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Published in: BMC Public Health 1/2017

Open Access 01-12-2017 | Research article

Poor dietary diversity, wealth status and use of un-iodized salt are associated with goiter among school children: a cross-sectional study in Ethiopia

Authors: Zegeye Abebe, Ejigu Gebeye, Amare Tariku

Published in: BMC Public Health | Issue 1/2017

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Abstract

Background

Globally, more than two billion people are at risk of iodine deficiency disorders, 32% of which are school children. Iodine deficiency has been recognized as a severe public health concern in Ethiopia, however little is known about the problem. Therefore, this study aimed to assess the prevalence of goiter and associated factors among school children (6 to 12 years) in Dabat District, northwest Ethiopia.

Methods

A school-based cross-sectional study was conducted from February 21 to March 31, 2016. A total of 735 school children were included in the study. A stratified multistage sampling followed by systematic sampling technique was employed to select the study participants. Thyroid physical examination was done and classified according to the World Health Organization recommendations as grade 0, grade 1, and grade 2. The level of salt iodine content was determined using the rapid field test kit. The value 0 parts per million (PPM), <15 PPM and ≥15 PPM with the corresponding color chart on the rapid test kit were used to classify the level of iodine in the sampled salt. A multivariable logistic regression analysis was employed to identify factors associated with goiter. Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was calculated to show the strength of association. In multivariable analysis, variables with a P-value of <0.05 were considered statistically significant.

Results

In this community, the overall prevalence of goiter was 29.1% [95% CI: 25.9, 32.6], in which about 22.4 and 6.7% had goiter grade 1 and grade 2, respectively. The age of children (AOR = 1.13; 95% CI: 1.01, 1.26), being housewife mother (AOR = 1.49; 95% CI: 1.08, 2.15), use of unprotected well water source for drinking (AOR = 6.25; 95% CI: 2.50, 15.66), medium household wealth status (AOR = 1.78; 95% CI: 1.18, 2.92), use of inadequately iodized salt (AOR = 2.79; 95% CI: 1.86, 4.19), poor dietary diversity score of the child (AOR = 1.92;95% CI: 1.06, 3.48) and medium maternal knowledge (AOR = 0.65; 95% CI: 0.42, 0.94) were significantly associated with goiter.

