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Salt Intake- Related Knowledge, Attitudes, and Practices among Jordanian Adults

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Submitted:

25 September 2023

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28 September 2023

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Abstract
Keywords: Knowledge; Attitudes; Practices; Salt intake.
Keywords: 
Subject: Public Health and Healthcare  -   Other

1. Introduction

Non-communicable diseases (NCDS) are the world’s commonest killers and the leading cause of death in the WHO Eastern Mediterranean Region (EMR). Commonly known as chronic or lifestyle-related diseases, they include cardiovascular diseases, cancers, chronic respiratory diseases and diabetes (1). Many of these deaths are preventable through lifestyle-related changes and cost-effective interventions implemented by national governments (2). Globally, two thirds (63%) of deaths are attributable to NCDs, with low- and middle-income countries (LMICs) bearing 86% of the burden of these deaths occurring prematurely (3). Raised blood pressure is a major cause of premature deaths worldwide. The complications arising from increased blood pressure contribute to 9.4 million deaths every year (4). Raised blood pressure is reported to cause at least 45% of deaths due to heart diseases and 51% of deaths due to stroke (16). Globally, raised blood pressure is evident in 1 in 4 men and 1 in 5 women in 2015.
In Jordan, 78% of all deaths in 2016 were due to NCDs (5). The prevalence of hypertension has doubled from 16% in 1995 to 32% in 2009, while the prevalence of DM increased significantly from 13% in 1994 to 17% in 2004(6,7). Moreover, researchers estimated that by the year 2050, 3.8 million (37%) Jordanian citizens would have hypertension, 3.0 million (30%) will have DM, and 2.9 million (29%) will have dyslipidemia (8). A systematic review from 10 Arab countries reported an overall prevalence of hypertension of 29.5% (9). The high rate of obesity and physical inactivity coupled with high salt and fat intake explains the high prevalence of hypertension in Jordan as well as other Arab countries (10).
Consuming a healthy diet throughout life helps protect against malnutrition in all its forms and NCDs such as heart disease, stroke, diabetes, and cancer. As detailed data regarding salt consumption in the Jordanian population is lacking, a cross-sectional study on salt consumption in Jordan revealed that participants were consuming at least double the current WHO recommended daily sodium allowance of 2 g (5 g salt) (11). These results are consistent with the reported results from Tehran, where an average sodium level of 130 mmol/day was reported, with higher intake in males at 151 mmol/day, compared with 117 mmol/day in females (12). A report from Saudi Arabia demonstrated a mean sodium level of 153 mmol/ day and 118 mmol/day (6.7–9 g salt) in males and females, respectively(13 ). Results from the INTERSALT study also revealed that salt ingestion in Italy, Finland and Portugal were between 9 and 12 g/day, while people in the Netherlands, Denmark and Belgium ingested between 8 and 9 g/day(14 ).
Like other countries in EMR, people in Jordan consume higher energy, fats, free sugars, and salt/sodium. Furthermore, many people are not eating enough fruit, vegetables, and other dietary fibres such as whole grains. Jordanian citizens currently consume high sodium and low potassium diet and are mostly unaware of its negative impact on their health. Hence, it is crucial for healthcare providers to intervene and adopt long-term strategies to control salt intake to reduce its negative effects in Jordan and elsewhere (11). The most recent STEPwise survey in Jordan (15) showed that the fruit and vegetable consumption is considered low, where 84% consumed less than five portions per day, as recommended by the WHO. The average number of servings per day of vegetables were two and of fruit was one, where half of the sample (50%) consumed 1-2 servings of vegetables or fruit per day (16)
Several epidemiological, experimental, and clinical studies positively correlated excessive sodium consumption with hypertension (17). High sodium intake increases the risk of cardiovascular disease and mortality and may have other harmful effects, including increased risk of stroke, heart failure, osteoporosis, obesity, gastric cancer, and chronic kidney disease (18). A meta-analysis of 31 trials shows that reduction of sodium consumption by 75 mmol/day (equivalent to 4 g salt) led to an average decrease of 5.0 mmHg systolic blood pressure (BP) and 2.7 mmHg diastolic BP in hypertensive patients (19). High potassium consumption has been found to be beneficial in preventing hypertension and cardiovascular events (20). Keeping salt intake to less than five g/day (equivalent to sodium intake of less than two g/day) helps prevent hypertension and reduces the risk of heart disease and stroke in the adult population (16). One-third of the people in the Jordan STEP survey were found to always add salt to their food, with the mean daily salt intake in all respondents being 11 g/day (6), which revealed the high daily intake of salt among Jordanians, being double that recommended by the WHO.
Cost-effective interventions to reduce the impact of NCDs are widely available, and their implementation can avert premature death and prevent economic losses, which have been estimated to account for USD 7 trillion over the timeframe of 2015-2030(3). NCDs can be prevented by changing policies and actively engaging all sectors through a whole government and whole society approach. Among these are the strengthening of NCDs surveillance system at all levels, the improvement of NCDs programs at the primary healthcare level and the promotion of a healthy lifestyle through awareness campaigns within the community. This can positively reflect on reducing NCDs morbidity and mortality rates in Jordan and pave the way for achieving sustainable development goals by 2030(21). Although high salt consumption is considered a worldwide public health problem, its magnitude is highly variable among different communities; therefore, it is essential to study locally salt consumption habits in Jordan and specifically in the capital Amman.

2. Materials and Methods

The study population is the Jordanian adults aged above 18 years residing in the Capital, Amman. The total Amman population is estimated at 2,182,151 persons in 2021.

Study Design

A cross-sectional study was conducted among adults living in Amman to assess the knowledge, attitude and practices related to salt intake.

Sampling

A multi-stage sampling technique was used to select representative sample from the population of Amman. In the first stage, well-defined geopolitical areas were selected from each district of Amman governorate. In the second stage, a random sample of households using a systematic sampling technique was selected from in each selected area. Within each selected household, only one person was selected and interviewed. For this KAP study, the number of households included in the study was determined using the appropriate formula for estimation of single proportion using cluster sampling approach. At 95% confidence interval (CI), 5% precision and 10% nonresponse rate and assuming that the expected proportion of population with adequate knowledge is 50% the sample size calculated was 856 persons.

Institutional Review Board Statement

“The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board of Jordan University of Science and Technology IRB #637/2021, ” (approval number: 53/637/2021) was approved by the IRB committee on the 8th of October 2021.

Questionnaire

Data were collected using a structured, validated questionnaire administered by trained interviewers. The questionnaire is developed based on previous similar surveys(14,32 ). The questionnaire included items on the socio-demographic characteristics and health characteristics of participants, including previous diagnoses of diabetes, high cholesterol and triglyceride levels and hypertension. The questionnaire was prepared in English (Appendix 1) and translated to Arabic using backward forward translation method. The questionnaire was checked for clarity, consistency, and cultural acceptability. The questionnaire contained 41 questions divided into sections to examine people’s knowledge, attitudes, and practices and potential interventions

Demographics and general health information section

This section describes the characteristics of people under study and confirms the inclusion criteria of sampling.

