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

Area of Science:

• Public Health
• Nutrition Policy
• Health Behavior

Background:

• Nigeria's 2019 National Multi-sectoral Action Plan (NMSAP) targets reduced sodium consumption using WHO SHAKE package strategies.
• Priority actions include mandatory sodium limits, advertising restrictions, and improved front-of-package labeling.

Purpose of the Study:

• To conduct a qualitative evaluation of stakeholder knowledge, barriers, and strategies for implementing NMSAP sodium reduction actions.
• To identify facilitators and barriers to the adoption and acceptability of NMSAP priority actions.

Main Methods:

• Qualitative study using key informant interviews (n=23) and focus groups (n=5) with diverse stakeholders.
• Directed content qualitative analysis informed by RE-AIM and CFIR frameworks.

Main Results:

• Stakeholders found NMSAP highly appropriate due to high sodium intake and hypertension prevalence in Nigeria.
• Barriers include poor public knowledge, profit concerns, and taste preferences; facilitators include lessons from tobacco control strategies.
• Key strategies: consumer education, mandatory labeling, legislative limits, advertising regulation, and school nutrition integration.

Conclusions:

• Implementation and scale-up of NMSAP sodium reduction actions are feasible.
• Strategies require community education, strengthened regulation and enforcement, and improved front-of-package labeling.