SECOND ANNUAL INTERNATIONAL SYMPOSIUM SECOND ANNUAL INTERNATIONAL SYMPOSIUM OF THE AFRICAN SCIENCE ACADEMY OF THE AFRICAN SCIENCE ACADEMY

DEVELOPMENT INITIATIVE: PRIORITIZING FOOD DEVELOPMENT INITIATIVE: PRIORITIZING FOOD SECURITY POLICIES FOR HEALTH AND SECURITY POLICIES FOR HEALTH AND

DEVELOPMENT IN AFRICA.DEVELOPMENT IN AFRICA.YAOUNDE, NOVEMBER 15 – 16, 2006YAOUNDE, NOVEMBER 15 – 16, 2006WED. 15/11/2006WED. 15/11/2006 11.30 – 13.0011.30 – 13.00

SESSION III: STRUCTURED, DOCUMENTED SESSION III: STRUCTURED, DOCUMENTED PROCESSES FOR PROVIDING EVIDENCED-BASED PROCESSES FOR PROVIDING EVIDENCED-BASED

POLICY-ADVICE: CASE STUDIES.POLICY-ADVICE: CASE STUDIES.

CASE STUDY FROM CAMEROON: INFORMING CASE STUDY FROM CAMEROON: INFORMING POLICIES TO IODIZED SALTPOLICIES TO IODIZED SALT

BY Prof Daniel. N. LANTUMBY Prof Daniel. N. LANTUM

I. PLAN OF PRESENTATIONI. PLAN OF PRESENTATION

SYMPOSIUM OBJECTIVE: TO FOSTER ACADEMY/POLICY-MAKER SYMPOSIUM OBJECTIVE: TO FOSTER ACADEMY/POLICY-MAKER INTERACTION FOR EVIDENCE – BASED POLICY ENACTMENT.INTERACTION FOR EVIDENCE – BASED POLICY ENACTMENT.

WHAT WAS THE PUBLIC HEALTH PROBLEM REQUIRING POLICY?WHAT WAS THE PUBLIC HEALTH PROBLEM REQUIRING POLICY? A CASE OF ENDEMIC GOITERA CASE OF ENDEMIC GOITER GOITER PREVALENCE SURVEYS: EVIDENCEGOITER PREVALENCE SURVEYS: EVIDENCE POLICY STRATEGIC OPTIONSPOLICY STRATEGIC OPTIONS POLICY INSTRUMENTSPOLICY INSTRUMENTS PARTNERSHIPS – COALITIONS = ALLIANCES = BY POLICYPARTNERSHIPS – COALITIONS = ALLIANCES = BY POLICY IMPLEMENTATION – MONITORING = POLICY AMENDMENTIMPLEMENTATION – MONITORING = POLICY AMENDMENT OUTCOMES: IODIZED SALT; USI, MONITORING. PROCESSOUTCOMES: IODIZED SALT; USI, MONITORING. PROCESS PROGRAMME – USI IMPACT EVALUATIONPROGRAMME – USI IMPACT EVALUATION SUSTAINABILITYSUSTAINABILITY REVIEW OF SCIENTIST/POLICY MAKER INTERACTION CYCLEREVIEW OF SCIENTIST/POLICY MAKER INTERACTION CYCLE LESSONS LEARNT LESSONS LEARNT

II. WHAT WAS THE PUBLIC HEALTH PROBLEM?II. WHAT WAS THE PUBLIC HEALTH PROBLEM?IODINE DEFICIENCY MALNUTRITIONIODINE DEFICIENCY MALNUTRITION

