India: Educating Children to Eat Less Salt

Educating children and parents to eat less salt: A Randomized Controlled Trial in School settings

Background

We are all eating too much salt. In India, adults are consuming on average almost double the World Health Organization’s recommended maximum intake of 5 grams a day. Children are also consuming excess salt due to regular consumption of fast foods, salty snacks, processed, junk foods and home-cooked foods. Awareness of salt-related issues with health education lessons for school children seems to be a cost-effective salt reduction strategy and is effective in lowering salt intake in families. 

High salt intake contributes to high blood pressure, increasing the risk of heart attack and stroke, and can put stress on the kidneys, increasing the risk of kidney disease and kidney failure. These conditions have both a human toll and a considerable impact on the health system. 

Reducing salt intake is the key to cost-effective public health intervention to reduce the risk of cardiovascular diseases in both developed and developing countries. Under the ‘25 by 25’ initiative for the control of non-communicable diseases, India is committed to reducing salt intake by 30% in the mean population by 2025.

However, few educational interventions have been conducted to promote a lower salt diet in a range of settings. The school-based educational interventions to reduce salt intake has been effective for the prevention of blood pressure-related diseases, through educating children and their parents about the harmful effects of salt on diet.

This research comprises a randomised control trial among school in Chandigarh, aimed at reducing dietary salt intake among early adolescents and through them, reducing salt intake in their families.

Aim

The aim is to assess the impact of salt reduction intervention package on mean salt intake targeted at school adolescents and their parents.

Research Methodology

The George Institute launched an advocacy campaign to raise funds for a pilot study reaching out to 15,000 school children in Delhi and Hyderabad.

The pilot study aims to gather concrete evidence on how this proposed intervention will benefit children’s health outcomes. Under the guidance of our researchers, the program will be able to show a marked difference between the situation before the intervention and after thus proving that reducing salt can make a concrete difference to health outcomes.

The study design is Cluster Randomized Controlled Trial includes three phases: Baseline for 12-weeks; Intervention delivery for 6 months; and Follow-up by end line at 12-months. Government schools of urban slum and urban non-slums located in the Union Territory of Chandigarh, India were selected. A total of 12 schools have been included in the study: 6 intervention and 6 control. All the students from class 8th from the identified schools were involved in the study groups. Also, either mother or the father of the child will be involved in the research study based on their time availability. Intervention components are comprised of classroom teaching consultation with school children and their parents that employs the activity schedule with a micro plan of activities aimed to reduce salt intake and to improve knowledge and behaviours related to salt consumption. A survey on knowledge, attitudes, and practice (KAP) related to salt intake will be conducted at baseline and end line.  

Effectiveness will be measured by comparing salt intake measured by two 24-hr urine collections at baseline and 12 months. 

Impact

Educating children on salt consumption will help current and future generations and save millions of lives. The current school-based salt reduction intervention package includes a package of activities along with health education lessons for school children. It is a cost-effective salt reduction strategy and would be effective in lowering salt intake in families. 

Outcomes

The primary outcome of the study is the changes in the mean consumption of salt among school adolescents and their parents. 

The secondary outcomes are changes in knowledge levels and current practices related to salt consumption.

Research Sites

Chandigarh, India