Department of Nursing and Midwifery, Ambo University, Ethiopia
Submission: November 07, 2017;Published: November 30, 2018
*Corresponding author: Dereje Bayissa Demissie, College of Medicine and Health Sciences, Department of Nursing and Midwifery, Ambo University, Ethiopia
How to cite this article: Dereje B D, Chala B, Kebede C, Fenet B, Gadise L, Bizu B. Knowledge and Practice of Antenatal care Attendant Mothers Towards Iodized Salt Utilization and Associated Factors in Ambo Town Public Health Facilities, Oromia, Ethiopia. J Gynecol Women’s Health. 2018: 13(3): 555861. DOI: 10.19080/JGWH.2018.13.555861
Background: Globally iodized salt deficiency affects more than 2.2 billion peoples and the effect is severe when occurs in pregnant women. Different reasons contribute for insufficient iodized salt utilization in population. Even though knowledge and practice of iodized salt utilization has paramount contribution in improving iodized salt utilization among pregnant mothers. To assess the knowledge and practice of iodized salt utilization and associated factors among ANC follower pregnant women at Public Health Facilities, Ambo Town.
Results: The complete response rate of the study was 240(93.02%). Almost all of 97.1% are Oromo in Ethnicity and 53.8% were housewives and only 29.6% were attending college and university in Educational status. This study determined knowledge and practice of pregnant women towards iodized salt utilization which revealed that 65.6% have had good knowledge towards iodized salt utilization with factors educational level, ever heard iodized salt and occupation were significantly associated with knowledge of mothers about iodized salt utilization. Out of total study respondents 3/4th of pregnant women had good practice of Iodized salt utilization with independent predictor of family income, being educated and occupation status respectively.
Methods: Institution based cross sectional study design was employed on total of 240 pregnant women was enrolled in the study. Data were collected using interviewer administered questionnaire and was entered and analyzed using statistical package for social science version 20. Binary and multiple logistic regression analysis were carried utilized to identify significant association at p-value of less than 0.05 that was considered as significant association.
Conclusion: This study determined knowledge and practice of pregnant women towards iodized salt utilization which revealed low and high compared to previous studies respectively. This study identified that factors contributed to knowledge and practice of pregnant women towards iodized salt utilization. Therefore, police makers and health planner would be better to reconsider these factors affecting iodized salt utilization practice and knowledge pregnant mothers while developing guidelines and Health education programs for this population.
Maternal iodine deficiency results in a range of intellectual, motor and hearing defects in their off springs but it is very damaging. when the deficiency of iodine happens during pregnancy because it retards all fetal development especially the development of brain. This loss of intellectual capacity limits educational achievement of population and economic power of nation [1,2].
More importantly this iodine deficiency during pregnancy is intergenerational and its effect can continue throughout the generation since its deficiency greatly affect the level of IQ and on the hand during pregnancy the need for iodized salt is raised due to three main reasons those are an increase in the production of thyroxin (T4) by the mother to maintain her euthyroid state and transfer thyroid hormone to the fetus and the transfer of iodine to the fetus, particularly in the late gestation and 3, an increase in renal iodine clearance (RIC) by the mother and greatly plays role on the future intellectuality of the baby .
In order to reduce and eliminate multi aspect of the problem associated with the insufficient iodized salt consumption; WHO and UNICEF jointly prepare universal salt iodization (USI) strangely in 1994 and WHO proposed the national iodized salt consumption guidelines including that of pregnant mothers and lactating mothers.
All those threats are aimed to improve attitude knowledge and practice of global nations towards iodized salt consumption and to abolish those evil problems which occurs due to lack of insufficiency of iodized salt consumption . During pregnancy,
iodine deficiency is extremely damaging because it retards fetal
physical and mental development. Reports show that there is
enormous loss of humor intellectual physical and social potentials
due to iodine deficiency worldwide . This indicates that; the
iodine deficiency during pregnancy is intergenerational problems
. Universal salt iodization (USI) strategy is considered as the
main strategy in reduction and elimination of iodine deficiency
associated problems and Ethiopian government also adopt this
strategy and trying to access iodized salt for communities with cost
effective price but the problem still continued to be public health
issue in the country [7,8]. Despite few local studies conducted in
certain part of the country, no significant studies performed in
the selected area and even in the country. So, this study would
identify and believe on the need of research to know and coped up
with problems related to the knowledge &practice and associated
factors on iodized salt utilization of pregnant mothers in the study
Out of the total of 240 pregnant women ANC attendants the
majority 91.9% of the respondents were in age group of 18-30
years with mean value of 24.89 years, which ranges from18 and
38years (Figure 1). The respondents were married and almost all
of 97.1% were Oromo in Ethnicity and 53.8% were housewives.
