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

Abstract

Background: Iodine deficiency disorders are one of Madagascar's public health issues regarding the low level of iodine concentration in the population as assessed in 2015. Since then, the national salt iodization program has been revitalized. Therefore, this study aimed to estimate the coverage of households' adequately iodized salt in Madagascar and assess their level of Knowledge, Attitudes, and Practices regarding iodized salt use and associated factors. Materials and Methods: A cross-sectional population-based study using a multistage random sampling was conducted in 2020 in 4410 households in Madagascar. After informed consent, a pre-tested questionnaire on iodized salt was administered to the households, followed by a table, or cooking salt sample collected for iodine content testing using the iodometric titration technique. In addition, bivariate and multivariate analyses were conducted at 95% confidence level to identify associated factors. Results: The study results estimated the coverage of adequately iodized salt (15-60 ppm) nationwide at 41.1% (CI95%: 39.7%-42.2%) with significant differences between provinces. In addition, 36.8% of women had a “good” knowledge, 45.0% “good” practice of iodized salt, and 24.4% had a “positive” attitude towards iodized salt. Finally, the study identified the following associated factors to adequately iodized salt: attitude or perception towards iodized salt, household size, residence, economic status, and education level. Conclusion: Household coverage of adequately iodized salt has improved since 2015 but remains below WHO recommendations. Thus, the Ministry of Health and its partners could reinforce nutrition education efforts on household attitudes toward iodized salt and other associated factors to maintain coverage progress. Keywords: Coverage, iodine deficiency disorders, iodized salt, supplementation.