In Africa hypertension is common and stroke is increasing. Detection, treatment
and control of high blood pressure (BP) is limited. BP can be lowered by reducing salt intake. In
Africa salt is added to the food by the consumer, as processed food is rare. A population-wide
approach with programmes based on health education and promotion is thus possible.In West Africa the lower the salt intake, the lower the BP. It would appear that a reduction in the average salt intake in the whole community may lead to a small but significant
reduction in population systolic BP.

Hypertension is a problem in SA. Low use of processed food in this area makes a population apprach to reducing salt intake feasible. Aim: to create an age-sex register for 12 villages in Ghana as the first stage of a community sutdy of the effect of dietary salt reduction on blood pressure and urinary salt reduction on blood pressure and urinary sodium excretion in West African Villagers. Conclusions: Accurate data is important in the design, implementation and intervention trials. 

 Questionnaire on Knowledge, Attitudes, Behavior toward Dietary Salt and Health

The PAHO/WHO Protocol for Population Level Sodium Determination in 24‐hour Urine Samples is a
resource to countries that want to start, contribute to and share information on dietary salt
reduction initiatives. It will assist with:
• Planning and preparing the scope and environment for a survey study to estimate dietary salt
intake
• Recruiting and training field staff for data collection
• Reporting and disseminating the results

Hypertension and stroke are important threats to the health of adults in sub-Saharan Africa. Nevertheless, detection of hypertension is haphazard and  stroke prevention targets are currently unattainable. Prevalence, detection, management, and control of hypertension were assessed in 1013 men (n
385) and women (n
628), both aged 55 [SD 11] years, living in 12 villages in Ashanti, Ghana. Five hundred thirty two lived in semi-urban and 481 in rural  villages. The participants underwent measurements of height, weight, and blood pressure (BP) and answered a detailed questionnaire. Hypertension was  defined as BP
140 and/or
90 mm Hg or being on drug therapy. Women were heavier than men. Participants in semi-urban areas were heavier and had  higher BP (129/76 [26/14] versus 121/72 [25/13] mm Hg; P0.001 for both) than in rural areas. Prevalence of hypertension was 28.7% overall and  comparable in men and women, but higher in semi-urban villages (32.9% [95% CI 28.9 to 37.1] versus 24.1% [20.4 to 28.2]), and increased with age.  Detection rate was lower in men than women (13.9% versus 27.3%; P
0.007). Treatment and control rates were low in both groups (7.8% and 4.4%  versus 13.6% and 1.7%). Detection, treatment, and control rates were higher in semi-urban (25.7%, 14.3%, and 3.4%) than in rural villages (16.4%,  6.9%, and 1.7%). Hypertension is common in adults in central Ghana, particularly in urban areas. Detection rates are suboptimal in both men and women, especially in rural areas. Adequate treatment of high BP is at a very low level. There is an urgent need for preventive strategies on hypertension control in  Ghana. (Hypertension. 2004;43:1017-1022.) 

 PAHO/WHO Sodium Detection in 24-hr Urine Samples Questionnaire

Health education in Ghana normally takes place via village meetings and small groups in the villages, thus making a cluster trial the most appropriate design. Here we present a detailed account of steps taken to ensure comparability of intervention  =groups in a cluster randomized trial in Ghana of a health  education package to reduce salt intake and thereby reduce blood pressure. We stratified both at cluster and individual level and recruited subjects blind to  their intervention group. The baseline characteristics of the two intervention groups have been compared to evaluate recruitment bias. We also discuss  some of the problems encountered in running a trial in a developing country.