Assessment of Pregnant Women's Knowledge and practice about Risks of Iodine intake Deficiency during Pregnancy

Discussion

Women's health and reproductive performance, as well as children's health, survival, and development, all benefit from adequate and high-quality maternal nutrition (Zerfu, & Biadgilign, 2018). As a result, optimal dietary iodine consumption during pregnancy, lactation, and early childhood is critical for the fetuses/newborn's proper neurodevelopment and growth (Mohamed et al., 2020).

Regarding to socio demographic characteristics the current study revealed that more than two-fifth of the studied women aged ranged between 25 to < 30yrs with mean age 27.04+5.54 years, and have secondary education, more than three-quarter of them are housewife, and lives in an urban area. regarding obstetric data, more than one-third of the studied women have more than 28 weeks of gestational age, and around two-thirds of them their multi gravida and one-third of studied women have nothing child.

A similar finding showed in a cross-sectional study conducted by Fereja et al.,( 2018)entitled “Prevalence of iodine deficiency and associated factors among pregnant women in Ada district, Oromia region, Ethiopia”. Who concluded that, the median age of the 356 women who took part in the study was 27 years. At the time of recruitment, women were in their first trimester (9.0%), second trimester (26.4%), and third trimester (64.6 percent ). Of the women (45.0%) were illiterate, and virtually all (95.2%) did not work outside the home.

On the other hand, incongruent sample socio-demographic characteristics studied by Azzeh and Refaat. (2020) on 1222 pregnant women, in Saudi Arabia, aimed to measure urine iodine concentrations (UIC) alongside the potential socioeconomic factors contributing towards iodine inadequacy in reproductive age and pregnant Saudi women from the Western province of KSA. The average age was 28.7 5.7 years in this case. Multigravidas 78.2%, having more than four family members 64.3 percent, holding a university diploma 56.8%, unemployed 78.2% According to the sub-analysis, 29.8%, 28.8%, and 41.4 percent of women were in their first, second, and third trimesters, respectively.

Regarding iodine deficiency information received, the current study illustrates that less than two-thirds of the studied women do not receive information about iodine intake deficiency. The researcher returns this finding to the shortage level of awareness about intake of iodine during pregnancy.  Moreover, may return to the level of antenatal care.                     

This study finding goes in the same line with O’Kane et al. (2016)  in their study entitled “Iodine knowledge is positively associated with dietary iodine intake among women of childbearing age in the UK and Ireland”  carried on a total of 520 females of childbearing age, reported that only 9% of the studied women received information about iodine deficiency previously and had a significantly greater awareness of iodine, iodine deficiency and better knowledge of the dietary sources of iodine and the health problems associated with its deficiency than those who had never received information related to I (all P<0·05).

Regarding the source of iodine deficiency information, the present study determined that more than one-third of the studied women their source of knowledge from their mothers, followed by less than one-fifth of them from social media, the minority of them from their physician and family members. May be due to the difference of culture between the studied communities and the difference in the educational level.

On the other hand, this result was unconjugated with Tegegne. (2019) in a study entitled “Assessment of Knowledge and Practice of Iodized Salt Utilization and Associated Factors Among Pregnant Women in Debreberhan Town” which revealed that 66.8% of the studied women receive information about iodine deficiency from media (TV, radio), 22.6% from friends, family, and neighbours, and 43% from printed material (newspaper, brusher, and leaflet)in addition to The current study findings are in harmony with Hine. (2016) in his study entitled “Assessment of iodine knowledge, beliefs and practices of pregnant women attending Western Australia’s only tertiary women’s and neonatal hospital” who revealed that more than half of the women received their dietary information from a doctor, followed by a midwife and the internets.

As regard to women identification of the food that had rich sources of iodine, the present study finds that slightly less than two-fifths of the studied women know all the foods that had a good source of iodine, and more than one-quarter of them answer fish, do not know and slightly less than one-fifth of them answer iodized table salt.From the researcher supposes that this finding is related to their antenatal education about rich sources of iodine.