Conclusions

The prevalence of goiter is higher in Dabat District, which confirmed a moderate public health problem. Therefore, regular monitoring of household salt iodine content, improving access to safe water, promoting the importance of diversified food for children is recommended to address the higher burden of iodine deficiency.
Literature
1.
Andersson M, Karumbunathan V, Zimmermann MB. Global iodine status in 2011 and trends over the past decade. J Nutr. 2012;142(4):744–50.PubMedCrossRef
2.
WHO. Urinary iodine concentrations for determining iodine status deficiency in populations. Vitamin and Mineral Nutrition Information System. Geneva: World Health Organization; 2013.
3.
WHO. Iodine status worldwide WHO Global Database on Iodine Deficiency. In: ​de Benoist B, Andersson M, Egli I, Takkouche B, Allen H, editors. Geneva: World Health Organization; 2004.
4.
Andersson M, Takkouche B, Egli I, Allen HE, Benoist B. Current global iodine status and progress over the last decade towards the elimination of iodine deficiency. Bull World Health Organ. 2005;83(7):518–25.PubMedPubMedCentral
5.
WHO. Guideline: fortification of food-grade salt with iodine for the prevention and control of iodine deficiency disorders. In. Geneva: World Health Organization; 2014.
6.
Zimmermann MB, Andersson M. Update on iodine status worldwide. Curr Opin Endocrinol Diabetes Obes. 2012;19(5):382–7.PubMedCrossRef
7.
Buxton C, Baguune B. Knowledge and practices of people in Bia District, Ghana, with regard to iodine deficiency disorders and intake of iodized salt. Arch Public Health. 2012;70(5):5.PubMedPubMedCentralCrossRef
8.
Andersson M, Zimmermann M. Global iodine nutrition: a remarkable leap forward in the past decade. IDD Newsletter. 2012;40(1):1–5.
9.
Abuye C, Berhane Y, Akalu G, Getahun Z, Ersumo T. Prevalence of goiter in children 6 to 12 years of age in Ethiopia. Food Nutr Bull. 2007;28(4):391–8.PubMedCrossRef
10.
Wolka E, Shiferaw S, Biadgilign S. The effect of iodine-deficiency disorders on academic achievement of schoolchildren in Southern Ethiopia. Public Health Nutr. 2014;17(05):1120–4.PubMedCrossRef
11.
Win AZ. Micronutrient deficiencies in early childhood can lower a country’s GDP: The Myanmar example. Nutrition. 2016;32(1):138–40.PubMedCrossRef
12.
WHO/FAO. Guidelines on food fortification with micronutrients. In. 2006.
13.
Enyew HD, Zemedkun KG, Dagnaw AM. Prevalence of Goiter and Associated Factors Among Primary School Children Aged 6–12 Years Old in GobaTown, South East, Ethiopia. Int J Nutr Food Sc. 2015;4(3):381–7.CrossRef
14.
Matthys B, Davlatmamadova M, Karimova G, Jean-Richard V, Zimmermann MB, Wyss K. Iodine nutritional status and risk factors for goitre among schoolchildren in South Tajikistan. BMC Endocr Disord. 2013;13(1):1.CrossRef
15.
Mezgebu Y, Mossie A, Rajesh PN, Beyene G. Prevalence and severity of iodine deficiency disorder among children 6–12 years of age in shebe senbo district, jimma zone, southwest Ethiopia. Ethiop J Health Sci. 2012;22(3):196–204.PubMedPubMedCentral
16.
Gidey B, Alemu K, Atnafu A, Kifle M, Tefera Y, Sharma H. Availability of Adequate Iodized Salt at Household Level and Associated Factors in Rural Communities in Laelay Maychew District, Northern Ethiopia: A Cross Sectional Study. J Nutr Health Sci. 2015;2(1):1.
17.
Kazungu K, Mbakaya C, Makokha A. Factors contributing to iodide deficiency in coast province of Kenya. Eur J Res Med Sci. 2015;3(2). ​ISSN 2056-600X.
18.
Kedir H, Berhane Y, Worku A. Subclinical Iodine Deficiency among Pregnant Women in Haramaya District, Eastern Ethiopia. J Nutr Metab. 2014; 2014(2014). Article ID 878926.
19.
Alsanosy RMA, Gaffar AM, Khalafalla HEE, Mahfouz MS, Zaid ANS, Bani IA. Current iodine nutrition status and progress toward elimination of iodine deficiency disorders in Jazan, Saudi Arabia. BMC Public Health. 2012;12(1):1.CrossRef
20.
Girma M, Loha E, Bogale A, Teyikie N, Abuye C, Stoecker BJ. Iodine deficiency in primary school children and knowledge of iodine deficiency and iodized salt among caretakers in Hawassa Town: Southern Ethiopia. Ethiop J Health Dev. 2012;26(1):30–5.
21.
Jaruratanasirikul S, Sangsupawanich P, Koranantakul O, Chanvitan P, Ruaengrairatanaroj P, Sriplung H. Maternal iodine status and neonatal thyroid-stimulating hormone concentrationa:community survey in Songkhla, southern Thailand. Public Health Nutr. 2009;12(12):2279–84.PubMedCrossRef
22.
Vanderpas J. Nutritional epidemiology and thyroid hormone metabolism. Annu Rev Nutr. 2006;26:293–322.PubMedCrossRef
23.
Simone AJ, Thamm M. Iodine status in preschool children and evaluation of major dietary iodine sources. Eur J Nutr. 2013;52:1711–9.CrossRef
24.
Zimmermann MB. The influence of iron status on iodine utilization and thyroid function. Annu Rev Nutr. 2006;26:367–89.PubMedCrossRef
25.
Brauer VF, Schweizer U, Köhrle J, Paschke R. Selenium and goiter prevalence in borderline iodine sufficiency. Eur J Endocrinol. 2006;155(6):807–12.PubMedCrossRef
26.
Adish A, Chuko T, Abay A, Assey V, Desta T. Ethiopia breaking through with new iodized salt. MI/UNICEF-Ethiopia/GAIN/ICCIDD iodine network/FoH, Ethiopia. In. 2013.
27.
