Salt Use Behaviours of Ghanaians and South Africans: A Comparative Study of Knowledge, Attitudes and Practices

Abstract

Salt consumption is high in Africa and the continent also shares the greatest burden of hypertension. This study examines salt-related knowledge, attitude and self-reported behaviours (KAB) amongst adults from two African countries—Ghana and South Africa—which have distributed different public health messages related to salt. KAB was assessed in the multinational longitudinal World Health Organisation (WHO) study on global AGEing and adult health (WHO-SAGE) Wave 2 (2014–2015). Respondents were randomly selected across both countries—Ghana (n = 6746; mean age 58 years old; SD 17; 41% men; 31% hypertensive) and South Africa (n = 3776, mean age 54 years old; SD 17; 32% men; 45% hypertensive). South Africans were more likely than Ghanaians to add salt to food at the table (OR 4.80, CI 4.071–5.611, p < 0.001) but less likely to add salt to food during cooking (OR 0.16, CI 0.130–0.197, p < 0.001). South Africans were also less likely to take action to control their salt intake (OR 0.436, CI 0.379–0.488, p < 0.001). Considering the various salt reduction initiatives of South Africa that have been largely absent in Ghana, this study supports additional efforts to raise consumer awareness on discretionary salt use and behaviour change in both countries.

Salt and potassium intake among adult Ghanaians: WHO-SAGE Ghana Wave 3

“…Poor salt use behavior is widespread in the Ghanaian population; a previous study involving 12 villages in Ghana in 2006 reported that 98% of participants added salt to food during cooking, while about half (52%) added salt to food at the table [21]. In comparison to South Africans, Ghanaians reported adding salt to food during cooking more frequently [45], presumably because mass media public health campaigns to lower salt use, such as Salt Watch in South Africa have not yet occurred in Ghana [46]. Further, Ghana's national salt iodization programme, along with accompanying major public health campaigns on iodine consumption [47][48][49][50] may partially be responsible for an increase in discretionary salt intake.…”

“…sugar, syrup, ice cream, candy, and carbonated and noncarbonated sweetened drinks). Additionally, frequent consumption of highly salted foods, such as fish and meat, remains part of the traditional Ghanaian cuisine, and salt use in cooking remains high [42,45].…”

Towards Population Salt Reduction to Control High Blood Pressure in Ghana: A Policy Direction

“…Such differences would need to be considered in policy development. It is clear that salt reduction strategies in Ghana would need to focus both on salt reduction in the food supply, as well as efforts to raise consumer awareness on discretionary salt use in cooking and added to foods at the table in Ghana ( 27 ).…”

“…In Ghana, the majority of the population consume processed foods that are high in salt ( 14 ) and report a high use of discretionary salt added to foods at the table and in food preparation ( 27 ). Rapid urbanization, population growth, and changing lifestyles have resulted in a rapid nutrition transition in the country and that has resulted in an increased intake of processed foods ( 28 ).…”

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

“…However, this knowledge did not seem to translate into attitudes and practices related to salt intake reduction. For example, participants were frequently unable to correctly identify the maximum recommended daily salt intake, nor were they aware of the link between salt and sodium, and generally did not perceive their salt intake to be high 25,27,32,41,55,56,59 . The latter may contribute to the low proportion of participants who reported adopting practices known to reduce salt consumption observed in the included studies.…”