Dietary Salt Consumption and Behavioral Predictors Among Adults in Afghanistan: Analysis of the WHO STEPS Survey

Background: Excess dietary salt intake is a major modifiable risk factor for hypertension and cardiovascular disease, yet nationally representative data from Afghanistan are limited. This study estimated the prevalence of high salt intake and identified associated behavioral and sociodemographic determinants among Afghan adults. Methods: We analyzed data from the 2018 Afghanistan WHO STEPwise survey, a nationally representative cross-sectional household survey of adults aged 18– 69 years (n = 3,955). High salt intake was defined based on self-perceived consumption. Survey-weighted descriptive statistics, Rao–Scott chi-square tests, and logistic regression models were used to examine associations between participant characteristics and high salt intake. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Results: Overall, 15.1% (95% CI: 12.7– 17.8) of participants reported high salt intake. Behavioral factors showed the strongest associations. Adding salt at the table (AOR 2.61, 95% CI 1.56– 4.37), frequent consumption of processed foods (AOR 3.60, 95% CI 2.15– 6.02), and eating meals outside the home 1– 2 times per week (AOR 1.68, 95% CI 1.00– 2.84) were independently associated with higher odds of high salt intake. Awareness of salt-related health harms was protective (AOR 0.42, 95% CI 0.26– 0.67). Most sociodemographic factors, including sex, age, education, wealth, and residence, were not significantly associated, although regional differences were observed. Conclusion: High salt intake in Afghanistan appears to be primarily determined by modifiable food behaviors rather than demographic characteristics. Population-level strategies, including reducing discretionary salt use, improving food environments, reformulating processed foods, and strengthening public awareness, may be effective approaches for lowering salt consumption and preventing non-communicable diseases. Plain Language Summary: Excess salt consumption is a major risk factor for high blood pressure, heart disease, and other non-communicable diseases. Reducing salt intake is therefore an important public health strategy worldwide. However, little is known about how adults in Afghanistan perceive their own salt consumption and which groups may be more likely to report high intake. In this study, we analyzed data from the World Health Organization’s STEPwise survey, a nationally representative survey of adults in Afghanistan. The aim was to examine how many adults believe they consume too much salt and to identify factors associated with self-reported high salt intake. We found that about one in seven adults reported consuming a high amount of salt. Men, younger adults, and people who frequently ate meals outside the home were more likely to report higher salt intake. However, previous reports suggest that actual salt consumption in Afghanistan is much higher than what people report. This indicates that many individuals may underestimate how much salt they consume. These findings highlight an important awareness gap. Public health programs in Afghanistan should strengthen education on the health risks of high salt intake and promote strategies to reduce salt consumption at both household and community levels.