title: Salt Reduction Interventions in Sub-Saharan Africa: A Systematic Review.
abstract: BACKGROUND
  Salt intake is associated with hypertension, the leading risk factor for cardiovascular disease. To promote population-level salt reduction, the World Health Organization recommends intervention around three core pillars: Reformulation of processed foods, consumer awareness, and environmental changes to increase availability and affordability of healthy food. This review investigates salt reduction interventions implemented and evaluated in sub-Saharan Africa (SSA).
  
  
  METHODS
  MEDLINE and google scholar electronic databases were searched for articles meeting inclusion criteria. Studies that reported evaluation results of a salt intervention in SSA were identified. Titles and abstracts were screened, and articles selected for full-text review. Quality of included articles was assessed, and a narrative synthesis of the findings undertaken. PROSPERO registration number CRD42015019055.
  
  
  RESULTS
  Seven studies representing four countries-South Africa, Nigeria, Ghana, and Tanzania-were included. Two examined product reformulation, one in hypertensive patients and the other in normotensive volunteers. Four examined consumer awareness interventions, including individualised counselling and advisory health sessions delivered to whole villages. One study used an environmental approach by offering discounts on healthy food purchases. All the interventions resulted in at least one significantly improved outcome measure including reduction in systolic blood pressure (BP), 24 hour urinary sodium excretion, or mean arterial BP.
  
  
  CONCLUSIONS
  More high quality studies on salt reduction interventions in the region are needed, particularly focused on consumer awareness and education in urban populations given the context of rapid urbanisation; and essentially, targeting product reformulation and environmental change, for greater promise for propagation across a vast, diverse continent.
authors.affiliation: African Population and Health Research Center, P.O. Box 10787-00100, Nairobi, Kenya.
authors.forename: Stella Kagwiria
authors.initials: SK
authors.lastname: Muthuri
authors.affiliation: African Population and Health Research Center, P.O. Box 10787-00100, Nairobi, Kenya.
authors.forename: Samuel Oji
authors.initials: SO
authors.lastname: Oti
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, CV4 7AL, United Kingdom.
authors.forename: Richard James
authors.initials: RJ
authors.lastname: Lilford
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, CV4 7AL, United Kingdom.
authors.forename: Oyinlola
authors.initials: O
authors.lastname: Oyebode
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000517:prevention & control* / Q000652:urine; D016239:MEDLINE; D017673:Sodium Chloride, Dietary
chemical_list: D017673:Sodium Chloride, Dietary