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Background. Iodine deficiency in pregnancy is a worldwide problem. This study aimed to assess prevalence and predictors of subclinical iodine deficiency among pregnant women in Haramaya district, eastern Ethiopia. Methods. A cross-sectional, community-based study was conducted on 435 pregnant women existing in ten randomly selected rural kebeles (kebele is the smallest administrative unit in Ethiopia). Data on the study subjects’ background characteristics, dietary habits, and gynecological/obstetric histories were collected via a structured questionnaire. UIC of <150 μg/L defined subclinical iodine deficiency. Data were analyzed by Stata 11. A multivariable logistic regression was used to identify the predictors of subclinical iodine deficiency. Results. The median urinary iodine concentration (MUIC) was 58.1 μg/L and 82.8% of the women who had subclinical iodine deficiency. The risk of subclinical iodine deficiency was reduced by the use of iodized salt (AOR = 0.13) and by intake of milk twice a month or more (AOR = 0.50), but it was increased by maternal illiteracy (AOR = 3.52). Conclusion. Iodine nutritional status of the pregnant women was poor. This shows that women and their children are exposed to iodine deficiency and its adverse effects. Thus, they need urgent supplementation with iodine and improved access to and intake of iodized salt and milk during pregnancy.
A community-based cross-sectional study was done in Haramaya district, eastern Ethiopia, from March 16 to 29, 2012. The district is 1400–2340 meters above sea level. It is divided into 4 semiurban kebeles and 33 rural kebeles (the lowest administrative units) and has a population of about 271,018 people, of whom more than 96% are Oromo in ethnicity and Muslim. We have described the study area in more detail in the previously published article [16]. Pregnant women in the randomly selected rural kebeles of the district were the study population. Pregnant women were identified by self-report, from the report of health extension workers in the kebeles and urine testing when pregnancy was doubtful. The sample size was estimated by assuming a 50% subclinical iodine deficiency, a 95% confidence interval, a 5% margin of error, and a 15% nonresponse rate and this yielded a sample size of 443. According to Andersen et al., a sample size of 500 subjects is adequate to assess iodine nutrition of the population from spot samples [17]. This study is a subsample of a prospective cohort study of the effects of maternal nutrition on birth outcomes. It was based on random subsample of ten of the twelve kebeles selected for the cohort study. To select the kebeles (primary sampling units), all the rural kebeles in the district (n = 33) were listed and each was assigned a unique number. Then, a simple random sampling technique was applied to select the twelve kebeles for the cohort study. Finally, the list of the twelve kebeles was considered as a sampling frame and ten kebeles were randomly selected from it. Cognizing the little difference between the larger estimated sample size (n = 500) and the number of the pregnant women in the ten selected kebeles (n = 525), we recruited all of them. Eight college graduates collected the data and two public health professionals and the principal investigator supervised the fieldwork. The respondents' sociodemographic, reproductive history and dietary characteristics were obtained via a pretested and interviewer-administered questionnaire. The items included in the questionnaire were taken from the Ethiopian Health and Demographic Survey (EDHS) and were adapted to suit the study context. A teaspoon of salt sample was taken from each household of the respondent and tested for contents of iodine, using a rapid test kit distributed by UNICEF for the purpose of assessing household salt iodine content. The rapid test kit comprises test solution and a color chart. We put a drop of the test solution on each salt sample. Then, salt samples that immediately turned into a purple blue color of any intensity as shown on the color chart after putting a drop of test solution were classified as containing iodine and those not remaining unchanged after putting a drop of test solution were classified as not containing iodine. A 10 mL urine sample was taken from each study subject in wide-opened plastic caps covered by an opaque paper bag and transferred into a labeled, clean tightly sealed plastic tubes that were free from iodine or any other chemical to avoid leakage and cross-contaminations with iodine from other sources. The urine samples were kept in a cold box and transported to iodine laboratory at Ethiopian Health and Nutrition Research Institute (EHNRI) under the cold chain. In the national laboratory of food and nutrition research at ENHRI, duplicates of each urine sample brought from each pregnant women were prepared and the determination of urinary iodine concentration was made using the duplicate samples. The Sandell-Kolthoff reaction method which is recommended by World Health Organization (WHO), United Nations Children's Fund (UNICEF), and International Council for the Control of Iodine Deficiency Disorders (ICCIDD) was used to determine the UIC [18]. The method is described in further detail by the publication of WHO [18]. Data were double-entered and validated by EpiData Version 3.1. Stata 11 and SPSS V. 16 were used to analyze the data. Using Mann-Whitney U test or Kruskal-Wallis test, we compared the median and the UIC between groups of categorical independent variables. Through bivariate and multivariable logistic regressions, the predictors of subclinical iodine deficiency (UIC <150 μg/L) were identified. Variables were included into the multivariable model based on the existing literature about their suspected effects on subclinical iodine deficiency and its predictors. In order to avoid confounding factors, the enter method of logistic regression was used and the risk estimates were adjusted for all the variables entered. A two-sided P value of <0.05 was considered to declare statistical significance. WHO recommends urinary iodine concentrations of <150, 150–249, 250–499, and ≥500 μg/L that should be used to indicate insufficient, adequate, more than adequate, and excessive levels of iodine intake in population of pregnant women [19]. In this study, UIC <150 μg/L defined subclinical iodine deficiency and value ≥150 μg/L absence of subclinical iodine deficiency. Median UIC and subclinical iodine deficiency were the dependent variables. The group with <150 μg/L were further categorized into <20 μg/L (severe iodine deficiency), 20–49 μg/L (moderate iodine deficiency), and 50–149 μg/L (mild iodine deficiency) [20]. The independent variables and covariates examined for their association with subclinical iodine deficiency were maternal age, educational status, family size, possession of milk cows, consumption of milk, consumption of cabbage, household use of iodized salt, prenatal visit, trimester of pregnancy, and number of pregnancies. The Institutional Review Board (IRB) of Haramaya University and the National Research Ethics Review Committee of Ethiopia reviewed and approved the protocol. All the study participants provided their written informed consent. The purposes, the data collection procedures, the risks, and the benefits of the research were explained to the eligible respondents before obtaining their informed consent.
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