Determinants of Goiter Among Patients Attending Ambo University Referral Hospital Surgical Outpatient Department: Un Matched Case-Control Study

Determinants of Goiter Among Patients Attending Ambo University Referral Hospital Surgical Outpatient Department: Un Matched Case-Control Study | 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 Determinants of Goiter Among Patients Attending Ambo University Referral Hospital Surgical Outpatient Department: Un Matched Case-Control Study Tadesse Ejeta Chala, Mulu Chala Gameda This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8767930/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Goiter refers to benign or malignant enlargement of thyroid gland affecting the structure and function of the gland that may present as a derangement of thyroid hormone secretion, thyroid enlargement or pain and presenting as myriad of devastating consequences if not treated. Goiter is a global health problem and accounting around 30% to 40% burden of the endocrine disorder. In Ethiopia approximately 28 million people have goiter. This makes it major public health problem in the country. Methods Facility based, unmatched case-control study design was conducted among 410 patients attending Ambo University Referral Hospital surgical OPD from May, 1–30 June2022. The cases were goiter patients and controls were patients with non-goiter. Cases were selected consecutively and following each case two controls were selected. A structured interviewer- assisted questionnaire was used to collect data. Data were entered into Epi data version 3.1; exported and analyzed by SPSS version 20. All independent variables with p-value < 0.25 in the bi-variable binary logistic regression analysis were entered into multivariable binary logistic regression analysis. Model fitness was checked by Hosmel-lemshow goodness of fit. An adjusted odds ratio with a 95% CI and a p-value of < 0.05 was used to identify determinants of goiter. Result A total of 410 patients (137 cases and 273 controls) were included in the study. The mean age of cases and controls were 37.8 (SD ± 3.1) and 38.1 (SD ± 3.24) years, respectively. Being female (AOR = 2.6,95% CI: 1.4, 4.9), none iodized salt consumption (AOR = 3.4, 95%CI: 1.4, 5.3), River water for drinking (AOR = 5.6, 95%CI: 2.9, 10.5), low income (AOR = 3.7, 95% CI: 1.1, 12.5), Living in area goiter is common (AOR = 1.8, 95%CI: 1.01,3.5) and not consuming egg once per week(AOR = 1.5,CI:1.01,2.31) were found to be determinants of goiter. Conclusion and Recommendations: Being female, low income, living in area where goiter is common, none iodize salt utilization, not consuming egg at least once per week and drinking river water were determinant of goiter. Health educations on iodized salt utilization, improving income, providing tap water for drinking are important for prevention of goiter. Goiter iodized salt drinking water Background Thyroid is an important endocrine gland necessary for maintenance of homeostasis in the body essential for growth, neuronal development, reproduction and regulation of energy metabolism by synthesizing thyroid hormones. In the synthesis of thyroid hormones, iodine is required as an essential ingredient. Iodine exists in foodstuffs (milk, meat and sea foods) as inorganic iodides which are efficiently absorbed in the gastrointestinal tract ( 1 ). Goiter, defined as enlargement of the thyroid gland that normally weighs 25-30g, is a common endocrine disease that is reported to affect approximately 4–15% of a given population worldwide. The incidence and prevalence of these thyroid diseases in a given community are variable depending on various factors ( 2 ). There are many conditions in which the thyroid gland is enlarged. Goiter is manifested by alterations in hormone secretion and enlargement of the thyroid gland or enlargement only. This condition can be due to benign or malignant condition affecting the structure and function of the thyroid gland. ( 3 ). Simple (non-toxic) goiter is common throughout the world and is thought to affect more than 200 million individuals. It is most prevalent in mountainous areas because of top soil erosion that deplete iodine but also occurs in non-mountainous areas remote from sea. Iodine deficiency is the major cause but goitrogens as well are incriminated. Depending on the severity of iodine deficiency, goiter may appearing early childhood but usually peaks at about puberty or soon after, affecting more females than males. Iodine supplementation has been shown to decrease the incidence of benign goiters and it can reduce the size of small sized early stage goiters ( 4 , 5 ). Thyroid gland enlargement is also common in the elderly and is associated with significant morbidity if left untreated. Thyroid gland undergoes slight “Physiological” changes with ageing, either as a result of its participation in the senescence process or as an effect of other system changes. The changes can lead to either clinical/sub clinical states of Hypo/Hyperthyroidism ( 6 ). Iodine deficiency is as high as 42% in Africa. Approximately 350 million Africans remain under at risk of IDD, which is a quarter of the global burden of iodine deficiency. From 40 African countries that had urinary iodine concentration (UIC), fifteen countries (38%) were iodine deficient, 22 countries (55%) had adequate iodine nutrition, and three countries (8%) had above the recommended intake. In Africa, the largest burden of ID, was in Ethiopia, Sudan, Algeria, Morocco, Ghana, and Mozambique [1]. In Ethiopia, more than 35 million people are at risk of iodine deficiency, and approximately 28 million people have goiter. This makes it a major public health problem in the country. Endemic and non-endemic areas have high goiter rates. From a global perspective, Ethiopia ranks 6th among 13 countries, which significantly add to the global high iodine deficiency disorders (IDD) burden. It is one of the nations with the lowest consumption of iodized salt (15%) and the highest goiter prevalence (36%) in Africa ( 9 , 10 ). Regarding the risk factors of goiter, as deferent studies show, non-iodized salt and insufficient iodine intake due to inadequate contents of iodine in food, dairy products, and iodized salt. In addition, family history of goiter, depleted soil of iodine, crops grown on iodine-depleted soil, exposure to goiterogenic food and substances, excessive cabbage consumption, poor time of salt storage (> 2 months), poor knowledge and practice towards iodized salt and IDD prevention mechanisms, and socio-demographic factors such as age, occupation, income, family size, educational status of females and their husband, and occupation of women’s and their husband are the major associated factors of goiter ( 11 , 12 , 28 ). Other factor related to goiter are smoking, family history of thyroid disease, female gender, alcohol, pregnancy, age, body mass index (BMI) and family history of diabetes mellitus. Higher risks for the developing goiter in autoimmune disease, women with postpartum period, personal history of neck or head irradiation, primary pulmonary hypertension, genetic syndromes, and people over 65years old ( 5 ). The prevalence of goiter in sub-Saharan Africa has fallen over the past four decades as populations covered by salt iodization programs increased. However, despite this success, goiter stills a significant public health problem in Eastern and Southern Africa. In Ethiopia, as of 2015, the national prevalence of goiter among children aged 6 to 12 was 39.9%. According to the World Health Organization/International Council for Control of Iodine Deficiency Disorders/ United Nations Children’s Fund (WHO/ ICCIDD/UNICEF) classification, both goiter prevalence and urinary iodine levels in Ethiopia indicate that the entire country is affected by iodine deficiency. One reason for the persistence of IDDs in Ethiopia is the mixed performance of the country’s salt iodization program. Since its launch in the 1980s it has achieved remarkable improvements in iodized salt coverage.