Abstract
The overarching Ethiopia project examined the effects of early market introduction of iodized salt on the growth and mental development of young children. Sixty districts were randomly assigned to intervention (early market access to iodized salt) or control (later access through market forces), and one community per district was randomly chosen as the sampling unit. For this project, 22 of the districts were included. The participants were 1,220 pregnant women who conceived after the intervention began. When their children were 2 to 13 months old, field staff collected information on household sociodemographic status and iodized salt intake, child stimulation, maternal depression symptoms, children's diet, anthropometry, urinary iodine concentration (UIC), hemoglobin, and mental development scores (Bayley III scales). Fewer mothers prepartum (28% vs. 41%, p < .05) and their children (13% vs. 20%, p < .05) were iodine deficient (UIC <50 μg/L) in the intervention compared with the control group. The intervention children had higher cognitive scores (33.3 ± 0.3 vs. 32.6 ± 0.3; Δ = 0.6; 95% CI [0.0, 1.3]; d = 0.17; p = .01; 4 IQ points) than their controls. The other Bayley subscale scores did not differ from control children. The intervention group had a higher child stimulation (22.7 ± 0.2 vs. 22.1 ± 0.2; Δ = 0.5; 95% CI [0.02, 0.89]; d = 0.17; p = .01) but not growth indicators (weight‐for‐age z score, length‐for‐age z score, and weight‐for‐length z score: −1.1 ± 0.1 vs. −1.1 ± 0.1, −1.7 ± 0.1 vs. −1.7 ± 0.1; −0.2 ± 0.1 vs. −0.1 ± 0.1, respectively, all p > .05) compared with their controls. Iodized salt intake improved iodine status of both pregnant women and their children and also child cognitive development.
Highlights
Iodine deficiency (ID) is a major public health problem for populations throughout the world with a global incidence of 29% (Andersson, Karumbunathan, & Zimmermann, 2012), and it is the main cause of preventable mental retardation in childhood (Delange et al, 1993; Hetzel, 2000)
Iodine is required for the synthesis of thyroid hormones that is necessary for brain development especially at the early stages of life
Mothers in the intervention compared with control communities recorded a significantly higher urinary iodine concentration (UIC), with a median UIC difference of 43 μg/L; fewer intervention mothers had low UIC (
Summary
Iodine deficiency (ID) is a major public health problem for populations throughout the world with a global incidence of 29% (Andersson, Karumbunathan, & Zimmermann, 2012), and it is the main cause of preventable mental retardation in childhood (Delange et al, 1993; Hetzel, 2000). The study in Zaire found positive effects, whereas the Peruvian study found no significant effect of iodine supplementation in pregnancy on child mental development. No previous randomized clinical trial has used iodized salt as a means to enhance iodine sufficiency in pregnant women or children (Aburto, Abudou, Candeias, & Wu, 2014; Qian et al, 2005). There is a need to examine with a rigorous design the effects of iodized salt given to mothers and infants on the mental and physical development of young children. The Ethiopian government passed legislation on universal salt iodization in 2011 to make iodized salt gradually available to families through the open market This provided an opportunity to use a randomized design to answer questions concerning the effect of iodized salt exposure from pregnancy to early childhood on infants' physical and mental development. It was hypothesized that children whose mothers were living in districts with early introduction of iodized salt would have higher mental and physical development than those in control districts
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