Towards Population Salt Reduction to Control High Blood Pressure in Ghana: Using epidemiological data for Policy Direction

A large body of evidence has shown that excess salt intake is associated with hypertension and nutrition related non-communicable diseases (NCDs). Global salt intake is high with populations consuming as much as twice the World Health Organization (WHO)’s recommended intake of 5g/day. Low- and middle-income countries (LMICs) are disproportionately affected due to the nutrition transition taking place in those countries that is associated with an influx of highly processed foods that are becoming more affordable, and accompanied by changing lifestyles and changing dietary preferences. This has increased the availability and intake of energy dense nutrient poor (EDNP) foods that are particularly high in salt in LMICs. This thesis outlines six studies that sought to provide a systematic approach towards finding evidence, building advocacy and developing strategies to curb excess salt intake and rising hypertension in Ghana. Data used in studies that comprise the thesis were collected in the WHO’s Study on global AGEing and adult health (WHO-SAGE); a multi-country longitudinal study conducted in six LMICs namely China, Ghana, India, Mexico, Russia and South Africa (SA). Within each country, the WHO-SAGE study has recruited a nationally representative sample of predominantly 50+ year old participants. In the two WHO-SAGE countries from the African continent, namely Ghana and SA, a nested sub sample was additionally selected in Wave 3 to provided 24hr urine samples for the analysis of sodium (Na), potassium (K), creatinine (Cr) and iodine (WHO-SAGE Salt and Tobacco study). This thesis is largely based on data from the salt sub-study, and the PhD candidate was heavily involved in the planning and data collection for the Ghana sub-study. This thesis reports analyses from WHO-SAGE datasets from Ghana for Waves (W) 1 (2007/8), 2 (2015) and 3 (2019) and makes comparisons with corresponding WHO-SAGE data from South Africa Waves, where appropriate.