Transcript Slide 1

SECOND ANNUAL INTERNATIONAL SYMPOSIUM
OF THE AFRICAN SCIENCE ACADEMY
DEVELOPMENT INITIATIVE: PRIORITIZING FOOD
SECURITY POLICIES FOR HEALTH AND
DEVELOPMENT IN AFRICA.
YAOUNDE, NOVEMBER 15 – 16, 2006
WED. 15/11/2006
11.30 – 13.00
SESSION III: STRUCTURED, DOCUMENTED
PROCESSES FOR PROVIDING EVIDENCEDBASED POLICY-ADVICE: CASE STUDIES.
CASE STUDY FROM CAMEROON:
INFORMING POLICIES TO IODIZED SALT
BY Prof Daniel. N. LANTUM
 I. PLAN OF PRESENTATION
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SYMPOSIUM OBJECTIVE: TO FOSTER ACADEMY/POLICY-MAKER
INTERACTION FOR EVIDENCE – BASED POLICY ENACTMENT.
WHAT WAS THE PUBLIC HEALTH PROBLEM REQUIRING POLICY?
A CASE OF ENDEMIC GOITER
GOITER PREVALENCE SURVEYS: EVIDENCE
POLICY STRATEGIC OPTIONS
POLICY INSTRUMENTS
PARTNERSHIPS – COALITIONS = ALLIANCES = BY POLICY
IMPLEMENTATION – MONITORING = POLICY AMENDMENT
OUTCOMES: IODIZED SALT; USI, MONITORING. PROCESS
PROGRAMME – USI IMPACT EVALUATION
SUSTAINABILITY
REVIEW OF SCIENTIST/POLICY MAKER INTERACTION CYCLE
LESSONS LEARNT
II. WHAT WAS THE PUBLIC HEALTH PROBLEM?
IODINE DEFICIENCY MALNUTRITION
SEE TABLE
COMMON INDICATOR: GOITRE
Goitre
III. A CASE OF ENDEMIC CRETINISM
FROM OSHIE PHOTO
A Cretin 50 yrs old North
West Province with Dr Kamga
Fotso August 1993
IV. EVIDENCE – COLLECTION – GOITER
PREVALENCE SURVEYS
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ISOLATED RESEARCHERS – 1950 –1990
BASE-LINE SURVEY: 1990-1991
COMMUNITY DIAGNOSIS
COMMUNICATION TO POLICY MAKERS
EVIDENCE – GOITER PREVALENCE
GERMAN REPORT OF 1904 – WUM – NW
R. MASSEYEFF (1955) – EAST CAMEROUN
PELE PELE 1969 – AKONOLINGA
F. STEPHANY ET AL 1970 – EAST CAMEROUN
LOWEINSTEIN 1972 - EAST CAMEROUN
PIERRE NGUESSI 1975 – EAST CAMEROUN
D. MFONFU ET AL 1987 – OCEAC – NATIONAL REVIEW
ANDI CHI TEMBON – 1988 – NORTH WEST PROVINCE
R. AQUARON ET AL 1971-1977 – IODINE IN SPRINGS
J. WONGHI NGUM – 1990 – N/W – BUI SCHOOLS
V. COMMUNITY DIAGNOSIS
TABLE II: ESTIMATES OF POPULATION AT RISK OF IDD IN CAMEROON IN 1991
Province
Population
Site Surveyed
Clinical
Prevalence
Mean
Population At
Risk
Extreme
North
1,880,866
Mokolo
Doukoula
36%
75%
56.5%
1,880,862
North
833,103
Pitoa
12.5%
12.5%
227,701
Adamawa
491,042
Vina
45%
45%
491,042
North West
1,237,804
Wum
Jakiri
Djittin/Oku
Oshie
13.3%
45.9%
41.4%
64.0%
44.4%
1,237,804
Bamougoum
Bafang
Mbouda
Noun
29%
5.4%
502%
65%
13.3%
65%
347,942
287,375
West
1,331,201
Littoral
1,351,827
Edea
?
?
?