SEE TABLESEE TABLECOMMON INDICATOR: GOITRECOMMON INDICATOR: GOITRE

Goitre

III. A III. A CASE OF ENDEMIC CRETINISM CASE OF ENDEMIC CRETINISM

FROM OSHIE PHOTOFROM OSHIE PHOTO

A Cretin 50 yrs old North West Province with Dr Kamga Fotso August 1993

IV. EVIDENCE – COLLECTION – GOITER IV. EVIDENCE – COLLECTION – GOITER PREVALENCE SURVEYSPREVALENCE SURVEYS

ISOLATED RESEARCHERS – 1950 –1990ISOLATED RESEARCHERS – 1950 –1990 BASE-LINE SURVEY: 1990-1991BASE-LINE SURVEY: 1990-1991 COMMUNITY DIAGNOSISCOMMUNITY DIAGNOSIS COMMUNICATION TO POLICY MAKERSCOMMUNICATION TO POLICY MAKERS EVIDENCE – GOITER PREVALENCEEVIDENCE – GOITER PREVALENCE GERMAN REPORT OF 1904 – WUM – NWGERMAN REPORT OF 1904 – WUM – NW R. MASSEYEFF (1955) – EAST CAMEROUNR. MASSEYEFF (1955) – EAST CAMEROUN PELE PELE 1969 – AKONOLINGAPELE PELE 1969 – AKONOLINGA F. STEPHANY ET AL 1970 – EAST CAMEROUNF. STEPHANY ET AL 1970 – EAST CAMEROUN LOWEINSTEIN 1972 - EAST CAMEROUNLOWEINSTEIN 1972 - EAST CAMEROUN PIERRE NGUESSI 1975 – EAST CAMEROUNPIERRE NGUESSI 1975 – EAST CAMEROUN D. MFONFU ET AL 1987 – OCEAC – NATIONAL REVIEWD. MFONFU ET AL 1987 – OCEAC – NATIONAL REVIEW ANDI CHI TEMBON – 1988 – NORTH WEST PROVINCEANDI CHI TEMBON – 1988 – NORTH WEST PROVINCE R. AQUARON ET AL 1971-1977 – IODINE IN SPRINGSR. AQUARON ET AL 1971-1977 – IODINE IN SPRINGS J. WONGHI NGUM – 1990 – N/W – BUI SCHOOLS J. WONGHI NGUM – 1990 – N/W – BUI SCHOOLS

V. V. COMMUNITY DIAGNOSISCOMMUNITY DIAGNOSIS TABLE II: ESTIMATES OF POPULATION AT RISK OF IDD IN CAMEROON IN 1991TABLE II: ESTIMATES OF POPULATION AT RISK OF IDD IN CAMEROON IN 1991

ProvinceProvince PopulationPopulation Site SurveyedSite Surveyed Clinical Clinical PrevalencePrevalence

MeanMean Population At Population At RiskRisk

Extreme Extreme NorthNorth

1,880,8661,880,866 MokoloMokolo

DoukoulaDoukoula

36%36%

75%75%

56.5%56.5% 1,880,8621,880,862

NorthNorth 833,103833,103 PitoaPitoa 12.5%12.5% 12.5%12.5% 227,701227,701

AdamawaAdamawa 491,042491,042 VinaVina 45%45% 45%45% 491,042491,042

North WestNorth West 1,237,8041,237,804 WumWum

JakiriJakiri

Djittin/OkuDjittin/Oku

OshieOshie

13.3%13.3%

45.9%45.9%

41.4%41.4%

64.0%64.0%

44.4%44.4% 1,237,8041,237,804

WestWest 1,331,2011,331,201 BamougoumBamougoum

BafangBafang

MboudaMbouda

NounNoun

29%29%

5.4%5.4%

502%502%

65%65%

13.3%13.3%

65%65%

347,942347,942

287,375287,375

LittoralLittoral 1,351,8271,351,827 EdeaEdea ?? ?? ??

South WestSouth West 840,883840,883 LimbeLimbe

TikoTiko

MamfeMamfe

0.2%0.2%

2.8%2.8%

12.6%12.6%

1.5%1.5% 30,00030,000

72,00072,000

CentreCentre 1,655,5401,655,540 EsekaEseka

AkonolingaAkonolinga

EfokEfok

13.5%13.5%

16.5%16.5%

6.22%6.22%

12%12% 506,000506,000

EastEast 516,733516,733 BatouriBatouri 14.5%14.5% 14.5%14.5%

SouthSouth 377,237377,237 EbolowaEbolowa 6.0%6.0% 6.0%6.0% 56,58556,585

TOTALTOTAL 10,516,23610,516,236 21 Sites21 Sites AV 26.25%AV 26.25% -------- 5,654,0445,654,044

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 – VI. COMMUNICATION TO POLICY – MAKERS (MPHMAKERS (MPH))

COMMUNICATION TO POLICY – MAKERS COMMUNICATION TO POLICY – MAKERS (MPH)(MPH)

CONFERENCECONFERENCE WORKSHOP – YAOUNDE 8-24 APRIL 1991WORKSHOP – YAOUNDE 8-24 APRIL 1991 PAMPHLET: “IDD IN CAMEROON 1990-91”PAMPHLET: “IDD IN CAMEROON 1990-91”

VII. POLICY STRATEGIC OPTIONSVII. POLICY STRATEGIC OPTIONS

IODIZED CAPSULESIODIZED CAPSULES IODIZED BREADIODIZED BREAD IODIZED WATERIODIZED WATER IODIZED SALTIODIZED SALT * DECISION IODIZED SALT STRATEGY* DECISION IODIZED SALT STRATEGY (WHO/UNICEF/ICCIDD MARCH 1986(WHO/UNICEF/ICCIDD MARCH 1986 WHA 43.2 MAY 1990WHA 43.2 MAY 1990

