NATIONAL FORUM ON PUBLIC HEALTH

NUTRITION AND PUBLIC HEALTH IN CAMEROON: COMBATING THE CRISISForum summary

Science-Excellence-Progress

Science at the Service of Society: Science for Policy and Policy for Science

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NATIONAL FORUM ON PUBLIC HEALTH

NUTRITION AND PUBLIC HEALTH IN CAMEROON: COMBATING THE CRISISForum summary

Editors

Agatha K.N. Tanya B.S., M.S. (Univ. of Wisconsin), PhD (Ibadan)

Associate Professor of Dietetics/Nutrition Faculty of Medicine and Biomedical Sciences University of Yaoundé I, Yaoundé, Cameroon

Daniel N. Lantum

MBBS(Ibadan), DTM&H (Liverpool), MPH, DrPH (Tulane), MFCM (UK), FRSTM (Eng.), FCAS ICCIDD Regional Coordinator for Africa

Fellow of the Cameroon Academy of Sciences Former Professor of Public Health

Faculty of Medicine and Biomedical Sciences University of Yaoundé I, Yaoundé, Cameroon

Vincent N. Tanya

DVM (Ibadan), M.Sc. (Edin), PhD (Univ. Florida), FCAS, FTWAS Chief Research Officer Technical Adviser no 1

Ministry of Scientific Research and Innovation, Yaoundé

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Published by The Cameroon Academy of Sciences P.O. Box 1457 Yaoundé, Cameroon

Tel: (237)2223 9741; Fax: (237) 2222 9741 E-mail: cameroonacademyof.sciences@yahoo.com

Website: www.casciences.org

NOTICE: The project that is the subject of this forum report was supported by grant agreement no. IOM-5855-05-002 between the United States National Academy of Sciences and the Cameroon Academy of Sciences. Any opinions, conclusions and recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the organisations that provided support for the forum. International Standard Book Number 9956-26-38-x Additional copies of this publication are available from the Cameroon Academy of Sciences, P.O. Box 1457 Yaoundé, Cameroon or http:www.casciences.org Citation: Tanya A.N.K., Lantum D.N. and Tanya V.N. (eds.), 2011. Nutrition and Public Health in Cameroon: Combating the Crisis. Cameroon Academy of Sciences, Yaoundé, Cameroon.

All rights reserved © The Cameroon Academy of Sciences

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CONTENTS Acronyms

The Cameroon Academy of Sciences

Acknowledgements

Executive Summary

Introduction

Policy and Socio-cultural dimensions of nutrition and health in Cameroon

Evolution of the nutritional status of the Cameroonian population since 1960 Analysis of the Cameroon food and nutrition policy The health impact of the food habits of the Cameroonian population

Nutritional effects on Public Health in Cameroon

Sick genes, sick environments: the emergence of chronic diseases of lifestyle Nutrition and obesity Nutrition and diabetes Nutrition and maternal and infant/child mortality Breast feeding practices in Cameroon Nutrition and HIV/AIDS

Nutrition Interventions in Cameroon

Essential actions in nutrition Iodine deficiency malnutrition and control in Cameroon The fight against vitamin a deficiency in Cameroon 1960-2010 Preventing and mitigating child under-nutrition in Cameroon

Nutrition Education in Cameroon

Commission reports: Recommendations

Policy and Socio-cultural dimensions of nutrition and health in Cameroon Nutrition interventions in Cameroon

Appendices

Opening speech by the Minister of Public Health Programme of the forum Permanent Members of the CAS Forum on Public Health Members of the Forum Organising Committee List of participants

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ACRONYMS CAR Central African Republic CAS Cameroon Academy of Sciences CHD Child Health Days EAN Essential Actions in Nutrition ENA Essential Nutrition Actions EPI Expanded Programme on Immunization FAO Food and Agriculture Organisation of the United Nations FCAS Fellow of the Cameroon Academy of Sciences FTWAS Fellow of the Third World Academy of Sciences HDL High Density Lipoproteins HIV/AIDS Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome HKI Helen Keller International IAMP Inter Academy Medical Pane IAP Inter Academy Panel on International Issues IMPM Institut de Recherches Médicales et d’Etudes des Plantes Médicinales IRAD Institut de Recherche Agricole pour le Développement JCAS Journal of the Cameroon Academy of Sciences LDL Low Density Lipoproteins MDG Millennium Development Goal MPH Ministry of Public Health NASAC Network of African Science Academies NAS National Academy of Sciences NGO Non-Governmental Organisation NIDDM Non-insulin Dependent Diabetes Mellitus ORSTOM Office de la Recherche Scientifique et Technique d’Outre- Mer SSA Sub-saharan Africa TWAS Third World Academy of Sciences (i.e. The Academy of Sciences for the Developing

World) UNHCR United Nations High Commission for Refugees UNICEF United Nations International Children Emergency Fund USI/IDD Universal Salt Iodization/Iodine Deficiency Disorders USNAS United States National Academy of Sciences WFP World Food Programme WHO World Health Organisation

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THE CAMEROON ACADEMY OF SCIENCES

The Cameroon Academy of Sciences (CAS) was formally recognized by declaration no. Reg. 00701/RDA/J06/BAPP of 29 May 1991 by the Cameroon government in accordance with law no. 90/053 of 19 December 1990, regulating freedom of association. It is a non-profit society of distinguished scholars engaged in promoting excellence and relevance in science and technology and providing advice to the government.

The vision of the Cameroon Academy of Sciences is to be the prime mover of science and technology, making scientific knowledge available to decision and policy makers with a view to influencing investment priorities in science and technology, and promoting the use of science and innovation in the economic, social and cultural development of Cameroon. Consequently, the Academy produces robust forum and committee advisory documents and reports priority problems and delivers them to policy and decision makers and the public. The independence, highly qualified membership, multidisciplinary composition and rigorous procedures for objective and unbiased analysis enable the Academy to effectively deliver credible advice.

In carrying out its work, the Academy collaborates with the various ministries of the Government of Cameroon, the United States National Academy of Sciences (USNAS), the Academy of Sciences of the Developing World (TWAS), Royal Society (UK), the Network of African Science Academies (NASAC), Inter Academy Panel on International Issues (IAP), Inter Academy Medical Panel (IAMP) and other international and national organizations. EXECUTIVE COMMITTEE President Prof. Samuel Domngang 1st Vice President Prof. Sammy Beban Chumbow 2nd Vice President Prof. Peter M. Ndumbe Past President Prof. Victor Anomah Ngu Executive Secretary Dr. David Akuro Mbah Assistant Executive Secretary Prof. Manguelle-Dicom E. Treasurer Dr. Vincent N. Tanya DEANS College of Biological Sciences Prof. Daniel N. Lantum College of Mathematics and Physical Sciences Prof. Samuel Domngang College of Social Sciences Prof. Sammy B. Chumbow JOURNAL OF THE CAMEROON ACADEMY OF SCIENCES (JCAS) Editor-in-Chief Prof. Vincent P. K. Titanji KEY STAFF David Akuro Mbah, Ph.D, Executive Secretary E. Manguelle-Dicom, Ph.D, Assistant Executive Secretary Vincent N. Tanya, Ph.D, Treasurer/Programme Officer Thaddeus A. Ego, Administrative Assistant CONTACT INFORMATION Cameroon Academy of Sciences P.O. BOX 1457 Yaoundé, Cameroon Telephone: +237 2223 9741 Fax: +237 2223 9741 Email: cameroonacademyof.sciences@yahoo.com Website: www.casciences.org

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ACKNOWLEDGEMENTS The Cameroon Academy of Sciences gratefully acknowledges the contributions and

efforts of the Permanent Members of the CAS Forum on Nutrition and Public Health, the members of the Forum Organising Committee, the resource persons who presented papers, the chairpersons and the rapporteurs of the plenary sessions and commissions and those who participated in the forum.

We thank the Minister of Public Health, Mr. Mama Fouda Andre, for patronising the Forum, chairing the opening ceremony and providing material and technical support.

Financial and technical support for the forum and the publication of this summary came from the United States National Academy of Sciences. We thank Dr. Patrick Kelley, Ms Patricia Cuff, Mr. Jim Banihashemi, Mr. Ijeoma Emenanjo and Ms Katherine McClure for facilitating the collaboration between the Cameroon Academy of Sciences and the United States National Academy of Sciences. Additional financial support for the Forum came from the Institute of Medical and Medicinal Plants Research (IMPM), Yaoundé, Cameroon. We also received financial assistance from UNICEF and Helen Keller International following appeals from the Minister of Public Health. We are grateful for all of this help.

We thank Professors Wali Muna, Jean-Claude Mbanya and Julius Oben and Drs Isatou Jallow, David A. Mbah, H. Rikong Adie and Tom Agbor Egbe for reviewing this summary. The review process was overseen by Dr. Vincent N. Tanya.

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EXECUTIVE SUMMARY The nutritional situation of the Cameroonian population Data from various surveys show that malnutrition remains a serious public health problem in Cameroon. It is a major contributor to the disease and death burden of the population. The overall underfive mortality rate in the country is 144 deaths per 1,000 live births. It is even higher in the northern regions. A total of 105,000 child deaths occur each year. The cause of this child mortality has been attributed largely to undernutrition. Chronic undernutrition (stunting) which is characterised by a deficit of height for age among underfives is widespread and severe. Wasting is common among some children as household incomes are too low to permit them to feed appropriately. Micronutrient deficiencies are also severe and wide spread. Vitamin A deficiency occurs in 38.8% of children (12 – 71 months). For children 6-59 months and women of child bearing age, 68.3% and 44.9% respectively are anaemic. The breastfeeding practices of Cameroonian women are still suboptimal. Diabetes and other diet-related diseases are increasing. National Forum on Nutrition and Public Health in Cameroon In keeping with its core values of quality, objectivity, integrity, independence and relevance, the Cameroon Academy of Sciences (CAS) brought together stakeholders involved in nutrition issues in Yaoundé, Cameroon, from 7 – 8 January 2010 to analyse the situation and suggest measures to prevent and mitigate the effects of nutrition on health in the country. The participants provided their insights into how to improve policies, adjust research goals and provide funding for infrastructure and programmes to fully tackle the problems of malnutrition. Forum outcomes Generally, the forum participants agreed that the pathetic picture of the nutritional situation of the Cameroonian population is a reflection of the fact that nutrition has never been adequately integrated into health, agriculture, education and socio-economic policies of the state. After analyzing the situation, it became clear that concerted action accompanied by realistic government policies is needed by various stakeholders in the short, medium and long term to eliminate or reduce malnutrition and its negative health effects in the country. Consequently, it was recommended among others as follows: Policy issues

A well-managed database should be set up in the Ministry of Public Health to provide a permanent source of evidence for periodic policy orientation for action by various stakeholders.

The Ministry of Public Health and other stakeholders should access, study and apply the existing literature in the following domains:

Nutrition guide for the prevention of chronic non-transmissible diseases, including

obesity, diabetes mellitus, cancer and cardiovascular disorders, which are now emergent in Cameroon.

Nutrition guide for persons living with the HIV/AIDS. Physical activities and exercises for health and fitness promotion.

Using existing research information and data on food composition in Cameroon and the Central African Region, a book of “Tables on Food Types and Composition” should be elaborated to valorise pervious research effort and to guide future researchers and current users.

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Nutrition interventions

As a result of the fact that most donor funded nutrition projects stop after the end of donor participation, it is necessary for the government to take all necessary measures to ensure the sustainability of such projects through the training of personnel and the provision of adequate material and financial resources.

Considering that micronutrient deficiencies constitute a huge hidden scourge that causes severe damage and contributes extensively to infant-juvenile malnutrition, poor development, morbidity and mortality, the Programme on Food Fortification (with Iron, Vitamin A, Iodine and Zinc) should be pursued with vigour.

Nutrition of mother and infant Intensified nutrition action for mothers and infants can greatly increase the chances of achieving the goals for reducing child and maternal mortality. Consequently, it is necessary that:

Research activities be started immediately on community participative approach in the application of essential nutrition actions such as:

promotion of exclusive breastfeeding for infants 0-6 months; prolonged breastfeeding for children 6-23 months; adequate complementary or fortified foods for children 6-23 months; adequate complementary feeding and hygiene practices; regular vitamin A supplementation and deworming; access to essential health services, including immunization; access to safe water and sanitation; support for pregnant women and lactating mothers.

