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

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.

Development of photographic food atlas of carbohydrate servings of banana varieties consumed in enugu state for dietary counselling of diabetic patients

Background and Objectives:

Intake of fruits as snacks for diabetic patients is usually encouraged, but there is the challenge of overconsumption and an inability to estimate the appropriate quantity to eat at a time. A photographic food atlas of three banana varieties (red Dacca, Gros Michel, and green mutant species) consumed in Enugu state, Nigeria, was developed using edible portions of foods that would supply a specific amount of carbohydrates (10g, 15g, 20g, 30g, and 45g) and their energy content was also calculated.

Methods:

The banana varieties were obtained from banana vendors in Nsukka local markets. The samples were analyzed for proximate (moisture, protein, carbohydrates, ash, fat, and crude fibre) composition, using standard methods. The energy content was calculated using Atwater factors for carbohydrates, fats, and protein. Standardized photographs of each carbohydrate portion size (10g, 15g, 20g, 30g, and 45g) of the selected banana variety were captured and their weights recorded. The photographs were formatted on A4 size paper, with each page containing 5 photographs.

Results:

Red dacca had the highest (19.5g/100g) carbohydrate content which is the least (12.3g/100g) in the green mutant. The carbohydrate content of red dacca and gros Michel species are comparable (p>0.05) but significantly (p<0.05) lower in green mutant species. Energy is highest (125kcal/100g) in green mutant and least (95kcal/100g) in gros Michel. The photographic food atlas developed contains 15 photographs from 3 banana varieties.

Conclusion:

This study develops a veritable visual aid for dietary counselling of diabetic patients.