Stakeholder perspectives on Nigeria's national sodium reduction program: Lessons for implementation and scale-up.

Autor: Sanuade OA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America.; Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, United States of America., Alfa V; Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria., Yin X; The George Institute for Global Health, University of New South Wales, Sydney, Australia., Liu H; The George Institute for Global Health, University of New South Wales, Sydney, Australia., Ojo AE; Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria., Shedul GL; Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria., Ojji DB; Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria., Huffman MD; The George Institute for Global Health, University of New South Wales, Sydney, Australia.; Cardiovascular Division and Global Health Center, Washington University in St. Louis, St. Louis, Missouri, United States of America., Orji IA; Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria., Okoli RCB; The University of Nigeria, Nsukka, Nigeria., Akor B; Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria., Ripiye NR; Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria., Eze H; Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria., Okoro CE; Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria., Van Horn L; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America., Tripathi P; Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States of America., Ojo TM; Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria., Trieu K; The George Institute for Global Health, University of New South Wales, Sydney, Australia., Neal B; The George Institute for Global Health, University of New South Wales, Sydney, Australia., Hirschhorn LR; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America.; Robert J Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2023 Jan 13; Vol. 18 (1), pp. e0280226. Date of Electronic Publication: 2023 Jan 13 (Print Publication: 2023).
DOI: 10.1371/journal.pone.0280226
Abstrakt: Background: To reduce excess dietary sodium consumption, Nigeria's 2019 National Multi-sectoral Action Plan (NMSAP) for the Prevention and Control of Non-communicable Diseases includes policies based on the World Health Organization SHAKE package. Priority actions and strategies include mandatory sodium limits in processed foods, advertising restrictions, mass-media campaigns, school-based interventions, and improved front-of-package labeling. We conducted a formative qualitative evaluation of stakeholders' knowledge, and potential barriers as well as effective strategies to implement these NMSAP priority actions.
Methods: From January 2021 to February 2021, key informant interviews (n = 23) and focus group discussions (n = 5) were conducted with regulators, food producers, consumers, food retailers and restaurant managers, academia, and healthcare workers in Nigeria. Building on RE-AIM and the Consolidated Framework for Implementation Research, we conducted directed content qualitative analysis to identify anticipated implementation outcomes, barriers, and facilitators to implementation of the NMSAP sodium reduction priority actions.
Results: Most stakeholders reported high appropriateness of the NMSAP because excess dietary sodium consumption is common in Nigeria and associated with high hypertension prevalence. Participants identified multiple barriers to adoption and acceptability of implementing the priority actions (e.g., poor population knowledge on the impact of excess salt intake on health, potential profit loss, resistance to change in taste) as well as facilitators to implementation (e.g., learning from favorable existing smoking reduction and advertising strategies). Key strategies to strengthen NMSAP implementation included consumer education, mandatory and improved front-of-package labeling, legislative initiatives to establish maximum sodium content limits in foods and ingredients, strengthening regulation and enforcement of food advertising restrictions, and integrating nutrition education into school curriculum.
Conclusion: We found that implementation and scale-up of the Nigeria NMSAP priority actions are feasible and will require several implementation strategies ranging from community-focused education to strengthening current and planned regulation and enforcement, and improvement of front-of-package labeling quality, consistency, and use.
Competing Interests: I have read the journal’s policy and MDH have the following competing interests: MDH has pending patents for heart failure polypills. George Health Enterprises Pty Ltd (GH) and its subsidiary, George Medicines Pty Ltd, have received investment funds to develop fixed-dose combination products, including combinations of blood pressure-lowering drugs. GH is the social enterprise arm of The George Institute for Global Health. Other authors declare no competing interests.
(Copyright: © 2023 Sanuade et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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