Double Fortified Salt Containing Iodine and Folic Acid and Triple Fortified Salt Containing Iodine, Folic Acid, and Vitamin B Are Acceptable to Ethiopian Women of Reproductive Age.

Recognizing the broader accessibility of iodized salt compared to wheat flour, the Ethiopian government is considering fortification of iodized salt with folic acid, and possibly vitamin B, to address the high incidence of neural tube defects (NTDs) in Ethiopia. To prepare for this program, we assessed practices related to edible salt procurement and consumption, and the acceptability of novel salts fortified with iodine and folic acid (double-fortified salt, DFS) or iodine, folic acid, and vitamin B (triple-fortified salt, TFS) compared to iodized salt (IS). We surveyed 840 women of reproductive age in urban (Addis Ababa) and rural (Gimbichu Woreda) areas to describe their salt preferences and practices and used a three-point hedonic scale to evaluate the sensory acceptability of fine and coarse forms of DFS, TFS, and IS for color, taste, aroma, texture and overall acceptability. We found that women were the primary salt purchasers (72.8% rural, 97.4% urban) for household. Rural women preferred coarse salt (76.1%), whereas urban women preferred fine salt (42.4%) or both types (30.0%). All salts received favorable mean sensory ratings (≥ 2.1), with fine salt preferred for all sensory characteristics ( < 0.05). Fine IS (2.8 ± 0.5) was rated slightly higher than DFS (2.6 ± 0.8) and TFS (2.5 ± 0.8) ( < 0.05). Rural women were more willing to purchase DFS (79.2%) and TFS (73.0%) than urban women (65.0% DFS, 63.8% TFS). In conclusion, DFS and TFS are highly acceptable in Ethiopia, with women being the key target for their introduction. Mandatory fortification of both coarse and fine salts is recommended to maximize reach.