Knowledge Section:

Knowledge is the understanding of a person, this study examined people’s awareness on salt and its intake.

Attitudes Section:

Attitudes are people’s feelings towards negative or positive statements. So, a person’s subjective norm and attitude along with perceived control can be used to decide his/her intent to be involved in a behavior such as irrational or rational use of salt.

Practices Section:

Theory of Planned Behavior defines intentions as key factors in the performance of behaviors (practices) since it captures motivational factors influencing a behavior. So, any factor that predict intentions can affect the performance of behaviors, and beliefs of this behavior state the person’s intention to carry it out such as salt usage.

Sources of receiving health information and the preferred method for obtaining information

This section explores Media and other communication channels usage habits and client preference to inform behavior and awareness future planning

Data collection

Research assistants (data collectors) were recruited and trained by research supervisors. Data were collected through face-to-face interviews with an automated household questionnaire. Ethical considerations were strictly followed, and informed consent was obtained from the respondents before each interview. Different measures were undertaken to ensure quality of the collected data. The supervisors and research assistants (data collectors) were recruited based on their good knowledge of the local context, as well as experience in data collection and working among local communities. The data collectors received training on the interpretation and use of the data collection tools to enable them collect quality data. The data collectors worked under the direct supervision to ensure that the team focused on the objectives of the study, and data collected as planned for. Data cleaning was carried out involving both field and office editing of the collected data. In the field, the supervisor sought to ensure that data was properly entered onto the questionnaires. At office level, data was further checked and screened for inconsistencies by core team.

Statistical analysis

Data were entered and analyzed using the Statistical Package for Social Sciences software IBM SPSSS (IBM Corp. Released 2016. IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp). Means, standard deviations, and percentages were used to describe the data. Gender-specific estimates were reported. Because the samples were self-weighted, weights in analysis were not included. Chi-square was used to compare percentages. A p-value of less than 0.05 was considered statistically significant.

3. Results

Participants’ characteristics

A total of 1354 persons (1042 (77.0%) females and 312 (23.0%) males) were included in the study. Table 1 shows the participants’ sociodemographic and clinical characteristics. Almost half of the participants were younger than 40 years and 45.6% had university education. Males were significantly more educated than females. Of all participants, 6.9% reported having cardiovascular disease and 22.4% reported having hypertension. Almost 9.3% and 14% of females and 59.6% and 9.3% of males reported smoking cigarettes and waterpipe every day, respectively.

Salt intake- related knowledge

Table 2 shows respondents’ knowledge about salt intake according to gender. Almost 70.8% of participants didn’t know the maximum salt intake amount per day for adults. However, they knew the relation between the access intake and illnesses such as hypertension (96.1%) and kidney stone (86.2%). Almost two thirds of the participants (65.0%) said it very important to lower salt intake. Almost 6.4% reported that salt is high in bread, pizza (27.5%), Pasta, Rice and other non-cooked grains (5.3%), cheese (89.3%), canned meat (47.0%), Canned food such as canned vegetables, tuna, sardine and canned mushrooms (31.8%), yogurt containing products (79.0%), readymade sauces (58.3%), nuts (58.0%), pickles and Olives (87.8%). Less than half of participants (40.8%) reported that there is a type of salt that is used in food making which is harmless regardless of its quantity (Table 3).

Salt intake practices

As shown in Table 4, almost three quarters (77.4%) of persons reported using iodized salt. Only 17.1% reported reading food label. Of those, 41.4% reported that they benefited from food labels in finding out the amount of salt in food items. About 67.7% of respondents don’t buy food if it contains high. Almost half of participants (48.2%) always add salt while cooking and 14.6 % add table salt always after cooking. The most common reported practices to reduce salt intake included using spices other than salt while cooking (67.2%) and avoiding or decreasing amount of salt rich food (64.2%) (Table 5).
Table 6 shows the frequency of eating common foods. Almost 87.2% of participants reported eating three or less Arabic breads daily and 62.1% of participants reported eating pickles and olives at least once per day.

Source of health information

Table 7 shows the main sources of health information. The most common source reported by participants was social media (72.7%) followed by Google (64.0%) and health centers (64.3%). Table 8 shows the preferred source of information on salt intake and health. The majority (82.8%) of respondents preferred health centers and 78.2% preferred social media source of information on salt intake and health.

Reasons of high salt intake

Table 9 shows the participants’ reported reasons of high salt intake. The main reasons of high salt intake included high cost of low salt food (72.1%), not reading food labels (78.2%), and limited options available at restaurants (72.1%).
Table 10 shows the respondents’ recommendation on best options to reduce salt intake. The majority of participants thought of different strategies to reduce salt intake including educating the public and the community about the importance of decreasing salt intake, amending food specifications to reduce salt Increasing awareness for restaurant’s owners to use low salt options, and establishing a bonus system for factories producing low salt food.

