Effect of nutrition education on iodine deficiency disorders and iodized salt intake in south west Ethiopian women: a cluster randomized controlled trial

Effect of nutrition education on iodine deficiency disorders and iodized salt intake in south west Ethiopian women: a cluster randomized controlled trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Effect of nutrition education on iodine deficiency disorders and iodized salt intake in south west Ethiopian women: a cluster randomized controlled trial Agize Asfaw, Tefera Belachew, Taye Gari This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-27067/v2 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Nov, 2020 Read the published version in BMC Women's Health → Version 2 posted 4 You are reading this latest preprint version Show more versions Abstract Background: Although iodine nutrition status is improving globally, the progress is not uniform throughout the world due to several factors. Among these, poor knowledge, negative attitude and improper practice of iodized salt are the main risk factors for poor iodine nutrition in Ethiopia. This study was aimed to assess the effect of nutrition education intervention on knowledge, attitude and practice (KAP) of iodine deficiency and iodized salt utilization. Methods: A cluster randomized controlled trial was carried out among 652 women of reproductive age group in southwest Ethiopia. A total of 24 clusters were selected and randomized in to an intervention and control villages. Women in the intervention village received iodine nutrition related education for six months; while those in the control village did not receive any education. Baseline and endline data were collected from both groups. Generalized Estimating Equations (GEE) was used to determine the effect of intervention. Results: A total of 647 (99.2%) participants were successfully involved in the study. In the intervention group the median attendance was 10 out of 12 sessions. Women in the intervention group had shown statistically significant change in knowledge, attitude and practice scores as compared to control one. In multivariable GEE linear model, after adjusting for other background characteristics, the mean difference (95% CI) scores were 8.81 (8.46, 9.16) for knowledge, 3.35 (3.17, 3.54) for attitude and 2.90 (2.74, 3.05) for practice in the intervention arm. Conclusions: Well designed and community-based iodine nutrition education is an effective strategy to improve the KAP of iodine deficiency disorders and iodized salt utilization. Trial registration: PACTR201809544276357 (Retrospectively registered on 14, Sept. 2018). http: //www.pactr.org Nutrition & Dietetics Ethiopia Iodine nutrition Peer-guided Iodized salt Figures Figure 1 Figure 2 Background Iodine is an essential micronutrient that supports different physiological functions in the body. Naturally, our body does not make it, so we need small quantity regularly from outside sources. Running low in iodine intake for long period of time will lead to its deficiency collectively called iodine deficiency disorder (IDD) [1, 2]. Globally, iodine nutrition status is improving from time to time. According to the previous studies, iodine deficient countries declined from 113 in 1993 to 30 in 2013 and only 19 countries remain iodine-deficient in 2017 [3-5]. However; the progress is not uniform throughout the world. Overall, there has been steady progress in developed countries and urban settings. But, there has been minimal progress in rural areas of the developing countries like Africa. Therefore, a great global effort is needed to achieve sustainable elimination of IDD in these iodine deficient areas and maintain the achievement for the decades to come in all countries. In Ethiopia, eradication of IDD remains a significant challenge due to several factors. From government side: lack of regular enforcement of the legislation, weak regulation and monitoring of the producers and retailers leading to poor salt handling and storage. On the population side, poor knowledge, negative attitude and improper practice of iodized salt are common [6-8]. Despite the efforts made by the Ethiopian government on universal salt iodization for the last decade, there was still unacceptably high goiter prevalence (54.6%) indicating the presence of severe chronic iodine deficiency in the area. Moreover, 63.5% of the salt consumed by the family was insufficiently iodized and 17.4% contained no iodine at all [9]. These are striking findings for a country like Ethiopia where universal salt iodization (USI) is being implemented. On the other hand, human behavior is a complex process influenced by many factors related to knowledge, attitude, norms, cultural practices, personal preferences and level of efforts needed to change that behavior [10, 11]. However; as recommended by several previous studies, public education and awareness raising campaigns are useful tools to bring behavior change and address the challenges of IDD prevention and control program [12-22]. In current study area, there is scarcity of evidence on the effect of interventions targeting the knowledge, attitude and practices (KAP) of households related to iodine nutrition. In this study we set out to document the effect of community-based and peer-guided iodine nutrition education intervention in improving knowledge of IDD, attitude towards and practice of iodized salt in settings where IDD is endemic and iodized salt consumption is poor. To achieve the objective, women of reproductive age group were selected as a target group, because women and children are highly vulnerable to IDD and relatively representative of the study population in IDD surveillance [23]. In addition, women are mainly responsible for household meal preparation using iodized salt. Methods The study Area This study was conducted in Dawro Zone, southwest part of Ethiopia. The zone has five districts and one town administration with a total land area of 4,437 km 2 . It has three different agro-ecological zones; high land with altitude range of 2300 to 3200 meters above sea level (masl), middle land between 1500 to 2300 masl and low land below 1500 masl. The mean annual temperature and rainfall ranges from 15.1 – 27.5 0 c and 1200 – 1800 mm respectively [24, 25]. The total population and health service coverage of the zone in 2016 was 702,517 and 93% respectively. Women of reproductive age group (15-49 years) accounted for 23% of the total population of the zone [26]. IDD is endemic and iodized salt consumption is poor in the study area [9, 27]. Study design Cluster randomized controlled trial was carried out for six months from January to June 2017. The unit of randomization was households served by health development armies (villages having 27-30 households). A health development army (HDA) in Ethiopia is defined as a network of women volunteers in the same village organized to promote health, prevent disease through community participation and empowerment. The HDA facilitate identification of local problems that hinder families from utilizing key maternal, neonatal and child health services and to come up with locally acceptable strategies to address the problem. They are also responsible frontline actors in discussing preventive health issues including health education and mobilize the community through different campaigns. Participants HDA inclusion and exclusion criteria This trial was conducted in 24 randomly selected HDAs (clusters). The clusters were stratified in to highland and lowland by expecting knowledge, attitude and practice (KAP) differences in IDD and iodized salt utilization between the dwellers of these two locations. As indicated by previous studies, highland areas are more at risk of IDD [28, 29]. Therefore, people living in these areas have more exposure to visible sequale of IDD like goiter and could have better knowledge about it. All the selected clusters in highland and lowland kebeles with a minimum inter-cluster distance of 9kms (to minimize information contamination) were included in the trial. Middle land clusters located at the boarder of lowland and highland (having no clear boundary) were excluded. Participant inclusion and exclusion criteria: Individual participants were all women or reproductive age group (15-49 years) who were primarily responsible for meal preparation. Women who refused to give verbal consent, those who were mentally ill; those who had severe learning difficulties or planned to leave the area within next one year were excluded. Randomization The study zone had five districts and one town administration. Two of the districts were selected by simple random sampling (SRS) and the town administration was included. The list of kebeles (the smallest administrative unit in the district) as a sampling frame was obtained from each district and the town administration bureau. The kebeles were stratified in to highland and lowland. Accordingly, 29 highland and 31 lowland kebeles were identified, sequentially numbered and three of them randomly drawn from each stratum. In the six selected kebeles there were a total of 55 HDAs (clusters). Among them, four clusters were randomly selected from each Kebele (4*6=24clusters). Finally, two of the clusters were randomly assigned to intervention or control arm by a supervisor (health officer with BSc degree) who was unaware of the study-arm assignments in each stratum. Due to the nature of intervention, blinding of the participants was not applied. The schematic presentation of the sampling procedure was summarized in (figure 1). Intervention Modalities The intervention was targeted at the cluster level. Clusters were health development armies containing 27-30 households in the village. From each household a women of reproductive age group who was primarily responsible for household meal preparation was selected to participate in the trial. Tool development To execute the trial, first educational and training tools were prepared. The tools contain clear message on iodine, its source, benefits of iodized salt, how to handle and use iodized salt, how to store it and the consequences of not using iodized salt. To prepare these tools, we referred available resources from World Health Organization (WHO), United Nations children’s fund (UNICEF), Iodine Global Network (IGN), Ethiopian Demographic and Health Survey (EDHS), National micro-nutrient guide lines and adapted to local context and target groups [23, 30-34]. Health Development Army members selection for training Two HDA members who fulfill the criteria (Volunteer, 10th grade completed, fluent in speaking local language, active participant in the group, stable and live in the area for the next one year) were selected from each intervention site. Five days training supported by demonstration and posters was given by principal investigator (PI). A copy of the teaching material was also given for each TOT (training of trainer) members. Nutrition education for intervention groups For intervention groups, a six month iodine nutrition education was given by using the prepared materials. Members of HDA who actively completed five days training handled the sessions. The schedule for the session was twice every month for six consecutive months. In each one hour education session, two-way process of sharing message, active involvement of the participants, freely exchange of ideas and demonstration of iodized salt was practiced. Control groups On the contrary to the intervention clusters, the control clusters did not participate in any nutrition education session. They continued with their routine health care services of the ministry of health (MOH) as usual. The MOH routine health care package for the frontline health workers in Ethiopia includes 16 components. These components can be categorized in to four major areas: family health (family planning, maternal and child health, nutrition and vaccination services), disease prevention and control (HIV/AIDS and STI, tuberculosis, malaria and first aid cares), hygiene and sanitation (promotion of sanitary latrines, waste disposal management, water supply, food hygiene and safety, control of insects and rodents, personal hygiene and healthy home environment services) and health education and communication [35]. Supervision, endline data collection and measurement The sessions were monitored by PI and/or assigned supervisor every month. At the end of each three month, there was review meeting in which all members including the supervisor present their work in the presence of PI. The purpose of this three months review meeting was for monitoring and process evaluation to ensure the sessions were being implemented as planned or need any adjustment. At the end of intervention period (after six months), data were collected from both groups (intervention and control) using the same data collectors and questionnaire that was used at the baseline. All factors and tools used were made similar for both arms except the intervention. This ensured that the observed change in intervention arm was reasonably attributed to the intervention. The change in KAP (increment in knowledge, change in attitudes or reduction of risky behaviors, and improvement of practice) was measured by comparing the baseline data with end line findings. Deviations from the protocol Generally, the intervention was carried out as planned. However, there were some deviations from the protocol. Initially, the intervention was planned for nine months, but we believe this is too long to see the effect of intervention and reduced to six months. As this is one of the unfunded studies, we could not be able to measure urinary iodine concentration of participants and failed to assess nutritional status as a secondary outcome. The last deviation from the study protocol was that the study lagged seven months behind the schedule because of the political instability in the country that interfered data collection. Outcomes The outcomes were change in mean score of the three composite variables (knowledge, attitude and practice) about IDD and iodized salt after intervention. The secondary outcome, according to our plan, was change in iodine nutrition status of participants after intervention. Unfortunately, this was not done due to resource limitations. Sample Size Determination The sample size was calculated using GPOWER 3:0 Software, by taking into account the intracluster correlation coefficient (ICC), the average cluster size, the expected effect size, and the power of the study. The ICC was assumed to be 0.04 from previous studies [36, 37], total number of clusters 24 with a minimum of 27 participants in each cluster and the expected effect size of 0.29. The effect size was estimated from the previous studies conducted in south and northwest Ethiopia [38, 39]. The study in southwest Ethiopia reported about 44.7% respondents had good knowledge and 42.6% had positive attitude towards consumption of iodized salt [38]. Similarly the northwest Ethiopian study reported about half of the households’ (49.8%) added salt at the beginning and middle of food preparation (inappropriate practice). This means, the rest 50.2% added at the end of cooking process (appropriate practice) [39]. Therefore, most likely the current study zone might have similar proportions and we planned to increase good knowledge from 44.7% to 74%, positive attitude from 42.6% to 72% and appropriate practice from 50.2% to 79%. With these assumptions a power of 80% was anticipated to detect a difference in KAP scores between the two groups with α err prob. of 0.05. Finally, 10% expected non-response rate/drop-out was added to get 652 as the sample size for the trial. Data collection Training was given for twelve data collectors (health extension workers) on how to use the questionnaire, ethical issue, revisiting closed houses and their work relationship with the supervisor for three days. The questionnaire was pretested on non-selected but similar adjacent kebeles. A week after pretest, baseline data were collected from both intervention and control clusters by face to face interview using structured and modified questionnaire. The same tool and data collectors were used to collect endline data after six months of intervention. Instrument Validity For face validity, 32 households (5% of the sample) were interviewed and each questionnaire was completed by data collectors. The completed questionnaire was collected and evaluated by the principal investigator, co-investigators and a statistician. For content validity, an expert of three specialists in endocrinology, nutrition and biostatistics examined the