This study finding agrees with the current study of AL Hadid et al .(2018) entitled “The Relationship between Iodine Nutrition, Thyroid Function and Obstetrical Outcomes for Jordanian Pregnant Women”, clarified that only 27.6% of the participating women knew about the importance of fish-containing diets as a source of iodine essential for the body mechanisms

 This study finding disagrees with O’Kane et al. (2016), who reported that39% of the women identified fish and seafood as the richest source of I and only 9% identified milk and dairy products. Younger women (18–25 years) had significantly better knowledge of the dietary sources of I than older participants (41–45 years) (P< 0·001).

Other cross-sectional study findings by ÇİN and ÖZÇELİK. (2020) entitled “The Iodine Knowledge of Pregnant Women in an Endemic Goiter Area”, carried on 150 pregnant women, in Turkey, revealed that Three main dietary sources of iodine in Turkey, fish, milk and dairy products and table salt are 68.0%, 20.0% and 77.3% of them correctly identified as good sources, respectively. ÇİN and ÖZÇELİK (2020) also reported that some of the pregnant women described meat (27.3%), fruit (22.0%) and bread (34.0%) as the most important sources of iodine. About half of the pregnant could not correctly mark which sources of iodine are the best.

Related the women’s knowledge about consequences of iodine intake deficiency during pregnancy, the current study proved that slightly less than three-quarters of the pregnant women answer do not know the consequences of iodine intake deficiency during pregnancy, less than one-fifth of them answer spontaneous abortion and the minority of them answer a stillborn baby. This current finding of the study may be interpreted due to the low level of education and lack of sources that provide information about iodine intake deficiency and its consequences and complications.

A parallel finding reported by Hine (2016), that over half of the study women (55.8%) selected “I do not know” in relation to the list of health problems. While Approximately one-quarter of subjects selected the correct responses goiter and mental retardation.

Moreover, similar results claimed to be Al Hadid et al. (2018), that a few numbers of women (10 %) knew about the complications of iodine deficiency.

Contrary findings relate to health problems caused by iodine deficiency are presented explored by ÇİN and ÖZÇELİK (2020), That 44.7% of pregnant women marked goiter, 63.3% mental retardation, 31.3% preterm birth; 29.3% knew that it can cause miscarriages and 26.7% of them stated that it can cause stillbirths. Moreover, the current study finding disagree Jin et al. (2020) in studyentitled“Use of Iodine Supplements by Breastfeeding Mothers Is Associated with Better Maternal and Infant Iodine Status” carried on 87 breastfeeding mothers, in New Zealand, reported that health issues associated with iodine deficiency correctly answered as the following: goiter 48%, birth defects 38%, mental retardation 26%, impaired physical development during childhood 32%.

ÇİN and ÖZÇELİK (2020) also reported that the answers given by the women to the statements about the health problems caused by iodine deficiency are presented. The 44.7% of women marked goiter, 63.3% mental retardation, 31.3% preterm birth; 29.3% knew that it can cause miscarriages and 26.7% of them stated that it can cause stillbirth.

As regarding our current study demonstrates that slightly less than two-thirds of the studied women have unsatisfactory level of knowledge about iodine intake deficiency during pregnancy. From the researcher point of view, those prominent findings are related to low educational level, unavailable educational healthcare program.

 This results in harmony with Abu-Baker et al. (2021) in a quasi-experimental study; entitled "The Effect of Health Education on Dietary Knowledge and Practices of Pregnant Women in Jordan”, proved that after health education, the intervention group recorded significantly higher dietary knowledge score (mean= 19.30, SD= 0.88) compared to the control group score (mean= 14.36, SD= 2.11), p < 0.001.

 On the other hand, contradictory finding proved by Almuzaini et al. (2019) in a study entitled "Assessment of knowledge and awareness regarding thyroid disorders among Saudi people", among 367 adult residents in Saudi Arabia, demonstrated that 57.32% of respondents had good knowledge, whereas 42.68% had poor knowledge of thyroid disorder diseases.

 According to the current study demonstrates that more than two-thirds of the studied women have unsatisfactory practice about iodine salt intake deficiency during pregnancy.The researcher normalizes her study findings to the poor knowledge of the study women which directly reflect on their practice.