4. Discussion

For designing salt reduction policies, it is essential to know and understand the population patterns for salt intake, their views on it, and the potential impact of salt on health. There are available data regarding salt consumption in most developed and developing countries and there is a wide variation among different nations and population groups in salt consumption. It is necessary to study the profile of sodium intake on a national scale because of its relation with most common illnesses such as high blood pressure. Several studies showed an increased intake of salt is associated with increased prevalence of cardiovascular diseases (22-25). Although limited, studies in Jordan have shown both rising hypertension over time and high salt consumption (10,15). Studying salt consumption in the Jordanian population will guide future efforts to address this critical health concern.
Actions to decrease salt intake are essential to reduce hypertension and its burden. Studying Knowledge, Attitudes and Practices towards dietary salt amongst the public is a valuable tool to guide the design of appropriate intervention programs, for example, a public education or awareness campaign, advocacy efforts related to food labelling, or as a tool to engage the food industry in reformulation to reduce levels of salt in their products. Knowledge and attitudes define the role of people in specific health-related activities, which assess the part of their intentions. These intentions are valued by many researchers and are recognized as key predictors of actual behaviours and practices (26 ). This study helped to demonstrate variations regarding salt consumption.
This study showed high rates of self-reported non-communicable diseases as 22.4% were previously diagnosed with hypertension, 13.7% were previously diagnosed with diabetes, 15.9% were previously diagnosed with high cholesterol levels, and 6.9% were previously diagnosed with heart disease. One should consider that these estimates are underestimated because a high proportion of Jordanian adults have undiagnosed diseases such as diabetes and hypertension. The study showed that almost 9.3% and 14% of females and 59.6% and 9.3% of males reported smoking cigarettes and waterpipe every day, respectively. This finding is consistent with the findings of other studies in Jordan (15).
Our study showed that people have limited knowledge of issues pertaining to salt intake. Most respondents did not know the maximum amount of salt intake allowed per day for healthy adults. However, they knew that too many salty sauces cause serious health problems such as hypertension and kidney stones, with 65% of participants saying it is essential to lower salt in their diet where female showed relatively higher knowledge. The Stepwise survey showed that 49% of people believed in the high importance of lowering salt in their diets and 89% believed that too much salt could cause serious health while female. Females showed more awareness compared to males of the harmful effects of salt on health.(15). Only 29.2% participants knew the amount of salt intake allowed per day. Females (31.5%) had higher knowledge around the allowed salt intake amount per day than males (21.5%). This finding is not consistent with the findings from Tehran study, where males had higher knowledge of salt intake than females (27).
Overall, participants’ attitudes were generally negative, where only 17% were interested in reading the nutritional label on food items. Around half of the participants think that there is a type of salt that can be added to the food that is harmless regardless of its quantity. That indicate inadequate interest in reducing salt intake. Subsequently more effort is needed to address knowledge gap to influence this negative attitude
On the other hand, most of the participants’ practices were incorrect. The existing literature showed that checking food labels for salt content is considered one of the most important measures to control salt intake [39]. However, 82.9% of our participants do not check food labels for salt content. Compared this with other studies, 38.3% of people in Lebanon check food labels for salt content regularly (28). This finding should be considered when planning educational campaigns in Jordan to raise community awareness about checking food labels for salt content.
More than half of the participants reported feeling thirsty after eating, which could indicate that the food they consumed contains a high amount of salt because elevation of plasma osmolality stimulate thirst (29). Almost half of participants (48.2%) reported that they always add salt while cooking and 14.6 % add table salt always after cooking.
In a study conducted in Jordan, 68 bread samples were collected from 13 different bakeries from Amman. The mean salt content was 1.19±0.21 g /100 g bread, while the mean salt content in local bread “Shrak” was 2.06±0.19 100 g [44]. According to the national guideline of nutrition, the estimated salt content in bread is 1g in one piece of Arabic bread and in one big slice of pizza is around 1.2g. In addition, two table spoons of salsa contains around 0.5g of salt while five pieces of salty biscuit contains around 0.5g of salt (30). On average, 70.4% of people reported eating two or less pieces of Arabic bread daily. A rough estimates show that people ingest two gram or less of sodium from bread which is considered an acceptable amount. However, the intake of salt remains high. For example a study showed that 46.8% of participants always add salty spices such as Maggi or chicken broth when cooking their daily meals, 61.1% eat at least once pickles and olives per day and 18.6% eat salty biscuits and chips 3-4 times weekly. The majority of participants thought that the amount of salt in bread, pizza, pasta, rice, canned meat, canned vegetables and non-cooked grains was average. Around 40% of participants also noted that ready-made sauces such as soya sauces and nuts have an acceptable amount of salt, however large amounts of sodium can be hidden in canned, processed and convenience foods. Some High-Sodium Foods are Smoked, cured, salted or canned meat, sausage, Frozen breaded meats and dinners, such as burritos and pizza. Salted nuts. Beans canned with salt added.(31). There is a dire need for increasing public awareness messaging around salt intake and its risks, through educational materials development and implementing community awareness strategies.
Participants were also found to eat only up to two servings of fruits and vegetables per day. This result matches what was found previously in the literature, where Jordanians usually eat little fruits and vegetables (15). Around 40% of participants eat one to two salty biscuits and chips per day.
The most common reported practices to reduce salt intake included using spices other than salt while cooking and avoiding or decreasing amount of salt rich food followed by not adding salt when cooking or add a very small amount, avoiding eating outside a lot, buying alternative products with low salt content, reading the salt content on the food labels. Similar practices were reported in the stepwise survey (15)
On the other hand, social media platforms constitute the most widely preferred media to receive health information generally and around salt intake in particular. Approximately 87% of participants think that working through community awareness campaigns can help promote salt reduction while preferring places such as malls, bakeries, schools and universities to conduct these awareness campaigns. Furthermore, 85.2% of participants thought that community organizations and associations could support efforts to reduce salt intake.
Food is an essential aspect of Jordanian culture. Jordanians serve family, friends, and guests with great pride in their homes, no matter how modest their means. In villages, meals are a community event with immediate and extended family present. In addition, Jordanians commonly use food to express their hospitality and generosity subsequently on of the main barriers to using low salt foods, participants thought that the difficulty in eating with others, addition to limited options available at restaurants, and insufficient knowledge about decreasing sodium. As for the best ways to reduce salt intake, participants thought that providing individual counselling services should be the primary method.

5. Conclusions

This study showed that Jordanian adults have limited knowledge around salt intake and their practices of high salt intake are inappropriate. Therefore, it is necessary to take immediate steps to adopt long-term strategies to reduce salt intake among the Jordanian population and lessen the negative impacts on community health. The following are recommended:
  • Several strategies need to be adopted in Jordan to limit salt intake, such as increasing knowledge of the population around the significant sources of sodium in the diet and reformulating certain food products available in the market. This entails educational materials development and conduction of community awareness strategies to enhance consumer awareness on salt intake and educate the population on reading and interpreting food labels. This should be disseminated through interactive awareness campaigns in public places, such as malls, bakeries, schools, universities, hospitals, and public and private health centers. Furthermore, targeting males and those with younger age groups should focus with this awareness interventions as males had a relatively higher percentage for not buying alternative products with low salt content even if they are available.
  • Although male and female participants have adequate knowledge regarding salt consumption, their practices and attitudes were not. This shows a mismatch in the behavioral theory, where knowledge is expected to match the attitudes and practices of people. Therefore, the focus should not only be on awareness campaigns, but should be complemented by well-designed behavioral change programs.
  • Enforcement of food labelling policy measures such as labelling food items moreover, we need to simplify for the community through using the traffic light approach to be more user friendly
  • Furthermore, targeting food manufacturers to change the food culture around the salt intake is needed to decrease the salt intake malpractice. This can be done through social media chef influencers to promote cooking using low salt items. Giving incentives for manufacturers to announce low salt healthy food options can also be a target as a public health intervention. besides increasing availability of low-sodium foods at school, worksite and restaurants,
  • Develop a local food composition table and make it accessible for professionals and publics
  • Nutrition counselling should be a service provided in primary health care centers, and there is a need to invest in this area and build capacity for this service

Funding

“This research received no external funding”.

Appendix A

List of Abbreviations:
EMR Eastern Mediterranean Region
WHO World Health Organization
NCDs Noncommunicable Diseases
BP Blood Pressure
DM Diabetes Mellitus
LMICs Low- and middle-income countries
KAP Knowledge, attitude, and practice