Nutrition should be integrated in prenatal health care services. Nutrition Education

Since nutrition education plays an important role in our understanding of the concepts which explain how the body works and ways to ameliorate deviations from normal function, it is necessary for the various actors to:

Elaborate and adopt a document which defines the nutrition and health policy for schools.

Increase the number of teaching hours for nutrition courses in the medical, food technology and nursing schools.

Develop continuing education programmes on nutrition for medical doctors. Develop strategies to educate women on the importance of breast feeding.

For nutrition education to effectively play its role as a development tool in the country, public authorities need to:

Increase the personnel in the field of nutrition education nationwide; Provide sufficient training tools and manuals for proper teaching of nutrition

education; Make existing messages well adapted to the target groups; Recruit more dieticians for health structures in the country.

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INTRODUCTION

The interaction between malnutrition and infection is well documented. Consequently, the role of nutrition in promoting good health and preventing disease has always been of interest to consumers, scientists, policy makers, the food industry and other stakeholders as they all need information that can be useful in developing regulations, policies and new products. There is abundant documented evidence to show that in addition to preventing nutrient deficiency diseases like scurvy and rickets, dietary practices can play an important role in preventing other diseases like cardiovascular disease, diabetes, osteoporosis, dental caries, birth defects and some types of cancer (NAS, 2002; Gratham-McGregor et al., 1999). Many young children, particularly those from poor socio-cultural environments in developing countries suffer from nutritional deficiencies and infections. There is now evidence to indicate that these deficiencies and infections may affect the children’s cognitive, motor, and behavioural development, both pre- and postnatally (Grantham-McGregor et al, 1999). As described by the WHO (2008), nutrition is a foundation for health and development as good nutrition means stronger immune systems, less illness and better health for people of all ages. Healthy people are stronger, and can contribute better to the development endeavours of their societies. Nutritional status is considered an indicator of national development since nutrition is both an input into and an output of the development process (FAO, 2004).

The information available from various surveys (EDS, 2004 and 2006) for the past fifty years shows that malnutrition remains a serious public health problem in Cameroon. It is a major contributor to the disease and death burden of the population.

There are high child mortality rates especially in the northern regions. In 2004, the overall underfive mortality rate in the country was 144 deaths per 1,000 live births (i.e. 3 out of 20 children died before the age of five). A total of 105,000 child deaths occur per year and 40,000 of these are in northern Cameroon. Undernutrition is the major cause of this child mortality. Mild to moderate undernutrition explains about 80% of the burden of child mortality attributable to undernutrition. Chronic undernutrition (stunting) which is characterised by a deficit of height for age among underfives is widespread and severe. There are 1,080,000 underfives with chronic undernutrition and 375,000 of them are in northern Cameroon. Among these 1,080,000 underfives, 450,000 suffer from severe chronic undernutrition and 175,000 of them are in northern Cameroon. Wasting is common among some children as household incomes are too low to permit them to feed appropriately. There are also severe micronutrient deficiencies. About 38.8% of children (12-71 months) suffer from vitamin A deficiency with a prevalence greater than 50 % in the northern regions (Adamawa, North and Far North). For children 6-59 months and women of child bearing age, 68.3% and 44.9% respectively are anaemic (EDS, 2004).

Despite its demonstrated benefits for child health and growth, the breastfeeding practices of Cameroonian women are still suboptimal. Obesity has increased by 54 and 82% respectively for women and men (Fezeu et al., 2008). Consequently, diabetes and other diet-related diseases are increasing.

The above pathetic picture is a reflection of the fact that nutrition has never been adequately integrated into health, agriculture, education and socio-economic policies of Cameroon. Clearly, we have had and continue to have a nutrition crisis in Cameroon. The situation can only get worse as the world faces increasing threats to food security, as a result of

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rising food prices and less agricultural productivity. Inequities in nutritional well-being will continue and will even get worse, especially for the socio-economically disadvantaged.

In the midst of all of this, what do we do? Do we fold our arms and allow the vulnerable groups to continue to die?

In keeping with its core values of quality, objectivity, integrity, independence and relevance, the Cameroon Academy of Sciences (CAS) brought together stakeholders involved in nutrition issues in Yaoundé, Cameroon, from 7 – 8 January 2010 to analyse the situation and suggest measures to prevent and mitigate the effects of nutrition on health in the country. The participants provided their insights into how to improve policies, adjust research goals and provide funding for infrastructure and programmes to fully tackle the problems of malnutrition. This document provides a summary and synthesis of the work of the forum.

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POLICY AND SOCIO-CULTURAL DIMENSIONS OF NUTRITION AND HEALTH IN CAMEROON

EVOLUTION OF THE NUTRITIONAL STATUS OF THE CAMEROONIAN POPULATION SINCE 1960

As described by the FAO (2004), nutritional status is internationally recognized as an indicator of national development since nutrition is both an input into and an output of the development process. Consequently, undernutrition and poor health are manifestations of a failure of the development process to reach some segments of the population. Data on nutritional status available over the past fifty years show that malnutrition remains a public health problem in Cameroon. The most frequently available information is on protein-energy malnutrition, vitamin A deficiency, iodine deficiency disorders and iron deficiency anaemia. Before the national surveys that started in 1978, available data on the nutritional status was very inadequate and focused mostly on children under 5 years old and women. During the workshop, Mr. Daniel Sibetcheu, the then Director of Health Promotion in the Ministry of Public Health presented a paper in which he described the evolution of the nutritional status of the Cameroonian population since 1960. Nutritional status of the population from 1955-1978 The early surveys on the nutritional status of the population carried out in Cameroon were on iodine deficiency in the East Region where Masseyef (1955) reported a total goitre prevalence of 58%. It was 71% for women and 48% for men. In the same Region, Lowenstein (1968) found a prevalence of 69% for boys and 81% for girls among children aged 4 to 17 years. In Foumbot and Foumban in the West Region, he reported a prevalence of 46 and 54% for boys and girls respectively. The results for Ndop and Bamessing in the North West Region were 46% for boys and 54% among girls.

Vitamin deficiency was also of interest to these early researchers. Among school children aged 5 to 10 in Losev, Diamaré in the Far North Region, Bascoulerque (1960) and a team from ORSTOM found 41% of them with gingival bleeding in the dry season (around February to March) and 10% in the rainy season when fruits rich in vitamin C are abundant. For vitamin A, Mayesseff (1955) reported that for the Toupouris of Galoumpi, the requirements were covered at 38% in January and 71% in July. They also found underweight means of 5.7 and 10.7% respectively for men and women over ideal weight. The same team found in Adamawa that the coverage of vitamin A varied among ethnic groups: 24% among the Gbaya, 76% among Fulani and 113% in other ethnic groups.

In an attempt to evaluate protein-energy malnutrition in Douala, Martinaud (1973) found marasmus in 3% of children.

The nutritional problems of pregnant women were also studied3 by a number of researchers during the period under review. Eyong (1975) reported a 48.5% prevalence of anaemia among pregnant women in rural areas and 17% in a university clinic in Yaoundé. Tieche (1977) found an average weight gain during pregnancy of 11.72 kg in women in a suburb of Yaoundé while Rikong et al. (1987) found 7.17 kg in rural areas. Tsatchoua (1980) reported 9.54 kg for Shishong Hospital in Bui division of the North West Region.

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Nutritional status of the population after 1978 Protein-energy malnutrition Despite the repeated political rhetoric and the enormous food resources potential of the country, nutritional problems and food insecurity remain developmental headaches for Cameroon. For the period 1980 – 1990, food production did not keep pace with the population growth. Food availability regressed from 90% of needs in 1980 to 81% in 1992. The energy needs dropped from 2340 kcal/person/day in 1979 – 1981 to 2170 kcal/person/day in 1992 – 1994. The consumption of meat which was 16 kg/person/year in 1980 was only 11 kg/person/year in 1993. When judged against the severe economic depression of the 1990s, it is clear from the above figures that the vulnerable sections of the Cameroonian population have suffered from protein-energy malnutrition. Trends in infant mortality and underweight prevalence are important in understanding nutritional status in relation to human development. As seen from the data of several national surveys presented by Mr. Sibetcheu for the nutritional status of the population after 1978, there has been an increase in parameters linked to protein-energy malnutrition. It is associated with 38% of infant mortality and directly affects the severity of infectious diseases like measles. There has been a pronounced deterioration of the nutritional status of mothers and children less than 5 years of age. In 1998, 29% of preschool children in the country suffered from chronic retarded growth, 6% were emaciated and 22% had stunted growth. The prevalence of low birth weight was 13%. As for mothers, 8% of them were malnourished and were likely to produce children with low birth weights. Micronutrient deficiencies The lack of micronutrients can result in serious health repercussions. Micronutrient deficiencies, particularly those concerning iodine, vitamin A and iron affect the nutritional status and consequently the health of a significant part of the Cameroonian population. As shown by the EDSC III survey of 2004, vitamin A deficiency affects on the average 40% of children less than 5 years old and women aged 15 to 49 years. It has been estimated that more than 5,000 women will die during pregnancy by 2011 if appropriate measures are not taken to control iron deficiency anaemia in Cameroon (EDSC, 2004). Iodine deficiency disorders have reduced significantly following the iodization of salt in Cameroon. In children, it regressed from 29.1% in 1991 to 5.4% in 2002. The intervention strategies put in place need to be maintained for a sustainable elimination of the disorders. Prevalence of non-communicable diseases related to nutrition Non-communicable diseases related to nutrition are commonly observed in health structures in the country. Various surveys as described by Mr. Sibetcheu show that the prevalence of obesity is 16% and overweight is 27%. Diabetes was 1% in 1994 and 6% in 2003. Hypertension which was 13% in 1994 rose to 27% in 2003. Overall, the data presented by Mr. Sibetcheu showed that the evolution of the nutritional status of the Cameroonian population, especially for vulnerable groups such as children and women has deteriorated significantly especially after the serious economic recession of the 1990s. Protein-

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energy malnutrition has remained a serious public health problem. The ecologically fragile northern regions are the worst affected by all forms of malnutrition. Strong actions must therefore be taken for a reversal of the current trends of malnutrition so that the Millennium Development Goals can be attained by 2015.

ANALYSIS OF THE CAMEROON FOOD AND NUTRITION POLICY Food and nutrition policy is usually described as a set of decisions with related actions, established by a government and often supported by special legislation, which address a nutrition or food problem. Generally, food and nutritional policies are realised through programmes that deliver, enable access or encourage consumption of food or supplements (Austin and Overholt, 1988). An effective policy should therefore include actions that enable policy goals to be achieved. It should also include a means of translating policy decisions into effective programmes. Consequently, good programmes are the best indicators of good policies. With the above considerations, Professor Carl Mbofung of the University of Ngaoundéré provided a cursory analysis of the Cameroon food and nutrition policy for the forum. The data described in the previous section show that the nutritional status of the vulnerable sections of the Cameroonian population has deteriorated significantly over the years. The situation has been aggravated since the 1990s by the economic recession and the HIV/AIDS pandemic. It is surprising that despite this deplorable situation, there has been no clear government policy for a very long time to handle these problems. However, as a result of lobbying by donors and some advocacy groups, the government took some concrete measures, notably, the consideration of food and nutrition in the health sector strategy adopted in 2001, in accordance with the guidelines of the Poverty Reduction Strategy Document. To make this commitment operational, the government in collaboration with the United Nations International Children Emergency Fund (UNICEF) and other partners developed a food and nutrition policy in 2006. This policy defined the main actions to improve food and nutrition in the country. The policy is being executed in the form of a programme which has 9 general and 11 specific objectives and 10 strategies. The programme aims at improving the food and nutrition profile of Cameroonians through:

the promotion of breastfeeding; the fight against malnutrition; the fight against micronutrient deficiencies; the prevention of non transmissible diseases related to nutrition; the nutritional support of vulnerable groups; the nutritional support of individuals living with HIV/AIDS; the promotion of food hygiene; food security and training; the employment of qualified professionals in the field of nutrition.