South West
840,883
Limbe
Tiko
Mamfe
0.2%
2.8%
12.6%
1.5%
30,000
72,000
Eseka
Akonolinga
Efok
13.5%
16.5%
6.22%
12%
506,000
Centre
1,655,540
East
516,733
Batouri
14.5%
14.5%
South
377,237
Ebolowa
6.0%
6.0%
56,585
TOTAL
10,516,236
21 Sites
AV 26.25%
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5,654,044
For 1991, with population annual growth of 2.92%, add 10%. Pop at risk « Multiplier » is 2.5
(Source = 1987 census, Cameroon National IDD Survey 1990 – 1991, By Lantum et al 1991
VI. COMMUNICATION TO POLICY –
MAKERS (MPH)
 COMMUNICATION TO POLICY – MAKERS
(MPH)
 CONFERENCE
 WORKSHOP – YAOUNDE 8-24 APRIL 1991
 PAMPHLET: “IDD IN CAMEROON 1990-91”
VII. POLICY STRATEGIC OPTIONS
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IODIZED CAPSULES
IODIZED BREAD
IODIZED WATER
IODIZED SALT
* DECISION IODIZED SALT STRATEGY
(WHO/UNICEF/ICCIDD MARCH 1986
WHA 43.2 MAY 1990
VIII. POLICY ENACTMENT PROCESS
 MPH/MINCOM – INDUSTRY – TO IODIZE
 IODIZED SALT – READY IN THE MARKET
 MIN ORDER NO 0133/A/MSP/SG/DSFM/SDSF/SN
OF 09 MAY 1991
 LAUNCHING – PRESS CONFERENCE 21ST JUNE
1991 = COMMUNICATION – USI
 MONITORING PROCESS COVERAGE: 1992/93
 BY FACULTY OF MEDICINE/IMPM
 BY MIN P. HEALTH
IX. CREATION OF ADVISORY/CONSULTATIVE
PARTNERSHIP = COALITION = ALLIANCE
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 DECISION NO 255/D/MSP/SG/DSFM/SDSF/SN OF
14/2/1995
 INTER- SECTORAL – LIST
 MPH, MINCOM, MINDIC, MINAS, MINAGRIC
 WHO, UNICEF, WFP, ICCIDD
 3 Sub – Committees CREATED
IDD
VIT A
FER - ANAEMIA
INDUSTRY
 FAC/MED - RESEARCH
X. IMPLIMENTATION OF IDD/USI, POLICY
MADIFICATION
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 LABELING
 FIELD FINDINGS: K1 USED
 DECISION: K103: MANDATORY
NO 096/A/MSP/SG/DSFM/SDSF/SN/BCDA DU 16
MAI 1995 MODIFYING
No 0133/A/MSP/SG/DSFM/SDSF/SN of 9 May 1991
MONITORING – USI COVERAGE
- CONSERVATION - MAGAZINAGE
- QUALITY ASSURANCE
- PRODUCTION
- NORMS – ICCIDD/UNICEF/WHO
- IMPORTATION
- NORMS – CODEX ALIMENTARIUS
- COMMUNICATION FOR “DEMAND
CREATION”
XI. RESULTS OF PROGRAMME
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IODIZED SALT PRODUCTION – INCREASE
PROGRESS: USI COVERAGE 0% - 90%
GOOD QUALITY IODIZED SALT IN MARKET
CHANGE: GOITRE PREVALENCE DECREASE
USE OF SENTINEL SITES
NATIONAL SURVEY 2002
CHANGE: URINARY IODINE EXCRETION LEVELS –
PROGRESSIVE RISE
PRESENCE: CASES OF ENDEMIC CRETINISM – NO NEW
ONES
POPULATION AWARENESS INCREASE
RADIO, PRESS, TV, LITERATURE, SCHOOL CURRICULA
INCREASE DEMAND FOR IODISED SALT
XII. PROGRAMME MONITIRING: PRODUCTION AT
FACTORY
XIII. TESTING FOR IODINE IN SALT IN
SCHOOLS
XIVPROGRAMME IMPACT VERIFICATION
(2003)
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PRODUCERS – COMMITMENTS – ALL 4
USI COVERAGE – SUSTAINED
IODIZED SALT PRODUCTION/IMPORTATION
PREVALENCE – TGR = 5-8%
URINARY IODINE EXCRETION MEDIAN 159ug/L
NO NEW CRETINS
XV. SUSTAINABILITY
1. POLICY – LEGISLATION IN PLACE
2. ENFORCEMENT OF POLICY
3. QUALITY ASSURANCE INSPECTIONS
4. QUALITY CONTROL PRACTICES
5. IODINE LABORATORY IN IMPM / MINRESI
6. PRODUCERS ASSOCIATION IN PROCESS OF FORMATION
7. MPH – NUTRITION SERVICE – IDD DATA BANK
8. RETRAINED PERSONNEL - NEEDED
9. IDD IN SCHOOL CURRICULA
10. VIGILANT CIVIL SECTOR – NUTRITIONISTS, COMMUNITIES
11. YEARLY REPORTING = EPIDEMIOLOGIC SURVEILLANCE
SYSTEM
XVI. RESUME: REVOLVING SOCIAL PROCESS OF
CHRONIC ENDEMIC DISEASE CONTROL
Scientists
1
Research
Academies
Scientists
Managers
Sustain
6
Evaluation
Feedback
Manager
s
5
Implementatio
n
Monitoring
2
Communication
SC/PM
Resolution
3
Policy
4
Resource
Developmen
t
Management
-Training
-Equipment
-Material
-Infrastructure
STRENGTHS AND WEAKNESSES
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STRENGTHS
CONCERNED ACADEMIES
SCIENTIST IN POLICY POSITION
ACADEMY LINKS WITH SCIENTISTS/ PARTNERSHIP
CHAMPIONS OF A CAUSE
LINKS WITH INDUSTRY
DATA-BASE SERVICE IN FACULTY OF MEDICINE
COMMUNICATION SYSTEM
PARTNERSHIPS
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WEAKNESSES
NON COORDINATION OF SCIENTISTS BY SOME MINISTRIES
LIMITED COMMUNICATION
VERTICAL/PARALLEL RELATIONSHIPS
WEAK ACADEMIES