( 11 , 31 , 32 , 33 ) A number of environmental and dietary factors associated with the availability of iodine affect the prevalence and severity of goiter and IDD in iodine deficient areas. The topography of Ethiopia is mountainous and the top layer of the soil has been eroded for decades leading to leaching away of nutrients including iodine ( 7 , 29 ). The prevalence of goiter varies in different areas of Ethiopia based on age, sex and residency of the individuals. Study done on the prevalence of goiter in Sekotta district showed the overall prevalence of goiter to be 22.8%. Similarly a study carried out to detect the prevalence of goiter in school children and household members has shown the prevalence of goiter to be 30.6% and 18.7% respectively (14, 25, 26 ). Although there has been significant progress in the reduction of goiter and related IDDs globally, they remain significant burden in Ethiopia due, in part, to poor salt storage practices and a weak universal salt iodization program. Understanding the extent of goiter and its associated factors is important for designing strategies that can reduce the burden of goiter in Ethiopia. ( 20 , 32 ). Study showed that individuals with goiter safer from upper air way obstruction, difficulty of swallowing, complications of increased hormone production and cosmetically disfiguring when the goiter size increase ( 15 ). Although studies showed that goiter is public health problem in the country and that the problem is common, most of the previous studies show only the prevalence of goiter among pregnant women, school children, and primary school girls but not identified what determine the enlargement of thyroid gland. ( 19 , 20 ) Methods Study design, area and period An institution based unmatched case-control study was conducted among goiter patients attending Ambo University Referral Hospital outpatient department. Ambo University Referral Hospital is found in Ambo town which is one of administrative town in Oromia regional state, located in West Show Zone which is about 114km west of Addis Ababa the capital city of Ethiopia with latitude and longitude of 8°59′N 37°51′E and an elevation of 2101 meters above sea level. Regarding health institutions in the town, there are two hospitals (one teaching and referral and one General hospital), two health centers, thirty nine medium clinics, six lower private clinics and there are many pharmacy and different drug stores as reported by Ambo Town health office. AURH is a teaching hospital having four main departments and serving about 3 million peoples. These departments are surgery, internal medicine, gynecology/obstetrics and pediatric which have cold OPD, emergency OPD and Inpatient services. Patients with goiter have follow up and treatment at surgical outpatient department. From the previous year patient flow record in Ambo University Referral Hospital on average about 75 patients with goiter and about 450 patients with other diagnosis were attending the hospital per month. This study was conducted in outpatient department of surgery from May 1, - June 30, 2022. Source and study population All patients who were attending ambo university referral hospitals outpatient department were the source population. All patients who were attending surgical outpatient and who were selected randomly were the study population. Cases were all patients who were diagnosed as having goiter by physician and on follow up. Controls were all patients who were attending surgical outpatient with no diagnosis of goiter. Critically ill patients were excluded from the study. Sample size and sampling technique Sample size was calculated by using Epi info version 7.2.4.0 software by using double population proportion formula for unmatched case control study with the assumptions of: 95% two-sided confidence level (CI), Power of 80%, 2:1 ratio of controls to cases, and using being female as determinants of goiter with, 64% proportion of case and 1.91 odds ratio taken from previous case-control study done on determinants of goiter ( 21 ). Considering a 10% non-response rate, the final sample size was determined to be 410 (137 cases and 273 controls) All goiter cases were included in the study consecutively until required sample size was reached. Controls were selected by systematic random sampling with k = 3 after case was selected from all patients treated at Ambo University Referral Hospital surgical outpatient department with diagnosis other than goitre. For one case two controls were selected following selection of case. If the selected control did not meet inclusion criteria, next patient was selected. Measurement Cases is defined as thyroid gland enlargement which has lateral lobes with a volume greater than the terminal phalanges of the thumb of the person which is diagnosed by clinician or imaging (ultrasound or CT scan). Controls All patients with non-goitre diagnosis Data collection tools, procedure and quality control A questionnaire was developed after reviewing different relevant literatures ( 16 , 17 , 18 , 19 , 20 , 24 , and 25 ) and structured interviewer based questionnaire was used for data collection. It had four parts. Part I: socio-demographic characteristics (age, sex, religion, ethnicity, marital status, educational status, income and occupation). Part II: Patient related factors (knowledge about goiter, family history of goiter, person live in the area with goiter, co morbidity, types of co morbidity, malignancy history and medication). Part III: Dietary related factors (knowledge about iodized salt, types of salt used, time of addition while cooking, how store salt, duration of storage, where store, consumption of cabbage, meat, egg, and fish). Part IV: Environmental factors (radiation exposure, smoking history, drinking water, and residency). The developed questioner was modified to local context and translated to Afaan oromo for data collection. Two trained BSc nurses outside the study hospital were recruited to collect data and supervised by investigator. Data collectors waited until the study unit physician complete their consultation. After they finished, cases and controls were identified from the medical record history of patients. Data was collected through face to face interview using a structured questionnaire to obtain information on socio-demographic characteristics, patient related factors, dietary factors and environmental factors. Data collection tool was prepared in English version and translated into Afaan Oromo and, then back to English by language experts to ensure its coherence with the original version. One day training was given for data collectors and supervisors on data collection tools and procedure. Supervisors monitored the data collection process daily. The collected data were reviewed and checked for consistency, clarity and completeness throughout the data collection process by supervisors and investigators. Data processing and analysis The collected data was checked for its completeness, consistency and accuracy before analysis. Data were entered in to Epi-data version 3.1statistical software and exported to SPSS version 20 for further analysis. Descriptive statistics like frequencies, percentages and mean were calculated. Bi-variable and multivariable analyses were done using binary logistic regression model to examine determinants of goiter. Bi-variable logistic regression analysis was conducted to see the association of each independent variable to the outcome variable and variables with p-values of < 0.25 were entered into the multivariable logistic regression analysis. The multivariable analysis was done to examine the individual association that each explanatory variable has on goiter after adjusting for other variables that entered into the multivariable model. The presence of multi-co linearity between independent variables was checked using co linearity coefficient on SPSS ( co linearity matrix) < .80 assumptions of no multi-co linearity and the final result was 0.64. The Hosmer-Lemeshow goodness of fit test was used to assess the fitness of the model and the final model was fit at chi-X 2 = 7.9, P- value = 0.437. Adjusted Odd ratio with 95% Confidence Interval and p-value < 0.05 were reported to declare as determinants of goiter. The results were presented by texts, and tables. Result Socio Demographic Characteristics of the Study Participants A total of 410 (137 cases and 273 controls) participants were involved in this study with a response rate of 100%. Hundred eleven (81.0%) of cases and hundred forty one (51.6%) of controls were female. The mean age of cases and controls were 37.8 (SD ± 3.1) and 38.1 (SD ± 3.24) years, respectively. Fifty (36.5%) of cases and One hundred eight (39.4%) of control were not attended formal education. Sixty six (48.2%) of cases and 140(51.1%) of controls were farmer in occupation. Majority, 71(51.2%) of cases and 153(55.8%) of controls were live in rural area (Table 1). Patient related characteristics of study participants More than half 75 (54.5%) of case and less than half 125 (45.8) of controls had information about goiter. Majority of cases 114 (83.2) and controls 246(90.1%) had no family history of goiter. Most of cases 89(65%) and controls 199 (72.9%) did not know person living with goiter in their living area. Most of the cases 104(75.9%) and controls 224 (82.1%) had no chronic medical illness (Table 2). Dietary related characteristics of study participants Majority of the cases 103(75.2) and controls 173(63.4) had no information about iodized salt. More than half of cases 719 (51.8) and controls 137(50.2) were add salt to their food at the middle of cooking. Majority of the cases 129(94.4) and controls 243(89) were store salt in closed container. More than half of cases 74(54) and controls 154(56.4) were consumed cabbage at least three times per week. The remaining cases and controls were taken cabbage less than three times per week. (Table 3). Environmental related characteristics of study participants About half of cases 68(49.6) were use river water for drinking ware us one hundred thirty nine (50.9) of controls were use tape water for drinking. Majority of the cases 119(86.9) and controls 258(94.5) were not cigarette smoker. Almost all of cases 130(94.9) and controls 248(90.9) were have no history of radiation exposure. Most of the cases 135(98.5) and controls 253(92.7) were have no history of any cancer. One hundred five cases (75.9) and one hundred ninety three controls (82.1) had no history of medication use.