Spatial Distribution and Determinants of Household Iodized Salt Utilization in Ethiopia: A Spatial and Multilevel Analysis of Ethiopian Demographic and Health Survey

Abstract

Background: Iodine deficiency disorder is a significant public health problem, affecting both developed and developing nations worldwide. It is associated with poor body growth and irreversible mental retardation. However, little is known about the spatial distribution and determinants of household iodized salt utilization in Ethiopia. Therefore, this study aimed to explore the spatial distribution and determinants of iodized salt utilization at national level. Methods : Ethiopian Demographic and Health Survey 2016 data was used to investigate the spatial distribution and determinants of household iodized salt utilization in Ethiopia. ArcGIS 10.6 and SaTScan™ version 9.6 software were used to explore the spatial distribution and detect significant clusters, respectively. We used STATA version 14 software to analyze the determinants of household iodized salt utilization. The odds ratio with its 95% confidence interval (CI) was determined for potential determinants included in the multivariable multilevel logistic regression model and the corresponding p-value ≤ 0.05 was employed to declare the statistically significant variables. Results : Household iodized salt utilization was spatially clustered in Ethiopia (Moran’s Index = 0.076, p-value= 0.01). The significant hotspot areas with high iodized salt utilization were located in Benishangul, Amhara, Gambella, Tigray and Northwest Oromia regions. Those households with higher education level ((Adjusted Odds Ratio [AOR] =1.49, 95% CI =1.14-1.93), high community level education (AOR=1.51, 95% CI=1.03-2.20), middle wealth index (AOR=1.31, 95% CI=1.04-1.65) and high community media exposure (AOR=1.52, 95% CI=1.07-2.17) had higher odds of iodized salt utilization. Conclusions : Household iodized salt utilization had significant spatial variation across the country . The significant hotspot areas with high iodized salt utilization were located in Benishangul, Amhara, Gambella, Tigray and Northwest Oromia regions. Households with higher education level, high community level education and high community media exposure and middle wealth index had higher odds of iodized salt utilization. Increasing education level, wealth status and community media exposure is recommended to increase iodized salt utilization. A targeted intervention is also needed for those regions with low household iodized salt utilization.

Magnitude, Trends, and Determinants of Iodized Salt Availability among Households in Ethiopia: Analysis of Ethiopian Demographic and Health Surveys (2000–2016)

“…Radio ownership through the years had a positive influence on household iodized salt, pooling the 4 EDHS data, radio ownership decreased the odds of salt iodization. While previous studies 28,29 have found media exposure (which possibly follows the ownership) was effective in rising iodized salt coverage, the pooled effect of radio ownership to decrease the odds is strange. Firstly, ownership is not necessarily media exposure secondly, the type of message could be determinant and thirdly, the influence might be explained by other peculiar characteristics that radio owners exposed and not entered into the analysis.…”

“…24,26,27 There have been regional differences in household iodized salt coverage in this study as well as previous studies. 28 From literature including recent analysis from EDHS, these geographical differences might arise from lack of access to messages regarding the use of iodized salt which may encompassed the lack of access to mass media, 29,30 another factor could be market availability of iodized salt. 31 Other factors for regional discrepancies could be knowledge and attitude gaps regarding the deficiencies and associated consequences.…”