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Factors associated with the availability of iodized salt at household level: a case study in Bangladesh

  • Jahidur Rahman Khan (a1), Raaj Kishore Biswas (a2), Md Tuhin Sheikh (a3) (a4) and Molla Huq (a5)

The availability of iodized salt in households remains low in Bangladesh, which calls for improving the salt iodization quality and its coverage. The present study assessed the socio-economic disparity in Bangladesh to characterize the availability of iodized salt at household level.


Associations between different socio-economic factors and availability of iodized salt at household level were explored using Bayesian mixed-effects logistic models after adjusting the district- and cluster-level random effects.


Bangladesh Multiple Indicator Cluster Survey (MICS), 2012–13.


Households (sample size, n 50981).


Results showed that 73·15 % of household salt samples were iodized to some extent although iodization level varied. According to the regression model, houses with young (adjusted odds ratio of posterior mean (OR) = 1·31; 95 % credible interval (CI) 1·09, 1·64) and educated (OR = 3·66; 95 % CI 3·25, 4·23) household heads had significantly higher likelihood of availability of iodized salt. In addition, iodized salt was less likely be found in poor and rural households, as urban households were 2·88 times (95 % CI 2·41, 3·34) more likely have iodized salt. Moreover, the regional locations of the households were an important component that contributed to the local iodized salt coverage. As per the district-wise distribution, the north-west part of Bangladesh and Cox’s Bazar in the far south seemed to lack household-level iodized salt.


Our findings suggest that iodized salt intervention should be promoted considering the area variations, which could potentially help policy makers to design interventions in the context of Bangladesh.

