Iodine status of reproductive age women and their toddlers in northern Ghana improved through household supply of iodized salt and weekly indigenous meal consumption

Abstract

Iodine deficiency (ID) during pregnancy results in pregnancy losses, intrauterine growth retardation, and lower IQ in the offspring. Even after two decades of universal salt iodization (USI) implementation, the efficacy of USI has not been reported in high risk groups in vulnerable regions in Ghana. We aimed to assess and improve ID status in childbearing age women (all lactating women) and their toddlers in northern Ghana, a geographically and socioeconomically vulnerable region. We provided weekly supply of household iodized salt and community-based feeding of native Hibiscus Sabdariffaa leaves meal (HSM) prepared with iodized salt to women and their toddlers in intervention (n = 60) vs. control group (n = 60). At baseline, ID was prevalent in women (36%) and their toddlers (29%). For women, both median UIC values for intervention (57.4 ug/l) and control group (65.1 ug/l) were below the recommended UIC value of 100 ug/l with no significant differences between the two groups (p = 0.2778). At the endpoint, median UIC for the intervention group (123.6 ug/l) was significantly higher (p = 0.008) than the control group (59.7 ug/l). Our results suggest that weekly supply of iodized salt along with the feeding HSM is an effective channel for improving iodine status of economically disadvantaged groups in communities remote from coastal lands. Furthermore, our results suggest that decreased median UIC among lactating mothers does not necessarily imply lower iodine status for their breastfed toddlers. And finally, the observed median UIC<100 ug/l may point to a non-improvement in iodine status for the past decade for Ghana. There is a need to revisit, assess, and ascertain the challenges in preventing populations from attaining the intended benefits of the USI policy in Ghana.

Food-based indicators are related to iron and iodine deficiencies of mother–toddler dyads during the lean season in northern Ghana

“…Based on the monotony of the diet, one 24-h recall is enough to approximate routine or usual food intake in this setting. The non-significant findings in toddlers may be due to consumption of breast milk as their source of nutrients (15,25) . In this study, two DP were identified for women (DP 1 and DP 2) and one DP (DP 2) for toddlers.…”

“…Optimal design software (version 3.01) was used to calculate the minimal adequate sample size of 100 dyads with a power of 80 %, significance level of 5 %, coefficient of determination of 65 %, minimum detectable effect of 0•33 of diet on Fe and iodine status and 20 % attrition rate. Details of research methods and recruitment have been published earlier (15,25) . Data analyses were carried out using SAS 9.4 (SAS Institute Inc.).…”

“…Reference for formulae used by this software can be found online (26) . Details of research methods and recruitment have been published earlier (15,25) . The drawn sample had three sets of twins, two dyads relocated before the completion of data collection giving 118 dyads with three sets of twins (118 mothers, 121 children).…”

“…Urban areas are more likely to use adequately iodised salt (50 %) than rural areas (26 %) (12) . These data may suggest a possible high prevalence of inadequate iodine intake in northern Ghana as iodised salt is the main source of iodine in this part of the country (15) .…”