Appendix B

Table A1. Respondents knowledge about salt intake according to Age(n= 1354).
Table A1. Respondents knowledge about salt intake according to Age(n= 1354).
Variable <40 years >=40 years Total P value
How important to you is lowering salt in your diet 0.000
Not Important at All 59 8.4% 19 2.9% 78 5.8%
Somehow Important 230 32.7% 166 25.5% 396 29.2%
Very Important 415 58.9% 465 71.5% 880 65.0%
What is the amount of salt available in the normal white bread? 0.020
Normal/ Acceptable 415 58.9% 379 58.3% 794 58.6%
Low 256 36.4% 217 33.4% 473 34.9%
High 33 4.7% 54 8.3% 87 6.4%
What is the amount of salt available in Pizza 0.092
Normal/ Acceptable 430 61/1% 381 58.6% 811 59.9%
Low 97 13.8% 74 11.4% 171 12.6%
High 177 25.1% 195 30% 372 27.5%
What is the amount of salt available in Pasta, Rice and other non-cooked grains? 0.899
Normal/ Acceptable 383 54.4% 386 59.4% 769 56.8%
Low 277 39.3% 236 36.3% 513 37.9%
High 44 6.3% 28 4.3% 72 5.3%
what is the amount of salt available in white Cheese? 0.962
Normal/ Acceptable 58 8.2% 57 8.8% 115 8.5%
Low 14 2% 12 1.8% 26 1.9%
High 632 89.8% 581 89.4% 1213 89.6%
what is the amount of salt available in Canned Meat? 0.020
Normal/ Acceptable 347 49.3% 278 42.8% 625 46.2%
Low 52 7.4% 41 6.3% 93 6.9%
High 305 43.3% 331 50.9% 636 47.0%
What is the amount of salt available in Canned food such as canned vegetables, tuna, sardine and canned mushrooms? 0.287
Normal/ Acceptable 389 54% 363 55.8% 743 54.9%
Low 104 14.8% 77 11.8% 181 13.4%
High 220 31.3% 210 32.3% 430 31.8%
what is the amount of salt available in yogurt containing products such as Laban, Labaneh, Ayran and Jameed? 0.567
Normal/ Acceptable 129 18.3% 134 20.6% 263 19.4%
Low 11 1.6% 10 1.5% 21 1.6%
High 864 80.1% 506 77.8% 1070 79.0%
what is the amount of salt available in readymade sauces such as soya sauce and ketchup? 0.474
Normal/ Acceptable 353 35.9% 235 36.2% 488 36.0%
Low 35 5% 42 6.5% 77 5.7%
High 416 59.1% 373 57.4% 789 58.3%
what is the amount of salt available in Nuts? 0.003
Normal/ Acceptable 303 43% 221 34% 524 38.7%
Low 22 3.1% 23 3.5% 45 3.3%
High 379 53.8% 406 62.5% 785 58.0%
what is the amount of salt available in Pickles and Olives? 0.736
Normal/ Acceptable 80 11.4% 69 10.6% 149 11.0%
Low 7 1% 9 1.4% 16 1.2%
High 617 87.6% 572 88% 1189 87.8%
Table A2. Respondents attitude on salt intake according to Age(n= 1354).
Table A2. Respondents attitude on salt intake according to Age(n= 1354).
Variable <40 years >=40 years Total P value
Are you interested in reading the nutritional label of the salt content on food items when going grocery shopping? 0.000
No 526 74.7% 414 63.7% 940 69.4%
I do not know what a food label is 73 10.4% 109 16.8% 182 13.4%
Yes 105 14.9% 127 19.5% 232 17.1%
Do you think there is a type of salt that is used in food making which is harmless regardless of its quantity? 0.168
I do not think 404 57.4% 397 61.1% 801 59.2%
Yes, I think 300 42.6% 253 38.9% 553 40.8%
When eating meals outside the home, how do you feel the taste of food 0.000
No taste 21 3% 77 11.8% 98 7.2%
Normal 598 84.9% 448 68.9% 1046 77.3%
Salty 85 12.1% 125 19.2% 210 15.5%
Do you believe there are alternatives to salt that can be added to the food? 0.249
No 331 47% 326 50.2% 657 48.5%
Yes 373 53% 324 49.8% 697 51.5%
Table A3. Respondents salt intake practices according to Age (n= 1354).
Table A3. Respondents salt intake practices according to Age (n= 1354).
Variable <40 years >=40 years Total P value
What type of salt you usually use when preparing your meals at home? 0.003
Non- iodized 42 6% 27 4.2% 69 5.1%
I don’t Know 143 20.3% 94 14.5% 237 17.5%
Iodized 519 73.7% 529 81.4% 1048 77.4%
Do you read the nutritional label on the food items when grocery shopping 0.144
No 594 84.4% 529 81.4% 1123 82.9%
Yes 110 15.6% 121 18.6% 231 17.1%
In case the food item contains a higher amount of salt than the allowed one, do you still buy it? 0.000
No 442 62.8% 475 73.1% 917 67.7%
Don’t care 219 31.1% 122 18.8% 341 25.2%
Yes 43 6.1% 53 8.2% 96 7.1%
Do you feel thirsty after eating your meals? 0.002
Never 120 17% 82 12.6% 202 14.9%
Sometimes 415 58.9% 360 55.4% 775 57.2%
Always 169 24% 208 32% 377 27.8%
To reduce salt intake:
I Avoid or I decrease the usage of salt rich food? 385 54.7% 484 74.5% 869 64.2% 0.000
I buy alternative products with low salt content 315 44.7% 339 52.2% 654 48.3% 0.006
I read the salt content on the food labels 238 33.8% 236 36.3% 474 35.0% 0.335
I do not add salt when cooking or I add a very small amount 328 46.6% 377 58% 705 52.1% 0.000
I use spices instead of salt when cooking 299 42.5% 292 44.9% 591 43.6% 0.364
I avoid eating outside a lot 242 34.4% 434 66.8% 676 49.9% 0.000
If I eat outside, I choose low salt food options 227 32.2% 322 49.5% 549 40.5% 0.000
I use spices with salt while cooking 454 64.5% 456 70.2% 910 67.2% 0.027
Do you add table salt when cooking your daily meals? 0.003
Never 101 14.3% 135 20.8% 236 17.4%
Always 337 47.9% 315 48.5% 652 48.2%
Am not responsible for cooking meals 116 16.5% 79 12.2% 195 14.4%
Sometimes 150 21.3% 121 18.6% 271 20.0%
Do you add salt on the table in your daily meals? 0.000
Never 406 57.7% 443 68.2% 849 62.7%
Always 110 15.6% 88 13.5% 198 14.6%
Sometimes 188 26.7% 119 18.3% 307 22.7%
Do you add salty sauces to every male of your day 0.000
Never 344 48.9% 403 62% 747 55.2%
Always 86 12.2% 69 10.6% 155 11.4%
Sometimes 274 38.9% 178 27.4% 452 33.4%
Do you add salty spices such as Maggi or chicken broth when cooking your daily meals? 0.000
Never 145 20.6% 193 29.7% 338 25%
Always 361 51.3% 272 41.8% 633 46.8%
