Africa

Lead Researchers

Mr Dejen Tekle

Prof Jacqui Webster

Prof Stephen Jan

Related Investigators

A/Prof Anne-Marie Thow

Mr Joseph Alvin Santos

Dr Kathy Trieu

Mr Sudhir Raj Thout

Dr Rhoda Ndanuko

Prof. Karen Charlton

Dr Annet Hoek

Dr Mark D. Huffman

Funders

National Heart Foundation Future Leaders Fellowship II

The George Institute for Global Health, Australia

Partners

World Health Organization

Resolve to Save Lives

The Federal Ministry of Health Ethiopia

The George Institute for Global Health, Australia

Background

Excess dietary sodium consumption – most commonly through the consumption of salt is a risk factor for high blood pressure, stroke, cardiovascular disease and other adverse health outcomes. Given the negative impact of excessive salt consumption on health, the WHO has urged its member states to take action at a population level to reduce dietary salt intake, with expected accelerated results in terms of lives saved, cases of disease prevented, and costs avoided.

A systematic review conducted by Trieu et al, in 2015 showed that 75 countries already had national salt reduction strategies, twice the number observed in 2010. The review showed that 12 countries had achieved a decline in population salt intake.

In Africa, studies about salt reduction initiatives are not yet thoroughly studied nor did the barriers and enablers that affect the implementation of salt reduction program, as well as the appropriateness of the intervention approach and likely impact. In addition, there is a scant of evidence on the health and economic benefits of salt reduction to diet-related NCDs in Africa.

Aims

This study aims to comprehensively review and understand the potential for salt reduction interventions to reduce the burden of diet-related NCDs in Africa. The findings of this research, in addition to filling the research gap in the empirical literature, will inform recommendations to support the future development, implementation, and evaluation of national salt reduction programs in the region. It will also provide key inputs for policymakers and development practitioners in supporting the scale-up of salt reduction interventions in the continent.

Methods

This project has four objectives that guide the research methodology:

 

Objective 1: Monitoring and Implementation of Salt Reduction Initiatives in Africa: A systematic review. The aim of this systematic review was to document salt consumption patterns, the implementation status, and the potential impact of salt reduction initiatives in Africa from studies published between January 2009 and November 2019. Of the 887 records retrieved, 38 studies conducted in 18 African countries were included. The population salt intake studies determined by 24-hour urine collections showed that the mean (SD) salt intake in African adults ranged from 6.8 (2.2) g to 11.3 (5.4) g/day. Salt levels in foods were generally high and consumer knowledge was fairly high but didn’t seem to translate into salt lowering behaviours.

 

Objective 2: Policy analysis to understanding barriers and enablers to salt reduction programs in Ethiopia. A Qualitative policy analysis based on the Health Policy Analysis Triangle framework will be conducted. In this study, two data collection methods will be utilized including stakeholder analysis with key-informant interviews and a desk-based review and analysis of existing guidelines, policies and strategic documents relevant to salt reduction.

 

Objective 3: Quantifying health and economic benefits of dietary salt reduction in Ethiopia. An extensive literature search of national representative salt intake, blood pressure and CVD levels will be performed to estimate long term health and economic gains of salt reduction. With a view to deciding which model is most suited to assessing the potential economic benefits of salt reduction in Ethiopia, we will conduct a comprehensive scoping review of available models to estimate the economic benefits of salt reduction.

 

Objective 4: Supporting and evaluating interventions in Ethiopia. We are collaborating with Resolve to Save Lives, WHO and MOH in Ethiopia with a view to supporting and evaluating a tailored intervention to reduce salt in Ethiopia

Impact

The findings of this research, in addition to filling the research gap in the empirical literature, will inform recommendations to support the future development, implementation, and evaluation of national salt reduction programs in the region.

It will also provide key inputs for policymakers and development practitioners in supporting the scale-up of salt reduction interventions in the continent.

Research Sites

Ethiopia and (Tigray) regional state, Africa.

Project Status

The systematic review has been accepted in The Journal of Clinical Hypertension and it is in production.

Currently, the project team has secured ethics on 06-Apr-2020 (HC200056) and is making plans to conduct the policy analysis remotely.