It is clear that nutrition issues are not neatly circumscribed within a single sector as determinants of persistent under nutrition are complex and include health, education and agricultural pathways. As such, the comprehensive national nutrition strategy of a country requires cross-sectoral collaboration between ministries and organisations charged with these and other areas

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and the implementation of appropriately designed policies related to these. When the food and nutrition policy adopted in 2006 is examined in relation to the above comments, it can be seen that the concerns of stakeholders like educationists, researchers, industrialists, agriculturalists and even consumers were not sufficiently considered. The execution of the food and nutrition programme that came out of the adopted policy is not tied to complementary activities by other stakeholders. For example, it is not linked to any efforts to produce alternative crops or boost innovative research for alternative convenience foods of good health value.

The programme is ambitious as shown by the key specific objectives. Unfortunately, the source of all the funding necessary for execution is not indicated in the programme document. Following the food security forum of 2008 (Tanya and Mbah, 2009), a National Committee for Food Security was created and placed under the management of the Prime Minister’s Office. Unfortunately, its actions have not been visible as it is suffering from lack of funding.

THE HEALTH IMPACT OF THE FOOD HABITS OF THE CAMEROONIAN POPULATION

Diet is vital to health promotion and disease prevention. It has been shown that in addition to preventing nutrient deficiency diseases like scurvy and rickets, dietary practices can also help to prevent other diseases, including cardiovascular disease, diabetes, osteoporosis, dental caries, birth defects and potentially some types of cancer (Institute of Medicine, 2000). However, the effect of dietary practices on health also depends on food habits. During the Forum, Dr. Patrice Djiele described the health impact of the food habits of the Cameroonian population. As a result of its diversity, Cameroon has several ecosystems in which the foods consumed are a function of what is available locally. In all the ecosystems, the diet is monotonous and based largely on starchy foods which must meet the essential nutritional needs. In the forest zone, the diet is dominated by tubers. Proteins come largely from wildlife and fish. Legumes are abundant and fats come mostly from palm oil. In the sudano-sahelian and high guinea savannah zones, the diet is based on cereals. Animal proteins are provided by beef and fresh water fish. Vegetables, groundnuts and beans are also consumed in significant quantities. Cotton seed oil is widely used as a source of fat. In the forest-savannah transitional zone, both cereals and tubers are widely consumed. Fish and beef provide the animal proteins. There is little fat in this zone. The data on food consumption and habits indicate that the diets in general are not balanced. Consequently, the diseases linked to nutrition (diabetes, hypertension, obesity, etc) are on the rise in the country and the regional distribution as shown in Mr. Sibetcheu’s presentation is a reflection of the food habits of the population.

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NUTRITIONAL EFFECTS ON PUBLIC HEALTH IN CAMEROON

SICK GENES, SICK ENVIRONMENTS: THE EMERGENCE OF CHRONIC DISEASES OF LIFESTYLE

Thrifty Genes – Our Ancient Heritage It has been suggested that obesity and its sequelae stemmed from natural selection on our ancient ancestors favouring a 'thrifty genotype' that enabled highly efficient storage of fat during periods of food abundance (Neel, 1962). The development of insulin resistance was seen as part of this adaptive 'thrifty genotype', helping early humans with the process of efficient fat deposition (Speakman, 2006). Such a genotype was extremely advantageous for our ancestors, who were exposed to periods of food shortage. This allowed them to deposit fat stores efficiently and thus survive subsequent periods of food shortage. In modern society, however, where food supply is almost always available, this thrifty genotype proves deleterious because it promotes efficient storage of fat in preparation for a period of shortage that never comes. The result is widespread chronic obesity and related health problems like diabetes.

Prof. Jean Claude Mbanya who chaired this section of the forum used this theory of ‘thrifty genotype’ to introduce the nutritional effects on public health in Cameroon. As explained by Prof. Mbanya, humans have evolved over 2.5 million years and hundreds of thousands of generations. However, our genome has not changed much over the past 40,000 years. Our genes were designed for living in caves, eating the plants we gathered and the animals we hunted and killed. Our lifestyle has changed dramatically. He used the thrifty genotype hypothesis to explain high and rapidly escalating levels of obesity and diabetes among Cameroonians who have been introduced to western diets and environments. Only in the past few decades have our genes needed to figure out how to metabolize a hamburger, soda and fries. Studies in children and adolescents provide some support to the general observation that physical activity levels decrease with urbanization in African populations (Pan et al., 1997). Children spend most of their time in sedentary activities, such as watching television. Walking is no longer in fashion; people prefer to ride motor cycles and cars on very short walking distances. Our energy intake of different nutrients has changed. Our ancient genes and our modern environment have collided. Consequently, in the transition from a low to a high energy dense diet, we have developed a wide range of metabolic changes including diabetes, insulin resistance, obesity and metabolic syndromes.

NUTRITION AND OBESITY IN CAMEROON Obesity has been recognised as a condition in which excess body fat accumulates in the body to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems. It can be a result of poor eating and exercise habits. The incidence of obesity is increased when there is reduced physical activity and the diet is largely made up of energy-dense nutrient-poor food, high levels of sugar and saturated fat. People are considered obese when they have a body mass index greater than 30 kg/m2. It is a well known fact that

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obesity is a risk factor for insulin resistance and type II diabetes (Abbasi et al, 2002). Consequently, there is high prevalence of insulin resistance in obese individuals (McLaughlin et al, 2004). The plasma levels of insulin in such individuals are positively related to body mass index (Hickman et al, 2002). The complications for obesity include high blood pressure, high Cholesterol, type 2 diabetes, heart disease and stroke. Obesity has been shown to contribute to high serum cholesterol, low HDL cholesterol and hyperglycemia, all of which increase the chances of cardiovascular disease (Poirier et al., 2006).

For this forum, Professor Julius Oben presented a paper on the problem of obesity in Cameroon. He pointed out that obesity has increased by 54 and 82% respectively for women and men in the rural areas of Cameroon (Fezeu et al, 2008). Migration and urbanization have been described as predisposing factors for obesity in Cameroon.

Childhood obesity is also becoming a very serious problem in Cameroon. Kengne et al. (2009) evaluated the prevalence and some risk factors associated with obesity and overweight among school children aged 3 to 14 years. The prevalence of overweight or obesity was 16.20%, 13.57 % and 5.55 % using weight for height, weight for age and body mass index respectively. The identified risk factors for the childhood obesity were socio-economic (low family income, parental occupation and the educational level of parents) and nutritional (maternal breastfeeding, age of complementary feeding - 6-12 months, early weaning period and the lack of dietary diversity). Adolescent obesity in Cameroon is generally not considered as serious a health problem as adult obesity whose social implications are generally quite severe.

Prof. Oben concluded his presentation by emphasizing that the problem of obesity can be tackled by encouraging healthy eating, increasing physical activity and providing behavioural advice.

Obesity in Cameroon

Prevalence of overweight and obesity

30,81

23,82

33,61

18,75

23,7

28,8326,75

18,67

11,09

23,33

10,017,51

21,23

15,77

0

5

10

15

20

25

30

35

Biyem

Assi

Cité des

Palmiers

Bamenda Garoua Men Women Total

%

overweight Obesity

18

20

22

24

26

28

30

15 - 24 25 - 34 35 - 44 45 - 54 55 - 64 ≥ 65

Mean BMI (Kg/m2)

males females

Changes in BMI with age

Overweight: 25≤BMI≤30 Kg/m2

Obesity: BMI>30 Kg/m2

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Perceptions of Obesity in Cameroon

Obesity is a sign of:• Wealth• Peace of mind• Good living• Good health• Happiness• Authority

Small body size is a sign of:

• Illness e.g. HIV/AIDS• Poverty• Stress• Misery• Misfortune• Malnutrition

NUTRITION AND DIABETES IN CAMEROON Diabetes mellitus, is a metabolic condition in which there is high blood sugar, either because the body does not produce enough insulin or because the cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria, polydipsia, polyphagia, nocturia and weight loss (Cowell, 2008).

There are four clinical classes of diabetes (ADA, 2003). There is type 1 diabetes (also called insulin-dependent diabetes) which is due to the body's failure to produce enough insulin. This results from β-cell destruction and usually leads to absolute insulin deficiency. Type 2 diabetes results from insulin resistance, wherein cells do not use insulin properly. There is also gestational diabetes in which pregnant women with no history of diabetes have a high blood glucose level during pregnancy. There are other specific types of diabetes due to other causes, e.g., genetic defects in β-cell function, genetic defects in insulin action, diseases of the exocrine pancreas (such as cystic fibrosis) and drug- or chemical-induced.

The identified risk factors are not markedly different from those reported in other diseases. They can be classified as non-modifiable (age and ethnicity) and modifiable (residence and low physical activity) risk factors. Among other risk factors, obesity has long been recognized as one of the strongest risk factors for development of diabetes. It has been estimated to account for 60% to 90% of the risk variance (Wolf and Colditz, 1998; Colditz et al., 1990).

As Cameroonians are increasingly living in an obesogenic society that drives the global pandemic of type 2 diabetes, the situation of the disease deserves to be given some attention. Consequently, Professor Agatha Tanya of the Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I was invited by the organisers of the forum to present a paper on nutrition and diabetes in Cameroon. The situation of diabetes in Cameroon

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The prevalence of diabetes is increasing among Cameroonians. It is about 7.5%. About 80% of the cases are undetected. The estimated prevalence in Africa is 1% in rural areas. It is 5 to 7% in urban Sub-Saharan Africa.

Dr. Tanya suggested that the powerful commercial, socio-economic and political factors shaping Cameroonian society encourage individual choices that lead to a sedentary and unhealthy lifestyle. These predisposing factors include urbanization and fast changing diets which are marginalising traditional values in favour of western diets and lifestyle changes (Mbanya et al., 1997; Sobngwi et al., 2004; Sharma et al., 1996, 2007; Awah et al., 2008). The rural population tends to eat mostly complex carbohydrates whereas the urban population eats mostly simple carbohydrates and this could have an effect on glucose tolerance.

Prevalence of type 2 diabetes in Cameroon in 2003: CamBoD 2 Study

Raised blood glucose or currently on medication for diabetes and/or diagnosed with diabetes**

SiteMen Women Both Sexes

n % 95% CI n % 95% CI n % 95% CI

Bamenda 822 7.3 5.7 – 9.3 1266 6.6 5.4 – 8.1 2088 6.9 5.9 – 8.1

Douala 685 7.2 5.4 – 9.4 1033 8.6 7.0 – 10.5 1718 8.0 6.8 – 9.5

Garoua 825 6.7 5.1 – 8.6 888 6.7 5.3 – 8.6 1713 6.7 5.6 – 8.1

Yaounde 606 10.1 7.8 – 13.0 870 7.6 6.0 – 9.5 1476 8.6 7.2 – 10.2

Total 2938 7.7 6.7 – 8.7 4057 7.4 6.6 – 8.2 6995 7.5 6.9 – 8.2

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Trends in the Prevalence of Diabetes in Cameroon

Treatment and prevention As a result of the high prevalence of diabetes and associated vascular complications, preventing

even a small proportion of cases would save thousands of lives and a lot of money in healthcare costs and lost productivity. Consequently, it is necessary to make efforts to prevent and control the problem in the country.

The three cornerstones of diabetes management are diet, physical activity and medication if needed. Food raises blood glucose and blood fat levels. Activity and medications lower blood glucose and blood fat levels. Diabetes requires careful monitoring and dietary control. Hence, diet and other lifestyle factors form the basis of treatment of diabetes especially type 2 (Mbanya and Ramiaya, 2006).

The promotion of traditional African diets is a powerful weapon in the fight against diabetes. Unfortunately, in Cameroon, most diabetics do not follow prescribed dietary patterns because they have insufficient education and inadequate follow-up. They are also not given an individualised diet, but rather a standard 'handout' without any explanation. Cultural and socio-economic factors may interfere with the diet and they are not self-motivated or self disciplined

Professor Agatha Tanya suggested the use of the food exchange list with Cameroonian food items in planning the diabetic diet. She discussed carbohydrates, proteins, fibre and fats, giving examples of locally available foods of each. She also highlighted studies that she had carried out on the soluble and insoluble fibre (Tanya et al., 1997) and the glycaemic index (Tanya et al., 1998) of commonly consumed foods in Cameroon which are of benefit in planning the diabetic diet.

She concluded by saying that there are no nutritional guidelines or recommendations on the nutritional management of diabetes in Cameroon. The number of dieticians is inadequate to provide nutritional care for the diabetics and other patients.