initial questionnaire. The experts were asked to comment on individual items in relation to the accuracy and content. Finally, items were modified slightly based on the findings from pretest and the expert reviews. In addition, Cronbach’s α was determined for internal consistency (Cronbach’s α=0.93, 0.77 and 0.71 for knowledge, attitude and practice respectively). Addition of iodized salt at the end of cooking process, not washing the salt before use and not exposing it to sunlight are some of the recommended practices of iodized salt. Convergent validity was checked by observing the practice of women against these recommended practices during demonstration sessions. Measurement Data were collected using a series of 16 questions about knowledge of IDD and iodized salt and eight questions about practice of iodized salt. In each case a correct response was given a score of one, whereas an incorrect response was given a score of zero. Then, knowledge and practice indices were produced by adding individual answers across items. Similarly, data on attitude about iodized salt and goiter were collected using a series of seven questions. Each question had three options (yes, no or don’t know) and a three-point Likert scale (agree, disagree or neutral). The responses were dichotomized in to “yes” or “no” and “agree” or “disagree” as there was no response on third options (“don’t know” and “neutral”). A score of one was given for responses that defined positive attitude and a score of zero was given for negative ones. An index for attitude was produced after summing individual answers across items. Finally, for all the three indices (knowledge, attitude and practice scores), we computed the difference by subtracting the baseline value from the endline. These differences were used as response variables for the subsequent analysis. Data Processing and Analysis Data were doubly entered into Epi Info version 3.5.3, cleaned and analyzed using SPSS version 21 (SPSS Inc. Chicago, USA). Descriptive statistics were summarized using frequency and proportions. The mean difference in KAP scores between intervention and control groups was tested using independent sample t-test. Principal component analysis (PCA) was used to construct a wealth index from 20 household fixed asset such as presence of latrine, source of drinking water, possession of television, radio, mobile telephone, availability of separate kitchen from living house, domestic animal and land possessed in hectare. These variables were dichotomized and coded ‘1’ for the household possessing the asset and ‘0’ for the rest. Finally, the factor scores ranked ordered into three relative measures of socio-economic classes (poor, medium and rich). For this study, the primary outcome measures were composite variables (knowledge, attitude and practice scores) determined by summing all responses across items and subtracting the baseline sum from the endline to get the difference. These differences in scores were taken as an outcome variable for each. As mentioned above, there were two measurements on the same subject (baseline and endline). Since repeated observations within one subject are considered not independent of each other, the standard linear regression could not allow for the repeated measures and could underestimate the standard error. In this case, the Generalized Estimating Equations (GEE) was used to extend the generalized linear model to allow for analysis of repeated measurements. GEE helps to correct for the expected within-subject correlations [40]. Therefore, after checking all assumptions including multicolinearity (maximum VIF=1.240), we fitted generalized linear models (GEE). First, we run bivariate analysis for each outcome variable. Then, to control for confounding and adjust for within cluster correlation of measurements, all variables with a p-value ≤ 0.2 in the bivariate analysis were fitted into the model for multivariable analysis. All analysis was conducted according to intention-to treat principles and a p-value of 0.05 or less was considered statistically significant. Results Socio-economic and outcome variables at baseline Baseline data collected before the start of the intervention in 2016 showed that the two groups were comparable for both socioeconomic and outcome variables, except for age group and wealth category. Relatively higher numbers of participants with advanced age category (35-49 years) were found in the intervention group (37.1% vs. 17.8%). The numbers of participants with poor and medium wealth status were higher in control (44.5% vs. 34.7%) and intervention (25.2% vs. 16.3%) groups respectively. All the participants of this study were women of reproductive age group (15-49 years) in southwest Ethiopia (Table 1). Response rate and attendance A total of 647 (99.2%) participants were successfully surveyed at the endline. In the intervention group, the median attendance was 10 (ranging from 4 to 12 sessions). All participants in the intervention group attended the first session, but three (0.9%) of them dropped out during the intervention period. Similarly, two (0.6%) participants were disappeared from the control group. The overall participant flow had been summarized using CONSORT flow diagram (Figure 2). Outcomes and estimation Scores in knowledge about IDD, attitude towards and practice of iodized salt were analyzed for change between groups after six months nutrition education intervention. To appreciate the change, we calculated the mean difference between the two groups (intervention vs control) with the corresponding precision (95% CI) for each of the primary outcomes (knowledge, attitude and practice scores) after adjustment for the baseline covariates. The adjusted effect measures were considered as the main results. Women in the intervention group had shown statistically significant change in knowledge, attitude and practice scores as compared to control one. The mean difference (MD) + standard deviation (SD) for women in the intervention group was (8.82 + 3.56) for knowledge, (3.00 + 2.15) for attitude and (3.11 + 1.67) for practice scores respectively. The differences in score for all three outcome variables were statistically significant with knowledge (β=8.81; 95% CI: 8.46, 9.16), attitude (β=3.35; 95% CI: 3.17, 3.54) and practice (β=2.90; 95% CI: 2.74, 3.05). For the control groups such differences were negligible for all the outcome variables as indicated in (Table 2). To identify independent factors associated with the endline-baseline difference of the differences in the mean KAP scores, we employed multivariable Generalized Estimating Equations (GEE). Variables included in the model were: age, family size, educational status, geographic location, wealth index, availability of iodized salt in nearby shop/market and the intervention. Out of all other variables, intervention was the only independent predictor of all three outcome variable scores (knowledge, attitude and practice). Among the remaining variables, only wealth index was significantly associated with the knowledge score. On the other hand, family size, educational status and wealth index were significantly associated with attitude score and geographic location and availability of iodized salt in nearby shop were significantly associated with practice score. All the three outcome variable scores were increased on average nearly by nine points for knowledge (β = 8.81, 95%CI = 8.46, 9.16), by three points for attitude (β = 3.35, 95%CI = 3.17, 3.54), and practice (β = 2.90, 95%CI = 2.74, 3.05) each in the intervention arm. Wealth index and knowledge score were inversely related ((β =-0.499, 95%CI = -0.947, -0.050). For a unit increase in family size, the average attitude score increased by 0.538 (β = 0.538, 95%CI = 0.106, 0.970). Similarly, attitude score increased as educational level increases (β = 0.573, 95% CI = 0.174, 0.971) and for the poor wealth category (β = 0.695, 95% CI = 0.249, 1.142). On the other hand, practice score decreased (β =-0.567, 95%CI = -0.760, -0.375) as the availability of iodized salt in nearby shop/market decreased and for the highland dwellers (β = -0.314, 95% CI = -0.512, -0.117) (Table 3). Discussion Despite global improvement in iodine nutrition status, achieving sustainable elimination of its deficiency remained a great challenge in Ethiopia. Consumption of iodized salt, the most widely recommended global strategy to control and eliminate iodine deficiency, had several limitations and gaps in the country. Among these, knowledge gap, misperceptions and improper practices of iodized salt are at the top list [18-21]. This community based cluster randomized controlled trial study was designed and implemented iodine nutrition education intervention to address such problem in southwest Ethiopia. Before the study, baseline survey was conducted and identified the existing levels of KAP concerning IDD and iodized salt and the gap. At the beginning of the study, there was no significant difference for KAP scores about IDD and iodized salt in both intervention and control groups. Approximately half of the women in both groups scored below mean at baseline. However; as summarized in table 2 and 3, for all three outcome variable scores there was significant difference between the two groups after six months of nutrition education intervention. The average knowledge score approximately tripled for intervention arm at the endline. Similar results were observed in studies conducted in India to find out the impact of health education intervention on awareness and consumption of iodized salt in school children [14] and a randomized controlled trial conducted in Iran to evaluate the effectiveness of educational program on the iodine nutrition status of pregnant women [19]. Regarding the attitude and practice scores, the mean differences were 3.35 and 2.90 respectively at the endline. This means, on average, the scores tripled for both attitude and practice after the nutrition education intervention. The findings were supported by previous studies conducted and identified the positive impact of education and awareness raising program to increase the iodized salt consumption in Pakistan [14], India [14] and Iran [19]. As indicated in multivariable analysis, factors such as educational status, wealth status, geographic location and availability of iodized salt in nearby shop/market should be considered before designing education sessions. In this study, participants with poor wealth category and informal education had shown favorable attitude towards iodized salt. On the other hand, being in poor wealth category and living in highland area were negatively related with knowledge and practice scores respectively. According to the finding of this study, the effect of nutrition education was similar across women with different educational status for knowledge component. However, for poor women who had no formal education, the sessions should focus on attitude component. In addition, one should ensure the accessibility of iodized salt before designing educational sessions on practice as participants who had no access to iodized salt within less than 30 minutes walking distance had shown poor practice of iodized salt. Generally, the outcomes of this study were clear indications of the effectiveness of iodine nutrition related education intervention in improving the knowledge about IDD and iodized salt, changing misperception and inappropriate practice of iodized salt in the study population. The findings of this study have wide practical implications. Although the government of Ethiopia has been implementing iodization of salt as an intervention strategy for the past one decade, there are still differences in the way households understand the program and their uptake of it. The findings also showed that giving enhanced education through the existing government structure including the frontline actors and health development army will significantly contribute to the reduction of IDD in Ethiopia. Almost all sessions were peer-guided; interactive with free exchange of ideas and some of them were demonstration based, which could be considered as strength of this study. The fact that the questionnaire was filled based on self-report could be acknowledged as a limitation as it might induce some social desirability bias. However, efforts were made to probe the participants and explain the purpose of the study and we believe that it may not affect the validity. The other limitation could be our failure to assess nutritional status of participants. Even though we planned to measure nutritional status as a secondary outcome, we couldn’t be able to do this because of limited resources. However; failure to do this, may not affect our findings and conclusion as this was not our primary objective. Conclusions Despite the complex nature of human behavior, a well-designed, community-based and peer-guided iodine nutrition education is an effective tool to improve knowledge about IDD and to change misperception and inappropriate practice of iodized salt in settings where IDD is endemic and iodized salt consumption is poor. Abbreviations CONSORT--------------------------------Consolidated Standards of Reporting Trials EDHS---------------------------------------Ethiopian Demographic and Health Survey GEE-----------------------------------------Generalized Estimating Equations HAD-----------------------------------------Health Development Army HEW----------------------------------------Health Extension Worker IDD------------------------------------------Iodine Deficiency Disorders IGN------------------------------------------Iodine Global Network KAP-----------------------------------------Knowledge, Attitude, Practice MOH----------------------------------------Ministry of Health PCA-----------------------------------------Principal Component Analysis PI--------------------------------------------Principal Investigator SRS-----------------------------------------Simple Random Sampling UNICEF-----------------------------------United Nations Children’s Fund USI------------------------------------------Universal Salt Iodization VIF------------------------------------------Variance Inflation Factor WHO---------------------------------------World Health Organization Declarations Ethics approval and consent to participate Ethical clearance and approval was obtained from Jimma University, College of public health and medical sciences ethical clearance review committee (IRB). The IRB deeply examined this work at proposal level and approved with the letter issued on 10, Feb 2016 (Ref. No-RPGC/4052/ 08). Permission was obtained from government officials and community leaders before randomization. After establishment of consent at cluster levels, an eligible woman from household was consulted for voluntariness. Finally, the woman who agreed to participate was included in to the trial. Written consent was not necessary at least for two reasons: first, the research protocol was about nutrition education, which was neither hostile nor invasive to the study participants. Secondly, according to the legislative of research ethics in Jimma University, having verbal consent suffices for non-invasive research procedures. Moreover, all the study participants were informed about the purpose and confidentiality of the information along with their right to refuse. The study was also registered on pan African clinical trials registry with a registration number of PACTR 201809544276357 on 14 Sept 2018. Consent for publication- not applicable Availability of data and materials All data used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research was funded by Jimma University (Ref. No- RPGC/4052/2008). The funder had no role in this study other than financial contribution. Authors’ contribution A. A conceived and designed the study, performed the analysis and interpretation and drafted the manuscript. B.T participated in the study design, analysis and manuscript revision. G.T participated in the analysis and interpretation. All authors read and approved the final manuscript. Acknowledgement The authors would like to thank the study participants, data collectors and supervisor for their willingness and participation. We appreciate Jimma University, Wolkite University and Dawro zone health department for their support and encouragement. References Aburto N, Abudou M, Candeias V, Wu T. Effect and safety of salt iodization to prevent iodine deficiency disorders: a systematic review with meta-analyses. WHO eLibrary of Evidence for Nutrition Actions (eLENA). Geneva, World Health Organization. 