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This article describes the progress-as well as the challenges and limitations-in reducing salt intake in Costa Rica. The National Plan to Reduce Public Consumption of Salt/Sodium in Costa Rica 2011 - 2021 was complemented with multisectoral programs and projects specifically designed to: 1) determine sodium intake and the salt/sodium content of the most widely consumed foods; identify the consumer knowledge, attitudes, and behaviors with regard to salt/sodium, their relationship to health, and nutritional labeling; evaluate the cost-effectiveness of measures aimed at reducing the incidence of hypertension; 2) implement strategies to reduce the salt/sodium content of processed foods and foods prepared at home; 3) promote behavioral changes in the population to reduce salt in people's diets; and 4) monitor and evaluate action geared to reducing salt/sodium intake in the population. Meeting the proposed targets will require successful interinstitutional coordination among the strategic actors, the negotiation of commitments with the food industry and food services, and tighter regulation of critical nutrients in foods associated with chronic noncommunicable diseases. Given the progress made during the implementation of the National Plan, Costa Rica is expected to meet the international goal of reducing salt intake.

resumenPalabras clave Las enfermedades cronicas no transmi-sibles ocasionan dos de cada tres muertes en la poblacion general de America La-tina y casi la mitad de todas las defuncio-nes en personas menores de 70 anos (1). Se estima que su contribucion a la carga global de enfermedad aumentara en los proximos anos, principalmente en los paises de menos recursos economicos (2), en parte debido al envejecimiento de la poblacion, la disminucion de la actividad fisica y la transicion nutricional (3, 4).La presion arterial elevada es el factor de riesgo mas importante de muerte e Investigacion original / Original research 1 Instituto Costarricense de Investigacion y Ense-nanza en Nutricion y Salud (INCIENSA), San Jose, Costa Rica. La correspondencia se debe enviar a Germana Sanchez. Correo electronico: gmsanchez@inciensa.sa.cr. 2 Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina. 3 Escuela de Nutriologia de la Universidad Interna-cional del Ecuador, Quito, Ecuador.

Objetivos. Ofrecer una alternativa de educación sobre la diabetes con la participación de pacientes, familiares y personal sanitario, adaptada a las condiciones locales y a las necesidades sentidas por estas personas. Métodos. Se describe la metodología utilizada en una intervención educativa comunitaria sobre la diabetes de tipo 2, dirigida al primer nivel de atención. El estudio se realizó en el área de salud de El Guarco, Costa Rica. En una primera etapa se hizo un estudio cualitativo sobre los conocimientos y prácticas de los pacientes y del personal sanitario en relación con la prevención y el tratamiento de la diabetes y sobre la disponibilidad de alimentos en la comunidad. A partir de estos resultados, se desarrolló la metodología educativa, para lo cual se diseñaron un manual y dos procesos de capacitación sobre la diabetes, uno dirigido al personal sanitario y otro a los pacientes. Además, se desarrollaron estrategias comunitarias para dar sostenibilidad al proceso educativo. Resultados. Se verificó que los pacientes no asocian el origen de la enfermedad con los antecedentes familiares ni el sobrepeso, que confunden los síntomas de hiperglucemia e hipoglucemia y que no hay homogeneidad en los mensajes de nutrición que reciben. Sobre la base del manual sobre diabetes, se capacitó al personal sanitario, cuyos conocimientos sobre el tratamiento y la prevención de la diabetes y sobre la metodología educativa mejoraron (promedio de 85%). A su vez, el personal sanitario capacitó a los pacientes diabéticos de su comunidad (edad: 57,0 ± 8,9 años, 92% mujeres), quienes mostraron después del curso una disminución de la glucemia, de 189 ± 79 mg/dL a 157 ± 48 mg/dL (P = 0,03), y de la hemoglobina glucosilada, de 11,3 ± 2,4% a 9,7 ± 2,3% (P = 0,05). No hubo cambios significativos del peso ni del perfil lipídico, a excepción de los triglicéridos, que disminuyeron (P = 0,04). Conclusiones. El nivel primario de atención es ideal para ejecutar programas educativos sobre el tratamiento y la detección temprana de la diabetes dirigidos a los pacientes, sus familiares y el personal sanitario. Se logró incorporar el programa educativo a la planificación anual del área de salud.

This article describes the progress-as well as the challenges and limitations-in reducing salt intake in Costa Rica. The National Plan to Reduce Public Consumption of Salt/Sodium in Costa Rica 2011 - 2021 was complemented with multisectoral programs and projects specifically designed to: 1) determine sodium intake and the salt/sodium content of the most widely consumed foods; identify the consumer knowledge, attitudes, and behaviors with regard to salt/sodium, their relationship to health, and nutritional labeling; evaluate the cost-effectiveness of measures aimed at reducing the incidence of hypertension; 2) implement strategies to reduce the salt/sodium content of processed foods and foods prepared at home; 3) promote behavioral changes in the population to reduce salt in people's diets; and 4) monitor and evaluate action geared to reducing salt/sodium intake in the population. Meeting the proposed targets will require successful interinstitutional coordination among the strategic actors, the negotiation of commitments with the food industry and food services, and tighter regulation of critical nutrients in foods associated with chronic noncommunicable diseases. Given the progress made during the implementation of the National Plan, Costa Rica is expected to meet the international goal of reducing salt intake.

To identify the knowledge, perceptions, and behavior related to the consumption of salt and sodium in food and its relationship to health and the nutritional labeling of food in three countries of the Region.Qualitative-exploratory study based on semi-structured interviews, according to the categories of the Health Belief Model. Thirty-four interviews and six focus groups were conducted with community leaders (71 total respondents) in rural and urban areas of Argentina, Costa Rica, and Ecuador.Salt consumption varies in the rural and urban areas of the three countries. Most interviewees felt that food could not be consumed unsalted and that only people who consume an excessive amount of salt would have health risks. They did not know that processed food contains salt and sodium. Although they did not measure the amount of aggregate salt in foods, the participants believed that they consumed little salt and did not perceive that their health was at risk. The majority of the participants did not review nutritional information, and those who did said that they did not understand it.There is public awareness about salt, but not about the term "sodium." More salt and sodium are consumed than what is reported and there are no prospects of reducing that consumption. Although it is understood that excessive consumption of salt is a health risk, participants do not perceive that they are at risk. Replacing the word "sodium" with the word "salt" would facilitate food selection.

In 1981, Nicaragua was awarded a UNESCO prize in recognition of the success of the 1980 National Literacy Crusade (CNA) through which, it was claimed, three quarters of the country's illiterate had been taught to read and write. This article reports the follow-up of several women graduates of the CNA. It finds that, a decade later, a significant proportion of them are no longer able to read or write; and that of those who can, many had previously attended formal schooling as children for several years. An assessment of national census and survey figures suggests that about 9 per cent of the population became literate solely as a consequence of Nicaragua's ambitious adult-education interventions in the 1980s. Other benefits, such as the impact on child health and survival, have yet to be quantified.