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Food exchanges for diabetics Starch One exchange contains 15g CHO, 2g Protein &70 calories

Meat One exchange of meat is about 30g and contains, 7g pro, 3g fat, & 55calories

Fruits One fruit exchange Contains 10g of CHO and 40 calories

Vegetable- 100g One vegetable exchange Contains 5g of CHO, 2 g Pro. and 25calories

Milk-250ml One exchange of milk contains 12g CHO, 8g of pro. A trace of fat and 80 calories

Fat One exchange of fat contains 5g of fat and 45 calories

Bread Beef Apple(medium) Carrots Skimmed Butter Yams Chicken Banana – small Green beans Powered

skimmed Margarine

Plantains Fish Dates Green peppers Canned evaporated skim milk

Avocado

Sweet potatoes

Pork Grapefruit Onions Yogurt Palm oil

Irish potatoes Lamb Grapes/raisins Celery Cottage cheese Bleached or refine palm oil

Taro Cheese Mangoes Folon Whole milk Mayonnaise Rice Eggs Oranges Okro Cotton seed oil Sorghum Beans Pawpaw Mushroom Groundnut oil Corn Groundnut

paste Pineapple Cabbage Soya bean oil

Cassava Liver Guavas Tomatoes Njansa Gari Ham Strawberries Huckle berries Plums Pumpkin Tangerines Kpem Groundnuts Pasta Water melon Eru Creams Dried beans Orange juice Cucumbers Lard Pap Guava juice Spinach Avocados Fufu Pineapple juice Cauliflower Nuts/ seeds Beer Lemon Beets Salad creams Spirits Sour Sop Egg plant Champagne Bush berries Raw vegetables

as desired

NUTRITION AND MATERNAL AND INFANT/CHILD MORTALITY A pregnant woman needs a balanced diet for herself and also the foetus. She has special needs for iron folic acid, calcium and zinc. She needs an additional 500 Kcal extra per day during pregnancy and lactation. Other needs of other macronutrients like proteins, carbohydrates and fats are of importance. Micronutrients such as minerals and vitamins are needed by the pregnant woman. In order to obtain these nutrients, she needs to consume a variety of foods. Unfortunately, the average Cameroonian pregnant woman cannot afford this because she is a victim of the general poverty which is characterised by low incomes, food insecurity, unequal access to the means of production, poor health and illiteracy.

In view of this, Professors Robert Leke and Tetanye Ekoe presented the pathetic situation of maternal and infant mortality in Cameroon. As described by the Demographic and Health Survey of Cameroon (2004) and the WFP Country Programme for Cameroon for 2008 – 2012 (2007), the rate of maternal mortality is estimated at 669 deaths per 100,000 live births while the rates of infant and child mortalities are 74 and 144 per 1,000 live births respectively. These

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figures which are very high have been attributed to high levels of infectious and parasitic diseases, the low rate of child vaccination (only 48 percent of children aged 12–23 months have received all the basic vaccinations), poor access to drinking water especially in rural areas, the poor nutritional status of children and pregnant and lactating women and inefficient healthcare arising from the shortage of health staff, whose geographical distribution is uneven. About 32% of children under 5 suffer from moderate chronic malnutrition while 13% have severe chronic malnutrition.

BREASTFEEDING PRACTICES IN CAMEROON Breastfeeding is the unequalled and normal way to feed babies as breast milk contains the optimal combination of nutrients that are ideally suited to an infant’s metabolism. Exclusive breastfeeding among infants less than or equal to 6 months old and continued breastfeeding (20-23 months) are high-priority indicators of infant health. Breastfed infants have enhanced immune response and reduced risk for chronic illnesses such as asthma, diabetes and inflammatory bowel disease. Breastfeeding may also have a protective effect against childhood obesity. Furthermore, breastfeeding improves maternal health, minimizes postpartum bleeding, reduces the risk of ovarian cancer and breast cancer and facilitates bonding between mother and infant. Exclusive breastfeeding yields more health benefits. The American Academy of Paediatrics (1997) and

Malnutrition As a determinant of maternal, infant and child health, malnutrition can contribute directly or indirectly to high maternal and infant mortalities, stillbirths and congenital abnormalities (Lu and Lu, 2007). Maternal malnutrition is an important predisposing factor in preeclampsia,

puerperal infections, haemorrhage and obstructed labour which cause maternal mortality.

Nutritional deficiencies (e.g. folate, vitamin B12, vitamin K, magnesium, copper,

zinc) during pregnancy are associated with increased risk of spina bifida, anencephaly, cardiac and other neural tube defects.

Low birth weight: This results from preterm birth and foetal growth restriction.

Some nutritional deficiencies (e.g. calcium, zinc, iron, folate, etc) have been associated with the pathogenesis of preterm birth. Low pre-pregnancy body mass index which is a reflection of poor maternal nutrition before pregnancy is linked with a greater risk of foetal growth restriction.

Most diseases (infections, diarrhoea, pneumonia, etc) that kill children are enhanced

by poor nutrition.

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UNICEF (1999) recommend that infants be exclusively breastfed for the first six months of life and be breastfed for 12 months or longer with the addition of appropriate foods.

However, despite its demonstrated benefits for child health and growth, the breastfeeding practices of Cameroonian women are still suboptimal. Consequently, Dr. Makamto Sobgui described the infant feeding practices of Cameroonian mothers for this forum. Generally, the factors affecting breastfeeding practices in Cameroon include socio-economic circumstances, religion and the presence/absence of a senior nurse during delivery.

Prevalence and duration of breastfeeding Overall, the data she presented showed that almost all Cameroonian infants are breastfed with a mean duration of 17.1 months. About 21-24% of infants are exclusively breastfed from birth to six months. The practice of breastfeeding is more common in rural (96%) than urban areas (91 %). It is much lower in Yaoundé and Douala (85%). Rural women breastfeed for longer periods (19.1 months) than their urban counterparts (16.5 months). Generally, the duration of breastfeeding reduces with the level of education. Less educated women breastfeed for longer periods (21.1 months) than those with levels greater than or equal to secondary school (14.6 months) (EDS, 2004; Nlend et al., 1997). The variation in feeding practices between rural and urban women can be explained by the increasing level of westernization of life in the urban areas. The rapid social and economic transformations in urban areas increase the difficulties faced by women in breastfeeding their children. Some work far from home. Consequently, they wean their children too early and given them poorly adapted food or milk substitutes.

Breastfeeding initiation There is great variation in the number of infants initiated into breastfeeding within one hour of birth. It has been at 31 and 19.6% respectively by EDS (2004) and MICS (2006). It is relatively high in the big urban areas of Yaoundé (35%) and Douala (26%) than in rural areas (17.3%) (MICS, 2006). However, within 24 hours following delivery, about 60% of infants in Cameroon are breastfed (MICS, 2006; EDS, 2004). There is a regional disparity in breastfeeding initiation. Only 10% and 28.9% of children born in the North Region are breastfed within one and 24 hours of birth respectively as against 19 and 70 – 75% in the Western Highlands (i.e. West and North West Regions) (MICS, 2006). The professional level of the medical personnel assisting in birth and the place of the birth of the child has a significant influence on the early initiation of breastfeeding. It has been shown that when delivery is assisted by a qualified mid wife, breastfeeding initiation is done early (21.8%) as compared to when there is no qualified mid wife (16.4%). When delivery is done in a Health Centre, breastfeeding initiation is done early (24.4%). When it is done out of health facilities, this is only 16% (MICS, 2006). The above figures show that many Cameroonian kids do not take in colostrum which is rich in vitamins, minerals and immunoglobulins and is important in the development of the digestive tract. This is at variance with the recommendations of the World Health Organisation which demand that infants be initiated into breastfeeding within one hour of birth (WHO, 2003) as this can contribute to reducing neonatal mortality by 22% (Edmonds et al., 2006). The late initiation of breastfeeding is a result of cultural taboos which do not encourage the taking in of

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colostrum (Kuate-Defo and Fournier, 2001). These taboos are particularly very strong in the North Region (EDS, 2004; MICS, 2006). Conclusion In conclusion, Dr. Makamto Sobgui said that child malnutrition as a public health problem in Cameroon can be successfully tackled if at birth families adopt good nutritional habits as it is generally the result of poor feeding practices and weaning. Improved breastfeeding practices of women can help to prevent child malnutrition, morbidity and infant mortality and could contribute to achieving the Millennium Development Goals. It is therefore important that actions be undertaken to improve infant feeding practices. Women need to be better educated about breastfeeding. Therefore, more efforts and resources should be put into providing opportunities for education to discuss breastfeeding during antenatal care.

NUTRITION AND HIV/AIDS Well organised activities for the fight against HIV/AIDS in Cameroon started in 1986 when a National AIDS Committee and a National AIDS Control Programme were created. In the face of this growing epidemic, the government prioritised HIV/AIDS and made it a programme in the strategic document to reduce poverty in 2000. Several activities were carried out in the area of treatment and control of HIV/AIDS by government structures and NGOs in order to improve the condition of patients living with the disease. Unfortunately, little or no attention was paid to the role of nutrition in the care of HIV/AIDS patients.

The interaction between HIV/AIDS and nutritional status has been a defining characteristic of the disease since the early years of the epidemic. It is associated with poor nutritional status and weight loss. It has been shown that weight loss is an important predictor of death from AIDS. This linkage suggests that nutrition may have an important role to play in slowing the progression of the disease and in contributing to successful antiretroviral (ARV) therapy. The disease can also inhibit a person’s ability to secure adequate nutrition through inability to work and loss of appetite.

In view of the above, Dr. Ndzana Abomo and her colleagues of the Nutrition Centre of the Institute of Medical Research and Medicinal Plants Studies (IMPM) described the pathetic situation of the nutritional care of HIV/AIDS patients in Cameroon. In general, there is an absence of a coordinated approach to the problem. There are isolated initiatives by some NGOs and researchers.

Researchers of the Nutrition Centre of IMPM are currently carrying out a collaborative research project with the International Atomic Energy Agency on strengthening national strategies to fight HIV/AIDS by integrating a nutrition component in the care of people living with the disease. This project aims at improving the nutritional status of people living with HIV/AIDS by providing them with a local fortified supplementary food which is in the forms of flour and dry biscuits (Medoua et al., 2008).

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NUTRITION INTERVENTIONS

ESSENTIAL ACTIONS IN NUTRITION

During the last 30-40 years, nutrition interventions were not integrated. Currently, it is the consensus that nutrition programmes should be integrated. The majority of causes of child failure to grow occur during the first two years of life and many children are victims of the poor nutrition conditions of their mothers during pregnancy. All of this can be reversed when essential actions in nutrition (EAN) are carried out. When EAN are properly applied they could reduce infant-juvenile mortality by 25%. What are these Essential Actions in Nutrition?

For this forum, Mr. Martin Nankap, the Nutrition programme Manager for Helen Keller International answered this question by outlining what his organisation does in this domain. He described the actions as follows:

Promotion of optimal maternal breastfeeding. It can reduce by 13% infant-juvenile mortality;

Promotion of complementary feeding of maternal breastfeeding which can reduce infant mortality by up to 6%;

Provision of Nutrition care to the sick and malnourished children; Promotion of good nutrition for women; Waging a war against vitamin A deficiency; Fighting against iron deficiency; Fighting against iodine deficiency Providing appropriate nutrition for vulnerable groups who are sero-positive for

HIV/AIDS.

In health care systems, EAN can be applied during pregnancy, birth, immunization, child welfare service and when a child is sick. Outside the health service, EAN can be applied by health educators for health, agricultural extension agents and other agents involved in sensitisation for micro credit schemes and environmental sanitation.

Four key elements are necessary for EAN to be successful, namely: development of partnerships; continuous capacity building; community action approach; communication, information, education.

The challenge is to mobilize the resources to get the actions done.

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IODINE DEFICIENCY MALNUTRITION AND CONTROL IN CAMEROON

Iodine deficiency malnutrition which can manifest as goitre, endemic cretinism, low intellectual performance, juvenile hypothyroidism, high spontaneous abortion and still-birth was a serious public health problem in Cameroon during the period 1950 to 1995. Universal salt iodization (USI) and consumption was officially introduced in 1991 to fight and eliminate these manifestations as well as sustain their elimination. To track down the effectiveness of USI, it was necessary that national surveys be conducted every five years, as well as more frequent monitoring especially in formerly recognized endemic sites. As resources were extremely thin to support the surveys, monitoring through sentinel sites was adopted to follow up the impact. Good partnership was developed between the Ministry of Public Health, Faculty of Medicine and Biomedical Sciences and the National Nutrition Centre to carry out these activities. Professor Daniel N. Lantum who spearheaded the actions to control iodine deficiency in Cameroon described for this forum the evolution of the USI programme through sentinel site monitoring.