2014; Found at: http://apps.who.int/iris/bitstream/10665/148175/1/9789241508285_eng.pdf Hernando VU, Anilza BP, Hernan STC. Iodine Deficiency Disorders. Thyroid Disorders Therapy, 2015, 4:172. doi:10.4172/2167-7948.1000172 Andersson, V. Karumbunathan and M. B. Zimmermann. "Global Iodine Status in 2011 and Trends over the Past Decade”. Journal of Nutrition . 2012; 142 (4): 744-750. Elizabeth N. Pearce, Maria Andersson, Michael B. Zimmermann. Global Iodine Nutrition: where do we stand in 2013? Zurich, Switzerland. Thyroid; 2013, 23(5): Found at: http://www.ign.org/cm_data/2013_Pearce_Global_iodine_nutritionWhere_do_we_stand_in2013_Thyroid.pdf . Date accessed 21, Nov 2017. Francesco Branca, Jonas Vollmer, Jessica, Michael Zimmerman. Eliminating iodine deficiency disorders by 2020. Zurich, Switzerland. 26 May 2017. Available at: https://www.gainhealth.org/knowledge-centre/toward-elimination-iodine-deficiency-disorders-2020/ D. Accessed on 25, Oct 2017. Tirhas M. Gebretsadikan and Aron M. Troen. Progress and challenges in eliminating iodine deficiency in Ethiopia: a systematic review. BMC Nutrition. 2016; 2:12, pp 1-12 Kibatu Girma , Endalkachew Nibret , Molla Gedefaw . The Status of Iodine Nutrition and Iodine Deficiency Disorders Among School Children in Metekel Zone, Northwest Ethiopia. Eth. J. Health sci. 2014; 24(2): 109-116. Hailay Gebrearegawi Gebremariam, Melke Edris Yesuf, and Digsu Negese Koye. Availability of Adequately Iodized Salt at Household Level and Associated Factors in Gondar Town, Northwest Ethiopia. Hindawi Publishing Corporation. 2013; Vol.2013: 1-6. Asfaw A, Belachew T. Magnitude of iodine deficiency disorder and associated factors in Dawro zone, southwest Ethiopia; the hidden hunger: a cross-sectional study. BMC Nutrition, 2020 (Accepted); https://doi.org/10.1186/s40795-020-00345-8 . Michael P. Kelly, Mary Barker. Why is changing health-related behavior so difficult? Elsevier. 2016; 136:109-116. Available online at sciencedirect.com Johnson MJ, May CR. Promoting professional behavior change in healthcare: what interventions work, and why? A theory-led overview of systematic reviews. BMJ Open 2015; 5: e008592. doi: 10.1136/bmjopen-2015- 008592 Yvette Fautsch Macias and Peter Glasauer . Guidelines for assessing nutrition-related knowledge, attitudes and practices. Food and Agriculture Organization of the United Nations, Rome, 2014. Available at: http://www.fao.org/docrep/019/i3545e/i3545e.pdf . Nicola Lowe, Elizabeth Westaway, Akhtar Munir, et al (2015). Increasing Awareness and Use of Iodized Salt in a Marginalized Community Setting in North-West Pakistan. J Nut. 2015; 7, 9672–9682; mdpi.com/journal/nutrients.Publ Ansari MA, Khan Z. Impact of health education intervention on consumption of iodized salt in school children in Aligarh, India. Int J Comm. Med and Public Health, 2016; 3:1431-6. Lisa Garnweidner-Holme, Inger Aakre, Anne Marie Lilleengen, Anne Lise Brantsæter and Sigrun Henjum. Knowledge about Iodine in Pregnant and Lactating Women in the Oslo Area, Norway. Nutrients 2017, 9, 493; doi: 10.3390/nu9050493. Lucas, C.J.; Charlton, K.E.; Brown, L.; Brock, E.; Cummins, L. Antenatal shared care: Are pregnant women being adequately informed about iodine and nutritional supplementation? Aust. N. Z. J. Obstet. Gynaecol. 2014, 54 (6):515–521. Mahshid Naghashpour , Ghodratollah Shakerinejad , Mohammad Reza, Lourizadeh Saeedeh Hajinajaf and Farzaneh Jarvandi. Nutrition Education Based on Health Belief Model Improves Dietary Calcium Intake among Female Students of Junior High Schools. J Health Popul Nutr . 2014; 32(3): 420–429. Ladan Mehran, Pantea Nazeri, Hossein Delshad, Parvin Mirmiran, Yadollah Mehrabi and Fereidoun Azizi. Does a text messaging intervention improve knowledge, attitudes and practice regarding iodine deficiency and iodized salt consumption? Iran. Public Health Nutrition, 2012, 15(12): 2320–2325. Amiri, P.; Hamzavi Zarghani, N.; Nazeri, P. Can an educational intervention improve iodine nutrition status in pregnant women? A randomized controlled trial. Thyroid 2017, 27, 418–425. Ahmed Elnadif Ahmed, Safa Abdalla Elnour, Yousif Mohammed Ahmed. Knowledge and attitude of population towards iodized salt in Shendi locality river Nile state in Sudan . European Scientific Journal, 2017, 13 (6):312-22. O’Kane, S., Pourshahidi, L., Farren, K., Mulhern, M., Strain, J., & Yeates, A. Iodine knowledge is positively associated with dietary iodine intake among women of childbearing age in the UK and Ireland. Br. J. Nutr. 2016, 116(10), 1728-1735. Teklay Kidane, Aregai Woldegebriel. Prevalence of Iodine deficiency disorder in a highland district in Tigray: Brief Communication. Ethip.J.Health Dev. 2006; 20(1): 59-60. World Health Organization, Assessment of iodine deficiency disorders and monitoring their elimination: A guide for program managers, 3rd ed., Geneva, WHO, 2007: 6-54. A. Enset Value Chain, the Case of Dawro Zone, Southern Nations Nationalities and Peoples Regional State, Ethiopia. International Journal of African and Asian Studies, Vol.30, 2017. ISSN 2409-6938. Available at: http://iiste.org/Journals /index. php/ JAAS/ article/view File/35383/36403 The development study on the strengthening agricultural marketing system in southern nation’s nationalities and peoples region. Final report, November 2012. PP.2.2. Date accessed 25, March 2018. Central Statistical Agency [Ethiopia]. 2014. Ethiopia Mini Demographic and Health Survey 2014. Addis Ababa, Ethiopia. Shimelash Bitew Workie, Yemane Gebremariam Abebe, Amha Admasie Gelaye and Tefera Chane Mekonen. Assessing the status of iodine deficiency disorder (IDD) and associated factors in Wolaita and Dawro Zones School Adolescents, southern Ethiopia. BMC Res Notes (2017), 10:156, pp 1-12. Available online at: https://www.ncbi.nlm.nih . gov/pmc/articles/PMC5395884/ Abuye C, Berhane Y, T. Ersumo. The Role of Changing Diet and Altitude on Goitre Prevalence in 5 Regional States in Ethiopia. East Afr. J. Public Health.2008; 5(3):163-8. Ahmed M, Zama SY, Nagarajarao V, Khan MA. Iodine deficiency in children: A comparative study in two districts of south-interior Karnataka, India. J Fam Community Med 2014; 21:48-5 Central Statistical Agency [Ethiopia] and ORC Macro EDHS 2011. CSA, Addis Ababa, Ethiopia and Calverton, Maryland, USA; 2012. Available at: https://dhs com/ pubs /pdf/FR255/FR255.pdf Iodine Global Network. Global Scorecard of Iodine Nutrition in 2017 in the general population and in pregnant women (PW). IGN: Zurich, Switzerland. 2017. Available at: http://www.ign.org/cm_data/IGN_Global_Scorecard_AllPop_and_PW_May2017.pdf . Accessed on 25, Oct 2017. UNICEF, IGN. Technical Working Group Meeting on Research Priorities for the Monitoring of Salt Iodization Programs and Determination of Population Iodine Status. New York: UNICEF; 2016.Found at https://www.unicef.org/nutrition/files/ UNICEF_ IGN _ Iodine_Technical_Consultation_2015.pdf National guideline for control and prevention of micronutrient deficiencies. Ethiopia, June 2004. Date accessed, 16 April 2016. Elimination of iodine deficiency disorders. A manual for health workers. EMRO Technical Publications Series 35; 2008. http://applications.emro.who.int/dsaf/dsa928.pdf Assefa, Y., Gelaw, Y.A., Hill, P.S. et al. Community health extension program of Ethiopia, 2003–2018: successes and challenges toward universal coverage for primary healthcare services. Global Health 15, 24 (2019) doi:10.1186/s12992-019-0470-1 Monica Taljaard & Jeremy M Grimshaw. Concept, characteristics and implications of cluster randomization. Clin. Invest. 2014; 4(1), 1–4. Francis NA, Butler CC, Hood K, Simpson S, Wood F, and Nuttall J. Effect of using an interactive booklet about childhood respiratory tract infections in primary care consultations on reconsulting and antibiotic prescribing: a cluster randomized controlled trial. BMJ . 2009; 339:b2885. Published 2009 Jul 29. doi:10.1136/bmj.b2885. Yusuf Haji , Junayde Abdurahmen , Wondimagegn Paulos . Knowledge and perception of Consumption of iodized salt among food handlers in Southern Ethiopia. SAGE J. 2016; 38 (1). Found at : http://journals.sagepub.com/doi/pdf/ 1177/03795 7211 6684909 Zegeye Abebe, Ejigu Gebeye and Amare Tariku. Poor dietary diversity, wealth status and use of un- iodized salt are associated with goiter among school children: a cross-sectional study in Ethiopia. BMC Public Health. 2017; 17:44. DOI 10.1186/s12889-016-3914-z. Twisk J. Applied longitudinal data analysis for epidemiology: A practical guide. United States of America: Cambridge University press; 2003. Tables Table 1 Description of s ocio-demographic and outcome variables at baseline in intervention and control groups, southwest Ethiopia, 2016 Variable Category Groups Intervention (n=326) Number (%) Control (n=326) Number (%) Age category in years 15-24 25-34 35-44 45-49 69 (21.2) 136 (41.7) 85 (26.1) 36 (11.0) 93 (28.5) 175 (53.7) 42 (12.9) 16 (4.9) Family size (number) 5 198 (60.7) 128 (39.3) 218 (66.9) 108 (33.1) Educatio nal status Informal Formal 195 (59.8) 131 (40.2) 190 (58.3) 136 (41.7) Marital status Married Singleᶿ 265 (81.3) 61 (18.7) 257 (78.8) 69 (21.2) Geographic location Highland Lowland 164 (50.3) 162 (49.7) 162 (49.7) 164 (50.3) Wealth index Poor Medium Rich 113 (34.7) 82 (25.2) 131 (40.2) 145 (44.5) 53 (16.3) 128 (39.3) Knowled ge score (5.22 ± 2.89) µ Poor Good 187 (57.4) 139 (42.6) 209 (64.1) 117 (35.9) Attitude score (3.36 ± 2.01) µ Unfavorable Favorable 213 (65.3) 113 (34.7) 210 (64.4) 116 (35.6) Practice score (4.26 ± 1.53) µ Inappropriate Appropriate 199 (61.0) 127 (39.0) 189 (58.0) 137 (42.0) Singleᶿ-Not married, separately living, divorced and widowed µ (mean ± SD) Table 2: Effect of nutrition education intervention on knowledge, attitude and practice of iodine deficiency and iodized salt consumption in southwest Ethiopian Women Outcome variables Groups Baseline Mean (SD) Endline Mean (SD) Difference Mean (SD) Adjusted effect (DoD),(95%CI) Knowledge Score Intervention 5.36 (2.94) 14.20 (2.00) 8.82 (3.56) 8.81 (8.46, 9.16) Control 5.08 (2.83) 5.24 (3.12) 0.14 (0.86) Ref Attitude Score Intervention 3.42 (2.03) 6.43 (0.92) 3.00 (2.15) 3.35 (3.17, 3.54) Control 3.30 (1.99) 3.12 (1.49) -0.19 (2.92) Ref Practice Score Intervention 4.21 (1.56) 7.32 (0.84) 3.11 (1.67) 2.90 (2.74, 3.05) Control 4.32 (1.50) 4.45 (1.51) 0.12 (0.78) Ref SD=Standard deviation, DOD=Difference of difference Table 3 Generalized Estimating Equations predicting baseline-endline difference of the differences in knowledge, attitude and practice of iodine deficiency disorder and iodized salt among women in Southwest Ethiopia, 2016-17 Knowledge Attitude Practice Predictors β (St. Error) 95% CI β (St. Error) 95% CI β (St. Error) 95% CI Lower Upper Lower Upper Lower Upper Nutrition education Age in year Family Size Educational status Geographic location 8.809** (0.178) 8.459 9.158 -0.010 (0.015) -0.038 0.019 -0.250 (0.225) -0.692 0.191 0.233 (0.212) -0.182 0.647 -0.395 (0.209) -0.804 0.014 3.352** (0.094) 3.168 -0.004 (0.013) -0.029 0.544* (0.220) 0.113 0.579* (0.203) 0.180 0.154 (0.196) -0.230 3.535 0.021 0.975 0.977 0.538 2.895** (0.081) 2.737 3.054 0.005 (0.008) -0.010 0.020 0.161 (0.114) -0.062 0.384 -0.095 (0.103) -0.297 0.106 -0.315* (0.100) - 0.511 -0.119 Wealth index -Medium -0.190 (0.283) -0.744 0.364 0.240 (0.265) -0.278 0.759 -0.278 (0.150) -0.572 0.017 -Poor -0.511* (0.230) -0.962 -0.059 0.700* (0.229) 0.252 1.148 -0.093 (0.106) -0.300 0.114 Iodized salt + -0.284 (0.210) -0.696 0.128 -0.164 (0.202) -0.560 0.231 -0.612** (0.099) - 0.807 -0.417 Reference Categories : Nutrition education (control), Age (continuous variable), Family size (<=5), Educational status (formal), Geographic location (lowland), Wealth index (rich), Iodized salt (available) **Significant at P<0.0001 *Significant at P<0.05 + Iodized salt, not available in nearby shop/market Supplementary Files S1CONSORTChecklistRevised.docx Cite Share Download PDF Status: Published Journal Publication published 16 Nov, 2020 Read the published version in BMC Women's Health → Version 2 posted Editor assigned by journal 22 Oct, 2020 Reviewers invited by journal 22 Oct, 2020 Submission checks completed at journal 21 Oct, 2020 Editor invited by journal 21 Oct, 2020 You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-27067","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":3876209,"identity":"ef07a33e-9a13-4dd1-b95f-b811e9ec89b2","order_by":0,"name":"Agize Asfaw","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYFACxgZmBgYbO372BiDHwIJoLWnJkj0HQFokiLMHqOUw44YbCSA2EVr4+xc3fy6oYWaWnPn86oYfBRIM/O3dCXi1SNx42CY94xgbH790TtnNHqDDJM6c3YDfmhsH25h52HiYJWfnpN3gAWoxkMjFr0X+xsHmzzz/JBg33DyTdvMPMVoMzjc2SPO2GQC9z37sNlG2GN5gbJPm7UsABnIO220ZAwkegn6RO3/88Weeb/+BUXn82c03f2zk+Nt7CXhfIgHG4jEAk/iVgwD/ARiL/QFh1aNgFIyCUTAiAQAdzEnwGPRrKAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0001-9562-9984","institution":"Wolkite University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Agize","middleName":"","lastName":"Asfaw","suffix":""},{"id":3876210,"identity":"d3623876-37a4-498b-a96a-84e0fc94d180","order_by":1,"name":"Tefera Belachew","email":"","orcid":"","institution":"Jimma University College of Public Health and Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tefera","middleName":"","lastName":"Belachew","suffix":""},{"id":3876211,"identity":"6ba1d1e7-629a-4738-9b0b-0f796d273a2a","order_by":2,"name":"Taye Gari","email":"","orcid":"","institution":"Hawassa University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Taye","middleName":"","lastName":"Gari","suffix":""}],"badges":[],"createdAt":"2020-05-03 14:35:37","currentVersionCode":2,"declarations":"","doi":"10.21203/rs.3.rs-27067/v2","doiUrl":"https://doi.org/10.21203/rs.3.rs-27067/v2","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12905-020-01126-y","type":"published","date":"2020-11-16T15:00:24+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":3275764,"identity":"c590db12-a71c-4a49-957d-ab141f9d6df8","added_by":"auto","created_at":"2020-10-29 19:07:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":105160,"visible":true,"origin":"","legend":"Schematic presentation of sampling procedure in southwest Ethiopia, 2017.","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-27067/v2/fdabdc06178ec9445bb70c64.png"},{"id":3275765,"identity":"e380385d-dc70-41a1-a7d1-ecdf194a0939","added_by":"auto","created_at":"2020-10-29 19:07:59","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":95552,"visible":true,"origin":"","legend":"Study profile for iodine nutrition education intervention among women of reproductive age in south west Ethiopia, 2017.","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-27067/v2/86afa883c390d907305d0b20.png"},{"id":13607546,"identity":"5600e6eb-4e1a-4bd7-b7bb-6f476f0cf04a","added_by":"auto","created_at":"2021-09-17 06:12:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":742226,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-27067/v2/2393d5a3-338f-4028-9d70-60643522d19f.pdf"},{"id":3275763,"identity":"f687844f-e44a-4b31-8f92-5194868d2a8c","added_by":"auto","created_at":"2020-10-29 19:07:58","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":93464,"visible":true,"origin":"","legend":"","description":"","filename":"S1CONSORTChecklistRevised.docx","url":"https://assets-eu.researchsquare.com/files/rs-27067/v2/04bdb8251214c33e17603a14.docx"}],"financialInterests":"","formattedTitle":"\u003cp\u003eEffect of nutrition education on iodine deficiency disorders and iodized salt intake in south west Ethiopian women: a cluster randomized controlled trial\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eIodine is an essential micronutrient that supports different physiological functions in the body. Naturally, our body does not make it, so we need small quantity regularly from outside sources. Running low in iodine intake for long period of time will lead to its deficiency collectively called iodine deficiency disorder (IDD) [1, 2].\u003c/p\u003e\n\u003cp\u003eGlobally, iodine nutrition status is improving from time to time. According to the previous studies, iodine deficient countries declined from 113 in 1993 to 30 in 2013 and only 19 countries remain iodine-deficient in 2017 [3-5]. However; the progress is not uniform throughout the world. Overall, there has been steady progress in developed countries and urban settings. But, there has been minimal progress in rural areas of the developing countries like Africa. Therefore, a great global effort is needed to achieve sustainable elimination of IDD in these iodine deficient areas and maintain the achievement for the decades to come in all countries.