Sodium reduction in Malawi

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High blood pressure (hypertension) and its complications (such stroke and heart disease) cause significantdisability and mortality, particularly in SSA where more than 25% of the adult population have the condition.Excessive salt intake is a major contributor, and the UN has recognised salt reduction as a “best-buy” intervention to prevent heart disease and stroke. There is much research on reducing salt intake in high-income countries, but little data on how this can be achieved in SSA. Different approaches are necessary, because, unlike developed countries where most salt consumed is from processed food (and interventions have targeted the food industry and policy regulations), in low-income Africa, most salt intake is from cooking at home and added to the plate. This, and profound cultural connotations attached to salt in African societies, will have to be addressed in successful interventions.Our work in Malawi shows that hypertension is common, and salt consumption very high. In both rural and urban areas; the majority of salt consumption is at home. Building on this information and our research platform, we will partner Ministries of Health and Nutrition to design and test interventions to reduce salt consumption, blood pressure and hypertensive complications. We will conduct preparatory activities to enable us to develop successfully cost-effective interventions that are appropriate for the community and sustainable. Initial steps willinclude assessing community acceptability of potential interventions, the size of population required to accurately test the effect of the intervention and what tools will be necessary to evaluate its success.