Engaging the Community in the Design and Implementation of an Intervention to Increase Household Consumption of Iodised Salt in Khyber Pakhtunkhwa, Pakistan

Abstract

Objectives: Pakistan's Iodine Deficiency Disorders Control Programme (IDDCP) was launched in 1994 however, approximately half of Pakistan's population of 200 million are affected with IDD. The National Nutrition Survey in Pakistan revealed marked provincial variation; within Khyber Pakhtunkhwa (KP), 25.7% of children 6-12 years of age have some form of IDD. The objective of this research was to engage the community in the design and implementation of an intervention to increase awareness, knowledge and promote use of iodised salt in KP. Methods: The study was undertaken in a community of 5,000 households, living in chronic rural poverty. A baseline survey of 1,043 households and 28 shopkeepers was conducted and focus groups were held with a range of stakeholders to explore the barriers to iodised salt use. Thematically analysed transcripts informed the design of a 4-month intervention, including leaflet and poster distribution, house to house visits, education sessions in schools, and awareness-raising through religious and social gatherings and a health centre. Results: At baseline, 2.6% of households reported use of iodised salt and 3.5% knew of its health benefits. 67.9% of shopkeepers stocked iodised salt, which cost Rs. 5-7 more than simple salt. Reasons for not using iodised salt included expense (35.7%), belief about a negative impact on reproduction (42.9%) and lack of awareness (7.1%). Following the intervention, iodised salt sales from the local shops increased by 45%. Conclusions: Engaging the community in the design and implementation of an intervention helped to overcome the barriers to the use of iodised salt.