Goiter examination. In all women and SAC surveyed in the NWZ and
SCZ, assessment for the presence or absence of visible goiter was
performed. Palpation of goiter was not performed due to the challenge of
ensuring the correct identification of an enlarged thyroid and concerns
about social acceptability.
To observe visible goiter, the participants were asked to raise their
head to the normal position and the presence or absence of an enlarged
thyroid (grade 2 goiter) was observed by a team member (11). Women
were asked to remove the veil around the neck, and in some cases they
were examined by fellow female staff from the team in private. In most
cases, team supervisors cross-checked goiter cases and took a photograph
of the case for cross-checking by the survey coordinator. Goiter
assessment was not performed in the NEZ due to initial concerns about
cultural acceptability.