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Adams KP, Jarvis M, Vosti SA, Manger MS, Tarini A, Somé JW, Somda H, McDonald CM. Estimating the cost and cost-effectiveness of adding zinc to, and improving the performance of, Burkina Faso's mandatory wheat flour fortification programme. Matern Child Nutr 2023:e13515. [PMID: 37021818 DOI: 10.1111/mcn.13515] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/11/2023] [Accepted: 03/17/2023] [Indexed: 04/07/2023]
Abstract
Zinc is an essential micronutrient that promotes normal growth, development and immune function. In the context of persistent dietary zinc inadequacies, large-scale food fortification can help fill the gap between intake and requirements. Burkina Faso mandates wheat flour fortification with iron and folic acid. We used activity-based cost modelling to estimate the cost of adding zinc to the country's wheat flour fortification standard assuming (1) no change in compliance with the national standard, and (2) a substantial improvement in compliance. We used household food consumption data to model effective coverage, that is, the number of women of reproductive age (WRA) predicted to achieve adequate zinc density (zinc intake/1000 kcal) with the addition of fortification to diets. Without interventions, the prevalence of inadequate dietary zinc density was ~35.5%. With no change in compliance, the annual average incremental cost of adding zinc to fortified wheat flour was $10,347, which would effectively cover <1% of WRA at an incremental cost of ~$0.54/WRA effectively covered. Improving compliance added ~$300,000/year to the cost of the fortification programme without zinc; including zinc added another ~$78,000/year but only reduced inadequate intake among WRA by 3.6% at an incremental cost of ~$0.45/WRA effectively covered. Although the incremental cost of adding zinc to wheat flour is low ($0.01/wheat flour consumer/year), given low levels of wheat flour consumption, zinc fortification of wheat flour alone contributes marginally to, but will not fully close, the dietary zinc gap. Future research should explore potential contributions of zinc to a broader set of delivery vehicles.
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Affiliation(s)
- Katherine P Adams
- Institute for Global Nutrition, University of California, Davis, California, USA
| | - Michael Jarvis
- Independent Consultant, Washington DC, District of Columbia, USA
| | - Stephen A Vosti
- Institute for Global Nutrition, University of California, Davis, California, USA
- Department of Agricultural and Resource Economics, University of California, Davis, California, USA
| | - Mari S Manger
- International Zinc Nutrition Consultative Group, University of California, San Francisco, California, USA
- Independent Consultant, Laval, Quebec, Canada
| | - Ann Tarini
- Independent Consultant, Laval, Quebec, Canada
- IZiNCG Fortification Task Force, San Francisco, California, USA
| | - Jérome W Somé
- Institut de Recherche en Sciences de la Santé, Centre National de Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Hervé Somda
- Développement Agricole et Transformation de l'Agriculture, University of Thomas Sankara, Ouagadougou, Burkina Faso
| | - Christine M McDonald
- Institute for Global Nutrition, University of California, Davis, California, USA
- International Zinc Nutrition Consultative Group, University of California, San Francisco, California, USA
- IZiNCG Fortification Task Force, San Francisco, California, USA
- Department of Pediatrics, School of Medicine, University of California, San Francisco, California, USA
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Vosti S, Jarvis M, Johnson Q, Some J, Somda H, Tarini A, Engle-Stone R, Adams K. Estimating the Costs of Alternative Large-Scale Food Fortification Programs in Burkina Faso: A MINIMOD Tool for Informing Policy Discussions. Curr Dev Nutr 2022. [PMCID: PMC9193285 DOI: 10.1093/cdn/nzac060.