Sometimes 198 28.1% 185 28.5% 383 28.3%
What is the amount of Arabic bread you eat daily? 0.261
One bread 198 28.1% 165 25.4% 363 26.8%
Two breads 280 39.8% 244 37.5% 524 38.7%
Three breads 105 14.9% 123 18.9% 228 16.8%
Four breads 45 6.4% 51 7.8% 96 7.1%
Five breads 31 4.4% 25 3.8% 56 4.1%
More than five breads 13 1.8% 7 1.1% 20 1.5%
I don’t eat bread 32 4.5% 35 5.4% 67 4.9%
How many times per week you eat white cheese? 0.139
1-2 times per week 409 58.1% 366 56.3% 775 57.2%
3-4 times per week 91 12.9% 110 16.9% 201 14.8%
more than five times per work 20 2.8% 23 3.5% 43 3.2%
I don’t eat 184 26.1% 151 23.2% 335 24.7%
How many servings of fruits and vegetables you eat daily? 0.079
One serving 210 29.8% 157 24.2% 367 27.1%
Two servings 224 31.8% 243 37.4% 467 34.5%
Three servings 148 21% 133 20.5% 281 20.8%
Four servings 53 7.5% 52 8% 105 7.8%
More than five servings 35 5% 42 6.5% 77 5.7%
I don’t eat 34 4.8% 23 3.5% 57 4.2%
How many times per week you eat salty biscuits and chips? 0.000
1-2 times per week 302 42.9% 236 36.3% 538 39.7%
3-4 times per week 197 28% 55 8.5% 252 18.6%
more than five times per work 104 14.8% 24 3.7% 128 9.5%
I don’t eat 101 14.3% 335 51.5% 436 32.2%
How many times per day you use pickles and olives? 0.143
More than three times per day 38 5.4% 55 8.5% 93 6.9%
I don’t eat 220 31.3% 200 30.8% 420 31.0%
Once per day 346 49.1% 299 46% 645 47.6%
Twice per day 100 14.2% 96 14.8% 196 14.5%
How many times per week you eat Indomi? 0.000
1-2 times per week 213 30.3% 77 11.8% 290 21.4%
3-4 times per week 81 11.5% 16 2.5% 97 7.2%
more than five times per work 37 5.3% 6 0.9% 43 3.2%
I don’t eat 373 53% 551 84.8% 924 68.2%
Table A4. Respondent’s source of health information according to Age (n= 1354).
Table A4. Respondent’s source of health information according to Age (n= 1354).
Variable <40 years >=40 years Total P value
Flyers, Brochures and Posters 169 24% 161 24.8% 330 24.4% 0.744
Television 335 47.6% 385 59.2% 720 53.2% 0.000
Radio 74 10.5% 97 14.9% 171 12.6% 0.015
YouTube 419 59.5% 289 44.5% 708 52.3% 0.000
Social Media Platforms 567 80.5% 418 64.3% 985 72.7% 0.000
Google 522 74.1% 345 53.1% 867 64.0% 0.000
Friends 352 50% 355 54.6% 707 52.2% 0.089
School or University 222 31.5% 74 11.4% 296 21.9% 0.000
Public or Private health centres (doctor, nutritionist) 437 62.1% 434 66.8% 871 64.3% 0.072
Do you benefit from food labels in finding out the amount of salt in food items? 303 43% 258 39.7% 561 41.4% 0.212
Table A5. Respondents preferred source of information on salt intake and health (n= 1354).
Table A5. Respondents preferred source of information on salt intake and health (n= 1354).
Variable <40 years >=40 years Total P value
Flyers, Brochures and Posters 274 38.9% 230 35.4% 504 37.2% 0.179
Television 391 55.5% 459 70.6% 850 62.8% 0.000
Radio 142 20.2% 167 25.7% 309 22.8% 0.016
YouTube 478 67.9% 339 52.2% 817 60.3% 0.000
Social Media Platforms 595 84.5% 464 87.4% 1059 78.2% 0.000
Google 566 80.4% 383 58.9% 949 70.1% 0.000
Friends 361 51.3% 353 54.3% 714 52.7% 0.256
School or University 261 37.1% 146 22.5% 407 30.1% 0.000
Public or Private health centers (doctor, nutritionist) 573 81.4% 548 84.3% 1121 82.8% 0.156
Table A6. Respondents opinion on reasons of high salt intake (n= 1354).
Table A6. Respondents opinion on reasons of high salt intake (n= 1354).
Variable <40 years >=40 years Total P value
Difficulty eating with others 0.023
No 270 38.4% 289 44.5% 559 41.3%
Yes 434 61.6% 361 55.5% 795 58.7%
Limited options available at restaurants 0.247
No 187 26.6% 191 29.4% 378 27.9%
Yes 517 73.4% 459 70.6% 976 72.1%
Complicated cooking process 0.021
No 371 52.7% 383 58.9% 754 55.7%
Yes 333 47.3% 267 41.1% 600 44.3%
Low amount of knowledge around methods of decreasing sodium 0.044
No 253 35.9% 200 30.8% 453 33.5%
Yes 451 64.1% 450 69.2% 901 66.5%
Not using or reading food labels 0.216
No 144 20.5% 151 23.2% 295 21.8%
Yes 560 79.5% 499 76.8% 1059 78.2%
Not knowing food labels 0.680
No 189 26.8% 181 27.8% 370 27.3%
Yes 515 73.2% 469 72.2% 984 72.7%
Not knowing the availability of low salt food 0.214
No 230 32.7% 192 29.5% 422 31.2%
Yes 474 67.3% 458 70.5% 932 68.8%
The high cost of low salt food 0.639
No 180 25.6% 159 24.5% 339 25.0%
Yes 524 74.4% 491 75.5% 1015 75.0%
Not knowing the risks of salt 0.268
No 292 41.5% 289 44.5% 581 42.9%
Yes 412 58.5% 361 55.5% 773 57.1%
Table A7. Respondents recommendation on best options to reduce salt intake.
Table A7. Respondents recommendation on best options to reduce salt intake.
Variable <40 years >=40 years Total P value
Do you think community organizations and associations can play a role in reducing salt intake? 0.490
No 100 14.2% 101 15.5% 201 14.8%
Yes 604 85.8% 549 84.5% 1153 85.2%
Educating the public and the community around the importance of decreasing salt intake 0.188
No 30 4.3% 19 2.9% 49 3.6%
Yes 674 95.7% 631 97.1% 1305 96.4%
Providing individual counselling services 0.356
No 100 14.2% 104 16% 204 15.1%
Yes 604 85.8% 546 84% 1150 84.9%
An easy-to-use food label 0.566
No 94 13.4% 80 12.3% 174 12.9%
Yes 610 86.6% 570 87.7% 1180 87.1%
Amending food specifications to reduce salt 0.237
No 35 5% 42 6.5% 77 5.7%
Yes 669 95% 608 93.5% 1277 94.3%
Using potassium chloride instead of sodium chloride 0.046
No 88 12.5% 106 16.3% 194 14.3%
Yes 616 87.5% 544 83.7% 1160 85.7%
Increasing awareness for restaurant’s owners to use low salt options 0.775
No 46 6.5% 45 6.9% 91 6.7%
Yes 658 93.5% 605 93.1% 1263 93.3%
Establishing a bonus system for factories producing low salt food 0.163
No 37 5.3% 46 7.1% 83 6.1%
Yes 667 94.7% 604 92.9% 1271 93.9%

