JCDR - Register at Journal of Clinical and Diagnostic Research
Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X
Epidemiology Section DOI : 10.7860/JCDR/2018/37587.12252
Year : 2018 | Month : Nov | Volume : 12 | Issue : 11 Full Version Page : LC16 - LC20

A Study on Knowledge, Attitude and Practices Regarding Household Consumption of Iodized Salt among Selected Urban Women of Tripura, India

Anjan Datta1, Nabarun Karmakar2, Kaushik Nag3, Simul Singha4

1 Assistant Professor, Department of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Hapania, P.O.-ONGC, Agartala, Tripura, India.
2 Assistant Professor, Department of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Hapania, P.O.-ONGC, Agartala, Tripura, India.
3 Assistant Professor, Department of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Hapania, P.O.-ONGC, Agartala, Tripura, India.
4 Lady Medical Officer, Department of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Hapania, P.O.-ONGC, Agartala, Tripura, India.


NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Dr. Nabarun Karmakar, Assistant Professor, Department of Community Medicine, 3rd Floor, Tripura Medical College and Dr. BRAM Teaching Hospital, Hapania, Agartala-799014, Tripura, India.
E-mail: drnabarunkarmakar@gmail.com
Abstract

Introduction

Iodine deficiency is not only responsible for endemic goiter but it is the single most common cause of preventable mental retardation and brain damage in the world today. Wide range of variation exists in household consumption of iodized salt across different states which warrant the need of the present study.

Aim

To assess the knowledge, attitude and practices regarding household consumption of iodized salt and associated factors among women in an urban area of Tripura.

Materials and Methods

A community based cross-divtional study was conducted among 260 randomly selected women, who were involved in day to day household cooking, residing within the field practice area of Urban Health Training Centre (UHTC), Dukli under Department of Community Medicine, Tripura Medical College and Dr BRAM Teaching Hospital, for a period of three months. A predesigned, pretested, semi-structured interview schedule was used for data collection and analysed using SPSS version 16.0 software. Data were represented in the form of frequency distribution tables; Chi-square test and Fisher’s-exact test was used to see the associations as and when required.

Results

In this study, majority (64.62%) of the participants have not heard of iodized salt but showed good practice (87.3%) regarding iodized salt consumption. Good knowledge, attitude was significantly associated with higher age group, education and socio-economic class of the participants.

Conclusion

Although majority of the participants showed good knowledge and practice related to iodized salt consumption at household level, time of adding salt while cooking was still faulty in most of them.

Keywords

Introduction

Iodine is the key element for maintaining normal thyroid function, as well as normal growth, development of body and brain. Though iodine deficiency is known for causing endemic goiter, it’s most deleterious effect is on the developing brain of a fetus, ranging from mild dysfunction to irreversible intellectual impairment. It is the single most common cause of preventable mental retardation and brain damage in the world today. World Health Organization (WHO) has mentioned that the normal dietary intake of iodized salt should be maximum upto 5 gm per person per day. Iodine Deficiency Disorder (IDD) is a significant Public Health (PH) problem all over the world [1-3].

Various thyroid related diseases like hypothyroidism, hyperthyroidism, goiter, cretinism etc. have been found to be associated with IDDs worldwide; even there is increased risk of coronary artery disease, autoimmune disorders, cognitive impairment and cancer [4]. Excess dietary salt causes high blood pressure, which is a major modifiable risk factor for coronary heart disease and stroke [5]. High salt intake is related not only with high blood pressure but also with an increased risk of stroke and cardiovascular disease. Moderate dietary sodium restriction is recommended as part of the non-pharmacologic therapy of hypertension [6,7].

About 1.5 billion people worldwide live at risk of IDD of which more than 655 million people are already affected with IDD [2]. Salt iodization programs have been implemented in many countries of the world including India, and two-thirds of the global population (71%) is estimated to be covered by iodized salt [8]. Current estimates (2011), based on Urinary Iodine Concentration (UIC) of school-aged children as a biomarker of recent iodine intake indicate that, overall, 29.8% of the population has an inadequate iodine intake [9].

In India, about 200 million people live at risk of IDD, whereas more than 71 million people are suffering from goiter and other IDDs [2]. No state or Union Territory (UT) in India has been found to be free from IDD [10].

