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. The odds ratio with its 95% confidence interval (CI) was determined for potential determinants included in the multivariable multilevel logistic regression model. 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. Significant cold spot areas (areas with low iodized salt utilization) were found in Somali, and East Afar 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. Both household and community level variables were found to be associated with household iodized salt utilization in Ethiopia. Therefore, increasing the education level, wealth status and community media exposure is recommended to improve iodized salt utilization in a country. A targeted intervention is also needed for those regions with low household iodized salt utilization.

Individual and community level factors associated with use of iodized salt in sub-Saharan Africa: A multilevel analysis of demographic health surveys

“…Similarly, households from high community education level had higher chance of using iodized salt compared to those households came from low community education level. The finding of this study is consistent with other studies conducted elsewhere [16][17][18][19]. This higher chance of using iodized salt among educated participants might be due an increased knowledge and awareness about the importance of using iodized salt [27,29].…”

“…This higher chance of using iodized salt among educated participants might be due an increased knowledge and awareness about the importance of using iodized salt [27,29]. Consistent with previous studies conducted in low income countries [16][17][18][19]30], in this study, wealth index is associated with use of iodized salt. Those households with middle, richer and richest wealth status had an increased chance of iodized salt utilization compared to households with poorest wealth status.…”

“…Similar to a study done in Ethiopia [18], in this study, those households from high community media exposure had an increased chance of using iodized salt compared to their counterparts. This is because media exposure is one effective way of increasing people's level of awareness and use of iodized salt [27,28].…”

“…Although this substantial progress has been made over the last several decades towards iodized salt consumption, still it is under the recommendation of the World Health Organization(at least 90% of households should consume iodized salt) [8] and hence, iodine deficiency remains a significant health problem in developing countries [15]. Some previous research works conducted revealed that the use of iodized salt is associated with wealth index [16][17][18][19], age [16,17], education status [16][17][18][19][20], community media exposure [18], knowledge of respondents on IDD and the importance of using iodized salt [20,21]. Despite the use of iodized salt is a cost-effective universal strategy to combat IDD [22], IDD is still a problem in SSA [23].…”

“…Some previous research works conducted revealed that the use of iodized salt is associated with wealth index [ 16 – 19 ], age [ 16 , 17 ], education status [ 16 – 20 ], community media exposure [ 18 ], knowledge of respondents on IDD and the importance of using iodized salt [ 20 , 21 ]. Despite the use of iodized salt is a cost-effective universal strategy to combat IDD [ 22 ], IDD is still a problem in SSA [ 23 ].…”