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

Menyanu, Elias; Baatiema, Leonard; Charlton, Karen E; Wilson, Michael D.; Aikins, Ama de‐Graft; Russell, Joanna

doi:10.1093/cdn/nzaa084

Cited by 5 publications

(6 citation statements)

References 34 publications

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“…While African regions in general are reported to have lower sodium intake compared to other world regions, the average amount consumed across all African regions is above the WHO recommended intake guidelines (1,3). Where studies have assessed intake in specific African countries, the reported salt intake is more comparable or above to the mean global intake level of 9-10 g/day (4)(5)(6)(7)(8)(9). Furthermore, sodium intake is likely to rise in African populations in the future (similar to other developing countries) as dietary patterns transition to a higher proportion of processed and convenience foods (10,11).…”

Section: Dietary Sodium Intake and Bouillon In Sub-saharan Africa Afr...mentioning

confidence: 92%

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

et al. 2022

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Bouillon cubes are a staple ingredient used in Sub-saharan African countries providing flavor enhancement to savory foods. Bouillon has been identified as a vehicle for fortification to overcome micronutrient deficiencies in Sub-saharan Africa. However, bouillon has a high sodium content (and in addition with other foods) contributes to dietary sodium intake above recommended guidelines. High dietary sodium intake is a key risk factor for hypertension and cardiovascular disease (CVD). Africa has the highest rates of hypertension and CVD globally with nearly half the adult population above 25 years affected. This review presents current state of research on sodium reduction strategies in bouillon. The key challenge is to reduce sodium levels while maintaining optimal flavor at the lowest possible production cost to ensure bouillon continues to be affordable in Sub-saharan Africa. To produce lower sodium bouillon with acceptable flavor at low cost will likely involve multiple sodium reduction strategies; direct reduction in sodium, sodium replacement and saltiness boosting flavor technologies. Efforts to reduce the sodium content of bouillon in Sub-saharan Africa is a worthwhile strategy to: (i) lower the overall sodium consumption across the population, and (ii) deliver population-wide health benefits in a region with high rates of hypertension and CVD.

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Section: Dietary Sodium Intake and Bouillon In Sub-saharan Africa Afr...mentioning

confidence: 92%

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

et al. 2022

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“…The procedure has been used as a knowledge translation strategy for health systems research in Africa [9]. In Ghana and in South Africa, process mapping has been used as a strategy to combat lung cancer and hypertension [10,11]. Our approach was novel because process mapping has been used to shape policy change in population health, but has never been used to analyze neurological care.…”

Section: Methodsmentioning

confidence: 99%

Task-shifting to optimize outpatient neurological care in Zambia

et al. 2021

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Objective To investigate opportunities for task shifting to decongest an outpatient neurology clinic in Zambia by describing current patient flow through the clinic and potential nodes for intervention using process mapping. Background Zambia has a population of approximately 18 million people with 4 full-time adult neurologists, as of 2018, who all practice at the University Teaching Hospital (UTH), the main tertiary care center in the country. As a result of this provider-to-patient ratio, the outpatient neurology clinic is overcrowded and overbooked. Task-shifting programs have shown to improve efficiency, access and quality of care through the use of less specialized healthcare workers in low- and middle-income countries (LMIC). Methods We evaluated patient flow in the UTH neurology outpatient clinic through the development and analysis of a process map. The characteristics of the clinic population between 2014 and 2018 were retrospectively reviewed from the clinic register. Between July and August 2018, we prospectively collected appointment lag times and time each patient spent waiting at various points in the clinic process. We conducted interviews with clinic staff and neurologists to generate a detailed process map of current pathways to care within the clinic. We then devised task-shifting strategies to help reduce patient wait times based on the overview of clinic process mapping and patient demographics. Results From 2014 to 2018, there were 4701 outpatients seen in the neurology clinic. The most common neurological diagnoses were epilepsy (39.2%), headache (21.5%) and cerebrovascular disease (16.7%). During prospective data collection, patients waited an average of 57.8 (SD 73.4) days to be seen by a neurologist. The average wait time from arrival in the clinic to departure was 4.0 (SD 2.5) h. The process map and interviews with clinic staff revealed long waiting times due to a paucity of providers. Nurses and clerks represent an influential stakeholder group, but are not actively involved in any activity to reduce wait times. A large proportion of follow-up patients were stable and seen solely to obtain medication refills. Conclusions Epilepsy, headache, and stroke make up the largest percentage of outpatient neurological illness in Zambia. Targeting stable patients in these diagnostic categories for a task-shifting intervention may lead to substantially decreased patient wait times. Potential interventions include shifting clinical follow-ups and medication refills to less specialized healthcare workers.

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“…Notwithstanding, the implementation of social and behavior change communication solely will not reduce dietary sodium intake to the recommended levels [ 65 ] in African countries because of the relationships of sodium intake with various aforementioned environmental factors. It is essential to incorporate families, communities, community organizations, industry leaders, and government stakeholders in policy development [ 66 ] when developing multi-level intervention strategies to reduce sodium intake among populations.…”

Section: Ebis That Can Mitigate Sodium Intake and Impact The Downstre...mentioning

confidence: 99%

Reducing Dietary Sodium Intake among Young Adults in Ghana: A Call to Action

Peprah,

Amegbor,

Laar

et al. 2023

Nutrients

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The positive association between excessive dietary sodium intake, hypertension, and cardiovascular disease (CVD) has been widely investigated in observational studies and clinical trials. Reducing sodium intake is a proven strategy to prevent hypertension and the onset of CVD, a major cause of morbidity and mortality globally. Africa has the youngest population globally, which is key to the continent’s sustainable development. However, in Africa, the epidemics of hypertension and CVD negatively impact life expectancy and economic growth. Ghana, like other African countries, is no exception. The factors contributing to the increasing burden of CVD and excessive sodium consumption are multi-faceted and multi-level, including individual lifestyle, neighborhood and built environments, and socio-economic and health policies. Thus, the implementation of evidence-based interventions such as the World Health Organization Best Buys that target the multi-level determinants of sodium consumption is urgently needed in Ghana and other African countries. The aim of this commentary is to highlight factors that contribute to excessive sodium consumption. Second, the commentary will showcase lessons of successful implementation of sodium reduction interventions in other countries. Such lessons may help avert CVD in young adults in Ghana and Africa.

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

Cited by 5 publications

References 34 publications

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

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

Task-shifting to optimize outpatient neurological care in Zambia

Reducing Dietary Sodium Intake among Young Adults in Ghana: A Call to Action

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