Deep-seated beliefs about salt may be major barriers to salt reduction strategies in coastal areas of Bangladesh

People living in the south-eastern coastal areas of Bangladesh have been found to have multiple misconceptions about salt, a recent icddr,b study has shown.

Although high levels of salt intake are known to be bad for health, the research revealed a range of misconceptions and cultural practices that lead people to consume excess amounts of salt – including a common belief that salt is actually good for health. Strategies to reduce salt intake will need to take account of these important perceptions and social practices if they are to be successful.

Photo by bengal*foam. CC BY-ND 2.0

Salt has played a major role in human history, and its significance goes beyond its simple use in cooking. The study, led by icddr,b scientist Dr Sabrina Rasheed and published in the journal PLOS One, looked at the sources of dietary salt, and assessed beliefs, perceptions and practices associated with salt consumption in Chakaria,  a coastal upazila of Bangladesh.

Coastal people of the country are at high risk of hypertension (high blood pressure) due to their exposure to salt in the environment and the availability of cheap locally produced salt. Hypertension, which currently affects about 27% of the general Bangladeshi population, is a major risk factor for cardiovascular diseases.

The study found that there was low awareness of the risks of consuming excessive salt. Some people were unaware that salt was present in drinking water, and some believed that the cooking process rendered salt harmless.

The study also found that many people believed that salt was actually beneficial to health. Suggested benefits included purifying blood, cleaning germs and worms, keeping body in equilibrium, reducing body fat, cure abdominal pain and nausea, increase appetite for the older people and reducing high blood pressure.

Salt was widely seen to be important in making food more appetising. As one participant put it: “Food without salt is like a pond without water, woman without modesty and a cloud that does not produce rain, food without salt is not satisfying”.

Notably, salt was added to a wide range of dishes, including sweet and sour fruits such as jackfruit, watermelon, rock melon and plum.

Photo by Tracy Benjamin. CC BY-ND 2.0

Respondents commonly reported using unrefined salt (khola lobon) in cooking, but refined salt as table salt (alga lobon). Use of iodised salt was seen as a sign of prestige, and often provided to impress guests.

Even those aware of the health risks linked to salt held important misconceptions. Some believed that table salt (alga lobon) was harmful cut down on its use but used more unrefined salt (khola lobon) in cooking, while others believed that toasting or frying salt rendered it harmless.

Respondents also cited religious reasons why salt should be consumed. Salt intake was considered by some people as Sunnah (the way of life prescribed by the Prophet Muhammad) and it becomes a duty to follow.

Commenting on the findings, Dr Rasheed said, “Many risk factors of hypertension are non-modifiable such as family history, age, gender etc. However, some of the risk factors are modifiable such as high salt intake, overweight and reduced physical activity. Interventions aimed to reduce prevalence of hypertension in the coastal areas must be designed to address the misconceptions persisting among the people and include specially crafted behaviour change communications component to be effective and successful.”

TK

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