This study aimed to evaluate the urinary excretion of sodium and potassium, and to estimate the main food sources of sodium in Maputo dwellers. A cross-sectional evaluation of a sample of 100 hospital workers was conducted between October 2012 and May 2013. Sodium and potassium urinary excretion was assessed in a 24-h urine sample; creatinine excretion was used to exclude unlikely urine values. Food intake in the same period of urine collection was assessed using a 24-h dietary recall. The Food Processor Plus® was used to estimate sodium intake corresponding to naturally occurring sodium and sodium added to processed foods (non-discretionary sodium). Salt added during culinary preparations (discretionary sodium) was computed as the difference between urinary sodium excretion and non-discretionary sodium. The mean (standard deviation) urinary sodium excretion was 4220 (1830) mg/day, and 92% of the participants were above the World Health Organization (WHO) recommendations. Discretionary sodium contributed 60.1% of total dietary sodium intake, followed by sodium from processed foods (29.0%) and naturally occurring sodium (10.9%). The mean (standard deviation) urinary potassium excretion was 1909 (778) mg/day, and 96% of the participants were below the WHO potassium intake recommendation. The mean (standard deviation) sodium to potassium molar ratio was 4.2 (2.4). Interventions to decrease sodium and increase potassium intake are needed in Mozambique.

IMPORTANCE Rheumatic heart disease (RHD), a sequela of rheumatic fever characterized by permanent heart valve damage, is the leading cause of cardiac surgery in Africa. However, its pathophysiologic characteristics and genetics are poorly understood. Understanding genetic susceptibility may aid in prevention, control, and interventions to eliminate RHD. OBJECTIVE To identify common genetic loci associated with RHD susceptibility in Black African individuals. DESIGN, SETTING, AND PARTICIPANTSThis multicenter case-control genome-wide association study (GWAS), the Genetics of Rheumatic Heart Disease, examined more than 7 million genotyped and imputed single-nucleotide variations. The 4809 GWAS participants and 116 independent trio families were enrolled from 8 African countries between

Objective: The Na content of bread is one of the most common targets of initiatives to reduce Na intake worldwide. Assessing the Na content of staple foods is of major relevance in Mozambique, given the high burden of hypertension in this setting. We aimed to estimate the Na content of white bread available in different bakeries and markets in Maputo. Design: A cross-sectional study of the Na content of white bread available for sale at twenty-five bakeries and markets in Mozambique. Flame photometry was used to quantify the Na content of the bread. The percentage of samples meeting manufacturer Na targets from South Africa and six countries from other regions, selected as benchmarks, was computed. Setting: Maputo, Mozambique. Subjects: Three loaves of white bread from each selected bakery/market. Results: The mean Na content of bread was 450·3 mg/100 g (range: 254·9-638·3 mg/100 g), with no significant differences between bakeries and traditional markets. Most samples (88 %) did not meet the regulation in South Africa (≤380 mg/100 g). When considering the targets from other countries (range: ≤ 360-550 mg/100 g), the prevalence of non-compliance varied between 8 % and 92 %. There were no significant differences in the price of bread with Na content below and above the targets. Conclusions: The content of Na in bread varies widely in Mozambique, reaching high values in a high proportion of the bakeries and markets in Maputo. Measures to regulate the Na content in bread may contribute to a reduction in Na intake and improved health at the population level. Keywords Sodium Bread Mozambique AfricaHigh Na intake is strongly associated with high blood pressure (1) and stroke, being responsible for an estimated 4·0 million deaths worldwide in 2010 (2) . The WHO recommends no more than 2 g Na/d (equivalent to 5 g salt (NaCl)/d) in adults, in order to reduce the burden of noncommunicable diseases (3) . However, in all countries with recent data available the dietary Na intake is much higher than recommended (4) . To our knowledge, no such data from Mozambique have been published, despite Na intake being of major relevance in this setting given the high prevalence of hypertension (25-64 years: 33·1 % in 2005), the low proportion of hypertensive individuals under pharmacological treatment (39·9 % from the 14·8 % who were aware of their condition) (5,6) and the increasing public health impact of CVD. It is estimated that the number of deaths due to CVD almost doubled in Mozambique in the last two decades (from nearly 9000 in 1990 to almost 17 000 in 2010) (7) . In 2005-2006, the incidence of stroke hospitalization in Maputo among those aged ≥ 25 years was estimated to be one of the highest in developing settings (adjusted incidence rate, world standard population: 260·1 per 100 000) (8) and the early case-fatality rate was also high (9) .

Objective:To assess the Na content and price of bread available in bakeries in the city of Maputo in 2018 and describe trends since 2012.Design:Cross-sectional evaluation of bread sold in twenty bakeries in the city of Maputo. Three loaves of white and three loaves of brown bread were collected from each bakery when available, and Na contents were quantified by flame photometry. To assess trends, samples of white bread collected in 2012 and analysed using the same methodology were compared with samples of white bread collected in 2018 from the same bakeries.Setting:City of Maputo, capital of Mozambique.Results:In 2018, the mean (range) Na content in mg/100 g of white and brown breads were 419·1 (325·4–538·8) and 389·8 (248·0–609·0), respectively. Non-compliance with Na targets in bread according to the South African regulation (<380 mg/100 g) was observed in 70 % of white and 43 % of brown bread samples. A total of twelve bakeries had samples evaluated in both 2012 and 2018; among these, the mean Na content in white bread decreased by just over 10 % – the mean difference (95 % CI) was 46·6 mg/100 g (1·7, 91·5); and there was a significant increase of 3·7–5·4 meticais in the mean price per 100 g of white bread.Conclusions:The Na content of bread available in bakeries in the city of Maputo decreased in recent years despite the absence of a specific regulation in Mozambique.