Since 1950, cardiovascular disease (CVD) has emerged as a leading cause of mortality in Sri Lanka, especially in men. In 2014, a survey in Kalutara to assess CVD and type 2 diabetes mellitus (T2DM) risk factors in adults aged 25 to 64 years (n = 1011), and associations with sex and socioeconomic status (SES), found similar CVD risk factors in both sexes, except for daily tobacco smoking at 19% in men and nil in women, and higher body mass index (BMI) in women than men. With increasing SES in men, there were significant linear increases in mean BMI, waist circumference, mean systolic and diastolic blood pressure, mean fasting plasma glucose, and T2DM prevalence, but decreases in tobacco smoking. Whereas in women higher SES was associated with a significant increase in mean BMI, but a significant decrease in hypertension prevalence. Tobacco smoking is the main risk factor explaining higher CVD mortality in men compared with women.
In Sri Lanka, a survey was conducted in 2018 to assess the levels of identified hazards in commonly consumed food items. Pesticide residue levels in vegetables, green-leaves and fruits, heavy metals in salt, mercury and formaldehyde in fish, artificial colouring in tea and rice, aflatoxins in chilli powder, peanut and coconut oil and microbiological quality of yoghurt were tested to assess the safety of such foods. 397 fruits, 199 vegetables and 85 green-leave samples were tested for pesticide residues and of them 10.08 % fruit samples, 11.56 % vegetable samples and 41.18 % green-leave samples were detected with the presence of pesticide residues exceeding Maximum Residue Limits (MRL). Among salt samples tested for lead, arsenic, cadmium and mercury, none of the samples exceeded Maximum Permissible Limits (MPL). About one fifth of red raw rice samples were detected with artificial colouring but none of the tea samples had added artificial colourings. Aflatoxin levels exceeding 10 ppm were detected in 8 (10 %) coconut oil, 9 (11.25 %) peanut and 15 (18.75 %) chilli powder samples. All the yoghurt brands tested complied with microbiological specifications given in SLS standard. This survey provides an overview of the level of contaminants and adulterants in commonly consumed food items in Sri Lanka. It is recommended to carry out regular surveillance to monitor food safety hazards.
Recent national surveys have estimated that Sri Lankans are consuming much higher salt than the recommended 5 g/day. However, population-level knowledge, attitudes, and practices regarding dietary salts have not been assessed. This study was conducted with the objective of assessing the knowledge, attitude and practices related to salt consumption among adolescents aged 15-18 years and adults in Sri Lanka. We conducted a countrywide cross-sectional descriptive household survey among a nationally representative sample of 1016 adult and 505 adolescents aged 15-18 years selected from 10 of 25 districts, using a multi-stage cluster sampling method. We used an electronic, interviewer-administered multicomponent questionnaire for data collection. Of all respondents (n = 1521), only 40% were aware of the recommended limit of 5g/day or less. Importantly, 90% of adults and 86% of adolescents knew the adverse health effects of high salt intake. Discretionary salt was a major contributor to intake, with half the survey population (50%) adding salt when cooking rice, the staple food. Although the household monthly purchase of salt indicated the per-person consumption is double the recommended amount, 48% of adults and 46% of adolescents believed that they consume the correct amount of salt. A majority (72% of adults; 69% of adolescents) were of the view that it would be easy to reduce their salt intake. Most preferred (adults - 72%, adolescents - 69%) media source for health-related information was television. The majority of Sri Lankan adults and adolescents are not aware of the recommended limits for salt intake. The average salt consumption is double the recommended amount. Although the belief that 'the respondents consume the correct amount of salt' was common, it was encouraging to note that a majority had positive attitudes towards reducing their salt consumption'. Raising public awareness to reduce daily salt intake should use preferred media sources. Key messages Sri Lankan adolescents and adults are not well aware of the recommended limits for salt consumption and consumed high amounts of dietary salt, mainly discretionary salt. Majority of the participant had positive attitudes, believing that they can easily reduce salt consumption, indicating opportunities for behavioral changes.
Background: The effectiveness of a 2015-17 community intervention to reduce cardiovascular disease (CVD) and type 2 diabetes (T2DM) risk factors is assessed in a Sri Lanka adult population, using a before-and-after study design. Methods: Four contiguous Public Health Midwife (PHM) areas in Kalutara district (Western Province) were exposed to a Sri Lankan designed community health promotion initiatives (without screening) to lower CVD and T2DM risk factors. Pre-and post-intervention surveys (2014, n = 1,019; 2017, n = 908) were of 25-64 year males (M) and females (F) from dissimilar randomly selected clusters (villages or settlements) from PHMs, with probability of selection proportional to population size, followed by household sampling, then individual selection to yield equal-probability samples. Differences in resting blood pressure (BP), fasting plasma glucose (FPG), total cholesterol, body mass index and tobacco smoking, adjusting for cluster sampling, age and socioeconomic differences, were examined. Results: Hypertension prevalence declined from 25% to 16% (F) (p <.0001), and 21% to 17% (M). Both mean systolic and diastolic BP declined. T2DM declined from 18% to 13% (F), and 18% to 15% (M), as did mean fasting plasma glucose. Elevated total cholesterol declined from 21% to 15% in women (p = 0.003) and mean cholesterol declined. Frequency distributions, medians and means of these continuous CVD risk factors shifted to lower levels, and were mostly statistically significant (p < 0.05). Conclusions: Community health promotion can lower key CVD and T2DM risk factors. Lowering tobacco consumption in males and obesity remain challenges in Sri Lanka.
Introduction: Sri Lankan citizens consume almost double the recommended daily amount of salt.Objectives: To assess the knowledge, attitudes and practices related to health effects of dietary salt among adults and adolescents in Sri Lanka to inform a national behaviour change communication campaign Methods: We conducted a descriptive household survey among adults (n=1016) and adolescents (n=505) in 10 districts. An interviewer-administered questionnaire was used for data collection. The approximate amount of dietary salt intake of the individuals was estimated based on household purchases. Results:The recommended salt limit was identified by 40% of the population. Majority of adults (90.8%) and adolescents (86.1%) knew the adverse health effects of high salt intake. Although household monthly purchase of salt indicated consumption is much higher than recommended, 48.3% of adults and 45.9% of adolescents believed they consume the right amount of salt. Discretionary salt added to home cooking was a major contributor to intake, while consumption of processed food was also high. For health-related information, most preferred media is television (adults: 72%, adolescents: 69%). Conclusions & Recommendations:The study identified gaps as well as strengths of Sri Lankan's knowledge, attitudes and practices on salt consumption and health. Study recommends a communication campaign that include specific messaging to address gaps and leveraging on strengths. The survey identified adult females to be a key target group for the campaign and television as the best mode of message delivery.
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