It was found that as the universal consumption of iodized salt increased in households to 95.6% and was sustained from 1991 to 2010, the goitre prevalence decreased, from 29.5% to less than 5% (EDS, 2004). No more new endemic cretins were registered in maternity and paediatric wards. The median urinary iodine excretion in the standard reference group of school children 5-18 years rose up from 60µg/L to 100-300µg/L. Juvenile hypothyroidism assessed by thyroid hormones decreased from 33-46% to 0%

During the Forum in January 2010, the Minister of Public Health, Mr. Andre Mama Fouda, declared that iodine deficiency as a public health problem, has been virtually eliminated in Cameroon and we are now in the phase of USI/IDD programme sustainability. Several lessons were learnt from this success story, particularly:

the role of monitoring and operational scientific research as a component of the country

nutrition’s programmes; the inevitable relevance of data-base; the necessity of scientific evidence as basis for policy.

THE FIGHT AGAINST VITAMIN A DEFICIENCY IN CAMEROON 1960-2010 As described for the Forum by Mr. Daniel Sibetcheu, the then Director of Health Promotion in the Ministry of Health, there is evidence of high prevalence of hypo-vitaminosis A established on standard indicators set by International Vitamin A Control Group (IVACG) and UNICEF. Indirect indicators such as infant-juvenile mortality, retarded child growth, high incidence of measles and low measles immunization coverage associated with frequent epidemics were also recorded.

A national survey of vitamin A deficiency and anaemia showed wide variations among the national ecologic zones, with the sahelian area topping with 50.6% and the High Plateaux registering 24.9%. Yaoundé and Douala rates were, respectively 37.5% and 39.1%. The results indicate that vitamin A deficiency is a public health problem in Cameroon, with a mean prevalence of 38.8% for children 1-5 years of age. Whereas all regions consumed food rich in

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Vitamin A, particularly red palm oil, green vegetables, butter and eggs, the very common practice of bleaching palm oil greatly reduced the serum retinol levels because of the destruction of B-carotene in palm oil.

In view of the above, it was necessary to institute vitamin A supplementation. This was done within the frame work of the Expanded Programme on Immunization (EPI). Vitamin A supplementation was then added to the routine EPI. Results so far obtained for vitamin A supplementation are encouraging as 57.7% of children (6-59 months) had received a vitamin A capsule during the last six months (MICS, 2006). Strategies for the fight against vitamin A deficiency In general, the Ministry of Health and its partners have adopted the following strategies to reduce vitamin A deficiency in Cameroon:

Exclusive maternal breastfeeding of children during first 6 months of life; Consumption of foods rich in Vitamin A: red palm oil (not bleached), tomatoes, fruits,

carrots, green vegetables, eggs, margarine and butter; Vitamin A supplementation to all the women (where possible) within eight weeks post

delivery to enrich maternal milk; Vitamin A supplementation to children 6 months to 5 years twice per year; Food fortification with vitamin A through industries producing flour, oils, salt and other

products. In conclusion, Mr. Sibetcheu said that combined strategies are needed to fight against

vitamin A deficiency despite the abundance of vitamin A rich foods. Operational research and monitoring are necessary to determine the impact of various strategies, especially supplementation.

PREVENTING AND MITIGATING CHILD UNDER-NUTRITION IN CAMEROON Available statistics show that malnutrition remains a serious public health problem in Cameroon. It is a major contributor to the disease and death burden of the population. As shown in the Table below, there are 3.5 million under-fives. This is equal to about 18.5% of the total population. The mortality rate for them is 144 deaths per 1000 live births (DHS, 2004). It is extremely high in the northern regions where 40,000 of the 105,000 child deaths per year occur. Half of the underfive deaths happen in the first year of life.

As explained by Dr. Garnier of UNICEF, who presented a paper on preventing and mitigating child under-nutrition, the major cause of child mortality (48%) in Cameroon is malnutrition. Mild to moderate undernutrition is responsible for about 80% of the burden of child mortality attributable to undernutrition. Chronic undernutrition (stunting) which is characterised by a deficit of height for age among underfives is widespread and severe. Chronic undernutrition affects 1,080,000 underfives and 375,000 of them are in northern Cameroon. Among these 1,080,000 underfives, 450,000 suffer from severe chronic undernutrition and 175,000 of them are in the northern regions. Wasting is common among some children as household incomes are

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too low to permit them to feed appropriately (MICS, 2006). Chronic or acute undernutrition in the country starts very early in life as shown by the fact that 8.1% of children under-three suffer from acute undernutrition, 28.3% of them have chronic undernutrition, 81.4% of underfives with acute undernutrition are underthrees and 56.8% of underfives with chronic undernutrition are underthrees.

There are also severe micronutrient deficiencies except for iodine which has 95.6% coverage. About 38.8% of children (12-71 months) suffer from vitamin A deficiency with a prevalence greater than 50% in the northern regions (Adamawa, North and Far North). For children 6-59 months and women of child bearing age, 68.3% and 44.9% respectively are anaemic (DHS, 2004).

The number of child deaths is higher than those in Ghana and is almost the same as in Chad. The figures indicate that Cameroon is not making enough effort to achieve Millennium Development Goal number 4 which requires every nation to reduce child mortality by two thirds by 2015.

Regional variations in underfive mortality rates in Cameroon

SUMMARY

Three Important Questions were asked and answers attempted:

1. What is the nutrition situation of Cameroon?

How much do we know for sure?

2. Is the situation getting worse?

How can we end child under-nutrition in Cameroon?

3. What are we up against?

A. GENERAL INTEGRATED RESPONSES

1. Cameroon is a

From DHS (2004)

Region PopulationNumber of births per

year

Population of children < 3

years old

Population of children < 5

years old

Underfive mortality rate per 1,000 live

births

Number of child deaths per year

Adamawa 928,771 36,686 119,533 181,110 136 4,989Center 3,097,742 111,485 337,344 511,127 116 12,904East 970,060 36,862 118,444 179,461 187 6,893Littoral 2,537,371 88,469 276,320 418,666 83 7,343North 1,564,473 65,708 201,348 305,072 205 13,470Far North 3,492,757 146,696 449,518 681,088 186 27,285North West 2,295,723 87,237 265,156 401,752 99 8,636West 2,512,908 95,491 298,533 452,323 126 12,032South 701,098 26,642 85,604 129,703 154 4,103South West 1,571,832 59,730 181,547 275,071 144 8,601

North Cameroon 5,057,230 212,404 650,866 986,160 192 40,755

Total 19,672,735 755,006 2,333,347 3,535,373 144 106,256

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Regional variations in underfive chronic and severe undernutrion

2. Neonatal causes: Malaria, Pneumonia and diarrheal diseases.

3. Chronic or acute under-five malnutrition starts very early in life.

From MICS (2006)

What are we up against? The above figures show that we are and have been up against a severe nutrition crisis in Cameroon which is:

affecting primarily very young children (< 3yrs); mostly located in the northern Regions and the emergency refugee areas in the East

Region (holding refugees from the Central African Republic); killing 106,256 children annually.

There are five main underlying causes. Children are nutrition insecure because they: lack access to age-appropriate foods; lack access to age-appropriate feeding practices; lack access to essential health services; lack access to safe water and hygiene practices; were born with a low birth weights.

Mitigating strategies

A number of strategies can be put in place to mitigate child undernutrition in Cameroon. When acute undernutrition in children 6-59 months is more than 10%, there is a nutrition crisis that

RegionPrevalence (%) of

global chronic undernutrition

Number of underfives with chronic

undernutrition

Prevalence (%) of severe chronic undernutrition

Number of underfives with severe chronic

undernutrition

Adamawa 28.4 51,435 12.2 22,095Center 22.3 113,934 5.6 28,379East 34.4 61,735 14.4 25,842Littoral 17.6 73,804 5.4 22,615North 43.3 132,096 21.5 65,590Far North 35.7 243,148 16.2 110,336North West 33.4 134,185 14.8 59,459West 28.8 130,269 12.5 56,540South 30.3 39,300 12.5 16,213South West 35.9 98,750 14.6 40,160

North Cameroon 38.1 375,244 17.8 175,926

Total 30.4 1,078,656 12.6 447,229

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requires treatment and prevention through facility-based and community-based programmes with food interventions. Young children (0-35 months old) should be prioritized through:

access to age-appropriate foods access to age-appropriate feeding practices access to essential health services access to safe water and key hygiene practices

Pregnant women and lactating mothers should also be supported in order to prevent low birth weight, maternal depletion and lactation failure. Essential package in nutrition This package can include: 1. Community-based management of acute undernutrition (WFP, UNHCR, NGOs, MPH and

UNICEF) can be in the form of: facility-based therapeutic feeding for malnourished children with medical

complications (19 have been opened in 2 yrs); community-based therapeutic care (176 have been opened in 2 years); community-based supplementary feeding (176 have been opened in 2 years).

2. Prevention of undernutrition through Essential Nutrition Actions (ENA) and Child Health

Days (CHD) by stakeholders such as HKI, MPH, NGOs, WHO and UNICEF. These actions include:

exclusive breastfeeding for infants 0-6 months; prolonged breastfeeding for children 6-23 months; adequate complementary or fortified foods for children 6-23 months; adequate complementary feeding and hygiene practices; regular vitamin A supplementation and deworming through CHD; access to essential health services, including immunization; access to safe water and sanitation; support pregnant women and lactating mothers.

Progress in nutrition Some progress in nutrition has been realized through the:

institutionalization of bi-annual National Child Health Days since 2008 with the introduction of deworming (1-5yrs) at national level;

accelerating process of Food Fortification (industrial assessment and creation of National Alliance for Food Fortification, FRAT Study);

implementation of community-based management of acute undernutrition in East, Adamawa, North and Far North Regions, including CAR and Chadian refugees;

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implementation of programmes of prevention of undernutrition (Essential Nutrition Actions) in North-west, Centre, East, North and Far North regions, including CAR and Chadian refugees.

The first implementation of a community-based management of acute undernutrition was

for the CAR refugees in July 2007. This resulted in a decrease in the prevalence of global acute undernutrition from 17.2 % to 6.0 % and in child mortality from 3.0 to 1.0 child deaths/day/10,000 children. A total of 7,849 acutely undernourished children (both CAR refugees and Cameroonians) have been cured between August 2007 and August 2009 in the East and Adamawa Regions. Needs in Nutrition There are several immediate needs for:

ensuring the functionality of the national programme for food security; ensuring collective response from Government, UN agencies, NGOs, Communities; human resources (Government, UNICEF, UNHCR, WFP, WHO, NGOs); monitoring and evaluation (i.e. improvement of planning and program quality).

The funding needs in nutrition for scaling up activities for the next three years have been estimated by UNICEF to be US$ 12,500,000 as described in the Table below.

Intensified nutrition action in Cameroon can lead to achievement of the Millennium Development Goal of halving severe hunger by 2015 (MDG 1) and greatly increase the chances of achieving goals for child and maternal mortality (MDGs 4 & 5) and offer the chance of a better, more productive life for the children born each year in Cameroon.