(Table 4) Determinants of goiter in patients attending Ambo University Referral Hospital surgical OPD. Variables with p-value < 0.25 were included in multivariable analysis include sex, marital status, occupational status, monthly income, place of residency, knowledge about goiter, family history of goiter, person who have goiter in living area, history of chronic medical illness, use of iodized salt, consumption of egg at least once per week, source of drinking water, history of smoking, radiation exposure history and any medication used in the past. The odds of developing goiter was 2.6 times (AOR = 3.81, 95% CI: 2.1, 7.1) more likely among females as compared to men. The odds of developing goiter was 5.04 times (AOR = 5.04, 95% CI: 1.17, 21.7) more likely among self-employ, 9.4 times (AOR = 9.4, 95%CI: 2.38, 37.64) more likely among daily laborers, 6.57 times (AOR = 6.75, 95% CI: 1.97, 21.9) more likely among merchants, as compared to public servants respectively. Those patients who live in area where individuals with goiter live were 1.8 times (AOR = 1.8, 95% CI: 1.01, 3.5) likely to develop goiter as compared to their counterpart. The odd of goiter was 3.4 times (AOR = 3.4, 95% CI: 1.78, 6.38) more likely to develop among iodized salt non user as compare to those who used iodized salt. The odd of goiter among patients who were not consumed egg at least once per week was 1.52 times (AOR = 1.52, 95%CI: 1.01, 2.31) more likely to develop as compared to those consumed egg at least once per week. Patients with river water for drinking were 5.6 times (AOR = 5.6, 95% CI: 2.9, 10.5) more likely to develop goiter compared to tape water drinkers (Table 5) Discussion The aim of the study was to identify the determinants of goiter among patients attending Ambo University Referral Hospital surgical OPD, Ethiopia. In this study, patients who are female were 2.6 times more likely to develop goiter than their male counterpart. This finding is consistent with studies conducted in India, Ghana, Nigeria, Sekota, Gamo Gofa and St. Paul Hospital Millennium medical Collage of Ethiopia ( 3 , 14 , 15 , 19 , 20 , 24 ). The possible explanation might be due to the effect of different hormonal changes in women at different time of their life. In addition the women’s bodies are more reactive and sensitive to different hormonal change than men. Women need higher amount of thyroid hormone during puberty and during pregnancy which lead to secretion of more thyroid stimulating hormones that increase the proliferation of thyroid follicles and goiter. In addition some pregnancy related hormones like chorionic gonadotropin increase stimulation of thyroid gland. Women are prone to iodine deficiency due to lack of information about iodized salt, low income and increased iodine demand during different physiologic stress like pregnancy. Iodine deficiencies directly lead into goiter development.( 25 ) This study found that odds of developing goiter was 5.04 times more likely among self- employ, 9.4 times more likely among daily laborers, 6.57 times more likely among merchants, than compared to public servants respectively. This finding is in line with a study conducted in Gagzebela district of north east Ethiopia ( 18 ). This could be due to lack of knowledge about goiter and dietary diversity for the family for those self-employed, daily laborers and merchants when compared to public servants. In addition there may be discrepancy in literacy level and income for purchasing and appropriate utilization of iodized salt which intern contributes to the development of goiter. The study indicated that patients with low income (less than 2500) had 3.7 times odd of developing goiter than those with higher income. This is in agreement with study done in Laku town Southern Ethiopia and Tach Armachihew northwest Ethiopia ( 20 , 23 ) which showed higher odd of developing goiter in low income. The possible explanation might be due to different factors that are related to the income of the patient like dietary diversity, lower consumption of diets that are important in prevention of goiter like fish, meat, milk and egg. In addition they may have higher tendency for the intake of goiterogenic foods like cabbages could increases the development of goiter. The study indicated that, patients who live in areas where persons with goiter live were 1.8 times more likely to develop goiter as compared to patients who were not live in areas where person with goiter live. This finding is in line with a study conducted in Gagzebela district of north east Ethiopia ( 18 ). This could be those who live where person with goiter live may share different environmental factors like high altitude which lead to top soil erosion that causes iodine deficiency, practice eating food incriminated with development of goiter like goitergenic vegetables, roots and also may not have distribution of iodized salt in this living area. In addition those patients might have water source which are contaminated that lead into infection and micronutrient deficiency that result in development of goiter.( 25 ) According to this study patients who were consumed non iodized salt were 2.7 times higher to develop goiter compared to patients consumed iodized salts. This finding is comparable with multiple study done at India, Ghana south west Ethiopia, southern Ethiopia and Northern Ethiopia ( 8 , 11 , 16 , 21 , 23 , 27 ). This could be because adequately iodized salt has both preventive and corrective effects for iodine deficiency goiter and is the main solution for eradicating IDDs. Iodine is one of the most important micronutrient required for normal thyroid function and majority of iodine is obtained from iodized salt. Use of none iodized salt lead into lower circulating iodide that result into lower production of thyroid hormone and this cause increased production of thyroid stimulating hormone that stimulate proliferation of thyroid gland and development of goiter. In addition iodine supplementation will reduce the development of goiter thus non iodized salt use end up into higher development of goiter and inhibit the regression of iodine dependent goiter that result into more goiter than those utilize iodized salt ( 15 ) The occurrence of goiter was 1.52 times more likely in patients who did not consumed eggs at least once per week compared to those who eat egg at least once per week. This finding is in line with the study performed in northeast Ethiopia and Sidama region ( 16 , 18 ). It may be due to the fact that animal products have higher content of iodine and also contain proteins required for iodine binding and transportation that could result in pathological enlargement of thyroid gland (goiter). This study revealed that odd of developing goiter in patients who drink river water were 5.6 times more likely as compared to those tape water drunker This finding is in line with a study conducted in Gagzebela district of north east Ethiopia ( 18 ) The possible explanation might be due to the contamination of river water that lead to infection and micronutrient deficiency that may cause goiter. Strengths and limitation of the study Strength of this study is that, cases and controls were selected from same source population (controls were selected from the hospital that yielded the cases) and as a result, cases and controls were comparable. Despite the authors' efforts to create a more representative sample by carefully identifying the study population and selecting the appropriate comparison, selection ( patients with goiter but did not complained about the goiter and come for other compliant may be selected as control) and recall bias may still exist. Conclusion and Recommendation Conclusion This study identified several determinants of goiter among patients attending Ambo University Referral Hospital Surgical OPD. Bing female, low income, occupation being daily laborer, self-employed, merchant, living in areas where person with goiter live, utilization of none iodized salt, not consuming egg at least once per week and river as source of drinking water were the identified determinants factors for goiter. Recommendation Based on the study finding the following recommendations are made. Zonal health Office As goiter is a one of the most common endocrine diseases health information about determinant factors, prevention, and consequences of goiter should be given. Hospital under study Encourage front-line health care providers to give health education on determinant of goiter like types of salt used, water source for drinking, occupation, educate the importance of animal products in preventing the development of goiter Researchers Future researchers should also be done at regional or national wide study for further generalization of the study result. Abbreviations AURH : Ambo University Referral Hospital EDHS : Ethiopian Demographic and Health Survey ICCIDD: International Council for Control of Iodine Deficiency Disorders ID : Iodine Deficiency IDDs : Iodine Deficiency Disorders OPD: Outpatient Department SPHMMC : St. Paul Hospital Millennium medical Collage TSH : Thyroid Stimulating Hormone UNICEF : United Nations Children’s Fund WHO : World Health Organization Declarations Ethics approval and consent to participate The study was conducted in accordance with the World Medical Association Declaration of Helsinki. Ethical clearance was obtained from an ethical review committee of the college of medicine and health science, Ambo University