Abstract
BackgroundSalt intake is associated with hypertension, the leading risk factor for cardiovascular disease. To promote population-level salt reduction, the World Health Organization recommends intervention around three core pillars: Reformulation of processed foods, consumer awareness, and environmental changes to increase availability and affordability of healthy food. This review investigates salt reduction interventions implemented and evaluated in sub-Saharan Africa (SSA).MethodsMEDLINE and google scholar electronic databases were searched for articles meeting inclusion criteria. Studies that reported evaluation results of a salt intervention in SSA were identified. Titles and abstracts were screened, and articles selected for full-text review. Quality of included articles was assessed, and a narrative synthesis of the findings undertaken. PROSPERO registration number CRD42015019055.ResultsSeven studies representing four countries—South Africa, Nigeria, Ghana, and Tanzania—were included. Two examined product reformulation, one in hypertensive patients and the other in normotensive volunteers. Four examined consumer awareness interventions, including individualised counselling and advisory health sessions delivered to whole villages. One study used an environmental approach by offering discounts on healthy food purchases. All the interventions resulted in at least one significantly improved outcome measure including reduction in systolic blood pressure (BP), 24 hour urinary sodium excretion, or mean arterial BP.ConclusionsMore high quality studies on salt reduction interventions in the region are needed, particularly focused on consumer awareness and education in urban populations given the context of rapid urbanisation; and essentially, targeting product reformulation and environmental change, for greater promise for propagation across a vast, diverse continent.
Highlights
This review investigates salt reduction interventions implemented and evaluated in sub-Saharan Africa (SSA)
Four examined consumer awareness interventions, including individualised counselling and advisory health sessions delivered to whole villages
Cardiovascular disease (CVD) is the leading cause of death globally, with 80% of such deaths occurring in low- and middle-income countries (LMICs) [1]
Summary
Cardiovascular disease (CVD) is the leading cause of death globally, with 80% of such deaths occurring in low- and middle-income countries (LMICs) [1]. To achieve realistic salt reduction targets, product reformulation ought to be approached in consultation with food producers and distributors, and include monitoring and evaluation, through implementation of mechanisms to track population-level sodium consumption and food sodium composition. The second pillar is consumer awareness and education, which would best be achieved through campaigns targeting individuals or the catering sector, and focusing on knowledge, attitudes, and behaviours regarding salt intake through clear and simple messages These messaged ought to be tested beforehand, and delivered by identified groups or individuals. To promote population-level salt reduction, the World Health Organization recommends intervention around three core pillars: Reformulation of processed foods, consumer awareness, and environmental changes to increase availability and affordability of healthy food. This review investigates salt reduction interventions implemented and evaluated in sub-Saharan Africa (SSA)
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