Relationship Between Knowledge,Attitude,Behavior And Salt Intake Among Adults In Developing Countries

Background: Among dietary factors,high salt intake has been the most associated with raised blood pressure and increased risk of stroke and cardiovascular diseases(CVDs).Therefore,dietary sodium restriction has been recommended as a non-pharmacological approach to blood pressure lowering and for the prevention and control of non-communicable diseases at the population level.Globally,noncommunicable diseases(NCDs)are the leading cause of mortality and morbidity,with CVDs accounting for 17 million deaths(48% of NCD deaths).For the prevention of disease,the World Health Organization(WHO)recommends that daily intake of sodium should not exceed 2 g(the equivalent of 5 g of salt).However,most adults consume more than the recommended maximum quantity of salt intake per day,which were almost doubled or above.Objective: Our study aims to synthesize the findings from articles that evaluated the relationship between the knowledge,attitude,behavior and salt intake among adults in developing countries in order to provide strategies to help the population to improve their diet of salt intake.Methods: Systematic review and meta-analysis were conducted from articles’ results.Medline(PubMed database);Web of Science;Scopus and Google Scholar were searched for relevant articles between February 2001 and September 2018.Endnote was used for proper reading of articles,literature review and for arrangement of references;Microsoft Excel and Microsoft Word were used to do some analysis and making tables for description then Comprehensive Meta-Analysis software(CMA)[Version 3] was used for meta-analysis(quantitative analysis).Results: 20 articles in total were included in our study.Among these,10 articles with19229 total sample of participants for meta-analysis from 13 countries in 3 continents;711(4%)participants from African countries,17991(93%)participants from Asian countries and 527(3%)participants from Oceania.Results of the meta-analysis yielded a big outcome confirming a strong relationship between knowledge,attitude and behavior(KAB)and the high salt intake with Pearson’s correlations of different variables(KAB),it founded in the overall corrections the positive effect size of 0.912(SE=0.051,95% CI=0.863 to 0.944).Through various studies,the number of participants who took a high amount of salt daily increased significantly,in relation to the increasing number of participants in different variables(KAB)(P < 0.001).Pearson’s correlation between variables(KAB)and their high salt intake confirmed a strong and significant relationship [r = 0.890 to 0.991];(P < 0.001).A test of heterogeneity was conducted to assess the Pearson’s correlations of true effect sizes using the Q statistic.In this case the Q statistic was not significant(Q=1.616,DF=5,p = 0.899).Conclusion: This systematic review and meta-analysis indicated that participants had great levels of knowledge,but low levels of attitude and behavior(practice)concerning daily salt intake.All the studies agreed with an excessive salt intake of participants,even though the consumption level was not the same.In order to reach the WHO 2025 sodium reduction target,future salt reduction programs must continue to take a multi-level approach.Greater emphasis of individual KAB is required,and specific initiatives are need to be focused on educating consumers about the relationship between salt and sodium,recognizing commonly consumed high-sodium foods and label reading to accurately interpret sodium/salt information in food packaging.Also,new strategies are needed to improve accessibility for other ingredients which could be used instead of salt.By doing so,consumers will be adequately informed and empowered to make healthier food choices and reduce individual sodium(salt)intake.