Program Total amountVitamin A supplementation + Deworming 1,000,000Community-based Therapeutic Care (management of acute undernutrition)

4,000,000

Essential Nutrition Actions (ENA) 2,500,000Zinc + Oral Rehydratation Salts 1,500,000Food Fortification 1,000,000Promotion of exclusive breastfeeding 2,000,000Nutrition Emergency 500,000

Total 12,500,000

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Nutrition Education in Cameroon This section of the Forum was done in the form of a panel discussion. It was moderated by Professor Carl Mbofung. Nutrition Education in Higher Institutions of Learning Professor Agatha Tanya of the Faculty of Medicine and Biomedical Sciences of the University of Yaounde I started the discussion with an overview of the situation of the teaching of nutrition in medical schools in general and in Cameroon in particular. She said that nutrition is a very important integrative topic as it does not belong to any specific medical discipline. As medical education moves away from fragmented teaching of single topics of knowledge to a more integrated model of understanding the concepts which explain how the body works and ways to ameliorate deviations from normal function, nutrition can represent a model for understanding this integration. To be effective, a medical doctor must be able to educate patients and help them to change poor dietary habits. Nutrition education can assist us in learning and teaching these skills because it represents a similar challenge for the doctor as well as for the patient. Clinicians need a good background in nutrition no matter their area of specialization. Physicians and medical students should learn nutritional assessment as part of physical diagnosis in order to recognize nutrition-related medical problems when they are present. They should be able to take the diet history of a patient which will help them identify unhealthy diets and eating disorders. Physicians who fail to diagnose and treat malnutrition in their patients because of ignorance, can contribute to greater morbidity and mortality of patients. Physicians need a good basic understanding of the science of nutrition so that they can keep up with the growing literature to which their patients are exposed. Unfortunately, as Professor Tanya observed, nutrition education in most medical schools is inadequate. It has been shown that 60 percent of medical schools in the United States are not meeting the minimum recommendations for their students’ nutrition education. The amount of nutrition education in medical schools remained generally inadequate (Committee on Nutrition in Medical Education, 1985; Young, 1992).

In order to understand the current knowledge in nutrition of medical students and physicians in the Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I and the teaching hospitals, Prof. Tanya and her group carried out a study which showed that the teaching of nutrition has been inadequate. Many of the students and clinicians questioned did not seem to appreciate that diet plays a critical role in the pathogenesis of major age-related chronic diseases which are rapidly becoming more common in Cameroon. This is due to the fact that the traditional medical education they received did not provide them adequate knowledge of nutrition. When questions on basic nutrition information were asked to evaluate the nutrition knowledge of medical students and physicians, the scores were very poor. Similar results have been obtained in the USA. About 98% of the participants in Prof. Tanya’s study thought it was important to improve the teaching of nutrition during training as it was only taught for a total of 30 hours, 16 during the first year and 14 during the second year of medical studies. This accounted for just 3% of total lectures delivered in the first and second year of medical studies. In the USA, a total of 21 hours is recommended.

As the need for accurate nutrition knowledge and information among physician’s increases, it is important to find a way to incorporate this information into the educational

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experience of physicians. Nutrition education programmes need to be developed, implemented, and studied for their effectiveness in improving the nutrition knowledge of physicians. In addition to increasing the physicians’ nutrition knowledge, it will be important to identify areas and study ways for physicians to effectively impart this knowledge to their patients. Nutrition Education in Secondary and Primary Schools Two other panelists, Mrs Mary Ngufor and Dr. Jeremie Mvondo of the Ministries of Secondary and Basic Education respectively talked of the nutrition education programmes for secondary and primary schools. From their presentations, it was clear that nutrition education at these levels was putting a lot of emphasis on the nutritive values of foods and chemical composition. It has not been seen as a tool that can contribute in the broadening of knowledge for proper feeding of children in schools and the homes. In this respect, teachers and school staffs have a vital role to play in sharing out knowledge in this field.

The forum participants and panelists were of the opinion that nutrition education at the primary and secondary school levels should communicate more so as to enable positive behavioral changes in the children or students in their choices of types, varieties and quantities of foods consumed. Their knowledge of essential nutrients in relation to locally available food stuff should be broadened. It was the general opinion that the role of nutrition education as a development tool is under estimated in the country as a number of issues plaguing its efficiency have been left unattended to for a very long time. Some of these are:

lack of personnel in the field of nutrition education nationwide; insufficient training tools and manuals for proper teaching of nutrition education; existing messages not well adapted for target groups; inadequate dieticians in health structures.

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COMMISSION REPORTS: RECOMMENDATIONS COMMISSION I: POLICY AND SOCIO-CULTURAL DIMENSIONS OF NUTRITION

AND HEALTH IN CAMEROON

The commission was mandated to consider the presentations and related discussions in the plenary session on the nutritional status and policy (and performance) since 1960 and the socio-cultural dimensions of nutrition which affect public health and to suggest improvements through policy/decision making, research and use of available knowledge to improve the existing situation.

After the analysis, it became clear that the public health and nutrition situation of Cameroon is indeed critical and would demand action by various stakeholders in the short, medium and long term to improve the situation. It was agreed that it is technically possible to eliminate or reduce malnutrition and its negative health effects in Cameroon. However, for this to succeed, there must be the political will that is accompanied by realistic policies and concerted actions. Consequently, the commission recommended as follows:

1. A well-managed database should be set up in the Ministry of Public Health to provide a permanent source of evidence for periodic policy orientation for action by various stakeholders.

2. The Ministries of Public Health and Economy, Planning and Territorial Development should convene the concerned actors more frequently and organize a robust national nutrition survey to update information on the key critical issues raised by recent reports. The surveys should be planned and executed on longitudinal basis rather than as a one-time venture, in order to be able to assess their impact and effectiveness for appropriate planning to assure progress.

3. The Ministry of Public Health and concerned nutrition development sectors should access, study and apply the existing literature in the following domains:

Nutrition guide for the prevention of chronic non-transmissible diseases, including:

obesity, diabetes mellitus, cancer and cardiovascular disorders, which are now emergent in Cameroon.

Nutrition guide for persons living with the HIV/AIDS. Physical activities and exercises for health and fitness promotion.

4. Using existing research information and data on food composition in Cameroon and

Central African Region, a book of “Tables on Food Types and Composition” should be elaborated to valorise pervious research effort and to guide future researchers and current users.

5. Considering that information on infant breast-feeding has not yet been consistently collected with periodic follow-up to demonstrate the Knowledge, Attitudes and Practices

35

of child-bearing mothers on this subject, it is necessary for more surveys to be carried out in all the 10 Regions of Cameroon to provide information for appropriate action and planning.

6. The probability of Cameroon attaining the United Nations Millennium Development Goals by 2015 is low. Consequently, a radical review and updating of the existing National Policy which is due to expire in 2011 is necessary. The new policy should state new targets with detailed programme framework to be pursued with adequate budgetary provisions.

COMMISSION II: NUTRITION INTERVENTIONS IN CAMEROON The Commission was mandated to consider the presentations and related discussions on the nutritional effects on public health in Cameroon, nutrition interventions and nutrition education and to make recommendations on realistic strategies or approaches to handle the issues. After going through the above, the Commission recommended as follows: Nutrition interventions

7. As a result of the fact that most donor funded nutrition projects stop after the end of donor participation, it is necessary for the government to take all necessary measures to ensure the sustainability of such projects through the training of personnel and the provision of adequate material and financial resources.

8. The Forum congratulates the Ministry of Public Health for having achieved the virtual elimination of Iodine deficiency as a public health problem in Cameroon and urges that all measures be taken to sustain the Universal Salt Iodization Programme orchestrated by the private economic operators who are iodized salt producers, the International Council for the Control of Iodine Deficiency Disorders and the National Coalition of Partners (UNICEF, WHO, Faculty of Medicine and Biomedical Sciences, National Nutrition Centre of IMPM).

9. Considering that micronutrient deficiencies constitute a huge hidden scourge that causes

severe damage and contributes extensively to infant-juvenile malnutrition, poor development, morbidity and mortality, the Forum strongly recommends that the Programme on Food Fortification (with Iron, Vitamin A, Iodine and Zinc) be pursued with vigour.

10. As school children in Cameroon still suffer from under-nutrition due to poor parental and

school planning of proper feeding, while the children are at school, it is strongly recommended that the present system of school canteens be revised and appropriately improved so that a balanced diet is assured.

11. As Food and Nutrition is related to the population to be fed, it is necessary for the

Ministry of Public Health and other stakeholders to propagate comprehensive reproductive health programmes with a strong family planning component for the

36

Cameroon population which is growing at 2.6% with a probability of doubling in about 20 years.

Nutrition of the mother and infant Intensified nutrition action in Cameroon for mothers and infants can greatly increase the chances of achieving the goals for reducing child and maternal mortality (MDGs 4 & 5) and offer the chance of a better, more productive life for the children born each year in Cameroon. Consequently, the Forum recommended that:

12. Research activities be started immediately on community participative approach in the application of essential nutrition actions such as:

promotion of exclusive breastfeeding for infants 0-6 months; prolonged breastfeeding for children 6-23 months; adequate complementary or fortified foods for children 6-23 months; adequate complementary feeding and hygiene practices; regular vitamin A supplementation and deworming through Child Health Days

(CHD) programme access to essential health services, including immunization; access to safe water and sanitation; support for pregnant women and lactating mothers.

13. Nutrition should be integrated in prenatal health care services.

Nutrition Education According to the FAO (2004), the principal aim of nutrition education is to provide people with enough information, skills and motivation to procure and to consume appropriate foods in order to provide well balanced diets and better care for vulnerable groups. Consequently, nutrition education programmes should be directed at:

Increasing the nutrition knowledge and awareness of the public and policy-makers; Promoting desirable healthy food choices and nutritional practices; Increasing diversity and quantity of family food supplies.

Using these FAO guidelines, the Forum made the following recommendations for

nutrition education:

14. Since nutrition education plays an important role in our understanding of the concepts which explain how the body works and ways to ameliorate deviations from normal function, it is necessary for the various actors to:

Elaborate and adopt a document which defines the nutrition and health policy for schools.

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Increase the number of teachings hours for nutrition courses in the medical, food technology and nursing schools.

Develop continuing education programmes on nutrition for medical doctors as they have to keep up with the growing literature to which their patients are exposed.

Organise refresher courses for teachers of nutrition and home economics in secondary and primary schools.

Encourage the organisation of public campaigns to inform the public on how and what to eat to assure a good nutrition status at all times by the Directorate of Health Promotion in the Ministry of Public Health, professional associations and consumer groups because it has been recognised that Cameroonians are not adequately informed about proper nutrition issues.

Develop strategies to educate women on the importance of breast feeding.

15. For nutrition education to effectively play its role as a development tool in the country, public authorities need to:

Increase the personnel in the field of nutrition education nationwide; Provide sufficient training tools and manuals for proper teaching of nutrition

education; Make existing messages well adapted to the target groups; Recruit more dieticians for health structures in the country.

38

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APPENDICES

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OPENING SPEECH BY HIS EXCELLENCY ANDRE MAMA FOUDA, CAMEROON’S MINISTER OF PUBLIC HEALTH

DISCOURS DE SON EXCELLENCE ANDRE MAMA FOUDA, MINISTRE DE LA SANTE PUBLIQUE A L’OCCASION DE LA CEREMONIE D’OUVERTURE DU FORUM

NATIONAL SUR LA NUTRITION ET SANTE AU CAMEROUN

07 JANVIER 2010 A HÔTEL HILTON YAOUNDE Madame le Ministre de la Recherche Scientifique et de l’Innovation; Madame le Ministre de la Promotion de la Femme et de la Famille; Monsieur le Président de l’Académie des Sciences du Cameroun; Madame le Représentant de l’UNICEF; Monsieur le Représentant de l’OMS; Madame le Représentant de la FAO; Monsieur le Doyen de la Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé; Mesdames et Messieurs les Scientifiques; Chers membres de l’Académie des Sciences du Cameroun; Partenaires de la Société Civile; Chers Collaborateurs; Excellences, Mesdames et Messieurs C’est pour moi un grand plaisir et un agréable devoir de présider ce jour la cérémonie d’ouverture du Forum National sur la Nutrition et la Santé au Cameroun. Permettez-moi avant toute chose de dire merci à Madame le Ministre de la Recherche Scientifique et de l’Innovation et à Madame le Ministre de la Promotion de la Femme et de la Famille qui ont honoré de leur présence cette cérémonie. Ceci est une preuve de la solidarité gouvernementale dans le combat que nous menons pour l’amélioration constante de l’état de santé des populations dans notre pays. Il s’agit d’une quête permanente et la place de la recherche est fondamentale. Je tiens à exprimer mes remerciements à Monsieur le Président de l’Académie des Sciences du Cameroun qui a choisi le thème, Nutrition et Santé, pour la rencontre de cette année. Ce qui témoigne de l’intérêt que votre institution accorde aux problèmes de santé en général et à la nutrition en particulier dans notre pays. Nous remercions nos partenaires, qui ont apporté un appui financier précieux pour l’organisation des présentes assises. Ceci est une preuve supplémentaire de la volonté de ces institutions de contribuer à la résolution des problèmes de nutrition au Cameroun. Excellences, Mesdames et Messieurs, Les malnutritions constituent un problème de santé publique dans notre pays. Au cours des trois dernières décennies certains indicateurs de l’état nutritionnel se sont dégradés.