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1. Azizi, F, Sheikholeslam, R, Hedayati, M et al. (2002) Sustainable control of iodine deficiency in Iran: beneficial results of the implementation of the mandatory law on salt iodization. J Endocrinol Invest 25, 409413.
2. Zimmermann, MB, Jooste, PL, Pandav, CS et al. (2008) Iodine-deficiency disorders. Lancet 372, 12511262.
3. Huang, CJ, Tseng, CL, Chen, HS et al. (2016) Iodine nutritional status of school children in Nauru 2015. Nutrients 8, E520.
4. Moleti, M, Lo Presti, VP, Campolo, MC et al. (2008) Iodine prophylaxis using iodized salt and risk of maternal thyroid failure in conditions of mild iodine deficiency. J Clin Endocrinol Metab 93, 26162621.
5. Andersson, M, de Benoist, B & Rogers, L (2010) Epidemiology of iodine deficiency: salt iodisation and iodine status. Best Pract Res Clin Endocrinol Metab 24, 111.
6. Dillon, J & Milliez, J (2000) Reproductive failure in women living in iodine deficient areas of West Africa. BJOG 107, 631636.
7. Institute of Public Health Nutrition (2015) National Strategy on Prevention and Control of Micronutrient Deficiencies, Bangladesh (2015–2024). Dhaka: Institute of Public Health Nutrition, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh.
8. Black, RE, Victora, CG, Walker, SP et al. (2013) Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382, 427451.
9. Feyrer, J, Politi, D & Weil, DN (2017) The cognitive effects of micronutrient deficiency: evidence from salt iodization in the United States. J Eur Econ Assoc 15, 355387.
10. UNICEF (2017) UNICEF Data: Monitoring the situation of children and women. (accessed June 2017).
11. Yusuf, HK, Rahman, AM, Chowdhury, FP et al. (2008) Iodine deficiency disorders in Bangladesh, 2004–05: ten years of iodized salt intervention brings remarkable achievement in lowering goitre and iodine deficiency among children and women. Asia Pac J Clin Nutr 17, 620628.
12. International Centre for Diarrheal Disease Research, Bangladesh, UNICEF, Global Alliance for Improved Nutrition et al. (2013) National Micronutrients Status Survey 2011–12: Final Report. Dhaka: Centre for Nutrition and Food Security, icddr,b.
13. Andersson, M & Zimmermann, M (2012) Global iodine nutrition: a remarkable leap forward in the past decade. IDD Newsl 40, 15.
14. Tran, TD, Hetzel, B & Fisher, J (2016) Access to iodized salt in 11 low-and lower-middle-income countries: 2000 and 2010. Bull World Health Organ 94, 122129.
15. De Benoist, B & Clugston, G (2002) Eliminating iron deficiency disorders. Bull World Health Organ 80, 341.
16. Bangladesh Bureau of Statistics & UNICEF (2014) Multiple Indicator Cluster Survey 2012–2013: Progotir pathey. Dhaka: BBS and UNICEF.
17. International Centre for Diarrheal Disease Research, Bangladesh (2015) National Salt Iodization Survey, Bangladesh 2015: Summary Report. Dhaka: Centre for Nutrition and Food Security, icddr,b.
18. Knowles, JM, Garrett, GS & Gorstein, J et al. (2017) Household coverage with adequately iodized salt varies greatly between countries and by residence type and socioeconomic status within countries: results from 10 national coverage surveys. J Nutr 147, 10041014.
19. Ahmed, SM, Adams, AM, Chowdhury, M et al. (2000) Gender, socioeconomic development and health-seeking behaviour in Bangladesh. Soc Sci Med 51, 361371.
20. Ahmed, SM, Chowdhury, M & Bhuiya, A (2001) Micro-credit and emotional well-being: experience of poor rural women from Matlab, Bangladesh. World Dev 29, 19571966.
21. Kabir, ME & Webb, EL (2009) Household and home garden characteristics in southwestern Bangladesh. Agroforestry Syst 75, 129.
22. Killewo, J, Anwar, I, Bashir, I et al. (2006) Perceived delay in healthcare-seeking for episodes of serious illness and its implications for safe motherhood interventions in rural Bangladesh. J Health Popul Nutr 24, 403412.
23. The DHS Program (2014) Survey Summary. Bangladesh: Standard DHS, 2014. (accessed July 2016).
24. The DHS Program (2007) Survey Summary. Bangladesh: Standard DHS, 2007. (accessed July 2016).
25. The DHS Program (2011) Survey Summary. Bangladesh: Standard DHS, 2011. (accessed July 2016).
26. Torheim, LE, Granli, GI, Sidibé, CS et al. (2005) Women’s iodine status and its determinants in an iodine-deficient area in the Kayes region, Mali. Public Health Nutr 8, 387394.
27. Wegmüller, R, Zimmermann, MB, Bühr, VG et al. (2006) Development, stability, and sensory testing of microcapsules containing iron, iodine, and vitamin A for use in food fortification. J Food Sci 71, issue 2, S181S187.
28. Sankar, R, Moorthy, D, Pandav, C et al. (2006) Tracking progress towards sustainable elimination of iodine deficiency disorders in Bihar. Indian J Pediatr 73, 799.
29. Andersson, M, Thankachan, P, Muthayya, S et al. (2008) Dual fortification of salt with iodine and iron: a randomized, double-blind, controlled trial of micronized ferric pyrophosphate and encapsulated ferrous fumarate in southern India. Am J Clin Nutr 88, 13781387.
30. Zimmermann, MB, Gizak, M, Abbott, K et al. (2015) Iodine deficiency in pregnant women in Europe. Lancet Diabetes Endocrinol 3, 672674.