Ethiopian public Health Institute. National salt iodization coverage towards Prevention of Iodine Deficiency Disorder in Ethiopia. In. 2014.
28.
Mesele M, Degu G, Gebrehiwot H. Prevalence and associated factors of goiter among rural children aged 6–12 years old in Northwest Ethiopia, cross-sectional study. BMC Public Health. 2014;14(1):1.CrossRef
29.
World Health Organization, UNICEF, ICCIDD. Assessment of iodine deficiency disorders and monitoring their elimination: a guide for programme managers. In. 2007.
30.
FAO. Guidelines for measuring household and individual dietary diversity. In. 2010.
31.
Central Statistical Agency [Ethiopia] and ICF International. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ICF International. In. Ethiopia Demographic and Health Survey 2011. 2012.
32.
Wang Y, Zhang Z, Ge P, Wang Y, Wang S. Iodine deficiency disorders after a decade of universal salt iodization in a severe iodine deficiency region in China. Indian J Med Res. 2009;130(4):413.PubMed
33.
Kapil U, Pandey RM, Prakash S, Kabra M, Sareen N, Bhadoria AS. Assessment of iodine deficiency in school age children in Nainital District, Uttarakhand State. Asia Pac J Clin Nutr. 2014;23(2):278.PubMed
34.
Shinde M, Joshi A, Naik G, Trivedi A. Prevalence of goiter and the status of iodized salt among the primary school children of a rural district in central India. Community Med. 2015;6(2):51–5.
35.
Sadou H, Dandano IG, Alma MM, Daouda H. Iodine Deficiency Disorders After Sixteen Years of Universal Dietary Salt Iodization in a Severe Iodine Deficiency Village in Niger. Open Nutr J. 2014;8:8–12.CrossRef
36.
Gorstein J, Sullivan K, Parvanta I, Begin F. Indicators and methods for cross-sectional surveys of vitamin and mineral status of populations. Atlanta (GA): Micronutrient Initiative (Ottawa) and the Centers for Disease Control; 2007.
37.
Biswas AB, Das DK, Chakraborty I, Biswas AK, Sharma PK, Biswas R. Goiter prevalence, urinary iodine, and salt iodization level in sub-Himalayan Darjeeling district of West Bengal, India. Indian J Public Health. 2014;58(2):129.PubMedCrossRef
38.
FLEURY Y, MELLE GV, WORINGER V, GAILLARD RC, PORTMANN L. Sex-Dependent Variations and Timing of Thyroid Growth during Puberty. J Clin Endocrinol Metab. 2001;86:750–4.PubMed
39.
Beyene M, Worku AG, Wassie MM. Dietary diversity, meal frequency and associated factors among infant and young children in Northwest Ethiopia: a cross-sectional study. BMC Public Health. 2015;15(1):1.CrossRef
40.
Gebriel TW, Assegid S, Assefa H. Cross-sectional Survey of Goiter Prevalence and Household Salt Iodization Levels in Assosa Town, Beni Shangul-Gumuz Region, West Ethiopia. J Preg Child Health. 2014;1:119.
41.
Steyn NP, Nel J, Labadarios D, Maunder EMW, Kruger HS. Which dietary diversity indicator is best to assess micronutrient adequacy in children 1 to 9 y? Nutrition. 2014;30(1):55–60.PubMedCrossRef
42.
Arimond M, Wiesmann D, Becquey E, Carriquiry A, Daniels MC, Deitchler M, Fanou-Fogny N, Joseph ML, Kennedy G, Martin-Prevel Y. Simple food group diversity indicators predict micronutrient adequacy of women’s diets in 5 diverse, resource-poor settings. J Nutr. 2010;140(11):2059S–69S.PubMedPubMedCentralCrossRef
43.
Kebede DL, Adinew YM. Predictors of Goiter among School Children in Southwest Ethiopia: Case-Control Study. J Nutr Food Sci. 2015;5(3):1.
44.
Kumar S, Berkman LF. Association of Inadequately Iodized Salt Use With Underweight Among Young Children in India. Asia Pac J Public Health. 2015;27(2):185–94.PubMedCrossRef
45.
Lisboa HRK, Gross JL. Ultrasonographic determination of goiter prevalence in southern Brazilian schoolchildren. Braz J Med Biol Res. 2002;35(10):1147–52.PubMedCrossRef
46.
Mardani M, Gholaami F, Rezapour P, Ebrahimzadeh F. The Prevalence of Endemic Goiter and Its Relationship to Urine Iodine in Primary School Age Children in Khoramabad. J Health Sci Surveil Syst. 2015;3(2):71–5.
47.
Habyarimana JB. Determinants of Household Food Insecurity in Developing Countries Evidences From a Probit Model for the Case of Rural Households in Rwanda. Sustain Agric Res. 2015;4(2):78-91.
48.
Aburto N, Abudou M, Candeias V, Wu T. Effect and safety of salt iodization to prevent iodine deficiency disorders: a systematic review with meta-analyses. In: WHO eLibrary of Evidence for Nutrition Actions (eLENA). Geneva: World Health Organization; 2014.
49.
Li M, Eastman CJ. The changing epidemiology of iodine deficiency. Nat Rev Endocrinol. 2012;8(7):434–40.PubMedCrossRef
50.
Abbag FI, Abu-Eshy SA, Mahfouz AA, Al-Fifi SA, El-Wadie H, Abdallah SM, Musa MG, Devansan CS, Patel A. Iodine-deficiency disorders in the Aseer region, south-western Saudi Arabia: 20 years after the national survey and universal salt iodization. Public Health Nutr. 2015;18(14):2523–9.PubMedCrossRef
Metadata
Title
Poor dietary diversity, wealth status and use of un-iodized salt are associated with goiter among school children: a cross-sectional study in Ethiopia
Authors
Zegeye Abebe
Ejigu Gebeye
Amare Tariku
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2017
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-3914-z

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