S1: Questionnaire English version
Questionnaires and checklists on Iodine concentration, coverage of adequately iodized salt
and factor affection on proper iodized salt utilization
Part I. Socio demographic characteristics of the household
No Questions and filters Response coding Categorization Skip
101 Area Identification
1. Kebele _________ Kebele
Code_____
2.Gote (Cluster) Name _______
3.Cluster #_________
4. code household_______if any
Residence of the household 1. Rural
2. Urban
102 Sex of the head of the household 1. Male_____
2. Female____
103 Age of the head of the household in years [--------]
104 Age of the housewife [……..]
105 What is your family size within the |___|
household?
106 How many children under 12 in the [……….]
household
107 Occupation of the house wife (multiple 1.Farmer____
answers allowed) 2. Merchant___
3. Governmental_____
4.NGO______
4. Daily worker_____
5. others_______ specify_________
108 What is the source of income for the 1.Farmer____
household? (multiple answers allowed) 2. Merchant___
3. Governmental_____
4.NGO______
4. Daily worker_____
5. Others_______ specify_________
109 Income level per month in Eth birr [-----]
110 What is the educational Status of the head 1. Illiterate----------
of the households? 2. Read and write -----
3. Elementary school----
4. High school----
5.Higher institution------
6. Others------- specify-----------------
111 What is the educational Status of the 1. Illiterate
housewife? 2. Read and write
3. Elementary school
4. High school
5.Higher institution
6. Hthers------- specify-----------------
Part ii. Knowledge about Iodine and Iodized salt
No Questions and filters Response coding Categorization Skip
201 Do you know what iodine is? 1.Yes----- go to ques # 202
2.No------ go to ques # 211
3.I don’t know------ go to ques #211
202 If yes what is iodine? 1.Mineral-------
2.Vitamin------
3.Protein------
4.Carbohydriate-----
5.Others-------
Specify---------
203 Do you know iodine rich foods? 1.Yes-----
2.No------
3.I don’t know------
204 If yes tell me iodine rich foods. [……………………………….]
205 Do you know iodine deficiency disorders?
1.Yes-----
2.No------
3.I don’t know------
206 If yes, would you tell me one iodine […………………………………….]
deficiency disorders?
207 Who are at risk for iodine deficiency? 1.Children------
(multiple answers allowed) 2.Elder----------
3.Pregnant Women-----
4.Adolescent------------
5.Men-------------
6.Women--------
7.Others -----------
Specify…………
208 Do you know how to prevent iodine 1.Yes-----
deficiency disorders? 2.No------
3.I don’t know------
209 If yes what are the prevention mechanisms 1.Iodized oil---------
you know? 2.Iodized salt--------
3.Sea foods-------
4.Iodized water-----
5.Others------------specify---------
210 From whom did you get the information of (Y = yes, N = no) (Y N)
prevention and control of IDDs?( multiple 1.Radio……………………1 2
answers allowed) 2. Television.………….…...1 2
3.Newspaper/magazine……1 2
4.Pamphlet/poster….....……1 2
5.Health Worker….……….1 2
6.Community events………1 2
7.Family/friends……………1 2
9.Health extension worker...1 2
10.Others…..………………1 2
(Specify)------------------------
211 What kind of salt do you use? 1. Refined…………..
2. Coarse -------------
4. Others ... ………
(please specify)-------------
212 Do you use iodized salt? 1.Yes-----(go to quest no 213)
2.No-------(go to quest no 214)
3.Don't know---(go to quest no 214)
213 If yes why do you choose iodized salt? 1.For health ---------
2.I don’t know------
3. Testy ……..
3.Others --------------
Specify--------------
214 If no why don’t you choose iodized salt 1.it looses salty taste---------
2. other--------------
Specify--------------
215 If you are using iodized salt how you did (Y = yes, N = no) Y N)
hear about iodized salt and its importance? 1.Radio……………………1 2
( multiple answers allowed) 2. Television.………….…...1 2
3.Newspaper/magazine……1 2
4.Pamphlet/poster….....……1 2
5.Health Worker….……….1 2
6.Community events………1 2
7.Family/friends……………1 2
9.Health extension worker...1 2
10. Others…….……………1 2
(Specify)……………………
217 Do you know iodized salt is sensitive to 1.Yes-----
temperature, sun light and humidity. 2.No------
3.I don’t know------
Part iii. Attitude about iodized salt
301 In adequate salt intake is good for your 1. Strongly agree 2. Agree
health. 3.Uncertain 4.disagree 5. Strongly
disagree
302 Resistance from you and member of your 1. Strongly agree 2. Agree
community against purchasing iodized salt 3.Uncertain 4.disagree 5. Strongly
may affect the health of you, your family disagree
and your community.
303 1. Strongly agree 2. Agree
Adding salt to the food of infant/children is 3.Uncertain 4.disagree 5. Strongly
good. disagree
304 Adding iodized salt to the food of pregnant 1. Strongly agree 2. Agree
mothers and lactating mothers is not good. 3.Uncertain 4.disagree 5. Strongly
disagree
305 There is no harmful effect in children, 1. Strongly agree 2. Agree
lactating and pregnant mothers if they take 3.Uncertain 4.disagree 5. Strongly
insufficient iodine. disagree
306 Influence on the decision to use iodized 1. Strongly agree 2. Agree
salt by friends and health workers are 3.Uncertain 4.disagree 5. Strongly
useful for you and your family. disagree
Part iv. Practice of iodized salt
401 Do you use iodized salt? 1.Yes-----
2.No-------
3.Don't know---------
402 Do you buy packed salt? Yes-------------(go to questi no 403)
No-------------(go to quest no 404)
I don’t know…(go to quest no 404)
403 If yes how is the salt packed? 1.plastic------
2. thick plastic bag------
3. glass/ bottle------
4.Other------specify
404 Is your storage of salt free from sun light, 1.yes
moisture and high temperature? 2. no
3. I don’t know
405 Do you add table salt? 1. Yes ……
2. No …….
3. I don’t know
409 When do you usually add salt to your 1. Before cooking……….
food? 2. During cooking……….
3. After cooking…………
4. Other………specify …………..
5. don't know[-------------------------]
v. Accessibility and availability of iodized salt
501 Where is your source of buying salt? 1.Market-----------
2. shop--------------
3. Super market-----
3.Others------------
Specify--------------
502 How often do you usually buy salt? 1.Weekly------
2. Monthly ----
3. Yearly--------
4. Others-------
5. Specify------
503 How much do you usually buy at a given [--------------]
time? (in kgs)
504 How much salt does your family consume [-----------------]
per month in KG?
505 Do you get as you want iodized salt in the 1.Yes
in the place where it sold? 2.No
3. I don’t know……
506 Is there both iodized and non iodized salt 1.Yes-------------(go to quest no 507)
in the market? 2.No--------------(go to quest no 601)
3. I don’t know--(go to quest no 601)
507 If yes is there a difference in cost? 1.Yes-----------------
2.No------------------
3. I don’t know-------
508 If the price of iodized salt is a little bit 1.Yes-----------------
more expensive than regular salt can you 2.No------------------
afford to buy the iodized salt? 3. I don’t know-------
Vi. Check list for iodine concentration in the salt.
601 Ask respondent three teaspoonful of 1.0 ppm (no iodine)……………….1
cooking salt: 2.Less than 15 ppm………………..2
Test salt for iodine 3.More than 15 ppm………...…….3
Record parts per million (ppm) 4.No salt in the house……………..4
5. Salt not tested, specify reason……
This is all my questions and Thank you for your response.