In India as per the Coverage Evaluation Survey 2009, 91% of households had access to iodized salt, of which 71% consumed adequately iodized salt [11]. Although this vary across different states and union territories, there is difference between rural and urban coverage of adequately iodized salt consumption at household level even within a state (83.2% in urban vs. 66.1% in rural areas) [2].

As per DLHS-4 (2012-13) reports, the prevalence of household consumption of iodized salt at rural level is 73.7% while it is 82.4% at urban level and 76.1% at overall level [12].

As it is evident from the previous studies [1-12], that emphasis has been given mainly on adequate iodized salt intake and household salt consumption assessment, but certain issues of knowledge, attitude and behavioural practices among population and difference in rural and urban areas, are much less explored throughout the country as well as in north-eastern India. Lack of adequate studies on these issues in Tripura warrants need of a study like the present one.

The specific objective of the study is to assess the knowledge, attitude and practices regarding household consumption of iodized salt and to find out the factors influencing them, among women in an urban area of Tripura.

Materials and Methods

The study is a community based cross-sectional study conducted among women residing in the field practice area of Urban Health Training Centre, Dukli under Department of Community Medicine, Tripura Medical College and Dr BRAM Teaching Hospital, for a period of three months (November 2017 to January 2018). A minimum sample size of 260 was calculated considering prevalence (p) as 82.4% as per DLHS-4 report of urban Tripura [12] and allowable error (l) as 5% using the formula of n=4 pq/l2, where n is total sample size and q=1-p. This gives a minimum sample size of 232. Finally, considering 10% as non-response rate, 260 individuals were selected from a peri-urban area for the purpose of this study.

Study individuals were selected by simple random sampling technique, where 260 individuals from the field practice area of UHTC Dukli were selected by using computer generated random number table starting from one fixed point. Household numbers from routine field survey of UHTC were used for random sampling. If women were not found or absent in the house during survey, the next household as per random number table was visited until the required sample size was achieved.

Women who were involved in cooking daily household meals and gave their consent to participate were included in the study. If more than one person from target population were found in the same household, the one with less experience in daily cooking was excluded from the study. Also, those who were not mentally healthy were not included. A pre-designed, semi-structured, pre-tested interview schedule was developed by the investigators to collect the required information from the study participants. The interview schedule consisted of two parts; in the first part the investigators asked questions (eight in number) related to socio-demographic characteristics of the respondents and second part of the schedule involved six questions related to knowledge, three questions of attitude and five questions to find out practice of consumption of iodized salt at household level. The interpretation of the questions has been mentioned. The schedule was translated into local language (Bengali) by experts in literature for appropriateness and comprehension. The schedule was pre-tested in a separate urban female population of the same city, by the investigators before commencing the original research work and Cronbach’s alpha calculated to be 0.69, which means good reliability.

The collected data were entered in SPSS version 16.0 computers based software and represented in proportions with the help of frequency distribution tables and charts. Chi-Square Test and Fisher’s-exact test were used to see the association between socio-demographic factors with the knowledge, attitude and practice of the study participants (p<0.05 was used as significant).

A well explained written informed consent, translated into local language (Bengali) was taken from all the study participants before interview.

Study proposal was submitted in front of the Institutional Ethics Committee of Tripura Medical College and Dr BRAM Teaching Hospital (Ref. Sl. IEC/SFTMC/2017/5/002, Dated: 15/09/2017) and ethical clearance was taken before commencing the study.

Results

The present study revealed mean age of participants as 36.89±12.001 years and nearly similar proportion of participants being above mean {115 (44.2%)} and below or equal to mean {145 (55.8%)}. All the study participants were Hindu by religion and General caste {124 (47.7%)} followed by ST {86 (33.1%)}. Most of them were married, housewives and had high school education. Majority belonged to nuclear families and from SES Class IV followed by SES Class III as per modified BG Prasad’s SES Classification, January 2017 [Table/Fig-1] [13].

Socio demographic characteristics of study of population (n=260).

