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					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 EVIDENCED-
   BASED POLICY-ADVICE: CASE STUDIES.

    CASE STUDY FROM CAMEROON:
 INFORMING POLICIES TO IODIZED SALT


         BY Prof Daniel. N. LANTUM
                I. PLAN OF PRESENTATION

   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

   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            Mean            Population At
                                                                Prevalence                          Risk
   Extreme            1,880,866            Mokolo               36%                 56.5%           1,880,862
   North                                   Doukoula             75%

   North              833,103              Pitoa                12.5%               12.5%           227,701

   Adamawa            491,042              Vina                 45%                 45%             491,042

   North West         1,237,804            Wum                  13.3%
                                           Jakiri               45.9%
                                           Djittin/Oku          41.4%               44.4%           1,237,804
                                           Oshie                64.0%

   West               1,331,201            Bamougoum            29%
                                           Baf ang              5.4%
                                           Mbouda               502%                13.3%           347,942
                                           Noun                 65%                 65%             287,375

   Littoral           1,351,827            Edea                 ?                   ?               ?

   South West         840,883              Limbe                0.2%
                                           Tiko                 2.8%                1.5%            30,000
                                           Mamf e               12.6%                               72,000

   Centre             1,655,540            Eseka                13.5%
                                           Akonolinga           16.5%               12%             506,000
                                           Ef ok                6.22%

   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%           ----            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

    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


       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

            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


    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)

     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
Managers                      Research
                              Academies
                              Scientists        2
                  Sustain                   Communication
                                            SC/PM
                                            Resolution

                6
           Evaluation
           Feedback                                  3
                                                  Policy


                                       4
                           5
                                     Resource
                    Implementatio
                                     Developmen
                    n
                                     t
      Manager       Monitoring
                                     Management
      s


                                            -Training
                                     -Equipment
                                     -Material
                                     -Infrastructure
STRENGTHS AND WEAKNESSES



                           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

                           WEAKNESSES
    NON COORDINATION OF SCIENTISTS BY SOME MINISTRIES
    LIMITED COMMUNICATION
    VERTICAL/PARALLEL RELATIONSHIPS
    WEAK ACADEMIES