to conduct the study reference number of PGC/229/2021. A support letter was submitted to hospital. Written informed consent was obtained from each study subject before the data collection process proceeded. During the data collection process, the data collectors had informed each study participant about the objective and anticipated benefits of the research project and the study participants were also informed of their full right to refuse, withdraw, or completely reject part or all of their parts in the study. Data was collected anonymously and kept in lock with the investigators. Clinical trial number: Not applicable Consent for publication Not applicable Data Availability: All the datasets used and/or analyzed during the current study are available from the corresponding author reasonable request. Conflicts of Interest : The authors report no conflict of interest Funding Statement : This research does not received grant from any funding agency in public, commercial or non-profit making organizations. Acknowledgements The authors are grateful to the study participants and data collectors of the study. Authors' contributions TEC, MCG, were involved in conception, design of the study, training and supervision of data collectors and supervisors, analysis, interpretations and preparation of subsequent drafts of the manuscript. All authors read and approved the final manuscript. Authors' information Tadesse Ejeta Chala: Assistant professor of General Surgery, Endocrine and Breast Surgery Sub-specialist, MPH in Epidemiology, MD. Email: [email protected] / [email protected] Mulu Chala Gameda: Masters of Sport Science, BSC in Physical education Email: [email protected] References Andersson M. Iodine Status Worldwide, WHO Global Database on Iodine Deficiency: Department of Nutrition for Health and Development. Geneva: World Health Organization; 2004. Wartofsky L. (1998). Diseases of the thyroid in Fauci, A.S., Braunwald, E. Principles of internal medicine 14th edition. Vanderpump MP. The epidemiology of thyroid disease. Br Med Bull. 2011;99(1):39–51. Abuye, Berhane. 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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-8767930","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":603919422,"identity":"cd518c87-3bed-4a4d-8bf2-ae8d2fa62f7a","order_by":0,"name":"Tadesse Ejeta Chala","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEUlEQVRIiWNgGAWjYHACAzDJ2AAkPjAwJIA4EvjU8yC0MDMwzkDSglMbXAsDAzMDMw8xWuzZD298+KOCQY65vf/gZ5uabXkGB5gP3uZhsKnDaQtPWrExzxkGY8aew8zSOcduFxscYEu25mFIw+OwHDNpxjaGxMYZyQzSOWy3Ezcc4DGT5mE4jFsL/xvznz//MdQ3zn/M/NviH0gL/zeglv+4tUjkmDHwNjAkMM5gZgNaB7aFDajlAG4tN54VS/MckzBs7Ek2s+ztu10seZjN2HKOQbJkAw4t7P3JGz/+qLGRN2w/+PjGj2+38/iONz+88abCjh+XLVAgwWAIN5QZRBjgVIoA8kSoGQWjYBSMghEKALFkUPc7VMsuAAAAAElFTkSuQmCC","orcid":"","institution":"Ambo University College Medicine and Health Sciences","correspondingAuthor":true,"prefix":"","firstName":"Tadesse","middleName":"Ejeta","lastName":"Chala","suffix":""},{"id":603919423,"identity":"240e312c-2151-40b6-b1a6-80a147be71cc","order_by":1,"name":"Mulu Chala Gameda","email":"","orcid":"","institution":"Ambo University","correspondingAuthor":false,"prefix":"","firstName":"Mulu","middleName":"Chala","lastName":"Gameda","suffix":""}],"badges":[],"createdAt":"2026-02-02 17:53:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8767930/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8767930/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104431519,"identity":"bb6791c9-da3a-44e5-8417-433bd3a408b2","added_by":"auto","created_at":"2026-03-11 15:42:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":799289,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8767930/v1/c23087d0-fe99-4134-994e-fb306852150f.pdf"},{"id":104431471,"identity":"b94430c8-715c-4f8a-9583-94c3dfe0958b","added_by":"auto","created_at":"2026-03-11 15:42:22","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":36850,"visible":true,"origin":"","legend":"","description":"","filename":"Annex.docx","url":"https://assets-eu.researchsquare.com/files/rs-8767930/v1/ce7853f1329e16e429456102.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eDeterminants of Goiter Among Patients Attending Ambo University Referral Hospital Surgical Outpatient Department: Un Matched Case-Control Study\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eThyroid is an important endocrine gland necessary for maintenance of homeostasis in the body essential for growth, neuronal development, reproduction and regulation of energy metabolism by synthesizing thyroid hormones. In the synthesis of thyroid hormones, iodine is required as an essential ingredient. Iodine exists in foodstuffs (milk, meat and sea foods) as inorganic iodides which are efficiently absorbed in the gastrointestinal tract (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGoiter, defined as enlargement of the thyroid gland that normally weighs 25-30g, is a common endocrine disease that is reported to affect approximately 4\u0026ndash;15% of a given population worldwide. The incidence and prevalence of these thyroid diseases in a given community are variable depending on various factors (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere are many conditions in which the thyroid gland is enlarged. Goiter is manifested by alterations in hormone secretion and enlargement of the thyroid gland or enlargement only. This condition can be due to benign or malignant condition affecting the structure and function of the thyroid gland. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSimple (non-toxic) goiter is common throughout the world and is thought to affect more than 200\u0026nbsp;million individuals. It is most prevalent in mountainous areas because of top soil erosion that deplete iodine but also occurs in non-mountainous areas remote from sea. Iodine deficiency is the major cause but goitrogens as well are incriminated. Depending on the severity of iodine deficiency, goiter may appearing early childhood but usually peaks at about puberty or soon after, affecting more females than males. Iodine supplementation has been shown to decrease the incidence of benign goiters and it can reduce the size of small sized early stage goiters (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThyroid gland enlargement is also common in the elderly and is associated with significant morbidity if left untreated. Thyroid gland undergoes slight \u0026ldquo;Physiological\u0026rdquo; changes with ageing, either as a result of its participation in the senescence process or as an effect of other system changes. The changes can lead to either clinical/sub clinical states of Hypo/Hyperthyroidism (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIodine deficiency is as high as 42% in Africa. Approximately 350\u0026nbsp;million Africans remain under at risk of IDD, which is a quarter of the global burden of iodine deficiency. From 40 African countries that had urinary iodine concentration (UIC), fifteen countries (38%) were iodine deficient, 22 countries (55%) had adequate iodine nutrition, and three countries (8%) had above the recommended intake. In Africa, the largest burden of ID, was in Ethiopia, Sudan, Algeria, Morocco, Ghana, and Mozambique [1].\u003c/p\u003e \u003cp\u003eIn Ethiopia, more than 35\u0026nbsp;million people are at risk of iodine deficiency, and approximately 28\u0026nbsp;million people have goiter. This makes it a major public health problem in the country. Endemic and non-endemic areas have high goiter rates. From a global perspective, Ethiopia ranks 6th among 13 countries, which significantly add to the global high iodine deficiency disorders (IDD) burden. It is one of the nations with the lowest consumption of iodized salt (15%) and the highest goiter prevalence (36%) in Africa (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRegarding the risk factors of goiter, as deferent studies show, non-iodized salt and insufficient iodine intake due to inadequate contents of iodine in food, dairy products, and iodized salt. In addition, family history of goiter, depleted soil of iodine, crops grown on iodine-depleted soil, exposure to goiterogenic food and substances, excessive cabbage consumption, poor time of salt storage (\u0026gt;\u0026thinsp;2 months), poor knowledge and practice towards iodized salt and IDD prevention mechanisms, and socio-demographic factors such as age, occupation, income, family size, educational status of females and their husband, and occupation of women\u0026rsquo;s and their husband are the major associated factors of goiter (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOther factor related to goiter are smoking, family history of thyroid disease, female gender, alcohol, pregnancy, age, body mass index (BMI) and family history of diabetes mellitus. Higher risks for the developing goiter in autoimmune disease, women with postpartum period, personal history of neck or head irradiation, primary pulmonary hypertension, genetic syndromes, and people over 65years old (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe prevalence of goiter in sub-Saharan Africa has fallen over the past four decades as populations covered by salt iodization programs increased. However, despite this success, goiter stills a significant public health problem in Eastern and Southern Africa. In Ethiopia, as of 2015, the national prevalence of goiter among children aged 6 to 12 was 39.9%. According to the World Health Organization/International Council for Control of Iodine Deficiency Disorders/ United Nations Children\u0026rsquo;s Fund (WHO/ ICCIDD/UNICEF) classification, both goiter prevalence and urinary iodine levels in Ethiopia indicate that the entire country is affected by iodine deficiency. One reason for the persistence of IDDs in Ethiopia is the mixed performance of the country\u0026rsquo;s salt iodization program. Since its launch in the 1980s it has achieved remarkable improvements in iodized salt coverage.