Monitoring and implementation of salt reduction initiatives in Africa: A systematic review

Abstract

This systematic review aims to document salt consumption patterns and the implementation status and potential impact of salt reduction initiatives in Africa, from studies published between January 2009 and November 2019. Studies were sourced using MEDLINE, Embase, Cochrane Library electronic databases, and gray literature. Of the 887 records retrieved, 38 studies conducted in 18 African countries were included. Twelve studies measured population salt intake, 11 examined salt level in foods, 11 assessed consumer knowledge, attitudes, and behaviors, 1 study evaluated a behavior change intervention, and 3 studies modeled potential health gains and cost savings of salt reduction interventions. 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/d. Salt levels in foods were generally high, and consumer knowledge was fairly high but did not seem to translate into salt lowering behaviors. Modeling studies showed that interventions for reducing dietary sodium would generate large health gains and cost savings for the health system. Despite this evidence, adoption of population salt reduction strategies in Africa has been slow, and dietary consumption of sodium remains high. Only South Africa adopted legislation in 2016 to reduce population salt intake, but success of this intervention has not yet been fully evaluated. Thus, rigorous evaluation of the salt reduction legislation in South Africa and initiation of salt reduction programs in other African countries will be vital to achieving the targeted 30% reduction in salt intake by 2025.

Sodium Content and Labelling Completeness of Packaged Foods and Beverages in Kenya

“…These findings clearly indicate that reformulation to reduce sodium in packaged products is possible and technically feasible. In the absence of data on salt consumption in Kenya [ 4 ], reformulation efforts could potentially be targeted toward high sodium categories for which there are demonstrably lower sodium options [ 29 , 30 ]. There may be much to learn from the UK when it comes to implementing a successful reformulation program in Kenya.…”

“…Salt is comprised of sodium and chlorine, with the sodium causing elevations in blood pressure. The World Health Organization recommends a maximum intake of 5 g salt (or 2 g of sodium) per day [3], though populations around the world, including in many African countries, exceed this recommended level [4,5]. National dietary guidelines, although often presented in different ways, are generally consistent in recommending that healthy diets include limiting daily sodium intake [6].…”

Immediate pressor response to oral salt and its assessment in the clinic: a time series clinical trial

“…Despite all guidelines and recommendations to reduce it, sodium intake in Western countries is about 140–160 mmol/day and in African adults 116–142 mmol/day [ 18 ]. Hence, each of the three meals of a day will have approximately 40–50 mmol (with the heaviest meal having a higher amount).…”

Sodium Reduction in Bouillon: Targeting a Food Staple to Reduce Hypertension in Sub-saharan Africa

“…Few studies have assessed the health and economic costs of sodium reduction in Sub-saharan Africa. The limited studies completed to date show lowering sodium across the population results in significant direct and indirect health cost savings and health gains (28). Modeling in South Africa show sodium reduction (through implementation of mandatory salt targets) would result in 11% reduction in CVD deaths and lower overall government health costs by 0.32% (29).…”