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives Decisions regarding the types and amounts of micronutrients to include in large-scale food fortification (LSFF) programs should consider costs. The Micronutrient Intervention Modeling (MINIMOD) cost tool estimates the costs of alternative LSFF programs, with focus on stakeholders’ cost burdens. Methods An activity-based cost model was developed and adapted to the context of Burkina Faso. Key national characteristics (e.g., population size), and information on existing and hypothetical LSFF programs (e.g., adherence to standards) establish the model's platform. Private- and public-sector costs (as relevant) of designing, implementing, and managing LSFF are included. The model contains a micronutrient premix cost calculator. LSFF-vehicle-specific consumption patterns (e.g., g/day of fortifiable wheat flour consumed, based on household survey data) link costs to program reach. A ten-year planning time horizon is adopted. Results The premix required to fortify wheat flour with iron and folic acid (60 mg/kg of ferrous fumarate, 2.5 mg/kg of folic acid – the current standard) is estimated to cost ∼$2.11 (2020 USD) per MT of fortified flour, with overall 10-year program costs of ∼$2.4m; ∼25% faced by industry (e.g., internal quality control), ∼23% by government (e.g., external monitoring), and 52% by stakeholders who would cover premix costs (generally assumed to be industry, with some pass-through to consumers). Cost per person and cost per person reached are ∼$0.010 and ∼$0.023, respectively. Including zinc in this premix (95 mg/kg of zinc oxide) would increase the cost per MT of fortified flour to ∼$3.02, total 10-year program costs to ∼$3.3m, and cost per person and per person reached to ∼$0.014 and ∼$0.032, respectively. The premix's share of costs increased to ∼54%. Conclusions The levels and compositions of the costs should be considered when designing and managing LSFF, in part because different stakeholder groups, including consumers, will be called upon to pay them. Premix costs are one main cost driver; increasing the number and/or amounts of fortificants will increase overall program costs and shift the burden of costs among stakeholders. Funding Sources Research was supported by a grant to UC Davis from Helen Keller International through their support from the Bill & Melinda Gates Foundation.
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Kumordzie S, Davis J, Adams K, Tan X, Adu-Afarwuah S, Wessells KR, Arnold C, Becher E, Haskell M, Vosti S, Engle-Stone R, Tarini A. Understanding Patterns and Drivers of Bouillon Use in Northern Ghana to Inform Fortification Planning. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab045_037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
To explore the potential for bouillon as a micronutrient fortification vehicle in northern Ghana, we assessed market availability, household purchase and consumption of bouillon products, and perceptions of bouillon and salt.
Methods
We selected 28 clusters in the Tolon and Kumbungu districts of the Northern region of Ghana (7 urban, 4 semi-urban, and 3 rural clusters per district). Among 369 randomly selected households, women of reproductive age (15–49 y; WRA) were interviewed about household bouillon purchasing habits, its use in food preparation, and perceptions about the positive/negative effects of bouillon consumption. Twenty focus groups of 5–6 participants each were held in 11 clusters (10 WRA, 5 men, 5 women > 49y). We also assessed availability of bouillon products for sale from vendors in clusters (n = 11) and major markets (n = 4).
Results
In the survey, almost all (99%) respondents had ever cooked with bouillon, and 77% reported typically cooking with bouillon at least twice per day. Seven brands and three flavors of bouillon products were for sale. Most households (87%) reported consuming shrimp flavor without other spice most frequently. On average, households purchased bouillon cubes weekly, most from open markets (74%) or kiosks (22%). Most common reasons for bouillon use included taste (98%) and family preference (46%). Economic access was also important: 59% reported purchasing less bouillon or switching bouillon brands (28%) or flavors (11%) when they had less money available. About two-thirds of respondents perceived having bouillon in a person's diet was “good” (vs 43% for salt); reasons provided included: “gives more energy” (43%) and “makes you stronger” (41%). Among the 18% of respondents who perceived having bouillon in a person's diet was “bad”, reasons included: stomach upset (63%) and high blood pressure (39%). High blood pressure (85%) was the most common concern among the 32% perceiving salt as “bad”. Focus groups revealed seasonal variation in quantity of bouillon used.
Conclusions
Bouillon consumption is common and frequent in northern Ghana, indicating good potential as a micronutrient fortification vehicle. Understanding perceptions of bouillon by different household members will inform research and program messaging.
Funding Sources
Funded by a grant to the University of California, Davis from Helen Keller International.