\u003c/p\u003e\n\u003cp\u003eIn Ethiopia, eradication of IDD remains a significant challenge due to several factors. From government side: lack of regular enforcement of the legislation, weak regulation and monitoring of the producers and retailers leading to poor salt handling and storage. On the population side, poor knowledge, negative attitude and improper practice of iodized salt are common [6-8].\u003c/p\u003e\n\u003cp\u003eDespite the efforts made by the Ethiopian government on universal salt iodization for the last decade, there was still unacceptably high goiter prevalence (54.6%) indicating the presence of severe chronic iodine deficiency in the area. Moreover, 63.5% of the salt consumed by the family was insufficiently iodized and 17.4% contained no iodine at all [9]. These are striking findings for a country like Ethiopia where universal salt iodization (USI) is being implemented.\u003c/p\u003e\n\u003cp\u003eOn the other hand, human behavior is a complex process influenced by many factors related to knowledge, attitude, norms, cultural practices, personal preferences and level of efforts needed to change that behavior [10, 11]. However; as recommended by several previous studies, public education and awareness raising campaigns are useful tools to bring behavior change and address the challenges of IDD prevention and control program [12-22].\u003c/p\u003e\n\u003cp\u003eIn current study area, there is scarcity of evidence on the effect of interventions targeting the knowledge, attitude and practices (KAP) of households related to iodine nutrition. In this study we set out to document the effect of community-based and peer-guided iodine nutrition education intervention in improving knowledge of IDD, attitude towards and practice of iodized salt in settings where IDD is endemic and iodized salt consumption is poor.\u003c/p\u003e\n\u003cp\u003eTo achieve the objective, women of reproductive age group were selected as a target group, because women and children are highly vulnerable to IDD and relatively representative of the study population in IDD surveillance [23]. In addition, women are mainly responsible for household meal preparation using iodized salt.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eThe study Area\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in Dawro Zone, southwest part of Ethiopia. The zone has five districts and one town administration with a total land area of 4,437 km\u003csup\u003e2\u003c/sup\u003e. It has three different agro-ecological zones; high land with altitude range of 2300 to 3200 meters above sea level (masl), middle land between 1500 to 2300 masl and low land below 1500 masl. The mean annual temperature and rainfall ranges from 15.1 \u0026ndash; 27.5\u003csup\u003e0\u003c/sup\u003ec and 1200 \u0026ndash; 1800 mm respectively [24, 25].\u003c/p\u003e\n\u003cp\u003eThe total population and health service coverage of the zone in 2016 was 702,517 and 93% respectively. Women of reproductive age group (15-49 years) accounted for 23% of the total population of the zone [26]. IDD is endemic and iodized salt consumption is poor in the study area [9, 27].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCluster randomized controlled trial was carried out for six months from January to June 2017. The unit of randomization was households served by health development armies (villages having 27-30 households). A health development army (HDA) in Ethiopia is defined as a network of women volunteers in the same village organized to promote health, prevent disease through community participation and empowerment. The HDA facilitate identification of local problems that hinder families from utilizing key maternal, neonatal and child health services and to come up with locally acceptable strategies to address the problem.\u0026nbsp; They are also responsible frontline actors in discussing preventive health issues including health education and mobilize the community through different campaigns.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHDA inclusion and exclusion criteria \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis trial was conducted in 24 randomly selected HDAs (clusters). The clusters were stratified in to highland and lowland by expecting knowledge, attitude and practice (KAP) differences in IDD and iodized salt utilization between the dwellers of these two locations. As indicated by previous studies, highland areas are more at risk of IDD [28, 29]. Therefore, people living in these areas have more exposure to visible sequale of IDD like goiter and could have better knowledge about it. All the selected clusters in highland and lowland kebeles with a minimum inter-cluster distance of 9kms (to minimize information contamination) were included in the trial. Middle land clusters located at the boarder of lowland and highland (having no clear boundary) were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipant inclusion and exclusion criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIndividual participants were all women or reproductive age group (15-49 years) who were primarily responsible for meal preparation. Women who refused to give verbal consent, those who were mentally ill; those who had severe learning difficulties or planned to leave the area within next one year were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRandomization\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study zone had five districts and one town administration. Two of the districts were selected by simple random sampling (SRS) and the town administration was included. The list of kebeles (the smallest administrative unit in the district) as a sampling frame was obtained from each district and the town administration bureau.\u003c/p\u003e\n\u003cp\u003eThe kebeles were stratified in to highland and lowland. Accordingly, 29 highland and 31 lowland kebeles were identified, sequentially numbered and three of them randomly drawn from each stratum. In the six selected kebeles there were a total of 55 HDAs (clusters). Among them, four clusters were randomly selected from each Kebele (4*6=24clusters). Finally, two of the clusters were randomly assigned to intervention or control arm by a supervisor (health officer with BSc degree) who was unaware of the study-arm assignments in each stratum. Due to the nature of intervention, blinding of the participants was not applied. The schematic presentation of the sampling procedure was summarized in (figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntervention Modalities\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe intervention was targeted at the cluster level. Clusters were health development armies containing 27-30 households in the village. From each household a women of reproductive age group who was primarily responsible for household meal preparation was selected to participate in the trial.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTool development \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo execute the trial, first educational and training tools were prepared. The tools contain clear message on iodine, its source, benefits of iodized salt, how to handle and use iodized salt, how to store it and the consequences of not using iodized salt. To prepare these tools, we referred available resources from World Health Organization (WHO), United Nations children\u0026rsquo;s fund (UNICEF), Iodine Global Network (IGN), Ethiopian Demographic and Health Survey (EDHS), National micro-nutrient guide lines and adapted to local context and target groups [23, 30-34].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealth Development Army members selection for training\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo HDA members who fulfill the criteria (Volunteer, 10th grade completed, fluent in speaking local language, active participant in the group, stable and live in the area for the next one year) were selected\u0026nbsp; from each intervention site. Five days training supported by demonstration and posters was given by principal investigator (PI). A copy of the teaching material was also given for each TOT (training of trainer) members.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNutrition education for intervention groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor intervention groups, a six month iodine nutrition education was given by using the prepared materials. Members of HDA who actively completed five days training handled the sessions. The schedule for the session was twice every month for six consecutive months. In each one hour\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;education session, two-way process of sharing message, active involvement of the participants, freely exchange of ideas and demonstration of iodized salt was practiced.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eControl groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOn the contrary to the intervention clusters, the control clusters did not participate in any nutrition education session. They continued with their routine health care services of the ministry of health (MOH) as usual. The MOH routine health care package for the frontline health workers in Ethiopia includes 16 components. These components can be categorized in to four major areas: \u003cstrong\u003efamily health \u003c/strong\u003e(family planning, maternal and child health, nutrition and vaccination services), \u003cstrong\u003edisease prevention and control\u003c/strong\u003e (HIV/AIDS and STI, tuberculosis, malaria and first aid cares),\u0026nbsp; \u003cstrong\u003ehygiene and sanitation\u003c/strong\u003e (promotion of sanitary latrines, waste disposal management, water supply, food hygiene and safety, control of insects and rodents, personal hygiene and healthy home environment services) and \u003cstrong\u003ehealth education and communication\u003c/strong\u003e [35].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupervision, endline data collection and measurement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sessions were monitored by PI and/or assigned supervisor every month. At the end of each three month, there was review meeting in which all members including the supervisor present their work in the presence of PI. The purpose of this three months review meeting was for monitoring and process evaluation to ensure the sessions were being implemented as planned or need any adjustment. At the end of intervention period (after six months), data were collected from both groups (intervention and control) using the same data collectors and questionnaire that was used at the baseline.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll factors and tools used were made similar for both arms except the intervention. This ensured that the observed change in intervention arm was reasonably attributed to the intervention. The change in KAP (increment in knowledge, change in attitudes or reduction of risky behaviors, and improvement of practice) was measured by comparing the baseline data with end line findings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeviations from the protocol\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGenerally, the intervention was carried out as planned. However, there were some deviations from the protocol. Initially, the intervention was planned for nine months, but we believe this is too long to see the effect of intervention and reduced to six months.\u0026nbsp; As this is one of the unfunded studies, we could not be able to measure urinary iodine concentration of participants and failed to assess nutritional status as a secondary outcome. The last deviation from the study protocol was that the study lagged seven months behind the schedule because of the political instability in the country that interfered data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe outcomes were change in mean score of the three composite variables (knowledge, attitude and practice) about IDD and iodized salt after intervention. The secondary outcome, according to our plan, was change in iodine nutrition status of participants after intervention. Unfortunately, this was not done due to resource limitations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size Determination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was calculated using GPOWER 3:0 Software, by taking into account the intracluster correlation coefficient (ICC), the average cluster size, the expected effect size, and the power of the study. The ICC was assumed to be 0.04 from previous studies [36, 37], total number of clusters 24 with a minimum of 27 participants in each cluster and the expected effect size of 0.29. The effect size was estimated from the previous studies conducted in south and northwest Ethiopia [38, 39]. The study in southwest Ethiopia reported about 44.7% respondents had good knowledge and 42.6% had positive attitude towards consumption of iodized salt [38]. Similarly the northwest Ethiopian study reported about half of the households\u0026rsquo; (49.8%) added salt at the beginning and middle of food preparation (inappropriate practice). This means, the rest 50.2% added at the end of cooking process (appropriate practice) [39].\u003c/p\u003e\n\u003cp\u003eTherefore, most likely the current study zone might have similar proportions and we planned to increase good knowledge from 44.7% to 74%, positive attitude from 42.6% to 72% and appropriate practice from 50.2% to 79%. With these assumptions a power of 80% was anticipated to detect a difference in KAP scores between the two groups with \u0026alpha; err prob. of 0.05. Finally, 10% expected non-response rate/drop-out was added to get 652 as the sample size for the trial.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTraining was given for twelve data collectors (health extension workers) on how to use the questionnaire, ethical issue, revisiting closed houses and their work relationship with the supervisor for three days. The questionnaire was pretested on non-selected but similar adjacent kebeles. A week after pretest, baseline data were collected from both intervention and control clusters by face to face interview using structured and modified questionnaire. The same tool and data collectors were used to collect endline data after six months of intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstrument Validity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor face validity, 32 households (5% of the sample) were interviewed and each questionnaire was completed by data collectors. The completed questionnaire was collected and evaluated by the principal investigator, co-investigators and a statistician. For content validity, an expert of three specialists in endocrinology, nutrition and biostatistics examined the initial questionnaire. The experts were asked to comment on individual items in relation to the accuracy and content. Finally, items were modified slightly based on the findings from pretest and the expert reviews.\u003c/p\u003e\n\u003cp\u003eIn addition, Cronbach\u0026rsquo;s \u0026alpha; was determined for internal consistency (Cronbach\u0026rsquo;s \u0026alpha;=0.93, 0.77 and 0.71 for knowledge, attitude and practice respectively). Addition of iodized salt at the end of cooking process, not washing the salt before use and not exposing it to sunlight are some of the recommended practices of iodized salt. Convergent validity was checked by observing the practice of women against these recommended practices during demonstration sessions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasurement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected using a series of 16 questions about knowledge of IDD and iodized salt and eight questions about practice of iodized salt. In each case a correct response was given a score of one, whereas an incorrect response was given a score of zero. Then, knowledge and practice indices were produced by adding individual answers across items.\u003c/p\u003e\n\u003cp\u003eSimilarly, data on attitude about iodized salt and goiter were collected using a series of seven questions. Each question had three options (yes, no or don\u0026rsquo;t know) and a three-point Likert scale (agree, disagree or neutral). The responses were dichotomized in to \u0026ldquo;yes\u0026rdquo; or \u0026ldquo;no\u0026rdquo; and \u0026ldquo;agree\u0026rdquo; or \u0026ldquo;disagree\u0026rdquo; as there was no response on third options (\u0026ldquo;don\u0026rsquo;t know\u0026rdquo; and \u0026ldquo;neutral\u0026rdquo;). A score of one was given for responses that defined positive attitude and a score of zero was given for negative ones. An index for attitude was produced after summing individual answers across items.