Progress and challenges in eliminating iodine deficiency in Ethiopia: a systematic review

Abstract

Background: Iodine deficiency disorders (IDD) and their attendant effects on human development, perinatal mortality and intellectual dysfunction are a major nutrition and public health problem worldwide, with Ethiopia counted among the top iodine-deficient countries. Despite the passing of new legislation in 2011 under the National Nutrition Programme and subsequent increase in the availability of iodized salt, the eradication of IDD in Ethiopia remains a significant challenge. This paper critically reviews the recent published data on iodine-status in Ethiopia as a basis for formulating future research and policy initiatives. Methods: We performed a structural search for IDD studies in Ethiopia for all population groups published after the year 2000. Results: Twenty four studies reported national and regional data giving a national total goiter rate above 35.8 % in women, with rates close to 60 % in four regional states, and an estimated prevalence of IDD ranging from 0.4 to 66.3 % depending on region. The prevalence of goiter in children was 35 %, but was as high as 71 % in the South Nations Nationalities and Peoples Region. The problem persists despite the widespread availability of iodized salt. Conclusions: Eradicating IDD in Ethiopia will require concerted efforts including the close evaluation of intervention programs through regular, nation-wide monitoring of IDD and salt-iodization coverage. Salt iodization became mandatory in Ethiopia in 2011 and despite significant progress, the current level of eradicating IDD could be improved. Prospective and controlled intervention studies to evaluate biomarkers of thyroid function and cognitive outcomes will help to monitor and improve eradication efforts. Ascertaining and improving health and development in the most vulnerable populations of women and children is a priority that may be advanced through a greater investment in outreach and education.

Prevalence of goiter among children in Ethiopia and associated factors: a systematic review and meta-analysis

“…This high prevalence meets WHO’s threshold for endemicity [3] and implies the presence of moderate to severe iodine deficiency in the country [53]. Our estimated prevalence is similar to the 39.9% rate (95% CI: 38.6–41.20) found in a nationwide, community-based, cross-sectional study conducted in 2005 [11] and a systematic review of the literature on progress in eliminating iodine deficiency in Ethiopia which found a 35% child prevalence of goiter [20]. Additionally, a survey among school children carried out in 2016 found that 48% of school-age children had iodine deficiency [54].…”

“…In sum, although there has been significant progress in the reduction of goiter and related IDDs globally, they remain significant burden in Ethiopia due, in part, to poor salt storage practices and a weak universal salt iodization program. There is little consistent data about the prevalence of goiter in Ethiopia, particularly among children; and most publicly available scientific literature and reports on the topic were published before 2016 [20]. Understanding the extent of goiter and its associated factors is important for designing strategies that can reduce the burden of goiter among children in Ethiopia.…”

National incidence, prevalence and disability-adjusted life years (DALYs) of common micronutrient deficiencies in Ethiopia from 1990 to 2017: estimates from the global burden of diseases study

“…The overall prevalence of iodine deficiency in 2017 was 6.8%, indicating it is still an important public health problem. Several pilot studies in the country reported 16% to 62.1% total goiter rate (TGR) [28][29][30][31][32]. These studies, however, mainly focused on highrisk areas of the country and high-risk groups such as school children and women, and most of them used all stages of goiter, which resulted in higher prevalence rates.…”

Goiter and Its Associated Factors among Adolescent High School Girls at Tach Armachiho District, Northwest Ethiopia: An Institution-Based Cross-Sectional Study

“…If no color change appeared on the salt after one minute, up to five drops of recheck solution were added in red ampule on a fresh sample, two drops of test solution were added on the same spot, and the color was compared with the color chart. The iodine content was determined, if it is 0 parts per million (no iodine), <15 ppm (light blue), ≥15 ppm (deep blue) [ 16 , 20 ].…”

“…The magnitude of goiter also varies from region to region in Ethiopia: in Southern Nations, Nationalities and Peoples region (SNNP) (56.2%), Oromia (42%), Benishangul Gummuz (40%), Amhara (29.1%), and Tigray (21.9%) [ 7 ]. The prevalence of goiter is also influenced by factors, such as sex [ 13 ], educational status and age [ 14 – 16 ], place of birth and family income [ 17 ], residence [ 18 ], consumption of iodized salt [ 17 ], knowledge, dietary intake, drinking unprotected water, eating goitrogenic foods, and family history [ 18 ].…”