31. Hoddinott, J, Maluccio, JA, Behrman, JR et al. (2008) Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults. Lancet 371, 411416.
32. Girma, M, Loha, E, Bogale, A et al. (2012) Iodine deficiency in primary school children and knowledge of iodine deficiency and iodized salt among caretakers in Hawassa town: Southern Ethiopia. Ethiop J Health Dev 26, 3035.
33. Tronko, M, Kravchenko, V, Fink, D et al. (2005) Iodine excretion in regions of Ukraine affected by the Chornobyl accident: experience of the Ukrainian–American cohort study of thyroid cancer and other thyroid diseases. Thyroid 15, 12911297.
34. Abuye, C & Berhane, Y (2007) The goitre rate, its association with reproductive failure, and the knowledge of iodine deficiency disorders (IDD) among women in Ethiopia: cross-section community based study. BMC Public Health 7, 316.
35. Azizi, F, Mehran, L, Sheikholeslam, R et al. (2008) Sustainability of a well-monitored salt iodization program in Iran: marked reduction in goiter prevalence and eventual normalization of urinary iodine concentrations without alteration in iodine content of salt. J Endocrinol Invest 31, 422431.
36. Erdoğan, M, Ağbaht, K & Altunsu, T et al. (2009) Current iodine status in Turkey. J Endocrinol Invest 32, 617622.
37. Saggiorato, E, Arecco, F, Mussa, A et al. (2006) Goiter prevalence and urinary iodine status in urban and rural/mountain areas of piedmont region. J Endocrinol Invest 29, 6773.
38. UNICEF (2013) UNICEF MICS surveys. (accessed March 2017).
39. Browne, WJ & Draper, D (2006) A comparison of Bayesian and likelihood-based methods for fitting multilevel models. Bayesian Anal 1, 473514.
40. Hadfield, JD (2010) MCMC methods for multi-response generalized linear mixed models: the mcmcglmm R package. J Stat Softw 33, 122.
41. English, S & Uller, T (2016) Does early-life diet affect longevity? A meta-analysis across experimental studies. Biol Lett 12, 20160291.
42. Guo, GZ, Sutherland, KR, Myers, C et al. (2016) Prospective swallowing outcomes after IMRT for oropharyngeal cancer: dosimetric correlations in a population-based cohort. Oral Oncol 61, 135141.
43. House, CM, Jensen, K, Rapkin, J et al. (2016) Macronutrient balance mediates the growth of sexually selected weapons but not genitalia in male broad-horned beetles. Funct Ecol 30, 769779.
44. Zimmermann, MB & Andersson, M (2012) Assessment of iodine nutrition in populations: past, present, and future. Nutr Rev 70, 553570.
45. Hetzel, BS (2002) Eliminating iodine deficiency disorders: the role of the international council in the global partnership. Bull World Health Organ 80, 410412.
46. Rydbeck, F, Bottai, M, Tofail, F et al. (2014) Urinary iodine concentrations of pregnant women in rural Bangladesh: a longitudinal study. J Expo Sci Environ Epidemiol 24, 504509.
47. Rasheed, S, Siddique, A, Sharmin, T et al. (2016) Salt intake and health risk in climate change vulnerable coastal Bangladesh: what role do beliefs and practices play? PLoS One 11, e0152783.
48. Pitt, MM, Khandker, SR & Cartwright, J (2006) Empowering women with micro finance: evidence from Bangladesh. Econ Dev Cult Change 54, 791831.
49. Kumar, D, Hossain, A & Gope, MC (2015) Role of micro credit program in empowering rural women in Bangladesh: a study on Grameen Bank Bangladesh Limited. Asian Bus Rev 3, 114120.
50. Hawas, S, Lemma, S, Mengesha, S et al. (2016) Proper utilization of adequately iodized salt at house hold level and associated factors in Asella town Arsi zone Ethiopia: a community based cross sectional study. J Food Process Technol 7, 573.
51. Rasheed, S, Hanifi, MA, Iqbal, M et al. (2001) Policy of universal salt iodization in Bangladesh: do coastal people benefit? J Health Popul Nutr 19, 6672.
52. Sen, TK, Das, DK, Biswas, AB et al. (2010) Limited access to iodized salt among the poor and disadvantaged in NORTH 24 PARGANAS district of West Bengal, India. J Health Popul Nutr 28, 369.
53. Kazungu, K, Mbakaya, C & Makokha, A (2015) Factors contributing to iodide deficiency in coast province of Kenya. Eur J Res Med Sci 3, 4551
54. Yaye, AB, Baraki, N & Endale, BS (2016) Availability of adequately iodized salt at household level and associated factors in Dire Dawa, Eastern Ethiopia. Int J Public Health Sci 5, 392399.
55. Roy, R, Chaturvedi, M, Agrawal, D et al. (2016) Household use of iodized salt in rural area. J Family Med Prim Care 5, 7781.
56. Haji, Y, Abdurahmen, J & Paulos, W (2017) Knowledge and perception of consumption of iodized salt among food handlers in Southern Ethiopia. Food Nutr Bull 38, 92102.
57. UNICEF Bangladesh (2009) Media release: Salt iodisation from mill to home. (accessed August 2017).
58. Jabin, S (2009) Study on consistency of salt iodization in salt factories. Bangl J Sci Indust Res 44, 225228.
59. Baulch, B (2011) The medium-term impact of the primary education stipend in rural Bangladesh. J Dev Effect 3, 243262.
60. World Health Organization (2016) Salt reduction. (accessed December 2017).
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