From the total of 240 pregnant women who had college and
university level were 29.6 % (Table 1-4).
From the total of 240 respondents, most of them have family
size of 3-5 were 133 (55.4%) with mean value of their family size
were 3.4, which ranges from 1 and 11 family size. From the total
of 240 pregnant women, 116(48.3 %) were had family monthly
income of greater than 2001, Ethiopian birr with Average income
was 3573.125 which ranges from300 and 25000 Ethiopian birr.
Out of 240 ANC attendants, the majority of them were in third
trimester 92 (38.3%) within mean value of 2.53 which ranges
from 1 and 3 trimester. From the total respondents 177 (73.8%)
had 1-2, pregnancies and from the number of pregnancy of
respondents the mean value was 2.125 of1 and 7 were minimum
and maximum respectively (Figure 2).
Majority of respondents had 0-1 deliveries which was 179
(74.6%) and from the number of deliveries of respondents the
mean value was1.07 which ranges from 0 and 6deliveries.From
240 respondents, 8 had history of still birth from those 6 of them
had 1 still birth and 23 of them had at least one history of abortion.
The majority of the respondents, 68(28.3%), were on their
third visits, most of them began ANC visit 178(74.2.1%) at 13-25
Regarding to the importance of iodized salt consumption
during pregnancy; about 43.3% of the respondents were didn’t
know. From total the respondents about 81.7% were ever heard
about iodized salt of which mentioned that they heard about iodized
salt 46.7% of them heard by media which is followed it from
health worker 4.6% and friends30.4%. Regarding to this study of
every salt contain iodine most of the respondents, 83.8% of them
said no and 16.3% of them said yes. From those respondents who
mentioned they know about iodized salt; most of them choose
(42.9%) didn’t know followed by maternal goiter (31.7%) and
healthy fetal physical and mental growth (25.4%). Majority of our
respondents 28.3%didn’t know how to store iodized salt and from
those who said that they know 70% store it in closed container
away from sunlight and don’t know 28.8%.
From the problem caused by iodine deficiency of the
respondents 42.1% didn’t know any health problem caused by
iodine deficiency. Even from those who mentioned that they knew
about it most of them knew only about goiter (45.8%). therefore,
the majority of respondents were responded problem caused by
iodine deficiency was 45.8% goiter caused by iodine deficiency.
Knowledge on the main source of iodine in food consumed by pregnant women in Ambo Town a higher percentage of the
respondents 48% said that drink water the major source. This
study determined knowledge of pregnant women towards iodized
salt utilization which revealed that 157(65.6% with 95%CI (60-
71.3%) were had good knowledge/ knowledgeable towards
iodized salt utilization.
Pregnant women who ever heard about Iodized salt utilization
were 33.43 times 95%CI (10.21-109.42). more likely to have
been knowledgeable as compared to had not ever heard women.
Pregnant women whose occupational status of government
and farmers were 11.1 times 95%CI [(1.33-92.91) and 13.86
times (1.64-117.24)] more likely to have been knowledgeable as
compared to daily labor/march respectively.
Pregnant mothers who have no formal education were 0.182
times (0.045- 0.742), able to read and write 0.24times (0.066
-0.85), being attend primary school 0.21 times (0.064 -0.71) and
secondary school 0.17 times (0.051- 0.55) less likely to have been
knowledgeable as compared to attended College and above study
Regarding to the question about the right timing to add
iodized salt to meal 25.8% of the respondents 74.2% knew about
it. From those who mentioned that they know 70.8% said that at
the end of cooking and 29.2% at the beginning of cooking. This
study identified that out of total study respondents 3/4th pregnant
women had good practice of Iodized salt utilization with 95% CI
Pregnant women’s family monthly income of 1001-2000
Ethiopian birr was 2.33 times 95%CI (0.975-5.6) and their
monthly income greater than 2001 was 2.83 times 95%CI
(1.265- 6.36) more likely to have been practiced as compared
to whose family monthly had less than 1000 Ethiopian birr
.Pregnant women whose occupational status of being house wife,
government and farmers were 8.285 times 95%CI [(1.345- 51.01),
9.825 times (1.428- 67.59)] and 11.25 times 95%CI (1.73-73.15)
more likely to have been practiced as compared to daily labor/
march respectively. Pregnant mothers whose educational status
of attend primary school 2.83times95%CI (1.08 -7.4), secondary
school were 1.97 times 95%CI (.717-5.43) and attended College
and above were 6.42 times 95%CI (1.86- 22.15) more likely to
have been practiced as compared to Illiterates.