References

  1. World Health Organization, WHO. Global Health Observatory Data Repository: Noncommunicable diseases. Available online: Available at: http://apps.who.int/gho/data/node.main.A860?lang=en (accessed on 30 November 2021).
  2. UN Interagency Task Force on NCDs 2016. Noncommunicable diseases in emergencies. Available at: http://apps.who.int/iris/bitstream/10665/204627/1/WHO_NMH_NVI_16.2_eng (accessed on 30 November 2021).
  3. World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013-2020. World Health Organization; 2013. Available online: https://www.who.int/publications-detail-redirect/9789241506236 (accessed on 30 November 2021).
  4. Alkhunaizi, A.M.; Al Jishi, H.A.; Al Sadah, Z.A. Salt intake in eastern Saudi Arabia. East Mediterr Health J. 2013, 19, 915–8. [Google Scholar] [CrossRef] [PubMed]
  5. Sphere Association. The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response, fourth edition, Geneva, Switzerland, 2018. Available online: www.spherestandards.org/handbookhttp://www.spherehandbook.org/en/essential-health-services-non-communicable-diseases-standard-1-non-communicable-diseases (accessed on 30 November 2021).
  6. Jaddou, H.Y.; Batieha, A.M.; et al. Hypertension prevalence, awareness, treatment and control, and associated factors: results from a national survey, Jordan. International journal of hypertension 2011, 2011. [Google Scholar] [CrossRef] [PubMed]
  7. Ajlouni, K.; Khader, Y.S.; Batieha, A.; Ajlouni, H.; El-Khateeb, M. An increase in prevalence of diabetes mellitus in Jordan over 10 years. Journal of Diabetes and its Complications. 2008, 22, 317–24. [Google Scholar] [CrossRef] [PubMed]
  8. Brown, D.W.; Mokdad, A.H.; Walke, H.; As’ ad, M.; Al-Nsour, M.; Zindah, M.; Arqoob, K.; Belbeisi, A. Projected burden of chronic, noncommunicable diseases in Jordan. Preventing chronic disease. 2009, 6. [Google Scholar]
  9. Tailakh, A.; Evangelista, L.S.; Mentes, J.C.; Pike, N.A.; Phillips, L.R.; Morisky, D.E. Hypertension prevalence, awareness, and control in A rab countries: A systematic review. Nursing & health sciences. 2014, 16, 126–30. [Google Scholar]
  10. Khader, Y.; Batieha, A.; et al. Hypertension in Jordan: prevalence, awareness, control, and its associated factors. International Journal of Hypertension. 2019, 2019. [Google Scholar] [CrossRef]
  11. Alawwa, I.; Dagash, R.; Saleh, A.; Ahmad, A. Dietary salt consumption and the knowledge, attitudes and behavior of healthy adults: a cross-sectional study from Jordan. Libyan Journal of Medicine. 2018, 13. [Google Scholar] [CrossRef] [PubMed]
  12. Esmaeili, M.; Houshirra, A.; Salehi, F. Determination of Sodium intake by dietary intake surveys and validation of the methods with 24 hour urine collections in Tehran. Tehran: National Nutrition and Food Technology Research Institute. 2014.
  13. Dyer, A.R.; Elliott, P.; Shipley, M. INTERSALT Cooperative Research Group. Urinary electrolyte excretion in 24 hours and blood pressure in the INTERSALT Study: II. Estimates of electrolyte-blood pressure associations corrected for regression dilution bias. American journal of epidemiology 1994, 139, 940–51. [Google Scholar] [CrossRef] [PubMed]
  14. Iaccarino Idelson, P.; D’Elia, L.; et al. Salt and health: Survey on knowledge and salt intake related behaviour in Italy. Nutrients 2020, 12, 279. [Google Scholar] [CrossRef] [PubMed]
  15. Ministry of Health Jordan, Jordan National Stepwise survey for noncommunicable diseases risk factors 2019. [pdf].
  16. World Health Organization, Sodium intake for adults and children. 25 December 2012. Available online: https://www.who.int/publications-detail/9789241504836 (accessed on January 2020).
  17. Jaddou, H.Y.; Batieha, A.M.; et al. Hypertension prevalence, awareness, treatment and control, and associated factors: results from a national survey, Jordan. International journal of hypertension. 2011. [CrossRef] [PubMed]
  18. United Nations High Commissioner for Refugees, UNHCR, health sector Jordan monthly report, 2014. Available at: https://data2.unhcr.org/en/documents/download/42741. Accessed on 05 December 2021. 05 December.
  19. He, F.J.; MacGregor, G.A. Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health. Journal of human hypertension. 2002, 16, 761–70. [Google Scholar] [CrossRef] [PubMed]
  20. Sacks, F.M.; Svetkey, L.P.; et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. New England journal of medicine. 2001, 344, 3–10. [Google Scholar] [CrossRef] [PubMed]
  21. He, F.J.; MacGregor, G.A. Reducing population salt intake worldwide: from evidence to implementation. Progress in cardiovascular diseases 2010, 52, 363–82. [Google Scholar] [CrossRef] [PubMed]
  22. Baharudin, A.; Ambak, R.; Othman, F.; Michael, V.; Cheong, S.M.; Abdul Aziz, N.S.; Ganapathy, S.S.; Palaniveloo, L.; He, F.J. Knowledge, attitude and behaviour on salt intake and its association with hypertension in the Malaysian population: findings from MyCoSS (Malaysian Community Salt Survey). Journal of Health, Population and Nutrition. 2021, 40, 1–9. [Google Scholar] [CrossRef] [PubMed]
  23. Cappuccio, F.P. Cardiovascular and other effects of salt consumption. Kidney International Supplements. 2013, 3, 312–5. [Google Scholar] [CrossRef] [PubMed]
  24. Kong, Y.W.; Baqar, S.; Jerums, G.; Ekinci, E.I. Sodium and its role in cardiovascular disease–the debate continues. Frontiers in endocrinology. 2016, 7, 164. [Google Scholar] [CrossRef] [PubMed]
  25. O’donnell, M.J.; Mente, A.; Smyth, A.; Yusuf, S. Salt intake and cardiovascular disease: why are the data inconsistent? European heart journal. 2013, 34, 1034–40. [Google Scholar] [CrossRef] [PubMed]
  26. Ajzen, I.; Fishbein, M. The influence of attitudes on behavior. Albarracín, D., Johnson, B.T., Zanna, M.P., Eds.; Handbook of Attitudes and Attitude Change: Basic Principles.
  27. Esmaeili, M.; Houshirra, A.; Salehi, F. Determination of Sodium intake by dietary intake surveys and validation of the methods with 24 hour urine collections in Tehran. Tehran: National Nutrition and Food Technology Research Institute. 2014.