\u003c/p\u003e\n\u003cp\u003eFinally, for all the three indices (knowledge, attitude and practice scores), we computed the difference by subtracting the baseline value from the endline. These differences were used as response variables for the subsequent analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Processing and Analysis \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were doubly entered into Epi Info version 3.5.3, cleaned and analyzed using SPSS version 21 (SPSS Inc. Chicago, USA). Descriptive statistics were summarized using frequency and proportions. The mean difference in KAP scores between intervention and control groups was tested using independent sample t-test. Principal component analysis (PCA) was used to construct a wealth index from 20 household fixed asset such as presence of latrine, source of drinking water, possession of television, radio, mobile telephone, availability of separate kitchen from living house, domestic animal and land possessed in hectare. These variables were dichotomized and coded \u0026lsquo;1\u0026rsquo; for the household possessing the asset and \u0026lsquo;0\u0026rsquo; for the rest. Finally, the factor scores ranked ordered into three relative measures of socio-economic classes (poor, medium and rich).\u003c/p\u003e\n\u003cp\u003eFor this study, the primary outcome measures were composite variables (knowledge, attitude and practice scores) determined by summing all responses across items and subtracting the baseline sum from the endline to get the difference. These differences in scores were taken as an outcome variable for each.\u003c/p\u003e\n\u003cp\u003eAs mentioned above, there were two measurements on the same subject (baseline and endline). Since repeated observations within one subject are considered not independent of each other, the standard linear regression could not allow for the repeated measures and could underestimate the standard error. In this case, the Generalized Estimating Equations (GEE) was used to extend the generalized linear model to allow for analysis of repeated measurements. GEE helps to correct for the expected within-subject correlations [40]. Therefore, after checking all assumptions including multicolinearity (maximum VIF=1.240), we fitted generalized linear models (GEE).\u003c/p\u003e\n\u003cp\u003eFirst, we run bivariate analysis for each outcome variable. Then, to control for confounding and adjust for within cluster correlation of measurements, all variables with a p-value \u0026le; 0.2 in the bivariate analysis were fitted into the model for multivariable analysis. All analysis was conducted according to intention-to treat principles and a p-value of 0.05 or less was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSocio-economic and outcome variables at baseline\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBaseline data collected before the start of the intervention in 2016 showed that the two groups were comparable for both socioeconomic and outcome variables, except for age group and wealth category. Relatively higher numbers of participants with advanced age category (35-49 years) were found in the intervention group (37.1% vs. 17.8%). The numbers of participants with poor and medium wealth status were higher in control (44.5% vs. 34.7%) and intervention (25.2% vs. 16.3%) groups respectively. All the participants of this study were women of reproductive age group (15-49 years) in southwest Ethiopia (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResponse rate and attendance\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 647 (99.2%) participants were successfully surveyed at the endline. In the intervention group, the median attendance was 10 (ranging from 4 to 12 sessions). All participants in the intervention group attended the first session, but three (0.9%) of them dropped out during the intervention period. Similarly, two (0.6%) participants were disappeared from the control group. The overall participant flow had been summarized using CONSORT flow diagram (Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcomes and estimation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eScores in knowledge about IDD, attitude towards and practice of iodized salt were analyzed for change between groups after six months nutrition education intervention. To appreciate the change, we calculated the mean difference between the two groups (intervention vs control) with the corresponding precision (95% CI) for each of the primary outcomes (knowledge, attitude and practice scores) after adjustment for the baseline covariates. The adjusted effect measures were considered as the main results.\u003c/p\u003e\n\u003cp\u003eWomen in the intervention group had shown statistically significant change in knowledge, attitude and practice scores as compared to control one. The mean difference (MD) \u003cu\u003e+\u003c/u\u003e standard deviation (SD) for women in the intervention group was (8.82\u003cu\u003e+\u003c/u\u003e3.56) for knowledge, (3.00\u003cu\u003e+\u003c/u\u003e2.15) for attitude and (3.11\u003cu\u003e+\u003c/u\u003e1.67) for practice scores respectively. The differences in score for all three outcome variables were statistically significant with knowledge (\u0026beta;=8.81; 95% CI: 8.46, 9.16), attitude (\u0026beta;=3.35; 95% CI: 3.17, 3.54) and practice (\u0026beta;=2.90; 95% CI: 2.74, 3.05). For the control groups such differences were negligible for all the outcome variables as indicated in (Table 2). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo identify independent factors associated with the endline-baseline difference of the differences in the mean KAP scores, we employed multivariable Generalized Estimating Equations (GEE). Variables included in the model were: age, family size, educational status, geographic location, wealth index, availability of iodized salt in nearby shop/market and the intervention.\u003c/p\u003e\n\u003cp\u003eOut of all other variables, intervention was the only independent predictor of all three outcome variable scores (knowledge, attitude and practice). Among the remaining variables, only wealth index was significantly associated with the knowledge score. On the other hand, family size, educational status and wealth index were significantly associated with attitude score and geographic location and availability of iodized salt in nearby shop were significantly associated with practice score.\u003c/p\u003e\n\u003cp\u003eAll the three outcome variable scores were increased on average nearly by nine points for knowledge (\u0026beta; = 8.81, 95%CI = 8.46, 9.16), by three points for attitude (\u0026beta; = 3.35, 95%CI = 3.17, 3.54), and practice (\u0026beta; = 2.90, 95%CI = 2.74, 3.05) each in the intervention arm. Wealth index and knowledge score were inversely related ((\u0026beta; =-0.499, 95%CI = -0.947, -0.050). For a unit increase in family size, the average attitude score increased by 0.538 (\u0026beta; = 0.538, 95%CI = 0.106, 0.970). Similarly, attitude score increased as educational level increases (\u0026beta; = 0.573, 95% CI = 0.174, 0.971) and for the poor wealth category (\u0026beta; = 0.695, 95% CI = 0.249, 1.142). On the other hand, practice score decreased (\u0026beta; =-0.567, 95%CI = -0.760, -0.375) as the availability of iodized salt in nearby shop/market decreased and for the highland dwellers (\u0026beta; = -0.314, 95% CI = -0.512, -0.117) (Table 3).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDespite global improvement in iodine nutrition status, achieving sustainable elimination of its deficiency remained a great challenge in Ethiopia. Consumption of iodized salt, the most widely recommended global strategy to control and eliminate iodine deficiency, had several limitations and gaps in the country. Among these, knowledge gap, misperceptions and improper practices of iodized salt are at the top list [18-21].\u003c/p\u003e\n\u003cp\u003eThis community based cluster randomized controlled trial study was designed and implemented iodine nutrition education intervention to address such problem in southwest Ethiopia. Before the study, baseline survey was conducted and identified the existing levels of KAP concerning IDD and iodized salt and the gap.\u003c/p\u003e\n\u003cp\u003eAt the beginning of the study, there was no significant difference for KAP scores about IDD and iodized salt in both intervention and control groups. Approximately half of the women in both groups scored below mean at baseline. However; as summarized in table 2 and 3, for all three outcome variable scores there was significant difference between the two groups after six months of nutrition education intervention.\u003c/p\u003e\n\u003cp\u003eThe average knowledge score approximately tripled for intervention arm at the endline. Similar results were observed in studies conducted in India to find out the impact of health education intervention on awareness and consumption of iodized salt in school children [14] and a randomized controlled trial conducted in Iran to evaluate the effectiveness of educational program on the iodine nutrition status of pregnant women [19].\u003c/p\u003e\n\u003cp\u003eRegarding the attitude and practice scores, the mean differences were 3.35 and 2.90 respectively at the endline. This means, on average, the scores tripled for both attitude and practice after the nutrition education intervention. The findings were supported by previous studies conducted and identified the positive impact of education and awareness raising program to increase the iodized salt consumption in Pakistan [14], India [14] and Iran [19].\u003c/p\u003e\n\u003cp\u003eAs indicated in multivariable analysis, factors such as educational status, wealth status, geographic location and availability of iodized salt in nearby shop/market should be considered before designing education sessions. In this study, participants with poor wealth category and informal education had shown favorable attitude towards iodized salt. On the other hand, being in poor wealth category and living in highland area were negatively related with knowledge and practice scores respectively.\u003c/p\u003e\n\u003cp\u003eAccording to the finding of this study, the effect of nutrition education was similar across women with different educational status for knowledge component. However, for poor women who had no formal education, the sessions should focus on attitude component. In addition, one should ensure the accessibility of iodized salt before designing educational sessions on practice as participants who had no access to iodized salt within less than 30 minutes walking distance had shown poor practice of iodized salt.\u003c/p\u003e\n\u003cp\u003eGenerally, the outcomes of this study were clear indications of the effectiveness of iodine nutrition related education intervention in improving the knowledge about IDD and iodized salt, changing misperception and inappropriate practice of iodized salt in the study population.\u003c/p\u003e\n\u003cp\u003eThe findings of this study have wide practical implications. Although the government of Ethiopia has been implementing iodization of salt as an intervention strategy for the past one decade, there are still differences in the way households understand the program and their uptake of it. The findings also showed that giving enhanced education through the existing government structure including the frontline actors and health development army will significantly contribute to the reduction of IDD in Ethiopia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlmost all sessions were peer-guided; interactive with free exchange of ideas and some of them were demonstration based, which could be considered as strength of this study. The fact that the questionnaire was filled based on self-report could be acknowledged as a limitation as it might induce some social desirability bias. However, efforts were made to probe the participants and explain the purpose of the study and we believe that it may not affect the validity. The other limitation could be our failure to assess nutritional status of participants.\u0026nbsp; Even though we planned to measure nutritional status as a secondary outcome, we couldn\u0026rsquo;t be able to do this because of limited resources. However; failure to do this, may not affect our findings and conclusion as this was not our primary objective.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eDespite the complex nature of human behavior, a well-designed, community-based and peer-guided iodine nutrition education is an effective tool to improve knowledge about IDD and to change misperception and inappropriate practice of iodized salt in settings where IDD is endemic and iodized salt consumption is poor.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCONSORT--------------------------------Consolidated Standards of Reporting Trials\u003c/p\u003e\n\u003cp\u003eEDHS---------------------------------------Ethiopian Demographic and Health Survey\u003c/p\u003e\n\u003cp\u003eGEE-----------------------------------------Generalized Estimating Equations\u003c/p\u003e\n\u003cp\u003eHAD-----------------------------------------Health Development Army\u003c/p\u003e\n\u003cp\u003eHEW----------------------------------------Health Extension Worker\u003c/p\u003e\n\u003cp\u003eIDD------------------------------------------Iodine Deficiency Disorders\u003c/p\u003e\n\u003cp\u003eIGN------------------------------------------Iodine Global Network\u003c/p\u003e\n\u003cp\u003eKAP-----------------------------------------Knowledge, Attitude, Practice\u003c/p\u003e\n\u003cp\u003eMOH----------------------------------------Ministry of Health\u003c/p\u003e\n\u003cp\u003ePCA-----------------------------------------Principal Component Analysis\u003c/p\u003e\n\u003cp\u003ePI--------------------------------------------Principal Investigator\u003c/p\u003e\n\u003cp\u003eSRS-----------------------------------------Simple Random Sampling\u003c/p\u003e\n\u003cp\u003eUNICEF-----------------------------------United Nations Children\u0026rsquo;s Fund\u003c/p\u003e\n\u003cp\u003eUSI------------------------------------------Universal Salt Iodization\u003c/p\u003e\n\u003cp\u003eVIF------------------------------------------Variance Inflation Factor\u003c/p\u003e\n\u003cp\u003eWHO---------------------------------------World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance and approval was obtained from Jimma University, College of public health and medical sciences ethical clearance review committee (IRB). The IRB deeply examined this work at proposal level and approved with the letter issued on 10, Feb 2016 (Ref. No-RPGC/4052/ 08). Permission was obtained from government officials and community leaders before randomization.\u0026nbsp; After establishment of consent at cluster levels, an eligible woman from household was consulted for voluntariness. Finally, the woman who agreed to participate was included in to the trial.\u003c/p\u003e\n\u003cp\u003eWritten consent was not necessary at least for two reasons: first, the research protocol was about nutrition education, which was neither hostile nor invasive to the study participants. Secondly, according to the legislative of research ethics in Jimma University, having verbal consent suffices for non-invasive research procedures. Moreover, all the study participants were informed about the purpose and confidentiality of the information along with their right to refuse. The study was also registered on pan African clinical trials registry with a registration number of PACTR 201809544276357 on 14 Sept 2018.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication-\u003c/strong\u003enot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by Jimma University (Ref. No- RPGC/4052/2008). The funder had no role in this study other than financial contribution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA. A \u003c/strong\u003econceived and designed the study, performed the analysis and interpretation and drafted the manuscript. \u003cstrong\u003eB.T\u003c/strong\u003e participated in the study design, analysis and manuscript revision. \u003cstrong\u003eG.T\u003c/strong\u003e participated in the analysis and interpretation. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the study participants, data collectors and supervisor for their willingness and participation. We appreciate Jimma University, Wolkite University and Dawro zone health department for their support and encouragement.