VIII. POLICY ENACTMENT PROCESSVIII. POLICY ENACTMENT PROCESS

MPH/MINCOM – INDUSTRY – TO IODIZEMPH/MINCOM – INDUSTRY – TO IODIZE IODIZED SALT – READY IN THE MARKETIODIZED SALT – READY IN THE MARKET MIN ORDER NO 0133/A/MSP/SG/DSFM/SDSF/SN OF MIN ORDER NO 0133/A/MSP/SG/DSFM/SDSF/SN OF

09 MAY 199109 MAY 1991 LAUNCHING – PRESS CONFERENCE 21ST JUNE LAUNCHING – PRESS CONFERENCE 21ST JUNE

1991 = COMMUNICATION – USI1991 = COMMUNICATION – USI MONITORING PROCESS COVERAGE: 1992/93MONITORING PROCESS COVERAGE: 1992/93 BY FACULTY OF MEDICINE/IMPMBY FACULTY OF MEDICINE/IMPM BY MIN P. HEALTHBY MIN P. HEALTH

IX. CREATION OF ADVISORY/CONSULTATIVE IX. CREATION OF ADVISORY/CONSULTATIVE PARTNERSHIP = COALITION = ALLIANCEPARTNERSHIP = COALITION = ALLIANCE

DECISION NO 255/D/MSP/SG/DSFM/SDSF/SN OF DECISION NO 255/D/MSP/SG/DSFM/SDSF/SN OF 14/2/199514/2/1995

INTER- SECTORAL – LISTINTER- SECTORAL – LIST MPH, MINCOM, MINDIC, MINAS, MINAGRICMPH, MINCOM, MINDIC, MINAS, MINAGRIC WHO, UNICEF, WFP, ICCIDDWHO, UNICEF, WFP, ICCIDD 3 Sub – Committees CREATED3 Sub – Committees CREATED

IDDIDD VIT AVIT A FER - ANAEMIAFER - ANAEMIA INDUSTRYINDUSTRY

FAC/MED - RESEARCHFAC/MED - RESEARCH

X. IMPLIMENTATION OF IDD/USI, POLICY X. IMPLIMENTATION OF IDD/USI, POLICY MADIFICATIONMADIFICATION

LABELINGLABELING FIELD FINDINGS: K1 USEDFIELD FINDINGS: K1 USED DECISION: K103: MANDATORYDECISION: K103: MANDATORY

NO 096/A/MSP/SG/DSFM/SDSF/SN/BCDA DU 16 NO 096/A/MSP/SG/DSFM/SDSF/SN/BCDA DU 16 MAI 1995 MODIFYING MAI 1995 MODIFYING

No 0133/A/MSP/SG/DSFM/SDSF/SN of 9 May 1991No 0133/A/MSP/SG/DSFM/SDSF/SN of 9 May 1991 MONITORING – USI COVERAGEMONITORING – USI COVERAGE - CONSERVATION - MAGAZINAGE- CONSERVATION - MAGAZINAGE - QUALITY ASSURANCE- QUALITY ASSURANCE - PRODUCTION- PRODUCTION - NORMS – ICCIDD/UNICEF/WHO- NORMS – ICCIDD/UNICEF/WHO - IMPORTATION- IMPORTATION - NORMS – CODEX ALIMENTARIUS- NORMS – CODEX ALIMENTARIUS - COMMUNICATION FOR “DEMAND - COMMUNICATION FOR “DEMAND

CREATION”CREATION”

XI. RESULTS OF PROGRAMMEXI. RESULTS OF PROGRAMME

IODIZED SALT PRODUCTION – INCREASEIODIZED SALT PRODUCTION – INCREASE PROGRESS: USI COVERAGE 0% - 90%PROGRESS: USI COVERAGE 0% - 90% GOOD QUALITY IODIZED SALT IN MARKETGOOD QUALITY IODIZED SALT IN MARKET CHANGE: GOITRE PREVALENCE DECREASECHANGE: GOITRE PREVALENCE DECREASE USE OF SENTINEL SITESUSE OF SENTINEL SITES NATIONAL SURVEY 2002NATIONAL SURVEY 2002 CHANGE: URINARY IODINE EXCRETION LEVELS – CHANGE: URINARY IODINE EXCRETION LEVELS –

PROGRESSIVE RISEPROGRESSIVE RISE PRESENCE: CASES OF ENDEMIC CRETINISM – NO NEW PRESENCE: CASES OF ENDEMIC CRETINISM – NO NEW

