iodized salt in the northwestern part of Ethiopia. Thus, the aim of this study was to assess the availability of adequately iodized salt at the household level and associated factors in Dabat District, northwest Ethiopia.A community-based cross-sectional study was conducted from February 21 to March 31, 2016. We included 705 households in the study. A stratified multistage followed by simple random sampling technique was employed to select households. The level of salt iodine content was determined using the rapid field test kit. Accordingly, the value of <15 parts per million (PPM) and ≥15 PPM with the corresponding color chart on the rapid test kit were used to classify the level of iodine content in the sampled salt. A multivariable binary logistic regression model was fitted to identify factors associated with the availability of adequately iodized salt. Adjusted Odds Ratio (AOR) with the corresponding 95% Confidence Interval (CI) was calculated to show the strength of association.This study indicated that about 33.2% [95% CI: 29.6, 36.7%] of households had adequately iodized salt. Urban residence (AOR = 2.15, 95% CI: 1.23, 3.76), use of packed salt (AOR = 2.23, 95% CI: 1.01, 4.89), and good respondents' knowledge on iodized salt use (AOR = 1.49, 95% CI: 1.08, 2.08) were positively associated with the availability of adequately iodized salt. However, longer distance to buy salt was inversely related with availability of adequately iodized salt (AOR = 0.68, 95% CI: 0.48, 0.99).The availability of iodized salt is well under the WHO recommendation in Dabat District in spite of the fact that Ethiopia has been implementing universal salt iodization since the last five years. Therefore, intensifying strategies targeting to enhance community awareness on the benefit and handling practice of iodized salt is essential to improve availability of iodized salt. In addition, the focus needs to be on improving accessibility of iodized salt.

Project description:BackgroundIodine 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.MethodWe 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.ResultsWe 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%).ConclusionsIn 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.

Project description:Currently, national governments of onchocerciasis endemic African countries are working towards the elimination of the disease using mass drug administration (MDA) with ivermectin as a primary strategy. Attainment of this goal requires implementation of prolonged high MDA coverage in all endemic areas, and vigilant monitoring and evaluation of the program. This study was thus conducted with the purpose of i) providing estimate of ivermectin coverage, ii) validating the MDA coverage reported through community drug distributors (CDDs), iii) determining the factors associated with MDA coverage, and iv) estimating the difference between MDA program reach and survey coverage rates following MDA campaign carried out in May 2017 in Asosa and Yeki districts in Ethiopia. A community-based cross-sectional study was conducted among 2,824 study participants in Asosa and Yeki districts. A total of 50 kebeles (smallest administrative units) were randomly selected from the two districts. A systematic sampling was employed to select study households from the 50 kebeles. Then, a household member was randomly selected for the interview. Univariate and multivariate logistic regression analysis were used to determine the odds ratio and to observe the associations between the MDA survey coverage and the variables used. Eighty-seven percent (2458/2824) of the respondents from both districts responded that they were offered ivermectin during the May 2017 MDA campaign. At the district level, 1182 individuals from Yeki and 1276 from Asosa, received the drug, that indicate 88.5% and 85.8% MDA program reach in Yeki and Assosa districts, respectively. Whereas, a total of 366 individuals were not offered ivermectin in both study districts. Of these, 47(12.8%), 143(39.1%), and 176(48.1%) did not receive the drug because of program implementation-related reasons, ineligibility criteria, and personal issues, respectively. Of the 1488 and 1336 respondents in Asosa and Yeki, 1272 and 1182 participants took the drug, resulting in survey coverage rate of 85.5% (95% CI: 83.6-87.2%) and 88.5% (95% CI: 86.7-90.1%), respectively. Multivariable logistic regression analysis revealed significantly low survey coverage rate in females (AOR = 0.5, 95%CI: 0.3-0.6; p<0.001) and in those whose age ranges between 15-24 years (AOR = 0.5, 95%CI: 0.3-0.8; p = 0.007) and 25-34 years (AOR = 0.5, 95%CI: 0.3-0.9; p = 0.021) in Asosa. The researchers believe that the current study generated operational evidence on MDA program reach and coverage rates in two study districts in Ethiopia. The survey coverages were lower than the recommended 90% minimum threshold for success. Only Yeki district reached the 90% threshold survey coverage. Both districts had reported higher coverages than the survey estimates (even outside the 95% CI), thus, were not validated. The majority (60.9%) of the reasons for not receiving the drug were related to program implementation and recipients`personal issues. Efforts must therefore be directed to enhance MDA coverage in future rounds via proper MDA planning and implementation, such as allocating adequate time to the MDA activities, health education, and mobilizing of all segments of the population, including adolescents and the youth. The researchers also recommend such studies to be extended to other MDA programs for other neglected tropical diseases (NTDs).

Dataset Information

Coverage of Adequately Iodized Salt Is Suboptimal and Rice Fortification Using Public Distribution Channels Could Reach Low-Income Households: Findings from a Cross-Sectional Survey of Anganwadi Center Catchment Areas in Telangana, India.

Publications

Coverage of Adequately Iodized Salt Is Suboptimal and Rice Fortification Using Public Distribution Channels Could Reach Low-Income Households: Findings from a Cross-Sectional Survey of Anganwadi Center Catchment Areas in Telangana, India.

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