Geographically, Bihar lies in the sub-Himalayan goitre belt. Iodine deficiency causes a spectrum of disorders, from poor growth, retarded development, lowurinary iodine excretion and poor cognitive function and goitre, to severe cognitive disabilityand death.

Consistent consumption of small quantities of iodine can prevent these disorders andreverse some, but not all, of the negative effects of iodine deficiency [1, 2].

The World Health Organization (WHO) estimates that approximately 37% of school-age children (285 million) and nearly 2 billion individuals worldwide, have insufficient iodine intake in 2004 [3,4].

In 1993, the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF) and the International Councilfor the Control of Iodine Deficiency Disorders (ICCIDD) recommended universal iodization of salt to prevent and treat iodine deficiency disorders [5].

Globally, the proportion of people consuming iodized salt rose from less than 20 percent in 1990 to about 70 percent by 2000 but the figure remains stagnant since that date [6].

Though universal salt iodization (USI) was made mandatory in India since 2005, only 71% of households were consuming adequately iodized salt (>15ppm) as per the Coverage Evaluation Survey, 2009 [7]. This gap in the utilization of adequately iodized salt couldbe due to various reasons.

Rural residence, illiteracy, lower monthly per-capital income, poor socioeconomic status, unavailability of the salt, lack of awareness about the risk of Iodine Deficiency Disorders (IDD), exposing salt to sunlight, expensiveness, and lack of knowledge about iodized salt are among the factors associated with the absence of adequately iodized salt at home[8].

This study was conducted with following objectives:

1. To assess the proportion of households consuming adequately iodized salt
2. To assess knowledge and practices regarding salt consumption
3. To find the factors associated with consumption of adequately iodized salt in selected districts of traditional goitre belt of Bihar.

Knowledge of Children and their caregivers related to Iodine deficiency disorders were assessed by showing clinical photographs of Goitrous patient and asking that ‘do you identify this condition’. If the answer came yes then the name of condition, cause of that condition and source of information regarding the condition were asked. We also assessed their knowledge regarding iodized salt by asking ‘have you heard about iodized salt’. If answer came yes then they were asked about ‘what are the benefits of consuming iodized salt’. The brand name of the salt used in household was also asked from mothers.

The practices regarding salt consumption were assessed by observing which type of salt they were using that is either refined or granular and the type of container they were using to store the salt after purchasing from the market. Mothers were asked about when they add salt into meal during cooking process i.e. either in the beginning or in between cookingor at the end of cooking.

The socio-economic status was calculated on the basis of Modified BG Prasad classification and then classified into upper, middle and lower class [10].

Salt iodine determination: Salt samples were collected from households that were routinely being consumedin their respective homes in auto-seal polythene pouches. The iodine content was measured by standard iodometric titration method. According to WHO, adequately iodized salt for the sustainable elimination of IDD is defined as salt with iodine content of 15 parts per million (ppm) or more [5].

Method of statistical analysis: Statistical analysis was performed by statistical software SPSS version 22. Frequency distribution and percentages were expressed for categorical variables. The association between salt consumption and various factors were assessed by applying chi-square test. In all cases the level of rejection of a null hypothesis was 0.05.

Ethical issue: The study was approved by Institute ethical committee of Patna Medical College, Patna. Head of the households were informed about the purpose of the study and written consent was taken from them.

A total of 1263 children and same number of mothers or any other family members were included in the study. Only 21 children (1.7%) were able to

In around 87% houses salt was either added in the beginning or in between cooking. Adequately iodized salt was consumed in 73.5% household (Table: 2)

Table- 2: Practices related to Iodised salt consumption in selected districts (N=1263).

(Figures in parenthesis denotes percentage. OBC: Other Backward Castes, SC: Scheduled caste, ST: Scheduled tribe)

The proportion of people consuming adequately iodized salt was most among General category (78.7%) followed by Other Backward Class (75.2%), Scheduled Caste (69.4%) and Scheduled Tribe category (62.4%) and the association was statistically significant (p=0.012). The family living in Katchha houses had poor iodized salt consumption in comparison to people living in mixed and pucca houses (p=0.005). The salt stored in air tight container had significantly higher iodine content in comparison to salt stored in open container (p=0.041). Religion, socio-economic status, caregiver’s knowledge about iodized salt and caregiver’s knowledge about brand name of salt had no any significant association with iodized salt consumption (Table: 3).

The present study collected information on the iodine content of household salt, knowledge and practices regarding storage of edible salt as well as the factors influencing iodized salt use. One of the objectives of present study was to assess the knowledge of children and adults regarding iodine deficiency disorders.

The knowledge of children was quite poor. As a little age group of 6-12 years we cannot expect too much from them to know about IDD. But one of the aims of National Iodine Deficiency Disorders Control Programme (NIDDCP) is to increase awareness among common people regarding IDDs and iodized salt consumption.

Only 33% adult were able to identify the condition of goitre. And only 19% had heard about iodized salt.

So the knowledge of adults was quite poor regarding these aspects. This poor knowledge is also reflected in their practices.

As we have found the consumption of adequately iodized salt was 73.5% against the goal of universal salt iodization (USI), which is to cover more than 90% of households [5]. The target of universal salt iodization is yet to be achieved at the consumer level in the surveyed districts of Bihar.

The use of non-iodized salt was not found in any household. This finding revealed that although the salt was being iodised; either the iodine was added in inadequate quantity or there were losses of iodine at the different points in distribution system.

In present study for 29% caregivers, the source for their information was book they had studied. Television and radio was the source of information in 26% respondent. Family members, relatives and health workers were source of information in 45% caregivers. Roy et al (2016) reported common sources of information for iodized salt were television and radio (60%) [11].

However, in a study by Sen et al. [12] television (66.7%) was the principal sourceof information. The salt was stored in container with closed lid in around 95% houses in our study. Almost similar finding was reported in a study where salt was stored in container with closed lid in 87% households [11].

In this study; Category, house status and container used to store salt in household were the factors significantly associated with iodized salt consumption in households. NFHS-4 (2015-16) data of Bihar reported that the iodized salt consumption was highest in households of other category followed by other backward class (OBC), scheduled caste (SC) and scheduled tribe (ST) [13].

Similar trend was found in present study which shows that the proportion of people consuming adequately iodized salt was most among General category (78.7%) followed by Other Backward Class (75.2%), Scheduled Caste (69.4%) and Scheduled Tribe category (62.4%).

The adequately iodized salt consumption in these districts was 73.5% which is around 16 point below the goal of universal salt iodization (USI) [5]. This gap may beeither due to iodine was added in inadequate quantity or there were losses of iodine due to faulty storage practice.