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eA number of environmental and dietary factors associated with the availability of iodine affect the prevalence and severity of goiter and IDD in iodine deficient areas. The topography of Ethiopia is mountainous and the top layer of the soil has been eroded for decades leading to leaching away of nutrients including iodine (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe prevalence of goiter varies in different areas of Ethiopia based on age, sex and residency of the individuals. Study done on the prevalence of goiter in Sekotta district showed the overall prevalence of goiter to be 22.8%. Similarly a study carried out to detect the prevalence of goiter in school children and household members has shown the prevalence of goiter to be 30.6% and 18.7% respectively (14, 25, 26 ).\u003c/p\u003e \u003cp\u003eAlthough there has been significant progress in the reduction of goiter and related IDDs globally, they remain significant burden in Ethiopia due, in part, to poor salt storage practices and a weak universal salt iodization program. Understanding the extent of goiter and its associated factors is important for designing strategies that can reduce the burden of goiter in Ethiopia. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStudy showed that individuals with goiter safer from upper air way obstruction, difficulty of swallowing, complications of increased hormone production and cosmetically disfiguring when the goiter size increase (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough studies showed that goiter is public health problem in the country and that the problem is common, most of the previous studies show only the prevalence of goiter among pregnant women, school children, and primary school girls but not identified what determine the enlargement of thyroid gland. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design, area and period\u003c/h2\u003e \u003cp\u003eAn institution based unmatched case-control study was conducted among goiter patients attending Ambo University Referral Hospital outpatient department. Ambo University Referral Hospital is found in Ambo town which is one of administrative town in Oromia regional state, located in West Show Zone which is about 114km west of Addis Ababa the capital city of Ethiopia with latitude and longitude of 8\u0026deg;59\u0026prime;N 37\u0026deg;51\u0026prime;E and an elevation of 2101 meters above sea level. Regarding health institutions in the town, there are two hospitals (one teaching and referral and one General hospital), two health centers, thirty nine medium clinics, six lower private clinics and there are many pharmacy and different drug stores as reported by Ambo Town health office.\u003c/p\u003e \u003cp\u003eAURH is a teaching hospital having four main departments and serving about 3\u0026nbsp;million peoples. These departments are surgery, internal medicine, gynecology/obstetrics and pediatric which have cold OPD, emergency OPD and Inpatient services. Patients with goiter have follow up and treatment at surgical outpatient department. From the previous year patient flow record in Ambo University Referral Hospital on average about 75 patients with goiter and about 450 patients with other diagnosis were attending the hospital per month.\u003c/p\u003e \u003cp\u003eThis study was conducted in outpatient department of surgery from May 1, - June 30, 2022.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSource and study population\u003c/h3\u003e\n\u003cp\u003eAll patients who were attending ambo university referral hospitals outpatient department were the source population. All patients who were attending surgical outpatient and who were selected randomly were the study population. Cases were all patients who were diagnosed as having goiter by physician and on follow up. Controls were all patients who were attending surgical outpatient with no diagnosis of goiter. Critically ill patients were excluded from the study.\u003c/p\u003e\n\u003ch3\u003eSample size and sampling technique\u003c/h3\u003e\n\u003cp\u003eSample size was calculated by using Epi info version 7.2.4.0 software by using double population proportion formula for unmatched case control study with the assumptions of: 95% two-sided confidence level (CI), Power of 80%, 2:1 ratio of controls to cases, and using being female as determinants of goiter with, 64% proportion of case and 1.91 odds ratio taken from previous case-control study done on determinants of goiter (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Considering a 10% non-response rate, the final sample size was determined to be 410 (137 cases and 273 controls)\u003c/p\u003e \u003cp\u003eAll goiter cases were included in the study consecutively until required sample size was reached.\u003c/p\u003e \u003cp\u003eControls were selected by systematic random sampling with k\u0026thinsp;=\u0026thinsp;3 after case was selected from all patients treated at Ambo University Referral Hospital surgical outpatient department with diagnosis other than goitre. For one case two controls were selected following selection of case. If the selected control did not meet inclusion criteria, next patient was selected.\u003c/p\u003e\n\u003ch3\u003eMeasurement\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eCases\u003c/strong\u003e \u003cp\u003eis defined as thyroid gland enlargement which has lateral lobes with a volume greater than the terminal phalanges of the thumb of the person which is diagnosed by clinician or imaging (ultrasound or CT scan).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eControls\u003c/strong\u003e \u003cp\u003eAll patients with non-goitre diagnosis\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003eData collection tools, procedure and quality control\u003c/h3\u003e\n\u003cp\u003eA questionnaire was developed after reviewing different relevant literatures (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, and \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) and structured interviewer based questionnaire was used for data collection. It had four parts. Part I: socio-demographic characteristics (age, sex, religion, ethnicity, marital status, educational status, income and occupation). Part II: Patient related factors (knowledge about goiter, family history of goiter, person live in the area with goiter, co morbidity, types of co morbidity, malignancy history and medication). Part III: Dietary related factors (knowledge about iodized salt, types of salt used, time of addition while cooking, how store salt, duration of storage, where store, consumption of cabbage, meat, egg, and fish). Part IV: Environmental factors (radiation exposure, smoking history, drinking water, and residency). The developed questioner was modified to local context and translated to Afaan oromo for data collection.\u003c/p\u003e \u003cp\u003eTwo trained BSc nurses outside the study hospital were recruited to collect data and supervised by investigator. Data collectors waited until the study unit physician complete their consultation. After they finished, cases and controls were identified from the medical record history of patients. Data was collected through face to face interview using a structured questionnaire to obtain information on socio-demographic characteristics, patient related factors, dietary factors and environmental factors.\u003c/p\u003e \u003cp\u003eData collection tool was prepared in English version and translated into Afaan Oromo and, then back to English by language experts to ensure its coherence with the original version. One day training was given for data collectors and supervisors on data collection tools and procedure. Supervisors monitored the data collection process daily. The collected data were reviewed and checked for consistency, clarity and completeness throughout the data collection process by supervisors and investigators.