Ethiopia is among those countries greatly affected with iodine
deficiency disorders and the problem is persists as public health
problem until now.
The study which is conducted among hyperthyroidism patients
in South Africa indicates that majority of the patients didn’t know
what iodine is (86.9%) . Even those who mentioned that they
know what it is (14.1%) were not clear because 4.9% indicated
that its vitamin while 4.9% indicated that it is mineral. On this
study of participant; 18.3% indicated that they didn’t know what
iodized salt is, and on importance of iodized salt consumption
during pregnancy, about 43.3% of the respondent didn’t know.
This discrepancy may be due to that study population of the
research done in South Africa were less than this study, because
it was done on hyperthyroidism patients whose may be less than
the study population of this study, and the sociodemographic
characteristics of the people in the two area may have also its own
contribution for the difference of the value.
The current study reveals that 20% of house hold were used
iodized salt, which is higher than that of Sudan 14.4%. This
difference may be due to the effort of Ethiopian government to
access the iodized salt for the people of the country . Currently
this finding 74% higher house hold used iodized salt utilization,
and this may be due to the effort of health worker to given health
education about iodized salt utilization for the ambo town
In this study proper period for addition of iodized salt to meal,
29% didn’t know proper (preferable) time of adding iodize salt
to their meal. 48.8% of the respondent mention that they didn’t
know single source of iodine. Even though, this study shows
slightly greater person used iodized salt in their home than that
of research done on Sudanese still there is a gap on using iodized
salts. The discrepancy may be due that this research was based on
ANC followers’ pregnant women.
The respondents who were illiterate and can only read and
write were less likely know about iodized salt utilization compared
to that complete elementary school. Regarding the proper period
for addition of iodized salt to meal, from of them 25.8% didn’t
know proper (preferable) time of adding iodize salt to their meal.
Monthly income of the respondent was highly associated
with knowledge of pregnant mothers on iodized salt utilization.
Respondents who Ethiopian birr got 1000-2000 per month were
more likely knows about iodized salt utilization as compared to
those who earn less than 1000 birr per month.
This study determined knowledge and practice of pregnant
women towards iodized salt utilization which revealed low
and high compared to previous studies respectively. This study
identified that factors contributed to knowledge and practice of
pregnant women towards iodized salt utilization. Out of 240 of
the pregnant mothers enrolled in the study responds 18.3% didn’t
know about iodized salt utilization and 43.3% of the participant
report they didn’t know the importance of iodized salt utilization
Therefore, police makers and health planner would be better
to reconsider these factors affecting iodized salt utilization prac tice and knowledge pregnant mothers while developing guidelines
and Health education programs for this population.
Finding of this study indicates that factors such as ever heard
iodine salt, occupation of respondents, Academic achievement
and monthly income, occupation of respondents, Academic
achievement highly associated with knowledge level and the
practiced of pregnant mothers enrolled in the study respectively.
The study participant from the urban, able to read and right and
those who have >2001 Ethiopian birr were more likely to know
about importance of iodized salt utilization during pregnancy.
In addition to factors mentioned above, there is no enough
information available to develop community knowledge on the
importance of iodized salt utilization.
Therefore, police makers and health planner would be better
to reconsider these factors affecting iodized salt utilization
practice and knowledge pregnant mothers while developing
guidelines and Health education programs for this population.
The Ambo town administration and health office collaborate to
create awareness in the community on iodized salt consumption
and effect of iodine deficiency.
The Ambo town public health facilities staffs would be better
to strengthen health education for ANC attendants about the
importance of using iodized salt during pregnancy, how to store
and right timing to add while cooking.
Dereje Bayissa, Chala Beka, Kebede Chala, Fenet Biru, Gadise
Lelisa & Bizu Beyu conceptualized the study, designed the study
instrument and conducted the data analysis and wrote the first
draft and final draft of the manuscript. Dereje Bayissa Demissie:
Approved the research proposal with some revisions, participated
in data analysis, revised subsequent drafts of the paper and involve
in critical review of the manuscript. All authors read and approved
the final manuscript.
The authors are grateful to Ambo University College of health
sciences department of Nursing for providing the opportunity to
conduct this research proposal. We would like to thank the study
participants and Public health facilities (General Ambo Hospital,
Ambo health center and Awaro health center administrative) for
their very important cooperation.