VariablesFrequencyPercentage (%)
Age≤mean14555.8
Above mean11544.2
Total260100.0
ReligionHindu260100.0
Total260100.0
CasteGeneral12447.7
OBC31.2
SC4718.1
ST8633.1
Total260100.0
Marital statusUnmarried124.6
Married22486.2
Widowed249.2
Total260100.0
EducationIlliterate3212.3
Primary school3011.5
Middle school5521.2
High school9436.2
Higher secondary2911.2
Graduate and above207.7
Total260100.0
OccupationStudent114.2
Housewife18470.8
Govt. Employee83.1
Health worker10.4
Private employee62.3
Shop owner10.4
Business10.4
Agriculture10.4
Agriculture labour10.4
Daily labour4316.5
Old age or Retired31.2
Total260100.0
Type of familyNuclear18470.8
Joint7629.2
Total260100.0
Socio-Economic Status classification as per modified BG Prasad’s scaleClass I83.1
Class II4918.8
Class III7729.6
Class IV9837.7
Class V2810.8
Total260100.0

In this study majority {168 (64.62%)} of the participants haven’t heard of iodized salt and among the rest 80 (86.96%) believed its common salt with iodine rather than any special salt. Only 31 (11.9%) participants were aware that the salt they consume at their home was having iodine and only 52 (20%) knew that iodized salt doesn’t taste any different than table salt. Only 19 (7.3%) participants knew how to identify iodized salt from the packet. Although almost all {258 (99.2%)} preferred packaged salt than unpackaged open salt and for majority {96 (36.9%)}, taste was the main reason for their salt preference. Still majority believed that iodized salt was somewhat important {118 (45.4%)} followed by very important {91 (35%)} in their diet for maintaining good health. When interviewed about their practices, almost all of them {258 (99.2%)} replied that they were using packaged salt and only 2 (0.8%) were using coarse salt. Most of them {243 (93.5%)} were avoiding direct exposure of edible salt to sunlight and storing salt in dry area {254 (99.7%)}. Most of them were using covered container for salt. Majority said that they used to add salt either in the middle of cooking {161 (61.9%)} or at the beginning {95 (36.5%)} but only 4 (1.5%) added salt at the end of cooking [Table/Fig-2].

Frequency distribution table of participants’ responses on their knowledge, attitude and practices of household iodised salt consumption (n=260).

VariablesFrequencyPercentage
Knowledge
Heard about iodised salt
Yes9235.38%
No16864.62%
If heard about iodised salt, what it is (n= 92)
Ordinary common salt with a small quantity of iodine8086.96%
Special type of salt with good quantity of iodine22.17%
Others33.26%
Don’t know77.61%
The salt used for cooking at your home contains iodine
Yes3111.9%
No11845.4%
Don’t know11142.7%
Iodised salt tastes different from that of non-iodised salt
Yes6123.5%
No5220.0%
Don’t know14756.5%
How to recognise iodised salt from its packet
By seeing “Smiling sun” sign197.3%
By seeing iodine level printed5922.7%
By seeing “Green leaves” sign10.4%
Others83.1%
Don’t know17366.5%
Intake of iodised salt is important for health
Yes17567.3%
No51.9%
Don’t know8030.8%
Attitude
Opinion on salt preference
Packaged salt25899.2%
Unpackaged salt20.8%
Reason for salt preference
Taste9636.9%
Tradition9135.0%
Quantity51.9%
Health4718.1%
Quality of salt197.3%
Cheaper10.4%
Others10.4%
Importance of iodised salt in your diet
Very important9135.0%
Somewhat Important11845.4%
Not important20.8%
Don’t know4918.8%
Practice
Type of salt used
Packaged salt25899.2%
Coarse salt (unpackaged)20.8%
Sunlight exposure to salt
Yes176.5%
No24393.5%
Salt storage place
Dry area25497.7%
Moist area31.2%
Near to fire31.2%
Type of salt container
With cover25196.5%
Without cover93.5%
Salt is added to food in kitchen
At the beginning of cooking9536.5%
In the middle of cooking16161.9%
At the end of cooking41.5%

[Table/Fig-3] revealed good knowledge and good practice among majority {146 (56.2%) and 227 (87.3%) respectively} of the participants regarding iodized salt consumption but poor attitude among 152 (58.5%) of the individuals.

Frequency distribution table of quality of knowledge, Attitude and practice of study population (n = 260).