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData processing and analysis\u003c/h2\u003e \u003cp\u003eThe collected data was checked for its completeness, consistency and accuracy before analysis. Data were entered in to Epi-data version 3.1statistical software and exported to SPSS version 20 for further analysis. Descriptive statistics like frequencies, percentages and mean were calculated. Bi-variable and multivariable analyses were done using binary logistic regression model to examine determinants of goiter. Bi-variable logistic regression analysis was conducted to see the association of each independent variable to the outcome variable and variables with p-values of \u0026lt;\u0026thinsp;0.25 were entered into the multivariable logistic regression analysis. The multivariable analysis was done to examine the individual association that each explanatory variable has on goiter after adjusting for other variables that entered into the multivariable model. The presence of multi-co linearity between independent variables was checked using co linearity coefficient on SPSS ( co linearity matrix) \u0026lt; .80 assumptions of no multi-co linearity and the final result was 0.64. The Hosmer-Lemeshow goodness of fit test was used to assess the fitness of the model and the final model was fit at chi-X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;7.9, P- value\u0026thinsp;=\u0026thinsp;0.437. Adjusted Odd ratio with 95% Confidence Interval and p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were reported to declare as determinants of goiter. The results were presented by texts, and tables.\u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cdiv id=\"Sec10\"\u003e\n \u003ch2\u003eSocio Demographic Characteristics of the Study Participants\u003c/h2\u003e\n \u003cp\u003eA total of 410 (137 cases and 273 controls) participants were involved in this study with a\u003c/p\u003e\n \u003cp\u003eresponse rate of 100%. Hundred eleven (81.0%) of cases and hundred forty one (51.6%) of controls were female. The mean age of cases and controls were 37.8 (SD ± 3.1) and 38.1 (SD ± 3.24) years, respectively. Fifty (36.5%) of cases and One hundred eight (39.4%) of control were not attended formal education. Sixty six (48.2%) of cases and 140(51.1%) of controls were farmer in occupation. Majority, 71(51.2%) of cases and 153(55.8%) of controls were live in rural area (Table 1).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\"\u003e\n \u003ch2\u003ePatient related characteristics of study participants\u003c/h2\u003e\n \u003cp\u003eMore than half 75 (54.5%) of case and less than half 125 (45.8) of controls had information about goiter. Majority of cases 114 (83.2) and controls 246(90.1%) had no family history of goiter. Most of cases 89(65%) and controls 199 (72.9%) did not know person living with goiter in their living area. Most of the cases 104(75.9%) and controls 224 (82.1%) had no chronic medical illness (Table 2).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\"\u003e\n \u003ch2\u003eDietary related characteristics of study participants\u003c/h2\u003e\n \u003cp\u003eMajority of the cases 103(75.2) and controls 173(63.4) had no information about iodized salt. More than half of cases 719 (51.8) and controls 137(50.2) were add salt to their food at the middle of cooking. Majority of the cases 129(94.4) and controls 243(89) were store salt in closed container. More than half of cases 74(54) and controls 154(56.4) were consumed cabbage at least three times per week. The remaining cases and controls were taken cabbage less than three times per week. (Table 3).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\"\u003e\n \u003ch2\u003eEnvironmental related characteristics of study participants\u003c/h2\u003e\n \u003cp\u003eAbout half of cases 68(49.6) were use river water for drinking ware us one hundred thirty nine (50.9) of controls were use tape water for drinking. Majority of the cases 119(86.9) and controls 258(94.5) were not cigarette smoker. Almost all of cases 130(94.9) and controls 248(90.9) were have no history of radiation exposure. Most of the cases 135(98.5) and controls 253(92.7) were have no history of any cancer. One hundred five cases (75.9) and one hundred ninety three controls (82.1) had no history of medication use.(Table 4)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDeterminants of goiter in patients attending Ambo University Referral Hospital surgical OPD.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eVariables with p-value \u0026lt; 0.25 were included in multivariable analysis include sex, marital status, occupational status, monthly income, place of residency, knowledge about goiter, family history of goiter, person who have goiter in living area, history of chronic medical illness, use of iodized salt, consumption of egg at least once per week, source of drinking water, history of smoking, radiation exposure history and any medication used in the past.\u003c/p\u003e\n \u003cp\u003eThe odds of developing goiter was 2.6 times (AOR = 3.81, 95% CI: 2.1, 7.1) more likely among females as compared to men. The odds of developing goiter was 5.04 times (AOR = 5.04, 95% CI: 1.17, 21.7) more likely among self-employ, 9.4 times (AOR = 9.4, 95%CI: 2.38, 37.64) more likely among daily laborers, 6.57 times (AOR = 6.75, 95% CI: 1.97, 21.9) more likely among merchants, as compared to public servants respectively. Those patients who live in area where individuals with goiter live were 1.8 times (AOR = 1.8, 95% CI: 1.01, 3.5) likely to develop goiter as compared to their counterpart. The odd of goiter was 3.4 times (AOR = 3.4, 95% CI: 1.78, 6.38) more likely to develop among iodized salt non user as compare to those who used iodized salt.\u003c/p\u003e\n \u003cp\u003eThe odd of goiter among patients who were not consumed egg at least once per week was 1.52 times (AOR = 1.52, 95%CI: 1.01, 2.31) more likely to develop as compared to those consumed egg at least once per week. Patients with river water for drinking were 5.6 times (AOR = 5.6, 95% CI: 2.9, 10.5) more likely to develop goiter compared to tape water drinkers (Table\u0026nbsp;5)\u003c/p\u003e\n \u003cdiv\u003e\u003cbr\u003e\u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of the study was to identify the determinants of goiter among patients attending Ambo University Referral Hospital surgical OPD, Ethiopia.\u003c/p\u003e \u003cp\u003eIn this study, patients who are female were 2.6 times more likely to develop goiter than their male counterpart. This finding is consistent with studies conducted in India, Ghana, Nigeria, Sekota, Gamo Gofa and St. Paul Hospital Millennium medical Collage of Ethiopia (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The possible explanation might be due to the effect of different hormonal changes in women at different time of their life. In addition the women\u0026rsquo;s bodies are more reactive and sensitive to different hormonal change than men. Women need higher amount of thyroid hormone during puberty and during pregnancy which lead to secretion of more thyroid stimulating hormones that increase the proliferation of thyroid follicles and goiter. In addition some pregnancy related hormones like chorionic gonadotropin increase stimulation of thyroid gland. Women are prone to iodine deficiency due to lack of information about iodized salt, low income and increased iodine demand during different physiologic stress like pregnancy. Iodine deficiencies directly lead into goiter development.(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThis study found that odds of developing goiter was 5.04 times more likely among self- employ, 9.4 times more likely among daily laborers, 6.57 times more likely among merchants, than compared to public servants respectively. This finding is in line with a study conducted in Gagzebela district of north east Ethiopia (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). This could be due to lack of knowledge about goiter and dietary diversity for the family for those self-employed, daily laborers and merchants when compared to public servants. In addition there may be discrepancy in literacy level and income for purchasing and appropriate utilization of iodized salt which intern contributes to the development of goiter.\u003c/p\u003e \u003cp\u003eThe study indicated that patients with low income (less than 2500) had 3.7 times odd of developing goiter than those with higher income. This is in agreement with study done in Laku town Southern Ethiopia and Tach Armachihew northwest Ethiopia (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) which showed higher odd of developing goiter in low income. The possible explanation might be due to different factors that are related to the income of the patient like dietary diversity, lower consumption of diets that are important in prevention of goiter like fish, meat, milk and egg. In addition they may have higher tendency for the intake of goiterogenic foods like cabbages could increases the development of goiter.\u003c/p\u003e \u003cp\u003eThe study indicated that, patients who live in areas where persons with goiter live were 1.8 times more likely to develop goiter as compared to patients who were not live in areas where person with goiter live. This finding is in line with a study conducted in Gagzebela district of north east Ethiopia (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). This could be those who live where person with goiter live may share different environmental factors like high altitude which lead to top soil erosion that causes iodine deficiency, practice eating food incriminated with development of goiter like goitergenic vegetables, roots and also may not have distribution of iodized salt in this living area. In addition those patients might have water source which are contaminated that lead into infection and micronutrient deficiency that result in development of goiter.