Sierra Leone Research and Action on Salt and Hypertension (SLASH)

A diet high in salt is the leading dietary risk factor for deaths and disability globally. This is mainly because it drives high blood pressure causing heart disease and stroke. High salt intake also increases the risk of stomach cancer, kidney damage, and weakening of the bones. In low-and middle-income countries death from heart disease and stroke are much more likely to occur under the age of 60, than in high-income countries. Salt intake in much of Africa is above the 5g per day recommended by the World Health Organisation. High blood pressure and stroke are important and growing problems in Sierra Leone (SL). Four in five of those experiencing a stroke have high blood pressure, and the average age of stroke is 59. Preventing high blood pressure is an important strategy to reduce population health burden, as resources to treat hypertension are scarce. Reducing salt consumption is a highly cost-effective approach to reduce hypertension and stroke. We do not know the most important sources of dietary salt in SL and there is little data on salt consumption, but it is likely to be excessive as 91.6% adults report adding salt to their food during cooking, and 31.1% report regularly eating salty snacks. This project brings together expert academic teams and wider stakeholders to develop, implement and evaluate policy interventions to reduce salt intake to prevent high blood pressure, heart disease and stroke in SL. Our team has expertise in heart disease, stroke, nutrition, public health, epidemiology, social science, economics, policy development and evaluation. We will support the Ministry of Health SL to design evidence-based interventions and monitor and evaluate initiatives in this area. We will build an on-going collaboration and create research capacity in SL and West Africa to provide leadership in this area and develop wider networks to facilitate future funded research addressing this important challenge. This will advance our understanding of what key actions to prioritise to reduce salt consumption and hypertension that is particularly relevant to West Africa, where countries face similar challenges, due to environmental and cultural similarities. We intend to use this funding to complete six objectives, underpinned by six associated work-packages (WPs): 1) to assess population salt intake and understand which foods and eating behaviours contribute high salt to the diet in SL through 24-hour urine collection and dietary recall , plus sampling and analysis of salt content in foods; 2) to understand knowledge, attitudes and behaviour regarding salt consumption of the SL population and of local food suppliers; to identify potential barriers and facilitators of using, producing and/or stocking lower salt food through qualitative research; 3) to build a shared resource of information for key audiences relating to salt intake and high blood pressure for use by our partnership and beyond, through reviewing published evidence, data from WP1-2, and expert input; 4) to use outputs from WP1-3 to establish priorities for research and evaluation with a multi-stakeholder consortium through a series of workshops and generation of theories of change for potential interventions; 5) to test the feasibility of implementation of at least one prioritised intervention in a pilot randomised controlled trial; 6) to extend a network across West Africa and wider Africa as appropriate and build on this project by applying for funding to develop and test further prioritised interventions.