VariablesFrequencyPercentage (%)
KnowledgePoor11443.8
Good14656.2
AttitudePoor15258.5
Good10841.5
PracticePoor3312.7
Good22787.3

Mean age, social caste, education, occupation and socio-economic class of the individuals were found to have significant association with their knowledge of iodized salt consumption (p-value=0.008, <0.001, <0.001, 0.002, 0.025 respectively). Similarly mean age, education and SES class had significant association with attitude of iodized salt consumption (p-value=0.026, <0.001, 0.009 respectively) [Table/Fig-4].

Association of socio-demographic factors with knowledge, attitude and practices of study participants (n=260).

Socio demographic factorsKnowledgeAttitudePractice
PoorGoodPoorGoodPoorGood
Age≤Mean5392766918127
>Mean6154763915100
p-value0.008*0.026*0.880
CasteSC7153794517107
ST121203
OBC13342324740
GEN29574937977
<0.001*□0.2460.790
Marital statusUnmarried4866012
Married961281299528196
Widow1410177519
p-value0.2630.3800.219
EducationIlliterate248311725
Literate9013812110726202
p-value<0.001*<0.001*0.150
OccupationNot working761221128624174
Working38244022953
p-value0.002*0.2680.621
Type of familyNuclear801041067820164
Joint344246301363
p-value0.8520.6640.170
Economic statusClass I352608
Class II15342326346
Class III294847301067
Class IV494957411781
Class V1810235325
p-value0.025*0.009*0.347

(*) denotes significant p-values (<0.05). Tests applied were Chi-square and Fisher’s-exact test.

() denotes p-values from Fisher’s-exact test


Discussion

The present study revealed mean age of participants as 36.89±12.001 years and majority (55.8%) were aged less than 37 years. As per modified BG Prasad’s SES Classification, January 2017, majority belonged to Class IV (lower middle socio-economic class). They had similarity in baseline characteristics to various other studies included in discussion [14-25].

While assessing knowledge of the study participants regarding consumption of iodized salt it was found in this study that only 35.38% of the participants have heard of iodized salt. Similar results were found in a study done by salt commission in 2010 in eight states [14] and study by Sen TK et al., West Bengal, where they have found that 57.8% and 60% of their study population have never heard of iodized salt [15]. Although there was lot of dissimilarities in various other studies regarding the same e.g., like study done in Chennai by Cariappa MP et al., where 79.6% population knew about iodized salt, only 30.6% in a study at Bangalore by Jaiswal N et al., 72% of the population in study done by Kumar P et al., and among studies done in other countries, 36.7% of the population in study done by Sarah NA et al., in Ghana, 85.3% in study at Sindh and provinces of Pakistan by GN Khan et al., 69.3% of urban population of study done by Tsegaye M et al., in Southern Ethiopia [16-21]. This difference in knowledge could probably be because of difference in population distribution, their education and salt consumption pattern.

In this study, 11.9% of the study participants were aware that the salt they consume at their homes were having iodine which is quite less than that of study results by Roy R et al., in Uttar Pradesh, where 90.9% of the study population knew that packaged salt contains iodine [22]. This is a matter of serious concern regarding knowledge of our study population. Similarly the proportion of our study population having knowledge on identifying iodized salt packet by ‘smiling sun’ logo was also very poor (7.3%) consistent to findings in various other studies, 12.2% in study done by Cariappa MP et al., in Chennai and only 4% in study done by Kumar P et al., [16,18].

While various other studies reported majority of their study population were unaware of the importance of iodized salt (63.4% in study by Sen TK et al., in West Bengal and 53.8% in the study by Roy R et al., [15,22]. Most of our study population (80.4%) opined that iodized salt was important in their daily food.

Although most of our study population were using packaged salt, avoiding direct sun exposure to salt, keeping salt in dry place and in covered container but only 1.5% were using salt at the end of cooking, whereas, it was 8.16% in the study at Chennai [16], 7.1% in study at Bangalore [17] but comparatively lesser than study at Ethiopia where 50.2% of study population used salt at the end of cooking [23].

Majority of the participants in the present study showed good knowledge and practice regarding iodized salt consumption, better than what Aruna RT et al., found in their study in Karnataka [24].

The present study revealed that higher age, improved literacy status and higher socio-economic class were the factors that were significantly associated with good knowledge and attitude of the participants which is consistent with study findings by salt commission in eight states of India and Singh S et al., in Kanpur [14,25]. This might be because higher education and income allowed people to understand and act upon information regarding iodized salt consumption at their household level.