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAburto N, Abudou M, Candeias V, Wu T. Effect and safety of salt iodization to prevent iodine deficiency disorders: a systematic review with meta-analyses. WHO eLibrary of Evidence for Nutrition Actions (eLENA). Geneva, World Health Organization. 2014; Found at: \u003ca href=\"http://apps.who.int/iris/bitstream/10665/148175/1/9789241508285_eng.pdf\"\u003ehttp://apps.who.int/iris/bitstream/10665/148175/1/9789241508285_eng.pdf\u003c/a\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"2\"\u003e\n\u003cli\u003eHernando VU, Anilza BP, Hernan STC. Iodine Deficiency Disorders. Thyroid Disorders Therapy, 2015, 4:172. doi:10.4172/2167-7948.1000172\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"3\"\u003e\n\u003cli\u003eAndersson, V. Karumbunathan and M. B. Zimmermann. \"Global Iodine Status in 2011 and Trends over the Past Decade\u0026rdquo;. \u003cem\u003eJournal of Nutrition\u003c/em\u003e. 2012; 142 (4): 744-750.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"4\"\u003e\n\u003cli\u003eElizabeth N. Pearce, Maria Andersson, Michael B. Zimmermann. Global Iodine Nutrition: where do we stand in 2013? Zurich, Switzerland. Thyroid; 2013, 23(5): Found at: \u003ca href=\"http://www.ign.org/cm_data/2013_Pearce_Global_iodine_nutritionWhere_do_we_stand_in2013_Thyroid.pdf\"\u003ehttp://www.ign.org/cm_data/2013_Pearce_Global_iodine_nutritionWhere_do_we_stand_in2013_Thyroid.pdf\u003c/a\u003e. Date accessed 21, Nov 2017.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"5\"\u003e\n\u003cli\u003eFrancesco Branca, Jonas Vollmer, Jessica, Michael Zimmerman. Eliminating iodine deficiency disorders by 2020. Zurich, Switzerland. 26 May\u0026nbsp;2017. Available at: https://www.gainhealth.org/knowledge-centre/toward-elimination-iodine-deficiency-disorders-2020/ D. Accessed on 25, Oct 2017.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"6\"\u003e\n\u003cli\u003eTirhas M. Gebretsadikan and Aron M. Troen. Progress and challenges in eliminating iodine deficiency in Ethiopia: a systematic review. BMC Nutrition. 2016; 2:12, pp 1-12\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"7\"\u003e\n\u003cli\u003e\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/?term=Girma%20K%5Bauth%5D\"\u003eKibatu Girma\u003c/a\u003e, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/?term=Nibret%20E%5Bauth%5D\"\u003eEndalkachew Nibret\u003c/a\u003e, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/?term=Gedefaw%20M%5Bauth%5D\"\u003eMolla Gedefaw\u003c/a\u003e. The Status of Iodine Nutrition and Iodine Deficiency Disorders Among School Children in Metekel Zone, Northwest Ethiopia. Eth. J. Health sci. 2014; 24(2): 109-116.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"8\"\u003e\n\u003cli\u003eHailay Gebrearegawi Gebremariam, Melke Edris Yesuf, and Digsu Negese Koye. Availability of Adequately Iodized Salt at Household Level and Associated Factors in Gondar Town, Northwest Ethiopia. Hindawi Publishing Corporation. 2013; Vol.2013: 1-6.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"9\"\u003e\n\u003cli\u003eAsfaw A, Belachew T. Magnitude of iodine deficiency disorder and associated factors in Dawro zone, southwest Ethiopia; the hidden hunger: a cross-sectional study.\u003cem\u003e BMC Nutrition, 2020 (Accepted); \u003c/em\u003e\u003ca href=\"https://doi.org/10.1186/s40795-020-00345-8\"\u003ehttps://doi.org/10.1186/s40795-020-00345-8\u003c/a\u003e.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"10\"\u003e\n\u003cli\u003eMichael P. Kelly, Mary Barker. Why is changing health-related behavior so difficult? Elsevier. 2016; 136:109-116. Available online at sciencedirect.com\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"11\"\u003e\n\u003cli\u003eJohnson MJ, May CR. Promoting professional behavior change in healthcare: what interventions work, and why? A theory-led overview of systematic reviews. BMJ Open 2015; 5: e008592. doi: 10.1136/bmjopen-2015- 008592\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"12\"\u003e\n\u003cli\u003eYvette Fautsch Macias and Peter Glasauer\u003cstrong\u003e.\u003c/strong\u003e Guidelines for assessing nutrition-related knowledge, attitudes and practices. Food and Agriculture Organization of the United Nations, Rome, 2014. Available at: \u003ca href=\"http://www.fao.org/docrep/019/i3545e/i3545e.pdf\"\u003ehttp://www.fao.org/docrep/019/i3545e/i3545e.pdf\u003c/a\u003e.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"13\"\u003e\n\u003cli\u003eNicola Lowe, Elizabeth Westaway, Akhtar Munir, et al (2015). Increasing Awareness and Use of Iodized Salt in a Marginalized Community Setting in North-West Pakistan. J Nut. 2015; 7, 9672\u0026ndash;9682; \u003ca href=\"http://www.mdpi.com/journal/nutrients.Publ\"\u003emdpi.com/journal/nutrients.Publ\u003c/a\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"14\"\u003e\n\u003cli\u003eAnsari MA, Khan Z. Impact of health education intervention on consumption of iodized salt in school children in Aligarh, India. Int J Comm. Med and Public Health, 2016; 3:1431-6.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"15\"\u003e\n\u003cli\u003eLisa Garnweidner-Holme, Inger Aakre, Anne Marie Lilleengen, Anne Lise Brants\u0026aelig;ter and Sigrun Henjum. Knowledge about Iodine in Pregnant and Lactating Women in the Oslo Area, Norway. Nutrients 2017, 9, 493; doi: 10.3390/nu9050493.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"16\"\u003e\n\u003cli\u003eLucas, C.J.; Charlton, K.E.; Brown, L.; Brock, E.; Cummins, L. Antenatal shared care: Are pregnant women being adequately informed about iodine and nutritional supplementation? Aust. N. Z. J. Obstet. Gynaecol. 2014, 54 (6):515\u0026ndash;521.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"17\"\u003e\n\u003cli\u003e\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Naghashpour%20M%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=25395905\"\u003eMahshid Naghashpour\u003c/a\u003e, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Shakerinejad%20G%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=25395905\"\u003eGhodratollah Shakerinejad\u003c/a\u003e, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Lourizadeh%20MR%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=25395905\"\u003eMohammad Reza, Lourizadeh\u003c/a\u003e \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Hajinajaf%20S%5BAuthor%5D\u0026amp;cauthor=true\u0026amp;cauthor_uid=25395905\"\u003eSaeedeh Hajinajaf\u003c/a\u003e and Farzaneh Jarvandi. Nutrition Education Based on Health Belief Model Improves Dietary Calcium Intake among Female Students of Junior High Schools. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221448/\"\u003eJ Health Popul Nutr\u003c/a\u003e. 2014; 32(3): 420\u0026ndash;429.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"18\"\u003e\n\u003cli\u003eLadan Mehran, Pantea Nazeri, Hossein Delshad, Parvin Mirmiran, Yadollah Mehrabi and Fereidoun Azizi. Does a text messaging intervention improve knowledge, attitudes and practice regarding iodine deficiency and iodized salt consumption? Iran. Public Health Nutrition, 2012, 15(12): 2320\u0026ndash;2325.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"19\"\u003e\n\u003cli\u003eAmiri, P.; Hamzavi Zarghani, N.; Nazeri, P. Can an educational intervention improve iodine nutrition status in pregnant women? A randomized controlled trial. Thyroid 2017, 27, 418\u0026ndash;425.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"20\"\u003e\n\u003cli\u003eAhmed Elnadif Ahmed, Safa Abdalla Elnour, Yousif Mohammed Ahmed. Knowledge and attitude of population towards iodized salt in Shendi locality river Nile state in Sudan\u003cstrong\u003e.\u003c/strong\u003e European Scientific Journal, 2017, 13 (6):312-22.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"21\"\u003e\n\u003cli\u003eO\u0026rsquo;Kane, S., Pourshahidi, L., Farren, K., Mulhern, M., Strain, J., \u0026amp; Yeates, A. Iodine knowledge is positively associated with dietary iodine intake among women of childbearing age in the UK and Ireland. Br. J. Nutr. 2016, 116(10), 1728-1735.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"22\"\u003e\n\u003cli\u003eTeklay Kidane, Aregai Woldegebriel. Prevalence of Iodine deficiency disorder in a highland district in Tigray: Brief Communication. Ethip.J.Health Dev. 2006; 20(1): 59-60.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"23\"\u003e\n\u003cli\u003eWorld Health Organization, Assessment of iodine deficiency disorders and monitoring their elimination: A guide for program managers, 3rd ed., Geneva, WHO, 2007: 6-54.\u003c/li\u003e\n\u003cli\u003eA. Enset Value Chain, the Case of Dawro Zone, Southern Nations Nationalities and Peoples Regional State, Ethiopia. International Journal of African and Asian Studies, Vol.30, 2017. ISSN 2409-6938. Available at: \u003ca href=\"http://iiste.org/Journals%20/index.%20php/%20JAAS/%20article/view%20File/35383/36403\"\u003ehttp://iiste.org/Journals /index. php/ JAAS/ article/view File/35383/36403\u003c/a\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"25\"\u003e\n\u003cli\u003eThe development study on the strengthening agricultural marketing system in southern nation\u0026rsquo;s nationalities and peoples region. Final report, November 2012. PP.2.2. Date accessed 25, March 2018.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"26\"\u003e\n\u003cli\u003eCentral Statistical Agency [Ethiopia]. 2014. Ethiopia Mini Demographic and Health Survey 2014. Addis Ababa, Ethiopia.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"27\"\u003e\n\u003cli\u003eShimelash Bitew Workie, Yemane Gebremariam Abebe, Amha Admasie Gelaye and Tefera Chane Mekonen. Assessing the status of iodine deficiency disorder (IDD) and associated factors in Wolaita and Dawro Zones School Adolescents, southern Ethiopia.\u003cem\u003e BMC Res Notes (2017), 10:156, pp 1-12. Available online at:\u003c/em\u003e \u003ca href=\"https://www.ncbi.nlm.nih\"\u003ehttps://www.ncbi.nlm.nih\u003c/a\u003e. gov/pmc/articles/PMC5395884/\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"28\"\u003e\n\u003cli\u003eAbuye C, Berhane Y, T. Ersumo. The Role of Changing Diet and Altitude on Goitre Prevalence in 5 Regional States in Ethiopia. East Afr. J. Public Health.2008; 5(3):163-8.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"29\"\u003e\n\u003cli\u003eAhmed M, Zama SY, Nagarajarao V, Khan MA. Iodine deficiency in children: A comparative study in two districts of south-interior Karnataka, India. J Fam Community Med 2014; 21:48-5\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"30\"\u003e\n\u003cli\u003eCentral Statistical Agency [Ethiopia] and ORC Macro EDHS 2011. CSA, Addis Ababa, Ethiopia and Calverton, Maryland, USA; 2012. Available at: \u003ca href=\"https://dhs\"\u003e\u003cem\u003ehttps://dhs\u003c/em\u003e\u003c/a\u003e\u003cem\u003e com/ pubs /pdf/FR255/FR255.pdf\u003c/em\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"31\"\u003e\n\u003cli\u003eIodine Global Network. Global Scorecard of Iodine Nutrition in 2017 in the general population and in pregnant women (PW). IGN: Zurich, Switzerland. 2017. Available at: \u003ca href=\"http://www.ign.org/cm_data/IGN_Global_Scorecard_AllPop_and_PW_May2017.pdf\"\u003ehttp://www.ign.org/cm_data/IGN_Global_Scorecard_AllPop_and_PW_May2017.pdf\u003c/a\u003e. Accessed on 25, Oct 2017.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"32\"\u003e\n\u003cli\u003eUNICEF, IGN. Technical Working Group Meeting on Research Priorities for the Monitoring of Salt Iodization Programs and Determination of Population Iodine Status. New York: UNICEF; 2016.Found at \u003ca href=\"https://www.unicef.org/nutrition/files/%20UNICEF_%20IGN%20_%20Iodine_Technical_Consultation_2015.pdf\"\u003ehttps://www.unicef.org/nutrition/files/ UNICEF_ IGN _ Iodine_Technical_Consultation_2015.pdf\u003c/a\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"33\"\u003e\n\u003cli\u003eNational guideline for control and prevention of micronutrient deficiencies. Ethiopia, June 2004. Date accessed, 16 April 2016.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"34\"\u003e\n\u003cli\u003eElimination of iodine deficiency disorders. A manual for health workers. EMRO Technical Publications Series 35; 2008. \u003ca href=\"http://applications.emro.who.int/dsaf/dsa928.pdf\"\u003ehttp://applications.emro.who.int/dsaf/dsa928.pdf\u003c/a\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"35\"\u003e\n\u003cli\u003eAssefa, Y., Gelaw, Y.A., Hill, P.S. \u003cem\u003eet al.\u003c/em\u003e Community health extension program of Ethiopia, 2003\u0026ndash;2018: successes and challenges toward universal coverage for primary healthcare services. \u003cem\u003eGlobal Health\u003c/em\u003e \u003cstrong\u003e15, \u003c/strong\u003e24 (2019) doi:10.1186/s12992-019-0470-1\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"36\"\u003e\n\u003cli\u003eMonica Taljaard \u0026amp; Jeremy M Grimshaw. Concept, characteristics and implications of cluster randomization. Clin. Invest. 2014; 4(1), 1\u0026ndash;4.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"37\"\u003e\n\u003cli\u003eFrancis NA, Butler CC, Hood K, Simpson S, Wood F, and Nuttall J. Effect of using an interactive booklet about childhood respiratory tract infections in primary care consultations on reconsulting and antibiotic prescribing: a cluster randomized controlled trial. \u003cem\u003eBMJ\u003c/em\u003e. 2009; 339:b2885. Published 2009 Jul 29. doi:10.1136/bmj.b2885.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"38\"\u003e\n\u003cli\u003e\u003ca href=\"http://journals.sagepub.com/author/Haji%2C+Yusuf\"\u003eYusuf Haji\u003c/a\u003e, \u003ca href=\"http://journals.sagepub.com/author/Abdurahmen%2C+Junayde\"\u003eJunayde Abdurahmen\u003c/a\u003e, \u003ca href=\"http://journals.sagepub.com/author/Paulos%2C+Wondimagegn\"\u003eWondimagegn Paulos\u003c/a\u003e. Knowledge and perception of Consumption of iodized salt among food handlers in Southern Ethiopia. SAGE J. 2016; 38 (1). Found at\u003cstrong\u003e: \u003c/strong\u003e\u003ca href=\"http://journals.sagepub.com/doi/pdf/\"\u003ehttp://journals.sagepub.com/doi/pdf/\u003c/a\u003e1177/03795 7211 6684909\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"39\"\u003e\n\u003cli\u003eZegeye Abebe, Ejigu Gebeye and Amare Tariku. Poor dietary diversity, wealth status and use of un- iodized salt are associated with goiter among school children: a cross-sectional study in Ethiopia. BMC Public Health. 2017; 17:44. DOI 10.1186/s12889-016-3914-z.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"40\"\u003e\n\u003cli\u003eTwisk J. Applied longitudinal data analysis for epidemiology: A practical guide. United States of America: Cambridge University press; 2003.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:40.5pt;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-indent:-40.5pt;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eTable 1\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;Description of s\u003c/span\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eocio-demographic and outcome variables at baseline in intervention and control groups, southwest Ethiopia, 2016\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003ctable style=\"width:461.7pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 128pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eVariable\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 124.05pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:-5.4pt;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:-5.4pt;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:-5.4pt;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Category\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 209.65pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 9.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eGroups\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118.3pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 35.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eIntervention\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e(n=326)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eNumber (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.35pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 35.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eControl\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e(n=326)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eNumber (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 128pt;border: none;padding: 0in 5.4pt;height: 51pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eAge category\u003cspan style=\"color:black;\"\u003e\u0026nbsp;in years\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New 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51pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e69 (21.2)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e136 (41.7)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e85 (26.1)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e36 (11.