  28. Pietinen, P.; Valsta, L.M.; Hirvonen, T.; Sinkko, H. Labelling the salt content in foods: a useful tool in reducing sodium intake in Finland. Public health nutrition. 2008, 11, 335–40. [Google Scholar] [CrossRef] [PubMed]
  29. Nina, S. United Nations High Commissioner for Refugees, UNHCR, health sector Jordan monthly report, 2014. Available at: https://data2.unhcr.org/en/documents/download/42741. Accessed on 05 December 2021.
  30. Ministry of Health Jordan, Jordanian nutrition guideline,2020. [pdf]. https://kaa.moh.gov.jo/EchoBusV3.0/SystemAssets/PDFs/Jordan%20Guide%20Book_Website.pdf.
  31. Patient education Guidelines for a Low Sodium Diet, University of California San Francisco https://www.ucsfhealth.org/education/guidelines-for-a-low-sodium-diet.
  32. Food, nutrition, and health in Moldova. In Nutritional and Health Aspects of Food in the Balkans 2021 Jan 1 (pp. 249-262). Academic Press. Available at: mda-salt-intake-eng.pdf (who.int).
Table 1. Participants’ sociodemographic and clinical characteristics (n= 1354).
Table 1. Participants’ sociodemographic and clinical characteristics (n= 1354).
Variable Female Male Total P value
n % n % N %
Age 0.625
<40 538 51.6 166 53.2 704 52.0
≥40 504 48.4 146 46.8 650 48.0
Qualifications 0.010
Less than university education 587 56.3 150 48.1 737 54.4
University education 455 43.7 162 51.9 617 45.6
Marital Status 0.000
Widow 88 8.4 8 2.6 96 7.1
Single 193 18.5 98 31.4 291 21.5
Married 700 67.2 198 63.5 898 66.3
Divorced 61 5.9 8 2.6 69 5.1
Hypertension 228 21.9 75 24.0 303 22.4 0.422
Diabetes 142 13.6 43 13.8 185 13.7 0.944
Hypercholesterolemia 165 15.8 50 16.0 215 15.9 0.936
Cardiovascular diseases 66 6.3 27 8.7 93 6.9 0.155
Other chronic illnesses 93 8.9 25 8.0 118 8.7 0.616
Current Cigarettes Smoker 0.000
Sometimes 56 5.4 12 3.8 68 5.0
Every day 97 9.3 186 59.6 283 20.9
Not at all 889 85.3 114 36.5 1003 74.1
Current waterpipe smokers 0.029
Sometimes 253 24.3 67 21.5 320 23.6
Every day 146 14.0 29 9.3 175 12.9
Not at all 643 61.7 216 69.2 859 63.4
Table 2. Respondents’ knowledge about salt intake according to gender (n= 1354).
Table 2. Respondents’ knowledge about salt intake according to gender (n= 1354).
Variable Female Male Total P value
n % n % N %
What is the maximum salt intake for an adult to maintain a healthy diet? 0.001
10g/day 84 8.1 21 6.7 105 7.8
2g/day 193 18.5 58 18.6 251 18.5
5g/day 328 31.5 67 21.5 395 29.2
I don’t know 437 41.9 166 53.2 603 44.5
Does eating too much salt or salty sauces in your diet causes: 0.381
Hypertension 1000 96.0 301 96.5 1301 96.1 0.687
Osteoporosis 558 53.6 136 43.6 694 51.3 0.002
Stomach Cancer 482 46.3 120 38.5 602 44.5 0.015
Kidney Stones 906 86.9 261 83.7 1167 86.2 0.139
How important to you is lowering salt in your diet? 0.003
Not Important at All 48 4.6 30 9.6 78 5.8
Somehow Important 305 29.3 91 29.2 396 29.2
Very Important 689 66.1 191 61.2 880 65.0
What is your estimate of the amount of salt available in the following diets: 0.477
White bread
Normal/ Acceptable 603 57.9 191 61.2 794 58.6
Low 373 35.8 100 32.1 473 34.9
High 66 6.3 21 6.7 87 6.4
Pizza 0.783
Normal/ Acceptable 621 59.6 190 60.9 811 59.9
Low 130 12.5 41 13.1 171 12.6
High 291 27.9 81 26.0 372 27.5
Pasta, Rice and other non-cooked grains 0.899
Normal/ Acceptable 591 56.7 178 57.1 769 56.8
Low 397 38.1 116 37.2 513 37.9
High 54 5.2 18 5.8 72 5.3
white Cheese 0.132
Normal/ Acceptable 81 7.8 34 10.9 115 8.5
Low 18 1.7 8 2.6 26 1.9
High 943 90.5 270 86.5 1213 89.6
Canned Meat 0.506
Normal/ Acceptable 483 46.4 142 45.5 625 46.2
Low 67 6.4 26 8.3 93 6.9
High 492 47.2 144 46.2 636 47.0
Canned food such as canned vegetables, tuna, sardine and canned mushrooms 0.990
Normal/ Acceptable 571 54.8 172 55.1 743 54.9
Low 140 13.4 41 13.1 181 13.4
High 331 31.8 99 31.7 430 31.8
yogurt containing products such as Laban, Labaneh, Ayran and Jameed 0.625
Normal/ Acceptable 198 19.0 65 20.8 263 19.4
Low 15 1.4 6 1.9 21 1.6
High 829 79.6 241 77.2 1070 79.0
Readymade sauces such as soya sauce and ketchup 0.092
Normal/ Acceptable 361 34.6 127 40.7 488 36.0
Low 64 6.1 13 4.2 77 5.7
High 617 59.2 172 55.1 789 58.3
Nuts 0.396
Normal/ Acceptable 393 37.7 131 42.0 524 38.7
Low 35 3.4 10 3.2 45 3.3
High 614 58.9 171 54.8 785 58.0
Pickles and Olives 0.191
Normal/ Acceptable 106 10.2 43 13.8 149 11.0
Low 13 1.2 3 1.0 16 1.2
High 923 88.6 266 85.3 1189 87.8
Table 3. Respondents’ attitude towards salt intake according to gender (n= 1354).
Table 3. Respondents’ attitude towards salt intake according to gender (n= 1354).
Variable Female Male Total P value
Do you think there is a type of salt that is used in food making which is harmless regardless of its quantity? 0.000
No 586 56.2 215 68.9 801 59.2
Yes 456 43.8 97 31.1 553 40.8
When eating meals outside the home, how do you feel the taste of food? 0.833
No taste 75 7.2 23 7.4 98 7.2
Normal 802 77.0 244 78.2 1046 77.3
Salty 165 15.8 45 14.4 210 15.5
Do you believe there are alternatives to salt that can be added to the food? 0.023
No 488 46.8 169 54.2 657 48.5
Yes 554 53.2 143 45.8 697 51.5
Table 4. Respondents’ salt intake related practice according to gender (n= 1354).
Table 4. Respondents’ salt intake related practice according to gender (n= 1354).
Variable Female Male Total P value
What type of salt you usually use when preparing your meals at home? 0.003
Non- iodized 50 4.8 19 6.1 69 5.1
I don’t Know 164 15.7 73 23.4 237 17.5
Iodized 828 79.5 220 70.5 1048 77.4
Do you read the nutritional label on the food items when grocery shopping? 0.285
No 858 82.3 265 84.9 1123 82.9
Yes 184 17.7 47 15.1 231 17.1
In case the food item contains a higher amount of salt than the allowed one, do you still buy it? 0.000
No 721 69.2 196 62.8 917 67.7
Don’t care 238 22.8 103 33.0 341 25.2
Yes 83 8.0 13 4.2 96 7.1
Do you feel thirsty after eating your meals? 0.201
Never 152 14.6 50 16.0 202 14.9