ONESONES POPULATION AWARENESS INCREASEPOPULATION AWARENESS INCREASE RADIO, PRESS, TV, LITERATURE, SCHOOL CURRICULARADIO, PRESS, TV, LITERATURE, SCHOOL CURRICULA INCREASE DEMAND FOR IODISED SALTINCREASE DEMAND FOR IODISED SALT

XII. PROGRAMME MONITIRING: PRODUCTION AT XII. PROGRAMME MONITIRING: PRODUCTION AT FACTORYFACTORY

XIII. TESTING FOR IODINE IN SALT IN XIII. TESTING FOR IODINE IN SALT IN SCHOOLSSCHOOLS

XIVPROGRAMME IMPACT VERIFICATION XIVPROGRAMME IMPACT VERIFICATION

(2003(2003)) PRODUCERS – COMMITMENTS – ALL 4PRODUCERS – COMMITMENTS – ALL 4 USI COVERAGE – SUSTAINEDUSI COVERAGE – SUSTAINED IODIZED SALT PRODUCTION/IMPORTATIONIODIZED SALT PRODUCTION/IMPORTATION PREVALENCE – TGR = 5-8%PREVALENCE – TGR = 5-8% URINARY IODINE EXCRETION MEDIAN 159ug/LURINARY IODINE EXCRETION MEDIAN 159ug/L NO NEW CRETINSNO NEW CRETINS

XV. SUSTAINABILITYXV. SUSTAINABILITY

1. POLICY – LEGISLATION IN PLACE1. POLICY – LEGISLATION IN PLACE2. ENFORCEMENT OF POLICY2. ENFORCEMENT OF POLICY3. QUALITY ASSURANCE INSPECTIONS3. QUALITY ASSURANCE INSPECTIONS4. QUALITY CONTROL PRACTICES4. QUALITY CONTROL PRACTICES5. IODINE LABORATORY IN IMPM / MINRESI5. IODINE LABORATORY IN IMPM / MINRESI6. PRODUCERS ASSOCIATION IN PROCESS OF FORMATION6. PRODUCERS ASSOCIATION IN PROCESS OF FORMATION7. MPH – NUTRITION SERVICE – IDD DATA BANK7. MPH – NUTRITION SERVICE – IDD DATA BANK8. RETRAINED PERSONNEL - NEEDED8. RETRAINED PERSONNEL - NEEDED9. IDD IN SCHOOL CURRICULA9. IDD IN SCHOOL CURRICULA10. VIGILANT CIVIL SECTOR – NUTRITIONISTS, COMMUNITIES10. VIGILANT CIVIL SECTOR – NUTRITIONISTS, COMMUNITIES11. YEARLY REPORTING = EPIDEMIOLOGIC SURVEILLANCE 11. YEARLY REPORTING = EPIDEMIOLOGIC SURVEILLANCE

SYSTEMSYSTEM

XVI. RESUME: REVOLVING SOCIAL PROCESS OF XVI. RESUME: REVOLVING SOCIAL PROCESS OF

CHRONICCHRONIC ENDEMIC DISEASE CONTROL ENDEMIC DISEASE CONTROL 1Research AcademiesScientists 2

CommunicationSC/PMResolution

3Policy

4ResourceDevelopmentManagement

5ImplementationMonitoring

6EvaluationFeedback

Sustain

Scientists

-Training-Equipment-Material-Infrastructure

Managers

Managers

STRENGTHS AND WEAKNESSESSTRENGTHS AND WEAKNESSES

STRENGTHSSTRENGTHS CONCERNED ACADEMIESCONCERNED ACADEMIES SCIENTIST IN POLICY POSITIONSCIENTIST IN POLICY POSITION ACADEMY LINKS WITH SCIENTISTS/ PARTNERSHIPACADEMY LINKS WITH SCIENTISTS/ PARTNERSHIP CHAMPIONS OF A CAUSECHAMPIONS OF A CAUSE LINKS WITH INDUSTRYLINKS WITH INDUSTRY DATA-BASE SERVICE IN FACULTY OF MEDICINEDATA-BASE SERVICE IN FACULTY OF MEDICINE COMMUNICATION SYSTEMCOMMUNICATION SYSTEM PARTNERSHIPSPARTNERSHIPS

WEAKNESSESWEAKNESSES NON COORDINATION OF SCIENTISTS BY SOME MINISTRIESNON COORDINATION OF SCIENTISTS BY SOME MINISTRIES LIMITED COMMUNICATIONLIMITED COMMUNICATION VERTICAL/PARALLEL RELATIONSHIPSVERTICAL/PARALLEL RELATIONSHIPS WEAK ACADEMIESWEAK ACADEMIES