Individual- and community-level factors associated with the presence of adequate iodized salt in households in Bangladesh: a multilevel modelling approach

Iqramul Haq; Md Ismail Hossain; Md Rukonozzaman Rukon; Md Jakaria Habib; Tanha Akther Tithy; Md Amit Hasan; Salma Akter; Md Rayhan Ali Rejvi; M Sheikh Giash Uddin; Md Mizanur Rahman Sarker; Fasil Wagnew; Ashis Talukder

doi:10.1093/inthealth/ihae016

Individual- and community-level factors associated with the presence of adequate iodized salt in households in Bangladesh: a multilevel modelling approach

Int Health. 2024 Feb 12:ihae016. doi: 10.1093/inthealth/ihae016. Online ahead of print.

Affiliations

¹ Department of Agricultural Statistics, Sher-e-Bangla Agricultural University, Dhaka-1207, Bangladesh.
² Department of Mathematics and Natural Sciences, BRAC University, Dhaka-1212, Bangladesh.
³ Department of Statistics, Jagannath University, Dhaka-1100, Bangladesh.
⁴ Department of Agricultural Economics, Sher-e-Bangla Agricultural University, Dhaka-1207, Bangladesh.
⁵ College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
⁶ National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia.
⁷ Statistics Discipline, Khulna University, Khulna-9208, Bangladesh.

PMID: 38344755
DOI: 10.1093/inthealth/ihae016

Abstract

Background: The aim of this study is to estimate the factors at both the individual and community levels related to the adequacy of iodized salt in households in Bangladesh.

Methods: For this study we utilized the 2019 Multiple Indicator Cluster Survey data. A total of 61 242 households were chosen as samples from Bangladesh. In our study of socio-economic disparities, we applied a concentration indexing method. To identify the factors associated with the adequacy of iodine in salt at both the individual and community levels, we employed multilevel logistic regression. Aside from the multilevel regression used in the study, we also applied spatial analysis.

Results: The results indicated that the prevalence of iodine adequacy in household salt was found to be 57.8% (95% confidence interval 57.4 to 58.2). Rural areas have a higher concentration of iodine than urban areas. According to the multilevel model, younger women (adjusted odds ratio [aOR] 0.70), Muslim women (aOR 0.89), illiterate women (aOR 0.80) and those from poor households (aOR 0.33) were found to be less likely to consume iodine in concentrated salt compared with their counterparts. Disabled women and those with low media exposure have a lower likelihood of iodine adequacy in salt compared to their reference group. Furthermore, households in urban areas exhibited higher odds of having iodine adequacy in salt compared with households in rural areas. Barisal, Chattogram, Dhaka, Khulna, Mymensingh, Rajshahi and Rangpur Divisions have lower iodine adequacy in salt compared with Sylhet Division.

Conclusions: The findings reveal that religion, physical disability and exposure to media exert an equal influence on the presence of iodized salt intake. Moreover, women's age, wealth status, education level and the educational background of the household head positively contribute to the adequacy of iodine in household salt. In light of these results, policymakers are advised to prioritize efforts aimed at enhancing iodine concentration, with a particular focus on mass media advertising, especially in rural areas (excluding Sylhet Division).

Keywords: T3; adequacy; hypothalamus; iodine; micronutrient; salt; thyroid.