Dataset Information

Iodine concentration level of iodized dietary salt and its associated factors: A systematic review and meta-analysis.

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 09 up to February 25, 2022. The rapid test kit (RTK) was used to measure the adequacy of iodine level of dietary salt. The quality of studies was assessed using Joanna Briggs Institute (JBI) 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 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 level 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 two 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.

SUBMITTER: Ewunie TM

PROVIDER: S-EPMC9254272 | biostudies-literature |

REPOSITORIES: biostudies-literature

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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:Hypothyroidism due to iodine deficiency can impair physical development, most visibly in the marked stunting of myxedematous cretinism caused by severe in utero iodine deficiency. Whether iodine repletion improves growth in noncretinous children is uncertain. Therefore, the aim of our systematic review was to assess the effects of iodine fortification or supplementation on prenatal and postnatal growth outcomes in noncretinous children. Following Cochrane methods and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines, we searched 10 databases including 2 Chinese databases (latest search February 2017). We included randomized and nonrandomized controlled trials (RCTs; non-RCTs), controlled before-after (CBA) studies, and interrupted time-series studies in pregnant women and children (≤18 y), which compared the effects of iodine (any form, dose, regimen) to placebo, noniodized salt, or no intervention on prenatal and postnatal growth outcomes. We calculated mean differences with 95% CIs, performed random-effects meta-analyses, and assessed the quality of evidence with the use of GRADE (Grading of Recommendations Assessment, Development and Evaluation). We included 18 studies (13 RCTs, 4 non-RCTs, 1 CBA) (n = 5729). Iodine supplementation of severely iodine-deficient pregnant women increased mean birthweight [mean difference (MD): 200 g; 95% CI: 183, 217 g; n = 635; 2 non-RCTs] compared to controls, but the quality of this evidence was assessed as very low. Iodine repletion across the other groups showed no effects on primary growth outcomes (quality of evidence mostly low and very low). Meta-analyses showed a positive effect in moderate-to-mildly iodine-deficient schoolchildren on insulin-like growth factor-1 (MD: 38.48 ng/mL; 95% CI: 6.19, 70.76 ng/mL; n = 498; 2 RCTs, low-quality evidence) and insulin-like growth factor binding protein-3 (MD: 0.46 μg/mL; 95% CI: 0.25, 0.66 μg/mL; n = 498; 2 RCTs, low-quality evidence). In conclusion, we identified few well-designed trials examining the effects of iodine repletion on growth. We are uncertain whether prenatal iodine repletion increases infant growth. Postnatal iodine repletion may improve growth factors but has no clear effects on somatic growth. Our systematic review was registered with PROSPERO as CRD42014012940.

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:Background:In developing countries most of the edible salts have insufficient iodine content; the problem is worse in Africa. Only 15.4% of the Ethiopian population was using adequately iodized salt. Several factors affect iodine content of edible salt including poor handling practices. The existing evidence isn't sufficient to detail the specific factors at the household level. Therefore, the aim of this study was to determine the iodine content of edible salt and identify factors associated with salt iodine content in Dera District, Northwest Ethiopia. Methods:A community-based cross-sectional study was conducted among 1194 households. A multi-stage sampling technique was used to select the households, and data were collected using the interview. A 50 g salt sample was collected from each selected household and was shipped to the Ethiopian Food, Medicine and Health Care administration and Control Authority (EFMHACA) laboratory center for iodine level analysis. The samples were analyzed using titration method. Data were entered into EPI-INFO and analyzed in SPSS. Results:Out of 1194 salt samples collected, 57.4% had iodine content in the range 15 ppm to 59.42 ppm. Salt stored in closed containers was more likely to have better iodine content compared to salt stored with open containers (AOR?=?1.7, 95% CI: 1.24-2.42). Salt samples stored in dry places were 1.5 times more likely to retain iodine compared to samples stored near to heat/fire or in a moist area (AOR?=?1.5, 95% CI: 1.03-2.14). Similarly, salt samples stored for less than 2 months were more likely to have adequate iodine level compared to samples stored for over 2 months (AOR?=?1.6, 95% CI: 1.12-2.29).Salt samples obtained from household heads attended primary education (AOR?=?1.5, 95% CI: 1.05-2.26), high school (AOR?=?1.7, 95% CI: 1.05-2.64), and University (AOR?=?2.8, 95% CI: 1.06-5.62) were more likely to have adequate iodine content in edible salt compared to whose didn't attend formal education. Conclusions:Nearly three out of five salt samples had enough iodine content. However, this level is low compared to the WHO recommendation (90%). The age, educational status of head of the household, duration of salt storage, use of cover to store salt and knowledge of household heads were associated with an iodine content of salt. Therefore, use of cover and proper storage of edible salt should be encouraged; improving the educational status of the community is essential the edible salt to retain its iodine content at the household level.

