A school-based education program to reduce salt intake in children and their families

Background

Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Raised blood pressure is a major cause of CVD. Although the prevalence of hypertension and CVD is very low in children, they originate in childhood. Accordingly, the greatest long-term potential to reduce these conditions is to initiate prevention activities in youth. Such a public heath strategy aimed at preventing or slowing the progression of rising blood pressure altogether would have enormous benefits. Dietary salt intake plays an important role in regulating blood pressure. A lower salt diet in children could prevent the development of hypertension and CVD later in life.

Aims

The team carried out a randomised trial to determine whether an education programme targeted at school children could lower salt intake in children and their families. Through this project, they developed a new approach, i.e. using the existing primary school education system rather than the healthcare system to prevent hypertension and CVD.

Project plan

Design: Cluster-randomised controlled trial in 28 primary schools in urban Changzhi, northern China. 279 children in Grade 5 of primary schools with mean age of 10.1 years were enrolled, and 553 adult family members (age 43.8 years) also participated in the assessments.
Intervention: Schools were randomly assigned to either the intervention or control group. Children in the intervention group were educated on the harmful effects of salt on health and how to reduce salt intake using the schools’ usual health education lessons. Children then delivered the salt reduction message to their families. The intervention lasted for one school term (~3.5 months).
Main outcome measures: The primary outcome was the difference between the intervention and the control group in the change of salt intake (measured by 24h urinary sodium) from baseline to the end of the trial in children and adults. The secondary outcome was the difference between the two groups in the change of blood pressure.

Impact

The School-EduSalt project showed that educating primary school children about the harmful effects of excess salt intake and asking children to deliver the message to the whole family was effective in lowering salt intake in both children and their families. The intervention also resulted in a significant decrease in the adults’ blood pressure. The team have successfully obtained funding to scale up the intervention, through the GACD Scale up call.

In addition, a member of the EduSalts project team led the drafting of standards for China Healthy Cities. Team members have also had a global impact, as part of the Scientific Advisory Board of the Ninth Global Conference on Health Promotion, organized by the WHO and ensuring that health literacy promotion became one of the three core priorities of the WHO’s 2030 Agenda.

Publications and output

GACD have published an end-of-programme report providing a comprehensive summary of the programme and outcomes.

This project has a related case study Reducing salt intake through a school-based education programme in China.

You may visit the project website for more information.

Principal investigators

Feng He Queen Mary University of Londo, United Kingdom
Yangfeng Wu The George Institute China, China

Team members

Xiangxian Feng Changzhi Medical College, China
Stephen Jan The George Institute for Global Health, Australia
Jun Ma Peking University, China
Jing Zhang The George Institute for Global Health, China
Ching-Ping Lin The George Institute for Global Health, China
Yuan Ma Queen Mary University of London, United Kingdom
Caryl Nowson Deakin University, Australia
Haijun Wang Peking University, China
Lijing Yan The George Institute for Global Health, China