A supported view by Abu-Baker et al. (2021) illustrated that, the intervention group recorded a significant increase in practices score from the pretest (mean= 6.69, SD= 1.97) to posttest (mean= 8.70, SD= 1.16), p < 0.001. Abu-Baker et al. (2018). Before health education, the result revealed no significant difference between the total dietary practices score of the intervention group (mean= 6.69, SD= 1.97) compared to the control group score (mean= 7.02, SD= 1.66), (t (193) = −1.24, p = 0.21). After health education, the intervention group recorded significantly higher total dietary practices score (mean= 8.70, SD= 1.16) compared to the control group score (mean= 7.02, SD= 1.66), (t (193) = 8.15, p < 0.001). Furthermore, the result revealed a significant increase in the total dietary practices score of the intervention group from the pretest (mean= 6.69, SD= 1.97) to the posttest (mean= 8.70, SD= 1.16), (t (94) = −11.62, p <0.001).

Remarkably, the current study demonstrates that there was a highly statistically significant relation between total knowledge of pregnant women's and their demographic characteristics related to age, educational level, occupation, residenceat (P= < 0.01). this finding due to difference of educational level and communities culture.

A supported view maintained by Tenaw et al. (2018) in a study entitled “Nutritional knowledge, attitude and practices among pregnant women who attend antenatal care at public hospitals of Addis Ababa, Ethiopia "that there was a positive significant association between the educational status of women (AOR=3.047, 95% CI (1.046 to 8.873)), attitude (AOR=4.4, 95%CI (2.315 to 8.299)), number of pregnancies (AOR=2.175, 95%CI (1.034 to 4.573)) and nutrition knowledge during pregnancy.

 Moreover, Aktaç et al. (2018) in a study entitled Evaluation of nutrition knowledge of pregnant women before and after nutrition education according to sociodemographic characteristics. showed that pretest scores were found for factors, such as education level, work status, and the number of pregnancies; significant differences in both test scores were found for age and nutrition information (p < .05). However, Post-test scores did not significantly differ according to the educational status, employment status, and number of pregnancies (p > .05)

 (Tegegne 2019) reported that, the women who had the household member greater than or equal to 6 were 6 more likely to have good knowledge than the participant who had the household member less than 6. The pregnant women who had educational level from grade 9-12 were 9 times more likely to have good knowledge compared with the women who cannot read and write, and the women who can read and write were 5 times more likely to have good knowledge on iodine compared with the participant who cannot read and write.

Furtherly, the present study mentioned that, there was a highly statistically significant relationship between the total practice of pregnant women's and their demographiccharacteristics as educational level, occupation, residence, (P= < 0.01). Also, there was a statistically significant relation with their age at (P= < 0.05)This result may be due to educational level, communities culture and level of knowledge reflect to total practice.

The current study supported with Tegegne (2019) reported that the women who had a primary school (1-8) were 2 times more likely to have good practice than those who cannot read and write and the women who had education level secondary (9-12) had 7 times more likely had good practices as compared to women who cannot read and write. Also, women with above secondary education level had 19 times more likely to have good practice compared with the women who cannot read and write.

Significantly, our study proved that are highly statistical significance between total level of  knowledge and total practice about iodine salt intake during pregnancy .The researcher normalizes her study findings to the poor knowledge of the study women which directly reflect on their practice Which supported by Tegegne (2019) reported that the mother who had good knowledge on iodine and iodizes salt utilization had 6 times more likely had good practice on iodine utilization. Moreover. These results agree with Tenaw et al. (2018) and Hine (2016).

Conclusion

Based on the findings of the present study conclude that most women did not know the adverse health effect of low iodine in the diet and did not have adequate knowledge of good dietary sources with which daily requirement of iodine can be achieved. in addition, this study indicated that around two-thirds of pregnant women knowledge and practice towards iodine intake deficiency during pregnancy were unsatisfactory with highly statistically significant between women knowledge and practice towards iodine intake deficiency during pregnancy.

Recommendations

Based on the results of the present study recommended that:

• There is a need to improve healthcare providers’ knowledge of and adherence to the iodine supplement recommendation. Strategies within antenatal and postnatal services, as well as public health initiatives, are required to improve the knowledge and practices of healthcare providers which reflect on patient knowledge through health education.

Further researches:

Effect of an educational program about iodine deficiency in pregnancy on pregnant women's knowledge, and practice.