title: Increasing Awareness and Use of Iodised Salt in a Marginalised Community Setting in North-West Pakistan.
abstract: Iodine deficiency is still prevalent in parts of Pakistan, despite the introduction of a national Iodine Deficiency Disorder Control Programme in 1994. The purpose of this study was to gain an understanding of the knowledge, attitudes and practice regarding the use of iodised salt in a brick kiln community, and to use this information to design an intervention to increase its consumption. A cross-sectional survey was used to assess the use of iodised salt and focus group discussions explored the attitudes and barriers to its use. Thematically analysed transcripts informed the design of a 4-month intervention. Iodised salt sales and urine iodine concentration (UIC) were monitored to assess the effectiveness of the intervention. At baseline, 2.6% of households reported use of iodised salt and barriers included its higher cost and belief about a negative impact on reproduction. During the intervention, sales of salt labelled as iodised increased by 45%, however this was not reflected in an increase in UIC. This study highlighted the positive impact of education and awareness raising on iodised salt consumption in a hard to reach, marginalised community. However, issues regarding adequate iodisation by local producers and appropriate storage also need to be urgently addressed at a provincial level.
authors.affiliation: International Institute of Nutritional Sciences and Applied Food Safety Studies, University of Central Lancashire, Preston PR1 2HE, UK. nmlowe@uclan.ac.uk.
authors.forename: Nicola
authors.initials: N
authors.lastname: Lowe
authors.affiliation: International Institute of Nutritional Sciences and Applied Food Safety Studies, University of Central Lancashire, Preston PR1 2HE, UK. elizabeth.westaway@gmail.com.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Westaway
authors.affiliation: Abaseen Foundation, Peshawar 25000, Pakistan. akhtar_psw@yahoo.com.
authors.forename: Akhtar
authors.initials: A
authors.lastname: Munir
authors.affiliation: Abaseen Foundation, Peshawar 25000, Pakistan. saba_ktk85@yahoo.com.
authors.forename: Saba
authors.initials: S
authors.lastname: Tahir
authors.affiliation: Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, Preston PR1 2HE, UK. FCDykes@uclan.ac.uk.
authors.forename: Fiona
authors.initials: F
authors.lastname: Dykes
authors.affiliation: Department of Public Health and Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne NE7 7XA, UK. monique.lhussier@northumbria.ac.uk.
authors.forename: Monique
authors.initials: M
authors.lastname: Lhussier
authors.affiliation: School of Nursing, University of Central Lancashire, Preston PR1 2HE, UK. MMckeown@uclan.ac.uk.
authors.forename: Mick
authors.initials: M
authors.lastname: McKeown
authors.affiliation: Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, 8092 Zurich, Switzerland. michael.zimmermann@hest.ethz.ch.
authors.forename: Michael
authors.initials: M
authors.lastname: Zimmerman
authors.affiliation: Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, 8092 Zurich, Switzerland. maria.andersson@hest.ethz.ch.
authors.forename: Maria
authors.initials: M
authors.lastname: Andersson
authors.affiliation: Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, 8092 Zurich, Switzerland. sara.stinca@hest.ethz.ch.
authors.forename: Sara
authors.initials: S
authors.lastname: Stinca
authors.affiliation: Khyber Teaching Hospital, Khyber Medical University, Peshawar, Pakistan. mza38@hotmail.com.
authors.forename: Mukhtiar
authors.initials: M
authors.lastname: Zaman
mesh_terms: D000328:Adult; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D017144:Focus Groups; D006042:Goiter / Q000175:diagnosis / Q000517:prevention & control / Q000652:urine; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007455:Iodine / Q000008:administration & dosage* / Q000172:deficiency / Q000652:urine; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010154:Pakistan; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage* / Q000652:urine
chemical_list: D017673:Sodium Chloride, Dietary; C034024:iodized salt; D007455:Iodine
keywords: Khyber Pakhtunkhwa; Pakistan; community engagement; goitre; iodine deficiency; iodised salt; urinary iodine concentration