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.35pt;border: none;padding: 0in 5.4pt;height: 51pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e93 (28.5)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e175 (53.7)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e42 (12.9)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New 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\u003ctd style=\"width: 118.3pt;padding: 0in 5.4pt;height: 24.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e198 (60.7)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e128 (39.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.35pt;padding: 0in 5.4pt;height: 24.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e218 (66.9)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e108 (33.1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 128pt;padding: 0in 5.4pt;height: 0.3in;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eEducatio\u003cspan style=\"color:black;\"\u003enal status\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124.05pt;padding: 0in 5.4pt;height: 0.3in;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eInformal\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eFormal\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118.3pt;padding: 0in 5.4pt;height: 0.3in;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 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style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e190 (58.3)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e136 (41.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 128pt;padding: 0in 5.4pt;height: 0.35in;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eMarital status\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124.05pt;padding: 0in 5.4pt;height: 0.35in;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eMarried\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eSingleᶿ\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118.3pt;padding: 0in 5.4pt;height: 0.35in;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e265 (81.3)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e61 (18.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.35pt;padding: 0in 5.4pt;height: 0.35in;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e257 (78.8)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e69 (21.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 128pt;padding: 0in 5.4pt;height: 22pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eGeographic location\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124.05pt;padding: 0in 5.4pt;height: 22pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eHighland\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eLowland\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118.3pt;padding: 0in 5.4pt;height: 22pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e164 (50.3)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e162 (49.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.35pt;padding: 0in 5.4pt;height: 22pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e162 (49.7)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e164 (50.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 128pt;padding: 0in 5.4pt;height: 35.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eWealth index\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124.05pt;padding: 0in 5.4pt;height: 35.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003ePoor\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eMedium\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eRich\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118.3pt;padding: 0in 5.4pt;height: 35.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e113 (34.7)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e82 (25.2)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e131 (40.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.35pt;padding: 0in 5.4pt;height: 35.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e145 (44.5)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e53 (16.3)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e128 (39.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 128pt;padding: 0in 5.4pt;height: 11.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eKnowled\u003cspan style=\"color:black;\"\u003ege score\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e(5.22 \u0026plusmn; 2.89)\u003c/span\u003e\u003csup\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026micro;\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124.05pt;padding: 0in 5.4pt;height: 11.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003ePoor\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eGood\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118.3pt;padding: 0in 5.4pt;height: 11.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e187 (57.4)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e139 (42.6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.35pt;padding: 0in 5.4pt;height: 11.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e209 (64.1)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e117 (35.9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 128pt;padding: 0in 5.4pt;height: 12.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eAttitude score\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e(3.36 \u0026nbsp;\u0026plusmn; 2.01)\u003c/span\u003e\u003csup\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u0026micro;\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124.05pt;padding: 0in 5.4pt;height: 12.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eUnfavorable\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eFavorable\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118.3pt;padding: 0in 5.4pt;height: 12.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e213 (65.3)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e113 (34.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.35pt;padding: 0in 5.4pt;height: 12.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e210 (64.4)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e116 (35.6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 128pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 25.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003ePractice score\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e(4.26 \u0026plusmn; 1.53)\u003c/span\u003e\u003csup\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u0026micro;\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124.05pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 25.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eInappropriate\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.25in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eAppropriate\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118.3pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 25.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e199 (61.0)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:.05in;margin-bottom: 0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e127 (39.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.35pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 25.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e189 (58.0)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e137 (42.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eSingleᶿ-Not married, separately living, divorced and widowed \u0026nbsp; \u003cspan style=\"color:black;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003csup\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026micro;\u003c/span\u003e\u003c/sup\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;(mean \u0026plusmn; SD) \u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\u003cp\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:45.0pt;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-indent:-45.0pt;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Times New Roman\",serif;'\u003eTable 2: Effect of nutrition education intervention on knowledge, attitude and practice of iodine deficiency and iodized salt consumption in southwest Ethiopian Women\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"width:473.4pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72.9pt;border-top: 1.5pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 35.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eOutcome variables\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;border-top: 1.5pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 35.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;Groups\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border-top: 1.5pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 35.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp; Baseline Mean (SD)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border-top: 1.5pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 35.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp; Endline\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eMean (SD)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border-top: 1.5pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 35.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eDifference\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eMean (SD)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;border-top: 1.5pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 35.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eAdjusted effect\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e(DoD),(95%CI)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72.9pt;border: none;padding: 0in 5.4pt;height: 6.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;border: none;padding: 0in 5.4pt;height: 6.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border: none;padding: 0in 5.4pt;height: 6.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border: none;padding: 0in 5.4pt;height: 6.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border: none;padding: 0in 5.4pt;height: 6.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;border: none;padding: 0in 5.4pt;height: 6.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 72.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eKnowledge Score\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eIntervention\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e5.36 (2.94)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e14.20 (2.00)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e8.82 (3.56)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e8.81 (8.46, 9.16)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eControl\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;padding: 0in 5.4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e5.08 (2.83)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;padding: 0in 5.4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e5.24 (3.12)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e0.14 (0.86)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 72.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eAttitude Score\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eIntervention\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e3.42 (2.03)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e6.43 (0.92)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e3.00 (2.15)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e3.35 (3.17, 3.54)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;height: 10.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eControl\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;padding: 0in 5.4pt;height: 10.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e3.30 (1.99)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;padding: 0in 5.4pt;height: 10.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e3.12 (1.49)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;height: 10.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e-0.19 (2.92)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 10.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 72.9pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003ePractice Score\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eIntervention\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e4.21 (1.56)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e7.32 (0.84)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e3.11 (1.67)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e2.90 (2.74, 3.05)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eControl\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e4.32 (1.50)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e4.45 (1.51)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e0.12 (0.78)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Times New Roman\",serif;'\u003eSD=Standard deviation, \u0026nbsp; \u0026nbsp;DOD=Difference of difference\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:20.0pt;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\u003cp\u003e\n\u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-right:-58.5pt;margin-bottom:.0001pt;margin-left:-27.0pt;text-indent:-.5in;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eTable 3\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;Generalized Estimating Equations predicting baseline-endline difference of the differences in knowledge, attitude and practice of iodine deficiency disorder and iodized salt among women in Southwest Ethiopia, 2016-17\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width: 6.0e+2pt;margin-left:-.8in;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 267.9pt;border-right: none;border-bottom: none;border-left: none;border-image: initial;border-top: 1.5pt solid windowtext;padding: 0in 5.4pt;height: 6.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-left:139.6pt;'\u003e\u003cstrong\u003eKnowledge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.8pt;border-top: 1.5pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 6.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 2.25in;border-top: 1.5pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 6.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-left:19.8pt;'\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;Attitude\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 157.2pt;border-top: 1.5pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 6.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-left:47.4pt;'\u003e\u003cstrong\u003ePractice\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height:6.15pt;border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 103.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;height: 13.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-left:7.6pt;'\u003ePredictors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 94.5pt;border-top: 1.5pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 13.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026beta; (St. Error)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69.9pt;border-top: 1.5pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 13.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" style=\"width: 11.8pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;height: 13.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 81pt;border: none;padding: 0in 5.4pt;height: 13.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-left:1.8pt;'\u003e\u0026nbsp;\u0026beta; (St. Error)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 81pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid black;padding: 0in 5.4pt;height: 13.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76.5pt;border: none;padding: 0in 5.4pt;height: 13.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp; \u0026nbsp;\u0026beta; (St. Error)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 80.7pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid black;padding: 0in 5.4pt;height: 13.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height:13.8pt;border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 69.9pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;height: 13.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eLower Upper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" style=\"width: 81pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;height: 13.