Limitation

Lack of availability of a standard questionnaire format and subjective nature of responses, especially lack of objective assessment of practice of iodized salt consumption by the participants could be the possible limitations of the study.

Conclusion

The study revealed good knowledge and practices regarding consumption of iodized salt among urban women involved in household cooking in Tripura, even though majority of them haven’t heard of iodized salt. Also, adding salt at the end of cooking to avoid loss of iodine content in salt was not among their common practices, consistent with other parts of our country. A positive change in the attitude and above mentioned practice might help in reducing the burden of IDD in our country which is a scope for future research work in this context.

Ethical Approval: The study was approved by the Institutional Ethics Committee (Tripura Medical College and Dr BRAM Teaching Hospital, Agartala).

(*) denotes significant p-values (<0.05). Tests applied were Chi-square and Fisher’s-exact test.() denotes p-values from Fisher’s-exact test

References

[1]Gupta P, Srivastava JP, Zaidi ZH, Srivastava MR, A study to assess the iodine deficiency disorder and salt consumption pattern in Lucknow Int J Community Med Public Health 2015 2(1):29-32.(Online) Available from http://www.ijcmph.com/index.php/ijcmph/article/view/917/788 (last accessed on 2018 Feb 12)10.5455/2394-6040.ijcmph20150207  [Google Scholar]  [CrossRef]

[2]Pandav CS, Yadav K, Srivastava R, Pandav R, Karmakar MG, Iodine Deficiency Disorders (IDD) control in India Indian Journal of Medical Research 2013 138(3):418  [Google Scholar]

[3]World Health Organization. Guideline: Sodium intake for adults and children. Geneva, Switzerland. 2012;1-56  [Google Scholar]

[4]Patrick L, Iodine: Deficiency and therapeutic considerations Altern Med Rev 2008 13:116-27.(Online) Available from https://pdfs.semanticscholar.org/fa1a/704a9e7df37eff86b865e152fb2812a10324.pdf (last accessed on 2018 Feb 12)  [Google Scholar]

[5]He FJ, Li J, Macgregor GA, Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials BMJ 2013 346:f1325(Online) Available from http://www.bmj.com/content/bmj/346/bmj. f1325.full.pdf (last accessed on 2018 Feb 12)10.1136/bmj.f132523558162  [Google Scholar]  [CrossRef]  [PubMed]

[6]Strazzullo P, D’Elia L, Kandala NB, Cappuccio FP, Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies BMJ 2009 339:b4567(Online) Available from https://www.ncbi.nlm.nih.gov/pubmed/19934192 (last accessed on 2018 Feb 12)10.1136/bmj.b456719934192  [Google Scholar]  [CrossRef]  [PubMed]

[7]Intersalt: an international study of electrolyte excretion and blood pressure Results for 24 hour urinary sodium and potassium excretion. Intersalt Cooperative Research Group BMJ 1988 297(6644):319-28.(Online) Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1834069/pdf/bmj00297-0019.pdf (last accessed on 2018 Jul 26)10.1136/bmj.297.6644.3193416162  [Google Scholar]  [CrossRef]  [PubMed]

[8]UNICEF The State of the World’s Children 2011. Adolescence: an age of opportunity 2011 New YorkUnited Nations Children’s Fund(Online) Available from https://www.unicef.org/adolescence/files/SOWC_2011_Main_Report_EN_02092011.pdf (last accessed on 2018 Jul 26)  [Google Scholar]

[9]Andersson M, Karumbunathan V, Zimmermann MB, Global iodine status in 2011 and trends over the past decade J Nutr 2012 142:744-50.(Online) Available from http://www.ign.org/cm_data/J._Nutr.-2012-Andersson-744-50.pdf (last accessed on 2018 Aug 24)10.3945/jn.111.14939322378324  [Google Scholar]  [CrossRef]  [PubMed]

[10]Taneja DK, Health policies and programmes in India National Iodine Deficiency Disorders Control Programme 2004 13th editionNew DelhiDoctors Publications:377  [Google Scholar]