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En effet, le retard de croissance chez les enfants de moins de cinq ans est passé de 23% en 1991 à 32% en 2004 et la malnutrition aiguë est passée de 4% à 7% pendant la même période. L’insuffisance pondérale chez les enfants de moins de 5 ans qui est l’un des indicateurs de l’Objectif du Millénaire pour le Développement N° 1 est passée de 16% en 1991 à 19,3% en 2004 pour une cible nationale de 8% au plus en 2015. De même, 40% d’enfants de moins de cinq ans souffrent de la carence en vitamine A et 68% d’anémie. Cette dernière affecte 45% des femmes. Cette situation nutritionnelle peu reluisante contribue à l’augmentation de cette morbidité et de la mortalité infantile puisqu’on sait aujourd’hui que la malnutrition est associée à 50% des causes de mortalité des enfants de moins 5 ans en Afrique. Par ailleurs, les changements de mode de vie avec une alimentation plus énergétique et la sédentarité constituent des facteurs de risque pour les pathologies comme le diabète et d’hypertension en progression dans notre pays. Face à cette situation, la volonté politique du Gouvernement de la République de lutter contre toute les formes de malnutritions a été matérialisée par des mesures concrètes entres autres:

la visibilité institutionnelle de la nutrition par la création dans l’organigramme du Ministère de la Santé Publique en 2002, d’une Sous-direction de l’Alimentation et de la Nutrition;

l’adoption en 2006 d’une Politique et d’un Programme d’Alimentation et de Nutrition; la mise en place en 2009 d’un Programme de Fortification des Aliments en Vitamines et

Minéraux; l’introduction depuis 1998 de la supplémentation systématique en vitamine A des enfants

de 6 à 59 mois et des femmes au postpartum dans le paquet minimum des activités de formations sanitaires.

Toutes ces mesures et bien d’autres ont porté des fruits puisqu’il y a eu:

l’élimination des troubles dus à la carence en iode comme problème de santé publique au Cameroun;

l’amélioration de la pratique de l’allaitement maternel exclusif qui est passé de 1% en 1991 à 23% en 2004.

Toutes les interventions en matière de nutrition sur le terrain restent encore insuffisantes eu égard à l’ampleur des problèmes et à la diversité de leur causes. Excellences, Mesdames et Messieurs, Les présentes assises qui viennent à point nommé ont pour objectifs entre autres de:

identifier les points critiques et les lacunes dans les politiques nutritionnelles actuelles; passer en revue les activités et les politiques de recherche et développement actuelles qui

affectent la nutrition et la santé; permettre aux principaux intervenants nationaux d’échanger des idées sur les points

critiques de la nutrition et de la santé;

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suggérer des approches de solutions sur la base des contributions pertinentes des participants.

La présence des participants des différents secteurs et d’éminentes sommités de la science permettra certainement d’enrichir vos débats en vue d’aboutir à des résultats concrets dont la mise en œuvre devra permettre l’inversion des tendances des indicateurs de l’état nutritionnels dans notre pays. Je vous exhorte donc à un examen minutieux des différents thèmes qui constituent des préoccupations réelles pour mon département ministériel. Nul doute, compte tenu de la qualité des participants et de votre assiduité tout au long de vos travaux que les résultats auxquels vous parviendrez combleront les attentes du Gouvernement. La mise en œuvre de vos pertinentes recommandations par les différents secteurs concernés par les problèmes nutritionnels devra contribuer à la réduction de la mortalité infantile aujourd’hui de 144 pour 1000 pour une cible de 75,6 pour 1000 d’ici 2015 dans le cadre de poursuite de l’atteinte des Objectifs du Millénaire pour le Développement. Dans cette perspective, nous vous encourageons à donner le meilleur de vous-même afin de garantir le succès de vos travaux. C’est sur cette note d’engagement que Madame le Ministre de la Recherche Scientifique et de l’Innovation, Madame le Ministre de la Promotion de la femme et de la Famille et moi-même déclarons officiellement ouvert les travaux du Forum National sur la Nutrition et la Santé au Cameroun.

Vive la coopération internationale, Vive le Cameroun et son illustre Chef, le Président Paul BIYA

Je vous remercie de votre bien aimable attention.

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PROGRAMME OF THE FORUM

NATIONAL FORUM ON NUTRITION AND PUBLIC HEALTH IN CAMEROON 7-8 January, 2010

HILTON HOTEL YAOUNDE, CAMEROON

DAY 1 (7/1/2010) 8:00-8:30 Registration 9:00-10:00 Opening Session

Objectives: 1. To present the role of the members of the National Forum, 2. To present the objectives of the Forum on nutrition and health, 3. To launch the food security report

Chair: Minister of Public Health Rapporteur: Dr. Ndi C., Chief Research Officer, IRAD

Welcome: Prof. Domngang Samuel, President, CAS

The launching of the Report of the last Forum on Food Security: “Exploring Opportunities to Reduce Food Insecurity in the Sudano-sahelian Zone of Cameroon”: Mr Ngniado Bonificace, National Coordinator, Special Programme on Food Security, MINADER and Prof. Tchuamo Isaac, MINRESI.

Role of members of Permanent National Forum on Nutrition and Public Health:

Executive Secretary, CAS Objectives of the Forum: Prof. D. N. Lantum, Chair, Planning Committee

Speech of the Minister of Public Health

10:00-10:30 Contact with the media/coffee break 10:30-11:50 Session 1: Policy and socio-cultural dimensions of nutrition and health in Cameroon:

Objectives: 1. To present an analysis of the nutrition and health policy (and performance) since

1960, 2. To present an analytical evaluation of socio-cultural patterns of nutrition affecting

national public health , 3. To inform policy and re-orientate nutrition patterns.

Moderator: Prof. Wali Muna, FMBS, University of Yaounde I Rapporteur: Dr. Ndi C., Chief Research Officer, IRAD

10:30-10:50 Mr. Daniel Sibetcheu, Directeur de la Promotion de la Santé, MINSANTE: Evolution de l’état nutritionnelle de la population camerounaise depuis 1960.

10:50-11:10 Prof. C.M. Mbofung, Director, Advanced School of Agro-industrial Sciences, University of Ngaoundere: The Cameroon Food and Nutrition Policy: A cursory analytical view.

11:10-11:30 Dr. Djiele Ngamani Patrice, Researcher Officer, Nutrition Centre, IMPM: Les habitudes alimentaires des populations camerounaise: Impact sur l’état de santé.

11:30-11:50 Discussion 13:00-14:30 LUNCH 14:30-18:40

Session II: Nutrition Effects on Public Health in Cameroon Objectives

1. To present the situation of chronic diseases as affected by nutrition in Cameroon,

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14:30-14:50 14:50-15:10 15:10-15:30 15:30-15:50

2. To present the situation of child and maternal mortality as affected by nutrition, 3. To suggest improvements of the situation.

Moderator: Prof. J.C. Mbanya, FMBS, Univ. Yaounde I Rapporteur: Dr. Etame L., Nutrition Centre, IMPM Prof. J.C. Mbanya, FMBS, University of Yaounde I : Sick Genes, Sick Environment : The

Emergence of chronic Diseases of Lifestyle. Prof. J. Oben, Dept. of Biochemistry, Univ. Yaounde I: Nutrition and obesity in Cameroon:

Could we really address a public health concern? Dr. A. Tanya, Senior Lecturer, FMBS, Univ. Yaoundé I.: Nutrition and diabetes in

Cameroon Prof. J.R. Leke, Dept. of Gynaecology, FMBS Univ. Yaounde I: Nutrition et grosses.

16:10-16:40 COFFEE BREAK 16:40-17:00 17:20-17:40 17:40-18:00 18:00-18:40

Prof. Tetanye E., Dean, Faculty of Medicine and Biomedical Sciences, Univ. Yaounde I: Malnutrition et mortalité infantile

Dr. Makamto Sobgui Caroline, Researcher, Nutrition Centre, Institute of Medical Research and Medicinal Plants Studies: Les practiques d’allaitement maternel au Cameroun

Dr. Ndzana Abomo Anne Christine, Researcher Officer, Nutrition Centre, Institute of Medical Research and Medicinal Plants Studies: Nutrition and HIV/AIDS

Discussion DAY 2 (8/1/2010)

8:30-10:30 8:30-8:45 8:45-9:00 9:00-9:15 9:15-9:30 9:30-9:45 9.45- 10.30 10.30- 11.00

Session III: Nutrition Interventions Objectives:

1. To present various interventions by stakeholders to improve nutrition 2. To evaluate the interventions and recommend improvements 3. To inform the various stakeholders of each other’s activities

Moderator : Prof. Daniel Lantum Rapporteur: Dr. Medoua Nama Gabriel, Nutrition Centre Dr. Martin Nankap, Nutrition Program Manager, Helen Keller International, Cameroon:

Actions Essentielles de Nutrition: Une approche de la nutrition orientée dur l’action Dr. Denis Garnier, Research Nutrition Specialist, UNICEF: Preventing and mitigating child

undernutrition in Cameroon Tanya A. N. K., Mbanya J. C., Sharma S., Cruickshank K., Cade J., Cao X., Hurbos M.,and

Wong M. R. K. M.: Micro nutrient composition of Cameroonian composite dishes Mr. Sibetcheu D.: La lute contre la carence en vitamine A au Cameroun Prof. Daniel Lantum, Coordinator, ICCIDD: Evolution of Cameroon USI/IDD programme

in 55 years through sentinel site monitoring. Discussion Coffee Break

11:00 – 12:00

Session IV: Nutrition Education in Cameroon Objectives

1. To discuss the importance of nutrition education in Cameroon 2. To discuss the situation of nutrition education in each sector concerned 3. To inform policy/decision making

Moderator: Prof. CM Mbofung, Director, ENSAI Rapporteur: Dr. Kameni Aselme, Senior Research Officer, IRAD.

Panellists: Ministry of Basic Education: Dr. J.M. Manguele.

48

Ministry of Secondary Education: Mrs. Ngufor Ministry of Employment and Vocational Training: Dr. Mbakop Clement Ministry of Public Health: Mr. Okala George National Centre for Education: Dr. Mbouombouo Pierre Faculty of Medicine and Biomedical Sciences, University of Yaoundé I: Dr. Mrs. A. Tanya Discussion

12:00-13:30 Session VI: Working Groups Objectives: 1. To consider the plenary presentations and related discussions 2. To suggest improvements in:

Policy/decision making Further study/research Use of available knowledge

Policy and Socio-cultural dimensions of Nutrition and Health in Cameroon Nutrition interventions in Cameroon

13:30-14:30 LUNCH 14:30-15:30 Completion of working group reports 15:30-16:30 Closing Session:

Presentation of working group reports Remarks by Forum Chair MINSANTE

49

PERMANENT MEMBERS OF THE CAS NATIONAL FORUM ON PUBLIC HEALTH The permanent members of the CAS National Forum on Public Health are representatives of the following organisations: STAKEHOLDER NAME OF

REPRESENTATIVE FUNCTION

Cameroon Academy of Sciences Prof. Samuel Domngang President of the Academy Prof. Beban Sammy Chombow Vice President of the Academy

Research and Academic communities

Prof. Wali F. Muna Chairman of the Forum; Professor of Internal Medicine and Cardiology, Faculty of Medicine and Biomedical Sciences(FMBS), University of Yaoundé I; Head of Department of Internal Medicine.