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eLower \u0026nbsp; \u0026nbsp;Upper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 80.7pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;height: 13.45pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eLower \u0026nbsp; \u0026nbsp;Upper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height:13.45pt;border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;height: 3.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;height: 3.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height:3.4pt;border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103.5pt;border: none;padding: 0in 5.4pt;height: 130.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-left:.6pt;line-height:200%;'\u003eNutrition education\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-left:.6pt;line-height:200%;'\u003eAge in year\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-left:.6pt;line-height:200%;'\u003eFamily Size\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-left:.6pt;line-height:200%;'\u003eEducational status\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-left:.6pt;line-height:200%;'\u003eGeographic location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 171pt;border: none;padding: 0in 5.4pt;height: 130.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e\u003cstrong\u003e8.809** (0.178) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;8.459 \u0026nbsp; \u0026nbsp;9.158\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e-0.010 (0.015) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;-0.038 \u0026nbsp; \u0026nbsp; \u0026nbsp;0.019\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e-0.250 (0.225) \u0026nbsp; \u0026nbsp; \u0026nbsp; -0.692 \u0026nbsp; \u0026nbsp; 0.191\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e\u0026nbsp;0.233 (0.212) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;-0.182 \u0026nbsp; \u0026nbsp; \u0026nbsp;0.647\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e-0.395 (0.209) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;-0.804 \u0026nbsp; \u0026nbsp; \u0026nbsp;0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 121.5pt;border: none;padding: 0in 5.4pt;height: 130.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e\u003cstrong\u003e3.352** (0.094) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3.168\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e-0.004 (0.013) \u0026nbsp; \u0026nbsp; \u0026nbsp; -0.029\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-left:1.8pt;line-height:200%;'\u003e\u003cstrong\u003e0.544* (0.220) \u0026nbsp; \u0026nbsp; \u0026nbsp;0.113\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-left:1.8pt;line-height:200%;'\u003e\u003cstrong\u003e0.579* (0.203) \u0026nbsp; \u0026nbsp; \u0026nbsp;0.180\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-left:1.8pt;line-height:200%;'\u003e0.154 (0.196) \u0026nbsp; \u0026nbsp; \u0026nbsp; -0.230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;border: none;padding: 0in 5.4pt;height: 130.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e\u003cstrong\u003e3.535\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e0.021\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e\u003cstrong\u003e0.975\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e\u003cstrong\u003e0.977\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e0.538\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 157.2pt;border: none;padding: 0in 5.4pt;height: 130.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e\u003cstrong\u003e\u0026nbsp;2.895** (0.081) \u0026nbsp; \u0026nbsp;2.737 \u0026nbsp; \u0026nbsp;3.054\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e\u0026nbsp;0.005 (0.008) \u0026nbsp; \u0026nbsp; \u0026nbsp; -0.010 \u0026nbsp; \u0026nbsp;0.020\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e\u0026nbsp;0.161 (0.114) \u0026nbsp; \u0026nbsp; \u0026nbsp; -0.062 \u0026nbsp; \u0026nbsp;0.384\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e-0.095 (0.103) \u0026nbsp; \u0026nbsp; \u0026nbsp;-0.297 \u0026nbsp; \u0026nbsp; 0.106\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e\u003cstrong\u003e-0.315* (0.100) \u0026nbsp; \u0026nbsp; \u0026nbsp; - 0.511 \u0026nbsp; -0.119\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height:130.8pt;border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 274.5pt;padding: 0in 5.4pt;height: 19.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e\u0026nbsp;Wealth index -Medium -0.190 (0.283) \u0026nbsp; \u0026nbsp; \u0026nbsp; -0.744 \u0026nbsp; \u0026nbsp; 0.364\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 121.5pt;padding: 0in 5.4pt;height: 19.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-left:1.8pt;line-height:200%;'\u003e0.240 (0.265) \u0026nbsp; \u0026nbsp; \u0026nbsp; -0.278\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;padding: 0in 5.4pt;height: 19.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e0.759\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 157.2pt;padding: 0in 5.4pt;height: 19.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e-0.278 (0.150) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;-0.572 \u0026nbsp; \u0026nbsp; 0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height:19.8pt;border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 274.5pt;padding: 0in 5.4pt;height: 0.3in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-left:.6pt;line-height:200%;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;-Poor \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cstrong\u003e-0.511* (0.230) \u0026nbsp; \u0026nbsp; \u0026nbsp; -0.962 \u0026nbsp; \u0026nbsp;-0.059\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 121.5pt;padding: 0in 5.4pt;height: 0.3in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-left:1.8pt;line-height:200%;'\u003e\u003cstrong\u003e0.700* (0.229) \u0026nbsp; \u0026nbsp; \u0026nbsp;0.252\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;padding: 0in 5.4pt;height: 0.3in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e\u003cstrong\u003e1.148\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 157.2pt;padding: 0in 5.4pt;height: 0.3in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e-0.093 (0.106) \u0026nbsp; \u0026nbsp; \u0026nbsp;-0.300 \u0026nbsp; \u0026nbsp; 0.114\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height:.3in;border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;height: 14.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-left:.6pt;line-height:200%;'\u003eIodized salt\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 171pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;height: 14.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e\u0026nbsp; -0.284 (0.210) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; -0.696 \u0026nbsp; \u0026nbsp; \u0026nbsp;0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 121.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;height: 14.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e-0.164 (0.202) \u0026nbsp; \u0026nbsp; \u0026nbsp; -0.560\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;height: 14.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e0.231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 157.2pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;height: 14.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;line-height:200%;'\u003e\u003cstrong\u003e-0.612** (0.099) \u0026nbsp; \u0026nbsp; - 0.807 \u0026nbsp; -0.417\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height:14.8pt;border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;margin-top:0in;margin-right:-.75in;margin-bottom:.0001pt;margin-left:-27.0pt;text-indent:-45.0pt;line-height:150%;'\u003e\u003cspan style=\"color:black;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cstrong\u003eReference Categories\u003c/strong\u003e: Nutrition education (control), Age (continuous variable), Family size (\u0026lt;=5), Educational status \u0026nbsp; (formal), Geographic location (lowland), Wealth index (rich), Iodized salt (available) \u0026nbsp;\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;text-indent:-45.0pt;line-height:150%;'\u003e\u003cspan style=\"color:black;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;**Significant at P\u0026lt;0.0001 \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;text-indent:-45.0pt;line-height:150%;'\u003e\u003cspan style=\"color:black;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;*Significant at P\u0026lt;0.05 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:15px;font-family:\"Calibri\",sans-serif;text-indent:-45.0pt;line-height:150%;'\u003e\u003cstrong\u003e\u003csup\u003e\u003cspan style=\"color:black;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; +\u003c/span\u003e\u003c/sup\u003e\u003c/strong\u003eIodized salt, not available in nearby shop/market \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Ethiopia, Iodine nutrition, Peer-guided, Iodized salt","lastPublishedDoi":"10.21203/rs.3.rs-27067/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-27067/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u0026nbsp;Although iodine nutrition status is improving globally, the progress is not uniform throughout the world due to several factors. Among these, poor knowledge, negative attitude and improper practice of iodized salt are the main risk factors for poor iodine nutrition in Ethiopia. This study was aimed to assess the effect of nutrition education intervention on knowledge, attitude and practice (KAP) of iodine deficiency and iodized salt utilization.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA cluster randomized controlled trial was carried out among 652 women of reproductive age group in southwest Ethiopia. A total of 24 clusters were selected and randomized in to an intervention and control villages. Women in the intervention village received iodine nutrition related education for six months; while those in the control village did not receive any education. Baseline and endline data were collected from both groups. Generalized Estimating Equations (GEE) was used to determine the effect of intervention.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of 647 (99.2%) participants were successfully involved in the study. In the intervention group the median attendance was 10 out of 12 sessions. Women in the intervention group had shown statistically significant change in knowledge, attitude and practice scores as compared to control one.\u003cstrong\u003e\u003cem\u003e \u003c/em\u003e\u003c/strong\u003eIn multivariable GEE linear model, after adjusting for other background characteristics, the mean difference (95% CI) scores were 8.81 (8.46, 9.16) for knowledge, 3.35 (3.17, 3.54) for attitude and 2.90 (2.74, 3.05) for practice in the intervention arm.\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eWell designed and community-based iodine nutrition education is an effective strategy to improve the KAP of iodine deficiency disorders and iodized salt utilization.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTrial registration:\u003c/strong\u003e PACTR201809544276357 (Retrospectively registered on 14, Sept. 2018).\u003c/p\u003e\u003cp\u003ehttp: //www.pactr.org\u003c/p\u003e","manuscriptTitle":"Effect of nutrition education on iodine deficiency disorders and iodized salt intake in south west Ethiopian women: a cluster randomized controlled trial","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2020-10-29 19:07:57","doi":"10.21203/rs.3.rs-27067/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorAssigned","content":"","date":"2020-10-22T12:00:00+00:00","index":"","fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-10-22T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-10-21T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-10-21T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2020-05-26 21:50:13","doi":"10.21203/rs.3.rs-27067/v1","editorialEvents":[{"type":"communityComments","content":2},{"type":"decision","content":"Major revision","date":"2020-10-02T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-06-01T12:00:00+00:00","index":2,"fulltext":"Recommendation: Major revisions required\nForm responses:\n---\n\nComments to Author:\n---\nThe authors state that this is a randomised controlled trial and it is good to see that the authors have used the CONSORT checklist. Two aspects of the CONSORT guidelines need to be revised in this paper (17a and 17b).\n\nFirstly, it is not appropriate to test for differences between randomly allocated groups at baseline (any differences, if they do exist, is due to chance). Thus the p-values for Table 1 should be deleted from the table. See CONSORT statement or paper \"Testing for baseline differences in randomised controlled trials: an unhealthy research behaviour that is hard to eradicate\" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4310023/\n\nIn presenting the results of such a trial, the authors need to provide the mean difference (95% CI) for each of the primary outcomes, after adjustment for baseline values. Indeed, presenting the mean difference and associated 95%CI means that the p-value is not required, but more importantly, this allows the reader to see the magnitude of the difference between the two groups. Thus, the text of the results section needs to be altered, Table 2 changed, and this data included in the abstract as well.* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **No**\n* Declaration of competing interests: **I declare that I have no competing interests.**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **No**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **No**\n"},{"type":"editorInvitedReview","content":"","date":"2020-06-01T12:00:00+00:00","index":1,"fulltext":"Recommendation: Accept after discretionary revisions\nForm responses:\n---\n\nComments to Author:\n---\nDear Authors,\n I have read with huge interest the manuscript entitled \"Effect of nutrition education on iodine deficiency disorder and iodized salt intake in south west Ethiopian women: a cluster randomized controlled trial\", which shows the impact of an educational intervention in women at childbearing age.\nThe study design (a cluster randomized controlled trial) as well as the intervention are described in full detail. The results are clear and meaningful. The discussion is pertinent and well-written.\nI have just a few remarks to make:\n Line 33: The sentence seems to be incomplete.\n Line 125: education.\n It would be great to analyse if there were significant differences according to the members of Health Development Army (HDA) who handled the sessions.\n* Are the methods appropriate and well described?: **Yes**\n* Does the work include the necessary controls?: **Yes**\n* Are the conclusions drawn adequately supported by the data shown?: **Yes**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **I am able to assess the statistics**\n* Quality of written English: **Acceptable**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please publish my name with my report.**\n"},{"type":"reviewerAgreed","content":"","date":"2020-05-29T12:00:00+00:00","index":2,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-05-26T12:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-05-26T12:00:00+00:00","index":1,"fulltext":""},{"type":"editorAssigned","content":"","date":"2020-05-06T12:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2020-05-05T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-05-05T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-05-05T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9e0c507e-c9a2-4ebf-88f5-dc0b981e44e2","owner":[],"postedDate":"October 29th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":926382,"name":"Nutrition \u0026 Dietetics"}],"tags":[],"updatedAt":"2020-11-22T15:01:50+00:00","versionOfRecord":{"articleIdentity":"rs-27067","link":"https://doi.org/10.1186/s12905-020-01126-y","journal":{"identity":"bmc-womens-health","isVorOnly":false,"title":"BMC Women's Health"},"publishedOn":"2020-11-16 15:00:24","publishedOnDateReadable":"November 16th, 2020"},"versionCreatedAt":"2020-10-29 19:07:57","video":"","vorDoi":"10.1186/s12905-020-01126-y","vorDoiUrl":"https://doi.org/10.1186/s12905-020-01126-y","workflowStages":[]},"version":"v2","identity":"rs-27067","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-27067","identity":"rs-27067","version":["v2"]},"buildId":"ehx78VzkSd0WSzXnipQa-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}