(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e According to this study patients who were consumed non iodized salt were 2.7 times higher to develop goiter compared to patients consumed iodized salts. This finding is comparable with multiple study done at India, Ghana south west Ethiopia, southern Ethiopia and Northern Ethiopia (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). This could be because adequately iodized salt has both preventive and corrective effects for iodine deficiency goiter and is the main solution for eradicating IDDs. Iodine is one of the most important micronutrient required for normal thyroid function and majority of iodine is obtained from iodized salt. Use of none iodized salt lead into lower circulating iodide that result into lower production of thyroid hormone and this cause increased production of thyroid stimulating hormone that stimulate proliferation of thyroid gland and development of goiter. In addition iodine supplementation will reduce the development of goiter thus non iodized salt use end up into higher development of goiter and inhibit the regression of iodine dependent goiter that result into more goiter than those utilize iodized salt (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe occurrence of goiter was 1.52 times more likely in patients who did not consumed eggs at least once per week compared to those who eat egg at least once per week. This finding is in line with the study performed in northeast Ethiopia and Sidama region (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). It may be due to the fact that animal products have higher content of iodine and also contain proteins required for iodine binding and transportation that could result in pathological enlargement of thyroid gland (goiter).\u003c/p\u003e \u003cp\u003eThis study revealed that odd of developing goiter in patients who drink river water were 5.6 times more likely as compared to those tape water drunker This finding is in line with a study conducted in Gagzebela district of north east Ethiopia (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) The possible explanation might be due to the contamination of river water that lead to infection and micronutrient deficiency that may cause goiter.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitation of the study\u003c/h2\u003e \u003cp\u003eStrength of this study is that, cases and controls were selected from same source population (controls were selected from the hospital that yielded the cases) and as a result, cases and controls were comparable.\u003c/p\u003e \u003cp\u003eDespite the authors' efforts to create a more representative sample by carefully identifying the study population and selecting the appropriate comparison, selection ( patients with goiter but did not complained about the goiter and come for other compliant may be selected as control) and recall bias may still exist.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion and Recommendation","content":"\u003cp\u003eConclusion\u003c/p\u003e\u003cp\u003eThis study identified several determinants of goiter among patients attending Ambo University Referral Hospital Surgical OPD. Bing female, low income, occupation being daily laborer, self-employed, merchant, living in areas where person with goiter live, utilization of none iodized salt, not consuming egg at least once per week and river as source of drinking water were the identified determinants factors for goiter.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eRecommendation\u003c/h2\u003e \u003cp\u003eBased on the study finding the following recommendations are made.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eZonal health Office\u003c/h2\u003e \u003cp\u003eAs goiter is a one of the most common endocrine diseases health information about determinant factors, prevention, and consequences of goiter should be given.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eHospital under study\u003c/h2\u003e \u003cp\u003eEncourage front-line health care providers to give health education on determinant of goiter like types of salt used, water source for drinking, occupation, educate the importance of animal products in preventing the development of goiter\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eResearchers\u003c/h2\u003e \u003cp\u003eFuture researchers should also be done at regional or national wide study for further generalization of the study result.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eAURH\u003c/strong\u003e: \u0026nbsp; \u0026nbsp; \u0026nbsp;Ambo University Referral Hospital\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEDHS\u003c/strong\u003e: \u0026nbsp; \u0026nbsp; \u0026nbsp; Ethiopian Demographic and Health Survey\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eICCIDD:\u003c/strong\u003e\u0026nbsp; \u0026nbsp; International Council for Control of Iodine Deficiency Disorders\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eID\u003c/strong\u003e: \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Iodine Deficiency\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIDDs\u003c/strong\u003e: \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Iodine Deficiency Disorders\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOPD:\u0026nbsp;\u003c/strong\u003e Outpatient Department\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSPHMMC\u003c/strong\u003e: \u0026nbsp;\u0026nbsp;St. Paul Hospital Millennium medical Collage\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTSH\u003c/strong\u003e: \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Thyroid Stimulating Hormone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUNICEF\u003c/strong\u003e: \u0026nbsp; \u0026nbsp; \u0026nbsp; United Nations Children\u0026rsquo;s Fund\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWHO\u003c/strong\u003e: \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;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\u003eThe study was conducted in accordance with the World Medical Association Declaration of Helsinki. Ethical clearance was obtained from an ethical review committee of the college of medicine and health science, Ambo University to conduct the study reference number of PGC/229/2021. A support letter was submitted to hospital. Written informed\u0026nbsp;consent was obtained from each study subject before the data collection process proceeded. During the data collection process, the data collectors had informed each study participant about the objective and anticipated benefits of the research project and the study participants were also informed of their full right to refuse, withdraw, or completely reject part or all of their parts in the study. Data was collected anonymously and kept in lock with the investigators.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eAll the datasets used and/or analyzed during the current study are available from the corresponding author reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors report no conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This research does not received grant from any funding agency in public, commercial or non-profit making organizations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to the study participants and data collectors of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTEC, MCG, were involved in conception, design of the study, training and supervision of data collectors and supervisors, analysis, interpretations and preparation of subsequent drafts of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTadesse Ejeta Chala: Assistant professor of General Surgery, Endocrine and Breast Surgery Sub-specialist, MPH in Epidemiology, MD.\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]/ [email protected]\u003c/p\u003e\n\u003cp\u003eMulu Chala Gameda: Masters of Sport Science, BSC in Physical education\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAndersson M. Iodine Status Worldwide, WHO Global Database on Iodine Deficiency: Department of Nutrition for Health and Development. Geneva: World Health Organization; 2004.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWartofsky L. (1998). Diseases of the thyroid in Fauci, A.S., Braunwald, E. Principles of internal medicine 14th edition.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVanderpump MP. The epidemiology of thyroid disease. Br Med Bull. 2011;99(1):39\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbuye, Berhane. The goiter rate, its association with reproductive failure, and the knowledge of iodine deficiency disorders (IDD) among women in Ethiopia. BMC Public Health. 2007;7(316):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhatiwada, Rajendra S, et al. Thyroid dysfunction and associated risk factors among nepalese diabetes mellitus patients. Int J Endocrinol Article ID. 2015;570198:5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMadhuvan HS. (2013).A prospective study of thyroid - dysfunction in elderly patients and its clinical correlation.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlemu B, Terefe M et al. ,(2016):Thyroid hormone dysfunction during pregnancy: a review. Int J Reproductive Biomed, 14, 11, pp. 677\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh MB, Marwal R, Lakshminarayan J. Assessment of iodine deficiency disorders in school Age children in Jodhpur district of Rajasthan. J Hum Ecol. 2010;32(2):79\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuressa F, Mohammed Y, Feyissa R, Tufa T, Siraj K. Comparative analysis of iodine concentration in water, soil, cereals and table salt of Horaboka, Mio and Besaso Towns of Bale Robe, South East Ethiopia. J Environ PollutHuman Health. 