Prof. Daniel N. Lantum Retired Prof. of Public Health and Community Medicine, FMBS, University of Yaoundé I

Prof. Carl M.F. Mbofung Prof. of Nutritional Biochemistry and Director of National School of Agro-industrial Sciences, University of Ngaoundere

Prof. J.C. Mbanya Prof. of Endocrinology, FMBS, University of Yaoundé I

Prof. L. Kaptue Retired Prof. of Haematology and Laboratory Medicine, FMBS, University of Yaoundé I

Prof. R.J. Leke Prof. of Gynaecology/Obstetrics, FMBS, University of Yaoundé I

Prof. P.M. Ndumbe Prof. of Virology/Immunology, Faculty of Health Sciences, University of Buea

Prof. J. Mbede Retired Prof. of Paediatric, FMBS, University of Yaoundé I

Prof. Rose F.G. Leke Prof. of Parasitology, FMBS, University of Yaoundé I

Prof. A.S. Doh Prof. of Obstetrics and Surgical Oncology, FMBS, University of Yaoundé

Government ministries Ministry of Public Health Dr. SAA Director of Health Promotion Ministry of Higher Education Prof. NYASSE Barthelemy Head of the University Research Promotion

Unit Ministry of Scientific Research and Innovation

Dr. Vincent N. Tanya Technical Adviser no 1

Ministry for the Promotion of Women and the Family

Prof. Messi Ndongo Marie-Louise

Inspector General

Ministry of Agriculture and Rural Development

Mr. TACHAGO Ingénieur Général d’Agriculture

Ministry of Livestock, Fisheries and Animal Industries

Dr. CHIMANGHA Herbert NJI Linus

Inspector General

Ministry of Environment and Nature Protection

Mr. NGUIMGOU SIGNING Bienvenue

Chef de Service de la Promotion

Ministry of Finance - - International and bilateral organisations

WHO Mr. KEMBOU Etienne National Programme Officer for HIV/AIDS and Nutrition

UNICEF - - Helen Keller International Ann TARINI HIEN Country Director

50

MEMBERS OF THE FORUM ORGANISING COMMITTEE Dr. Vincent N. Tanya Chief Research Officer, Ministry of Scientific Research and

Innovation, Chairman Prof. Daniel N. Lantum Retired Prof. of Public Health and Community Medicine, FMBS, University

of Yaoundé I, Member Prof. Agatha K.N. Tanya Associate Professor of Nutrition, Faculty of Medicine and Biomedical

Sciences, University of Yaoundé I Dr. Tom Agbor Egbe Senior Research Officer, Deputy Director, IMPM Mr. Daniel Sibetcheu Former Director of Health Promotion, Ministry of Public Health

51

LIST OF PARTICIPANTS No NAMES ADDRESS E-MAIL 1 H. E. Andre Mama

Fouda Minister of Public Health Yaoundé

2 Prof. Fru Angwafo

Secretary General, Ministry of Public Health Yaoundé

3 Prof. Samuel Domngang Cameroon Academy of Sciences Sdomngang@yahoo.fr 4 Dr. David A. Mbah Cameroon Academy of Sciences dambah@yahoo.co.uk 5 Dr. Vincent N. Tanya Ministry of Scientific Research and

Innovation vntanya@yahoo.com

6 Wali W.F. Muna, Prof. FMBS, University of Yaounde I walimuna@hotmail.com 7 Dr. Djiele N. Patrice IMPM Yaoundé pdjiele@yahoo.fr 8 Kangue Koum Henri

Directorate of Health Promotion, Ministry of Public Health Yaoundé

henrykangue@yahoo.com

9 Dr. Ngima Mawoung G.

Head, DPAI, Ministry of Scientific Research and Innovation

ngimagody@yahoo.fr

10 Dr. Bickié Jean CEA/DRN/IMPM Ministry of Scientific Research and Innovation, Yaoundé

jbickie@yahoo.fr

11 Dr. Ndi Christopher IRAD/MINRESI Yaoundé c_ndi@yahoo.com 12 Dr. Abba Dalil Head, DVVRR, Ministry of

Scientific Research and Innovation, Yaoundé

abbadalil@hotmail.com

13 Dr. Medona Nama Gabriel

CRAN/IMPM gmedona@yahoo.fr

14 Dawa Oumarou IG, Ministry of Livestocks, Fisheries and Animal Husbandry, Yaoundé

dawa37@hotmail.com

15 Sibetcheu Daniel

Former Director of Health Promotion, Ministry of Public Health, Yaoundé

dsibetcheu@yahoo.fr

16 Dr. Essama IGSA, Ministry of Public Health Yaoundé

piessama@yahoo.fr

17 Mr. Ndniado Boniface Coordonnateur National, Programme National de Sécurité Alimentaire, MINADER Yaoundé

ngniado@yahoo.fr

18 Prof. Tchouamo Isaac Chef de Cellule DCST/ Ministry of Scientific Research and Innovation, Yaoundé

istchouamo@aol.com

19 Prof. Agatha Tanya Faculty of Medicine and Biomedical Sciences University of Yaoundé I

agathanktanya@yahoo.com

20 Ngufor Mary NPI / Biology MINESEC Yaounde maylco_48@yahoo.com 21 Dr. Tom Agbor Egbe Deputy Director, IMPM agboregbetom@hotmail.com 22 Prof. Daniel N.

Lantum Dean, College of Biological Sciences, Cameroon Academy of Sciences Yaoundé

dlantum@camnet.cm

52

23 Mr. Hamadjoda Daniel Inspector no. 3, Ministry of Scientific Research and Innovation Yaoundé

hosteh@yahoo.fr

24 Dr. Mbouombouo P. CNE/MINRESI, Yaounde mbouomsp@yahoo.com 25 Dr. Makamto Sobgui

Christine IMPM Yaounde cmsobgui@yahoo.com

26 Dr. Etame Lucien IMPM/MINRESI Yaounde lhetame@yahoo.com 27 Ndongm Nanfack

Augustin CBSEAN/DPS, Ministry of Public Health, Yaoundé

augndongmo@yahoo.fr

28 Prof. Leke Robert Hôpital Central Yaoundé robertjleker@yahoo.fr 29 Mrs Zongo Paulin FAO Yaoundé paulin.zongo@fao.org 30 Mr. Okala Georges SAAN, Ministry of Public Health,

Yaoundé okalageorges@yahoo.fr

31 Prof. Messi Ndongo M. Louis

Inspector General, MINPROFF Yaoundé

mesmarylou@yahoo.fr

32 Mr. Issowa Aimé

Directorate of Health Promotion Ministry of Public Health, Yaoundé

issowame@yahoo.fr

33 Prof. Mbofung Carl ENSAI, University of Ngaoundere cmbofung@yahoo.com 34 Ms. Tihnje Abena

Mbah Student, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I

abene65@yahoo.co.uk

35 Dr. Jeanne Ejigui Nutrition Officer UNICEF jejigui@unicef.org 36 Dr. Denis Garnier Nutrition Specialist UNICEF

Yaoundé dgarnieer@unicef.org

37 Prof. Biwole Sida Inspector General, Ministry of Public Health, Yaoundé

38 Ms Maptouom Fotso Christiane Laure

Student, Faculty of Medicine and Biomedical Sciences University of Yaoundé I

mcchrislafotso@yahoo.fr

39 Mr. Enandjoum Inspector of Service, Ministry of Public Health Yaoundé

enandjoumbwang@yahoo.fr

40 Dr. Bahanad DAJC, Ministry of Public Health Yaoundé

41 Dr. Mounjouenpou P. IRAD Yaoundé mounjoupou@yahoo.fr 42 Mrs Grace Nde Ningo Department of Health Promotion,

Ministry of Public Health gningo@hotmail.com

43 Mr. Maina Djoulde Emmanuel

DCOOP, Ministry of Public Health

mainadjoulde@yahoo.fr

44 Dr. Nguefack-Tsague FMBS, University of Yaoundé I 45 Dr. Sajo Nana Estelle IMPM/MINRESI sajonanaes@yahoo.fr 46 Mr. Babi Kussana Head of Communication Unit,

Ministry of Public HealthYaounde

47 Dr. Menguele M.J Chef Service Santé Scolaire, 48Ministry of Basic Education Yaoundé

48 Mr. Nankap Martin Nutrition Programme Manager nankapm@hki.org

53

Helen Keller International Yaoundé

49 Mbakop Clement Directeur de F.P Yaoundé 50 Prof. Julius Oben Faculty of Science, University of

Yaoundé I juliusoben@hotmail.com

51 Dr. Aboubakar Njoya DGA/DRS IRAD, Yaoundé 52 Mr. Tata Japhet Ngol CBIN/DPS, Ministry of Public

Health Yaoundé jntata@yahoo.com

53 Dr. Kameni Anselme CS/SPEGR/IRAD Yaoundé anselmekameni@yahoo.com 54 Mr. N. Ndi MINFOPRA Norbert-lardy@yahoo.fr 55 Mr. Suh Nchang A FMBS, University of Yaoundé I abigirl22880@yahoo.com 56 Mrs. Zebaze Marie N Directorate of Health Promotion

Ministry of Public Health Yaoundé zebanoe@yahoo.fr

57 Mr. Tamwo Edgard FMBS, University of Yaoundé I newar2002@yahoo.com 58 Mr.Adamou Arouna FECOC, Yaoundé cedaeam@yahoo.fr 59 Mr.Thaddeus Ego Awa Assistant Program Officer,

Cameroon Academy of Sciences Yaoundé

ethawa_09@yahoo.com

60 Ms Lady Jeannette Secretariat Cameroon Academy of Sciences Yaoundé

61 Mr. Ndukong Ernest Secretariat Cameroon Academy of Sciences Yaoundé

62 Ngwang Pascal Secretariat Cameroon Academy of Sciences Yaoundé

63 Ms Edna Anyijap Secretariat Cameroon Academy of Sciences Yaoundé

64 Mr. Tangem Tansi University of Yaoundé II tangem_jat@yahoo.fr 65 Mr. Ayuk Narius Journalist, Ministry of Scientific

Research and Innovation, Yaoundé

66 Mr. Obono Ndongo DPS, Ministry of Public Health Yaoundé

obonoma1@yahoo.fr

67 Dr. Virgimè Owono SATAB, Directorate of Public Health, Ministry of Public Health

virgimèlise@yahoo.fr

68 Mogo Amos DCST, Ministry of Scientific Research and Innovation, Yaoundé

mogoamos@yahoo.fr

69 Prof. Jean Claude Mbanya

FMBS, University of Yaoundé I

70 Dr. Brahm Issa Sidi Chef Programme VIH-SIDA Ministry of Public Health Yaoundé

brahimis2002@yahoo.fr

71 Dr. Ndzana Anne Christine

IMPM/MINRESI abacndzana@yahoo.fr

72 Mr. Essossoa Ateba V. Mr. Apah Damain

ONG PASS Programme Action Yde Secretariat Cameroon Academy of Sciences Yaoundé

passeod2200@yahoo.fr

73 Mr. Zisuh William Secretariat Cameroon Academy of Sciences Yaoundé

zishuwilliam@yahoo.fr

54

74 Dr. Fokunang Charles FMBS, University of Yaoundé I charlesfokunang@yahoo.co.uk 75 Prof. Tetanye Ekoe Dean, Faculty of Medicine and

Biomedical Science, University of Yaoundé I

76 Mr. Essimi Bela Marcien

Journaliste, Crises and Solutions Yaoundé

ebmarcien@yahoo.fr

77 Mr. Engbwang Jean Journaliste Radio Jeunesse Yaoundé ejc@yahoo.fr 78 Mr. Essengué Blaise Journaliste Radio Venus blaise@yahoo.fr 79 Mr. Roger Mouti N. Journaliste Batele Sud mouti200@yahoo.fr 80 Mr. Christophe

Mvondo Journaliste La Nouvelle Expression Yaounde

christ_mvondo@yahoo.fr

81 Mr. Tatiana Matje Journaliste Radio Campus Regards Craires Yaoundé

clairetatiana@hotmail.fr

82 Ms Singha Journaliste Communicateur pour Jeune Yaoundé

83 Ms Claire Paule Tomo Journaliste CRTV Radio Yaoundé 84 Ms Bonglack Linda Journaliste CRTV Radio Yaoundé lbonglack@yahoo.com 85 Mr. Pascal Minyem Journaliste La Plume de l’Actualité

Yaoundé pascalminyem@yahoo.fr

86 Mr. Toni Nanyongo Journaliste CRTV Radio Yaoundé mado99us@yahoo.com 87 Ms Carine Olive Yabit Journaliste CRTV Radio Yaoundé cyabit@yahoo.fr 88 Mr. Idriss Nembouet Journaliste Canal 2 Yaoundé 89 Ms. Debean Andebe Journaliste Canal 2 Yaoundé 90 Ms Elizabeth Mosima Journaliste SOPECAM Yaoundé 91 Ms Marie Mbelle

Guichi Journaliste Le Messager Yaoundé

92 Mr. Evina Joel Journaliste African Press Yaoundé 93 Mr. Ngou Fabrice Journaliste SOPECAM Yaoundé 94 Mr. Aziz Salatou Journaliste Le Jour Yaoundé