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:The results of prospective cohort studies regarding the role of salt intake and subsequent gastric cancer risk are inconsistent. Thus, we performed a systematic review and meta-analysis to summarize the strength of the association of salt intake with gastric cancer morbidity and mortality. PubMed, EmBase, and Cochrane Library were systematically searched to identify eligible studies published throughout September 2021. The effect estimates with 95% confidence intervals (CIs) for gastric cancer morbidity or mortality in each study were applied to calculate the pooled results; these analyses were performed using the random-effects model. Twenty-six prospective cohort studies involving 4,956,350 individuals were selected; these studies reported 19,301 cases of gastric cancer and 2,871 cases of gastric cancer-associated mortality. High (RR: 1.25; 95%CI: 1.10-1.41; P = 0.001) or moderate (RR: 1.20; 95%CI: 1.04-1.38; P = 0.012) salt intake was associated with a greater risk of gastric cancer. High pickled food intake was associated with an increased gastric cancer risk (RR: 1.28; 95%CI: 1.05-1.57; P = 0.017), while moderate pickled foods intake had no significant effect on gastric cancer risk (RR: 1.10; 95%CI: 0.88-1.37; P = 0.390). Neither high (RR: 1.14; 95%CI: 0.95-1.36; P = 0.161) nor moderate (RR: 1.10; 95%CI: 0.87-1.40; P = 0.436) salted fish intake were associated with gastric cancer risk. A high intake of processed meat was significantly associated with a higher risk of gastric cancer (RR: 1.24; 95%CI: 1.03-1.49; P = 0.023), while moderate processed meat intake had no significant effect on the gastric cancer risk (RR: 1.01; 95%CI: 0.92-1.11; P = 0.844). High (RR: 1.04; 95%CI: 0.90-1.19; P = 0.626) and moderate (RR: 1.02; 95%CI: 0.94-1.11; P = 0.594) miso-soup intake had no effects on the gastric cancer risk. High intakes of salt, pickled food, and processed meat are associated with significantly increased risks of gastric cancer; these increased risks are also seen when participants consumed moderate amounts of salt.

Project description:ObjectiveMild to moderate iodine deficiency during pregnancy has been associated with adverse neurodevelopmental outcomes in offspring. Few research studies to date combine assessment of urinary iodine (UIC and/or ICr), biomarkers that best reflect dietary intake, with reported dietary intake of iodine rich foods in their assessment of iodine deficiency. Thus, a systematic review was conducted to incorporate both these important measures.DesignUsing PRISMA guidelines, a comprehensive search was conducted in three electronic databases (EMBASE®, MedLine® and Web of Science®) from January 1970-March 2021. Quality assessment was undertaken using the Newcastle Ottawa Scale. Eligible studies included reported assessment of iodine status through urinary iodine (UIC and/or ICr) and/or dietary intake measures in pregnancy alongside neurodevelopmental outcomes measured in the children. Data extracted included study author, design, sample size, country, gestational age, child age at testing, cognitive tests, urinary iodine assessment (UIC in μg/L and/or ICr in μg/g), dietary iodine intake assessment and results of associations for the assessed cognitive outcomes.ResultsTwelve studies were included with nine reporting women as mild-moderately iodine deficient based on World Health Organization (WHO) cut-offs for urinary iodine measurements < 150 μg/l, as the median UIC value in pregnant women. Only four of the nine studies reported a negative association with child cognitive outcomes based on deficient urinary iodine measurements. Five studies reported urinary iodine measurements and dietary intakes with four of these studies reporting a negative association of lower urinary iodine measurements and dietary iodine intakes with adverse offspring neurodevelopment. Milk was identified as the main dietary source of iodine in these studies.ConclusionThe majority of studies classified pregnant women to be mild-moderately iodine deficient based on urinary iodine assessment (UIC and/or ICr) and/or dietary intakes, with subsequent offspring neurodevelopment implications identified. Although a considerable number of studies did not report an adverse association with neurodevelopmental outcomes, these findings are still supportive of ensuring adequate dietary iodine intakes and urinary iodine monitoring throughout pregnancy due to the important role iodine plays within foetal neurodevelopment. This review suggests that dietary intake data may indicate a stronger association with cognitive outcomes than urinary iodine measurements alone. The strength of this review distinguishes results based on cognitive outcome per urinary iodine assessment strategy (UIC and/or ICr) with dietary data. Future work is needed respecting the usefulness of urinary iodine assessment (UIC and/or ICr) as an indicator of deficiency whilst also taking account of dietary intakes.