Sometimes 610 58.5 165 52.9 775 57.2
Always 280 26.9 97 31.1 377 27.8
Do you add table salt when cooking your daily meals? 0.000
Never 186 17.9 50 16.0 236 17.4
Always 581 55.8 71 22.8 652 48.2
Not responsible for cooking meals 53 5.1 142 45.5 195 14.4
Sometimes 222 21.3 49 15.7 271 20.0
Do you add salt on the table in your daily meals? 0.340
Never 659 63.2 190 60.9 849 62.7
Always 156 15.0 42 13.5 198 14.6
Sometimes 227 21.8 80 25.6 307 22.7
Do you add salty sauces to every meal of your day? 0.049
Never 556 53.4 191 61.2 747 55.2
Always 125 12.0 30 9.6 155 11.4
Sometimes 361 34.6 91 29.2 452 33.4
Do you add salty spices such as Maggi or chicken broth when cooking your daily meals? 0.000
Never 216 20.7 122 39.1 338 25.0
Always 541 51.9 92 29.5 633 46.8
Sometimes 285 27.4 98 31.4 383 28.3
Table 5. Common practices for reducing salt intake.
Table 5. Common practices for reducing salt intake.
Variable Female Male Total P value
To reduce salt intake:
I Avoid or I decrease amount of salt rich food I eat 689 66.1 180 57.7 869 64.2 0.006
I buy alternative products with low salt content 520 49.9 134 42.9 654 48.3 0.031
I read the salt content on the food labels 382 36.7 92 29.5 474 35.0 0.020
I do not add salt when cooking or I add a very small amount 569 54.6 136 43.6 705 52.1 0.001
I only use spices instead of salt when cooking 483 46.4 108 34.6 591 43.6 0.000
I avoid eating outside a lot 539 51.7 137 43.9 676 49.9 0.015
If I eat outside, I choose low salt food options 434 41.7 115 36.9 549 40.5 0.130
I use spices with salt while cooking 726 69.7 184 59.0 910 67.2 0.000
Table 6. Amount and frequency of eating common foods.
Table 6. Amount and frequency of eating common foods.
Variable Female Male Total P value
What is the amount of Arabic bread you eat daily? 0.000
One bread 328 31.5 35 11.2 363 26.8
Two breads 435 41.7 89 28.5 524 38.7
Three breads 141 13.5 87 27.9 228 16.8
Four breads 54 5.2 42 13.5 96 7.1
Five breads 18 1.7 38 12.2 56 4.1
More than five breads 8 0.8 12 3.8 20 1.5
I don’t eat bread 58 5.6 9 2.9 67 4.9
How many times per week you eat white cheese? 0.328
1-2 times per week 599 57.5 176 56.4 775 57.2
3-4 times per week 146 14.0 55 17.6 201 14.8
more than five times per week 36 3.5 7 2.2 43 3.2
I don’t eat 261 25.0 74 23.7 335 24.7
How many servings of fruits and vegetables you eat daily 0.000
One serving 303 29.1 64 20.5 367 27.1
Two servings 366 35.1 101 32.4 467 34.5
Three servings 205 19.7 76 24.4 281 20.8
Four servings 83 8.0 22 7.1 105 7.8
More than five servings 47 4.5 30 9.6 77 5.7
I don’t eat 38 3.6 19 6.1 57 4.2
How many times per week you eat salty biscuits and chips? 0.000
1-2 times per week 435 41.7 103 33.0 538 39.7
3-4 times per week 206 19.8 46 14.7 252 18.6
more than five times per work 97 9.3 31 9.9 128 9.5
I don’t eat 304 29.2 132 42.3 436 32.2
How many times per day you use pickles and olives? 0.387
More than three times per day 78 7.5 15 4.8 93 6.9
I don’t eat 320 30.7 100 32.1 420 31.0
Once per day 491 47.1 154 49.4 645 47.6
Twice per day 153 14.7 43 13.8 196 14.5
How many times per week you eat Indomi? 0.048
1-2 times per week 229 22.0 61 19.6 290 21.4
3-4 times per week 84 8.1 13 4.2 97 7.2
more than five times per work 30 2.9 13 4.2 43 3.2
I don’t eat 699 67.1 225 72.1 924 68.2
Table 7. The main sources of health information.
Table 7. The main sources of health information.
Variable Female Male Total P value
Flyers, Brochures and Posters 264 25.3 66 21.2 330 24.4 0.131
Television 571 54.8 149 47.8 720 53.2 0.029
Radio 123 11.8 48 15.4 171 12.6 0.095
YouTube 543 52.1 165 52.9 708 52.3 0.810
Social Media Platforms 756 72.6 229 73.4 985 72.7 0.769
Google 655 62.9 212 67.9 867 64.0 0.100
Friends 554 53.2 153 49.0 707 52.2 0.200
School or University 227 21.8 69 22.1 296 21.9 0.901
Health centers 673 64.6 198 63.5 871 64.3 0.716
Table 8. Respondent preferred source of information on salt intake.
Table 8. Respondent preferred source of information on salt intake.
Variable Female Male Total P value
Flyers, Brochures and Posters 402 38.6 102 32.7 504 37.2 0.059
Television 677 65.0 173 55.4 850 62.8 0.002
Radio 226 21.7 83 26.6 309 22.8 0.070
YouTube 621 59.6 196 62.8 817 60.3 0.307
Social Media Platforms 812 77.9 247 79.2 1059 78.2 0.642
Google 717 68.8 232 74.4 949 70.1 0.060
Friends 565 54.2 149 47.8 714 52.7 0.045
School or University 312 29.9 95 30.4 407 30.1 0.864
Health centers 854 82.0 267 85.6 1121 82.8 0.137
Table 9. Participants’ reported reasons of high salt intake.
Table 9. Participants’ reported reasons of high salt intake.
Variable Female Male Total P value
Limited options available at restaurants 758 72.7 218 69.9 976 72.1 0.321
Complicated cooking process 479 46.0 121 38.8 600 44.3 0.025
Low amount of knowledge around methods of decreasing sodium 686 65.8 215 68.9 901 66.5 0.313
Not reading food labels 801 76.9 258 82.7 1059 78.2 0.029
Not knowing food labels 744 71.4 240 76.9 984 72.7 0.055
Not knowing the availability of low salt food 700 67.2 232 74.4 932 68.8 0.016
The high cost of low salt food 773 74.2 242 77.6 1015 75.0 0.227
Not knowing the risks of salt 579 55.6 194 62.2 773 57.1 0.038
Table 10. Respondents’ recommendation on best options to reduce salt intake.
Table 10. Respondents’ recommendation on best options to reduce salt intake.
Variable Female Male Total P value
Educating the public and the community about the importance of decreasing salt intake 1007 96.6 298 95.5 1305 96.4 0.349
Providing individual counselling services 900 86.4 250 80.1 1150 84.9 0.007
An easy-to-use food label 899 86.3 281 90.1 1180 87.1 0.079
Amending food specifications to reduce salt 987 94.7 290 92.9 1277 94.3 0.236
Using potassium chloride instead of sodium chloride 894 85.8 266 85.3 1160 85.7 0.811
Increasing awareness for restaurant’s owners to use low salt options 975 93.6 288 92.3 1263 93.3 0.435
Establishing a bonus system for factories producing low salt food 980 94.0 291 93.3 1271 93.9 0.614
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