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Effect of Early Market Introduction of Iodized Salt on Pregnancy and Birth Outcomes in a Randomized Clinical Trial in the Amhara Region of Ethiopia
Author(s) -
Mohammed Husein,
Marquis Grace,
Aboud Frances,
Bougma Karim,
Harding Kimberly B,
Samuel Aregash
Publication year - 2017
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.31.1_supplement.786.44
Subject(s) - iodised salt , medicine , pregnancy , iodine deficiency , iodine , randomized controlled trial , obstetrics , environmental health , pediatrics , materials science , thyroid , biology , metallurgy , genetics
Iodine deficiency has been shown to lead to adverse pregnancy and birth outcomes. This study examined the effect of early introduction of iodized salt on pregnancy and birth outcomes in a moderately iodine deficient area. Sixty randomly selected districts across six zones in the Amhara region of Ethiopia were randomly assigned to receive the intervention (early access to iodized salt) or serve as the control (later access through normal market forces). One village each in twenty‐two of the intervention districts and 22 of the control districts was randomly selected for data collection. A total of 1220 pregnant women who conceived after the intervention began were assessed for their iodine and iron status, and their household salt was tested for iodine. Additional data were collected on their household socio‐demographic status and iodized salt, gestational history, adverse pregnancy and birth outcomes, and child nutritional status 2 to 13 months old after mothers gave birth. The mothers had an average age of 28 ± 6 y with low education (77% illiteracy), low household assets (42% scored <3 out of 10), and poor water and sanitation (61%). The median maternal urinary iodine concentration was adequate and significantly higher in the intervention communities than that of the controls (163 vs 121 μg/L, p<0.0001). Additionally, fewer pregnant women (28% vs 41%, p<0.05) and their children (13% vs 20%, p=0.06) had urinary iodine less than 50 μg/L in the intervention than control communities. After accounting for the effect of cluster and gestational history, the intervention did not significantly reduce miscarriages (OR (95% CI): 2.5 (0.9, 6.9)), stillbirths (OR (95% Cl): 1.0 (0.4, 2.8)), or infant mortality (OR (95%CI): 0.9 (0.5, 1.6)). Our inability to detect an effect of early access to iodized salt on birth outcomes may be due to (i) higher than expected access to iodized salt among the controls, (ii) lower than expected prevalence of poor birth outcomes, and (iii) inadequate sample size. The intervention improved pregnant women's iodine status and governments should pursue universal salt iodization program for the multiple known benefits. Support or Funding Information Sponsored by Micronutrient Initiative, Canada