2014;2:27\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO/UNICEF/ICCIDD. Assessment of iodine deficiency disorders and monitoring their elimination: A guide for program managers. 3rd ed. Geneva: World Health Organization; 2007.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTakele L, Belachew T, Bekele T. Iodine concentration in salt at household and retail shop levels in Shebe town, Southwest Ethiopia. E Afr Med J. 2003;80:532\u0026ndash;9. Google Scholar.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCSA [Ethiopia] and ORC Macro. Ethiopian Demographic and Health Survey preliminary report. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ORC Macro; 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeung M, Braverman E. Iodine-induced thyroid dysfunction. Curr Opin Endocrinol Diabetes Obes. 2012;19(5):414\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMekones E. (1996): Prevalence of goiter in Sekotta district, Ethiopia. East. Afr. Med. J; 73:264.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYisihak S, Engida A. Patterns of Surgically Treated Thyroid Disease: A Two Years Review at St. Paul Hospital Millennium medical Collage, Addis Ababa, Ethiopia; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGebreegziabher T, Nega A, Mulugeta, et al. Lack of dietary sources of iodine and the prevalence of iodine dificiency in rural women from Sidamazone,SouthernEthiopia. Afr J Food Agric Nutr Dev. 2013;13(5):8401\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDelange F. Iodine requirements during pregnancy, lactation and the neonatal period and indicators of optimal iodine nutrition. Public Health Nutr. 2007;10:1571\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGabramichael G, Et.al. Prevalence of Goiter and Associated Factors Among Adolescents in Gazgibla District. Northeast Ethiopia; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBefikaduwa Z. Prevalence of Goiter and Associated Factors among Women of Reproductive Age Group in Demba Gofa Woreda. Gamo Gofa Zone, Southwest Ethiopia; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDesalegn T. Epidemiology of goiter and its predictors among school age children in Leku town, Southern Ethiopia. Curr Pediatr Res. 2017;21(4):620\u0026ndash;6261.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKebede DL, Adinew YM. Predictors of Goiter among School Children in Southwest Ethiopia: Case-Control Study. J Nutr Food Sci. 2015;5:368.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld health organization report 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBelaynew Mesfin,1 Bisrat Misganaw. Goiter and Its Associated Factors among Adolescent High School Girls at Tach Armachiho District. Northwest Ethiopia: An Institution-Based Cross-Sectional Study; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOseiSarfo-Kantanka,1 IshmaelKyei. (2017).Thyroid Disorders in Central Ghana: The Influence of 20 Years of Iodization.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGetenet Dessie1*, Desalegne Amare1. (2017): Prevalence of goiter among children in Ethiopia and associated factors.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDaniel A et., Al. Thyroid Dysfunction and Cytological Patterns among Patients Requested for Thyroid Function Test in an Endemic Goiter Area of Gondar. North West Ethiopia; 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerhanu A, Abdu O. Determinants of iodine deficiency among school age children in Guraghe Zone. Southwest Ethiopia; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGebremariam, Yesuf M, Koye N. (2013):Availability of adequately iodized salt at household level and associated factors in Gondar town, northwest Ethiopia, ISRN Public Health, vol. 2013, Article ID 160582, 6 pages.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGidey B, Alemu K, et al. Availability of adequate iodized salt at household level and associated factors in rural communities in Laelay Maychew district, northern Ethiopia. J Nutr Health Sci. 2015;1(4):393.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZimmermann B. The effects of iodine deficiency in pregnancy and infancy. Paediatr Perinat Epidemiol. 2012;26:108\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiosady L, lberti O. Stability of iodine in iodine salt used for correction of iodine deficiency disorder. FoodNutr Bull. 1997;18:388\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (WHO). Iodine Deficiency Disorders. Geneva, Switzerland: Global Database, WHO; 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuzemil M, et al. Goiter and its associated factors among primary school children aged 6\u0026ndash;12 years in Anchar district. Eastern Ethiopia; 2019.\u003c/span\u003e\u003c/li\u003e \u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Goiter, iodized salt, drinking water","lastPublishedDoi":"10.21203/rs.3.rs-8767930/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8767930/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eGoiter refers to benign or malignant enlargement of thyroid gland affecting the structure and function of the gland that may present as a derangement of thyroid hormone secretion, thyroid enlargement or pain and presenting as myriad of devastating consequences if not treated. Goiter is a global health problem and accounting around 30% to 40% burden of the endocrine disorder. In Ethiopia approximately 28\u0026nbsp;million people have goiter. This makes it major public health problem in the country.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eFacility based, unmatched case-control study design was conducted among 410 patients attending Ambo University Referral Hospital surgical OPD from May, 1\u0026ndash;30 June2022. The cases were goiter patients and controls were patients with non-goiter. Cases were selected consecutively and following each case two controls were selected. A structured interviewer- assisted questionnaire was used to collect data. Data were entered into Epi data version 3.1; exported and analyzed by SPSS version 20. All independent variables with p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.25 in the bi-variable binary logistic regression analysis were entered into multivariable binary logistic regression analysis. Model fitness was checked by Hosmel-lemshow goodness of fit. An adjusted odds ratio with a 95% CI and a p-value of \u0026lt;\u0026thinsp;0.05 was used to identify determinants of goiter.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eA total of 410 patients (137 cases and 273 controls) were included in the study. The mean age of cases and controls were 37.8 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1) and 38.1 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;3.24) years, respectively. Being female (AOR\u0026thinsp;=\u0026thinsp;2.6,95% CI: 1.4, 4.9), none iodized salt consumption (AOR\u0026thinsp;=\u0026thinsp;3.4, 95%CI: 1.4, 5.3), River water for drinking (AOR\u0026thinsp;=\u0026thinsp;5.6, 95%CI: 2.9, 10.5), low income (AOR\u0026thinsp;=\u0026thinsp;3.7, 95% CI: 1.1, 12.5), Living in area goiter is common (AOR\u0026thinsp;=\u0026thinsp;1.8, 95%CI: 1.01,3.5) and not consuming egg once per week(AOR\u0026thinsp;=\u0026thinsp;1.5,CI:1.01,2.31) were found to be determinants of goiter.\u003c/p\u003e\u003ch2\u003eConclusion and Recommendations:\u003c/h2\u003e \u003cp\u003eBeing female, low income, living in area where goiter is common, none iodize salt utilization, not consuming egg at least once per week and drinking river water were determinant of goiter. Health educations on iodized salt utilization, improving income, providing tap water for drinking are important for prevention of goiter.\u003c/p\u003e","manuscriptTitle":"Determinants of Goiter Among Patients Attending Ambo University Referral Hospital Surgical Outpatient Department: Un Matched Case-Control Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-11 15:41:35","doi":"10.21203/rs.3.rs-8767930/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-03-22T00:43:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"286983894968120179761652657211369173187","date":"2026-03-18T03:06:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"320270907219765389399742848165049149816","date":"2026-03-15T23:18:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"152153251937423306088796226729819277292","date":"2026-03-06T14:05:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-06T13:58:41+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-05T06:52:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-05T01:24:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-05T01:24:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nutrition","date":"2026-02-02T17:34:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"751da829-74b5-44f0-a891-37e2a0f22250","owner":[],"postedDate":"March 11th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-11T15:41:35+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-11 15:41:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8767930","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8767930","identity":"rs-8767930","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}