title: Poor dietary diversity, wealth status and use of un-iodized salt are associated with goiter among school children: a cross-sectional study in Ethiopia.
abstract: Globally, more than two billion people are at risk of iodine deficiency disorders, 32% of which are school children. Iodine deficiency has been recognized as a severe public health concern in Ethiopia, however little is known about the problem. Therefore, this study aimed to assess the prevalence of goiter and associated factors among school children (6 to 12 years) in Dabat District, northwest Ethiopia.
  
  
  
  A school-based cross-sectional study was conducted from February 21 to March 31, 2016. A total of 735 school children were included in the study. A stratified multistage sampling followed by systematic sampling technique was employed to select the study participants. Thyroid physical examination was done and classified according to the World Health Organization recommendations as grade 0, grade 1, and grade 2. The level of salt iodine content was determined using the rapid field test kit. The value 0 parts per million (PPM), <15 PPM and ≥15 PPM with the corresponding color chart on the rapid test kit were used to classify the level of iodine in the sampled salt. A multivariable logistic regression analysis was employed to identify factors associated with goiter. Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was calculated to show the strength of association. In multivariable analysis, variables with a P-value of <0.05 were considered statistically significant.
  
  
  
  In this community, the overall prevalence of goiter was 29.1% [95% CI: 25.9, 32.6], in which about 22.4 and 6.7% had goiter grade 1 and grade 2, respectively. The age of children (AOR = 1.13; 95% CI: 1.01, 1.26), being housewife mother (AOR = 1.49; 95% CI: 1.08, 2.15), use of unprotected well water source for drinking (AOR = 6.25; 95% CI: 2.50, 15.66), medium household wealth status (AOR = 1.78; 95% CI: 1.18, 2.92), use of inadequately iodized salt (AOR = 2.79; 95% CI: 1.86, 4.19), poor dietary diversity score of the child (AOR = 1.92;95% CI: 1.06, 3.48) and medium maternal knowledge (AOR = 0.65; 95% CI: 0.42, 0.94) were significantly associated with goiter.
  
  
  
  The prevalence of goiter is higher in Dabat District, which confirmed a moderate public health problem. Therefore, regular monitoring of household salt iodine content, improving access to safe water, promoting the importance of diversified food for children is recommended to address the higher burden of iodine deficiency.
authors.affiliation: Department of Public Health Officer, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
authors.forename: Zegeye
authors.initials: Z
authors.lastname: Abebe
authors.affiliation: Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
authors.forename: Ejigu
authors.initials: E
authors.lastname: Gebeye
authors.affiliation: Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia. amaretariku15@yahoo.com.
authors.forename: Amare
authors.identifier: 0000-0002-4939-3701
authors.initials: A
authors.lastname: Tariku
mesh_terms: D002648:Child; D003430:Cross-Sectional Studies; D004032:Diet / Q000009:adverse effects* / Q000379:methods; D060766:Drinking Water; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006042:Goiter / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007455:Iodine / Q000032:analysis*; D016015:Logistic Models; D008297:Male; D009035:Mothers; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D012923:Social Class; D017673:Sodium Chloride, Dietary / Q000032:analysis*
chemical_list: D060766:Drinking Water; D017673:Sodium Chloride, Dietary; C034024:iodized salt; D007455:Iodine
keywords: Ethiopia; Goiter; Salt iodine content; School children