[11]UNICEF. Coverage Evaluation Survey 2009, All India Report. Ministry of Health and Family Welfare, Government of India, New Delhi. 2010. [Last accessed on 2018 Feb 12]. Available from http://www.indiaenvironmentportal.org.in/files/National_Factsheet_30_ August_no_logo.pdf  [Google Scholar]

[12]State fact sheet, Tripura. District level household and facility survey-4. Ministry of health and family welfare. International institute of population sciences (Deemed university), Mumbai. 2012-13. [Online] Available from http://rchiips.org/pdf/dlhs4/report/TR.pdf (Last accessed 2018 Feb 12)  [Google Scholar]

[13]Singh T, Sharma S, Nagesh S, Socio-economic status scales updated for 2017 Int J Res Med Sci 2017 5(7):3264-67.10.18203/2320-6012.ijrms20173029  [Google Scholar]  [CrossRef]

[14]Micronutrient Initiative, Summary Report: Iodized salt coverage study 2010 2010 New DelhiGovernment of India, Office of the Salt Commissioner  [Google Scholar]

[15]Sen TK, Das DK, Biswas AB, Chakrabarty I, Mukhopadhyay S, Roy R, Limited access to iodized salt among the poor and disadvantaged in North 24 Parganas district of West Bengal, India Journal of Health, Population and Nutrition 2010 28(4):369-74.10.3329/jhpn.v28i4.604320824980  [Google Scholar]  [CrossRef]  [PubMed]

[16]Cariappa MP, Singh P, Usage of iodized salt in an urban area in India National Medical Journal of India 2002 15(4):242  [Google Scholar]

[17]Jaiswal N, Melse Boonstra A, Sharma SK, Srinivasan K, Zimmermann MB, The iodized salt programme in Bangalore, India provides adequate iodine intakes in pregnant women and more-than-adequate iodine intakes in their children Public Health Nutrition 2015 18(3):40310.1017/S136898001400055X24762565  [Google Scholar]  [CrossRef]  [PubMed]

[18]Kumar P, Tiwari VK, Gautam RK, Knowledge, attitude and behaviour regarding use of iodised salt: an evaluation of national iodine deficiency disorders control programme in India OIDA International Journal of Sustainable Development 2013 05(12):95-106.  [Google Scholar]

[19]Sarah NA, Prince AK, Yao AS, Geoffrey AA, Wisdom TK, Margaret K, Knowledge on iodized salt use and iodine content of salt among households in the Hohoe Municipality, Volta Region-Ghana Central African Journal of Public Health 2016 2(1):1-10.  [Google Scholar]

[20]Khan GN, Hussain I, Soofi SB, Rizvi A, Bhutta ZA, A study on the household use of iodised salt in Sindh and Punjab provinces, Pakistan: Implications for policy makers. Division of Women & Child Health, Aga Khan University, Karachi, Pakistan Journal of Pharmacy and Nutrition Sciences 2012 2:148-54.  [Google Scholar]

[21]Tsegaye M, Hailu D, Zegeye M, Availability and utilization of adequately iodized salt by urban and rural households and associated factors in Southern Ethiopia, Sidama Zone, Bensa Woreda: A comparative cross-sectional study International Journal of Food Science and Nutrition Engineering 2016 6(3):62-71.  [Google Scholar]

[22]Roy R, Chaturvedi M, Agrawal D, Ali H, Household use of iodized salt in rural area Journal of Family Medicine and Primary Care 2016 5(1):7710.4103/2249-4863.18462827453848  [Google Scholar]  [CrossRef]  [PubMed]

[23]Gidey B, Alemu K, Atnafu A, Kifle M, Tefera Y, Sharma HR, Availability of adequate iodized salt at household level and associated factors in rural communities in Laelay Maychew District, Northern Ethiopia: a cross sectional study Journal of Nutrition and Health Sciences 2015 2(1):110.15744/2393-9060.1.403  [Google Scholar]  [CrossRef]

[24]Aruna RT, Sarojani JK, Bharati P, Uma SH, Impact of education intervention on knowledge regarding iodine deficiency disorder Karnataka Journal of Agricultural Sciences 2013 26(1):124-27.  [Google Scholar]

[25]Singh S, Singh R, Aggarwal K, A study on use of iodized salt and iodine intake in urban and rural areas of Kanpur Asian Journal of Home Science 2010 5(1):10-13.  [Google Scholar]