Knowledge, Utilization Practices, and Adequacy of Iodized Salt Among Pregnant Women in Awash Sebat Administrative City, Afar Region, Ethiopia: A Bayesian Logistic Regression Analysis.

Background: Iodine is an essential micronutrient required for thyroid hormone synthesis and fetal brain development, making pregnant women particularly vulnerable to iodine deficiency. Despite implementation of universal salt iodization in Ethiopia, adequate iodine intake remains suboptimal due to gaps in knowledge, utilization practices, and household availability of adequately iodized salt. These challenges are more pronounced in pastoral settings such as the Afar Region, where contextual factors may influence access to and use of iodized salt. Therefore, this study assessed knowledge, utilization practices, the availability of adequately iodized salt, and associated factors among pregnant women in Awash Sebat Administrative City using a Bayesian logistic regression approach. Methods: A community-based cross-sectional study was conducted among 411 pregnant women (response rate: 97.39%) in Awash Sebat Administrative City, Afar Region, Ethiopia, from December 1 to 30, 2024. Participants were selected using simple random sampling from health extension workers' registration lists of pregnant women. Data were collected using a structured interviewer-administered questionnaire and household salt iodine testing. Bayesian logistic regression was used to identify factors associated with knowledge, utilization practices, and the availability of adequately iodized salt. Results: Overall, 80.78% of pregnant women had good knowledge of iodized salt, and 62.8% demonstrated good utilization practices. Adequately iodized salt was found in nearly two-thirds of households (62.5%). Higher odds of good knowledge of iodized salt were observed among pregnant women with college-level or higher education (OR = 1.77; 95% CrI: 1.22-5.45), urban residence (OR = 2.48; 95% CrI: 1.57-6.32), and high wealth index (OR = 2.27; 95% CrI: 1.07-4.35). Good utilization practice was significantly associated with college-level or higher education among pregnant women (OR = 5.08; 95% CrI: 2.70-8.03), Christian religion (OR = 2.87; 95% CrI: 1.52-4.77), and urban residence (OR = 4.58; 95% CrI: 3.43-11.52), while husband-only decision-making was associated with lower odds (OR = 0.21; 95% CrI: 0.11-0.53). Women with good knowledge of iodized salt had higher odds of good utilization practice (OR = 5.06; 95% CrI: 3.88-33.45). The availability of adequately iodized salt was associated with college-level or higher education (OR = 2.13; 95% CrI: 1.10-4.20), urban residence (OR = 1.80; 95% CrI: 1.18-3.39), and a high household wealth index (OR = 2.05; 95% CrI: 1.53-4.88), whereas households with ≥ 4 members had lower odds (OR = 0.64; 95% CrI: 0.35-0.91). Conclusion: This study found that although a considerable proportion of pregnant women in Awash Sebat Administrative City had good knowledge of iodized salt, utilization practices and the availability of adequately iodized salt remained comparatively lower. Higher education, urban residence, and household wealth were consistently associated with better knowledge, utilization practices, and adequate household iodized salt. Good knowledge was positively associated with appropriate utilization practices, highlighting the importance of health education in promoting behavioral change. These findings underscore the need to strengthen community-based nutrition education, improve access to adequately iodized salt in pastoral settings, reinforce the implementation and monitoring of universal salt iodization policies, and promote women's participation in household decision-making to improve iodine nutrition among pregnant women.