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Affiliation(s)
| | | | | | | | | | | | - Charles Arnold
- Institute for Global Nutrition, University of California, Davis
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Vosti SA, Kagin J, Engle-Stone R, Luo H, Tarini A, Clermont A, Assiene JG, Nankap M, Brown KH. Strategies to achieve adequate vitamin A intake for young children: options for Cameroon. Ann N Y Acad Sci 2019; 1465:161-180. [PMID: 31797386 PMCID: PMC7187426 DOI: 10.1111/nyas.14275] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 10/21/2019] [Accepted: 10/25/2019] [Indexed: 01/05/2023]
Abstract
Meeting children's vitamin A (VA) needs remains a policy priority. Doing so efficiently is a fiscal imperative and protecting at-risk children during policy transitions is a moral imperative. Using the Micronutrient Intervention Modeling tool and data for Cameroon, we predict the impacts and costs of alternative VA intervention programs, identify the least-cost strategy for meeting targets nationally, and compare it to a business-as-usual (BAU) strategy over 10 years. BAU programs effectively cover ∼12.8 million (m) child-years (CY) and cost ∼$30.1 m; ∼US$2.34 per CY effectively covered. Improving the VA-fortified oil program, implementing a VA-fortified bouillon cube program, and periodic VA supplements (VAS) in the North macroregion for 3 years effectively cover ∼13.1 m CY at a cost of ∼US$9.5 m, or ∼US$0.71 per CY effectively covered. The tool then identifies a sequence of subnational policy choices leading from the BAU toward the more efficient strategy, while addressing VA-attributable mortality concerns. By year 4, fortification programs are predicted to eliminate inadequate VA intake in the South and Cities macroregions, but not the North, where VAS should continue until additional delivery platforms are implemented. This modeling approach offers a concrete example of the strategic use of data to follow the Global Alliance for VA framework and do so efficiently.
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Affiliation(s)
- Stephen A Vosti
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, California
| | | | - Reina Engle-Stone
- Department of Nutrition, University of California, Davis, Davis, California
| | - Hanqi Luo
- Department of Nutrition, University of California, Davis, Davis, California
| | - Ann Tarini
- Ann Tarini International Public Health Consulting, Montreal, Quebec, Canada
| | - Adrienne Clermont
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Kenneth H Brown
- Department of Nutrition, University of California, Davis, Davis, California
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Mark HE, Assiene JG, Luo H, Nankap M, Ndjebayi A, Ngnie-Teta I, Tarini A, Pattar A, Killilea DW, Brown KH, Engle-Stone R. Monitoring of the National Oil and Wheat Flour Fortification Program in Cameroon Using a Program Impact Pathway Approach. Curr Dev Nutr 2019; 3:nzz076. [PMID: 31367692 PMCID: PMC6660062 DOI: 10.1093/cdn/nzz076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/04/2019] [Accepted: 06/18/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Since 2011 Cameroon has mandated the fortification of refined vegetable oil with vitamin A and wheat flour with iron, zinc, folic acid, and vitamin B-12. In 2012, measured fortification levels for flour, and particularly oil, were below target. OBJECTIVES We assessed Cameroon's food fortification program using a program impact pathway (PIP) to identify barriers to optimal performance. METHODS We developed a PIP through literature review and key informant interviews. We conducted interviews at domestic factories for refined vegetable oil (n = 9) and wheat flour (n = 10). In 12 sentinel sites distributed nationally, we assessed availability and storage conditions of fortified foods in markets and frequency of consumption of fortified foods among women and children (n = 613 households). Food samples were collected from factories, markets, and households for measurement of micronutrient content. RESULTS Two-thirds of factories presented quality certificates for recent premix purchases. All factories had in-house capacity for micronutrient analysis, but most used qualitative methods. Industries cited premix import taxes and access to external laboratories as constraints. Mean vitamin A levels were 141% (95% CI: 116%, 167%), 75% (95% CI: 62%, 89%), and 75% (95% CI: 60%, 90%) of target in individual samples from factories, markets, and households, respectively. Most industry flour samples appeared to be fortified, but micronutrient levels were low. Among composite flour samples from markets and households, the mean iron and zinc content was 25 mg/kg and 43 mg/kg, respectively, ∼45% of target levels; folic acid (36%) and vitamin B-12 (29%) levels were also low. In the previous week, the majority of respondents had consumed "fortifiable" oil (63% women and 52% children) and wheat flour (82% women and 86% children). CONCLUSIONS In Cameroon, oil fortification program performance appears to have improved since 2012, but fortification levels remain below target, particularly for wheat flour. Consistent regulatory monitoring and program support, possibly through premix procurement and micronutrient analysis, are needed.
