Sodium reduction in Malawi

高血压及其并发症(如中风和心脏病)会导致严重的残疾和死亡，特别是在SSA，那里超过25%的成年人患有高血压。过量的盐分摄入是一个主要因素，联合国已将减少盐分作为预防心脏病和中风的最佳干预措施。关于在高收入国家减少盐摄入量的研究很多，但关于如何在SSA实现这一目标的数据很少。不同的做法是必要的，因为与发达国家不同，发达国家消费的大部分盐来自加工食品(干预措施针对的是食品业和政策法规)，在低收入非洲，大多数盐的摄入量是从家里烹饪并添加到盘子中的。这一点，以及非洲社会中与盐有关的深刻文化内涵，将必须在成功的干预中得到解决。我们在马拉维的工作表明，高血压很常见，盐的消费量非常高。在农村和城市地区，大部分的食盐消费都是在家里。在这些信息和我们的研究平台的基础上，我们将与卫生部和营养部合作，设计和测试减少盐摄入量、血压和高血压并发症的干预措施。我们将开展筹备活动，使我们能够成功地制定出符合成本效益、适合社会和可持续发展的干预措施。最初的步骤将包括评估社区对潜在干预措施的可接受性、准确测试干预效果所需的人口规模以及评估其成功所需的工具。

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.