Availability of adequately iodized salt at the household level in Ethiopia: A systematic review and meta-analysis

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.

Iodine status, impact of knowledge, and practice for adequate iodized salt utilization in house hold at North West Ethiopia

“…However, only 48.5% were confirmed with ≥15 ppm iodine content in their daily salt which self-reported as they always used adequate iodized salt utilization. Which is considerably lower than the WHO recommendation levels to be 90%, 24 Pradesh Indian 48%, 25 Mayhew district (59.7%), 26 Dessie town 68.8%, 20 Asella town 76.8% in 2016, 27 Goba town 57.2%, 28 Dega Damot 88.8% 29 but higher than previous finding in 33.2% in Gondar, 30 33.5% in Addis Ababa, 16 and 25.7% in Ziway. 26 This might be due to the difference in whether there was a problem in the identification of iodized salt during purchasing from the whole sellers, shops, and others where iodized salt was sold and the lower global and regional levels.…”

Bridging the Knowledge Gap: Discerning the Association between Adequately Iodized Salt Coverage and Household Knowledge, Attitudes and Practices in Madagascar

“…The results also showed that 41.1% (CI95% 39.7%-42.2%) of households were covered with salt adequately iodized according to National standards, and 28.2% (CI95% 26.8%-29.6%) according to WHO standards [1]. This result is similar to a meta-analysis of 28 studies conducted between 2013 and 2020 in Ethiopia [12], from which it was found a combined coverage of 37% (95% CI: 28%-46%) as a proportion of households with adequately iodized salt (>=15 ppm). However, it was lower than the results of other studies conducted in South Africa and India, where coverage was 62.4% [13] and 75% [14], respectively.…”

Knowledge, Practice, and Availability of Iodized Salt and Associated Factors in Jibat Woreda, West Shoa Zone, Ethiopia

“…This finding was lower than the study done in Addis Ababa City, which shows that 76.3% of households had good practice on iodized salt but higher than the study done in Tehran, which shows that the 14% of households had good practices on iodized salt [ 13 , 18 ]. Findings regarding to availability of iodized salt in the present study suggest that 41.7% of households have adequately iodized salt which was very lower than the WHO's recommendation according to which >90% of the households should utilize adequately iodized salt to eliminate IDD and in other developing countries like Kenya, Uganda, and Zimbabwe, which have successful household iodized salt coverage which is about 90% [ 4 , 19 ]. However, this finding is higher than study done in Gondar, North West Ethiopia in 2012, which was 28.9%, in Asosa, 26.1%, in Bale Goba, 30%, in rural of Ada District, 39%, and DHS, 2011, which showed that 23.2% of urban households have access to iodized salt [ 9 , 12 , 20 – 22 ].…”