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Affiliation(s)
- Henry E Mark
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | | | - Hanqi Luo
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | | | | | | | | | - Amrita Pattar
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - David W Killilea
- Children's Hospital Oakland Research Institute, Oakland, CA, USA
| | - Kenneth H Brown
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Reina Engle-Stone
- Department of Nutrition, University of California, Davis, Davis, CA, USA
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Engle-Stone R, Vosti SA, Luo H, Kagin J, Tarini A, Adams KP, French C, Brown KH. Weighing the risks of high intakes of selected micronutrients compared with the risks of deficiencies. Ann N Y Acad Sci 2019; 1446:81-101. [PMID: 31168822 PMCID: PMC6618252 DOI: 10.1111/nyas.14128] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/22/2019] [Accepted: 05/03/2019] [Indexed: 12/31/2022]
Abstract
Several intervention strategies are available to reduce micronutrient deficiencies, but uncoordinated implementation of multiple interventions may result in excessive intakes. We reviewed relevant data collection instruments and available information on excessive intakes for selected micronutrients and considered possible approaches for weighing competing risks of intake above tolerable upper intake levels (ULs) versus insufficient intakes at the population level. In general, population‐based surveys in low‐ and middle‐income countries suggest that dietary intakes greater than the UL are uncommon, but simulations indicate that fortification and supplementation programs could lead to high intakes under certain scenarios. The risk of excessive intakes can be reduced by considering baseline information on dietary intakes and voluntary supplement use and continuously monitoring program coverage. We describe a framework for comparing risks of micronutrient deficiency and excess, recognizing that critical information for judging these risks is often unavailable. We recommend (1) assessing total dietary intakes and nutritional status; (2) incorporating rapid screening tools for routine monitoring and surveillance; (3) addressing critical research needs, including evaluations of the current ULs, improving biomarkers of excess, and developing methods for predicting and comparing risks and benefits; and (4) ensuring that relevant information is used in decision‐making processes.
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Affiliation(s)
- Reina Engle-Stone
- Department of Nutrition, University of California, Davis, California
| | - Stephen A Vosti
- Department of Agricultural and Resource Economics, University of California, Davis, California
| | - Hanqi Luo
- Department of Nutrition, University of California, Davis, California
| | | | - Ann Tarini
- Independent consultant, Laval, Quebec, Canada
| | - Katherine P Adams
- Department of Nutrition, University of California, Davis, California
| | - Caitlin French
- Department of Nutrition, University of California, Davis, California
| | - Kenneth H Brown
- Department of Nutrition, University of California, Davis, California
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Engle-Stone R, Nankap M, Ndjebayi AO, Friedman A, Tarini A, Brown KH, Kaiser L. Prevalence and predictors of overweight and obesity among Cameroonian women in a national survey and relationships with waist circumference and inflammation in Yaoundé and Douala. Matern Child Nutr 2018; 14:e12648. [PMID: 30047256 PMCID: PMC6174999 DOI: 10.1111/mcn.12648] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 06/04/2018] [Accepted: 06/06/2018] [Indexed: 12/28/2022]
Abstract
Information on the distribution and predictors of obesity in Africa is needed to identify populations at risk and explore intervention options. Our objectives were to (a) examine the prevalence and geographic distribution of overweight and obesity among Cameroonian women; (b) evaluate change in anthropometric indicators among urban women between 2009 and 2012; (c) examine associations between household and individual characteristics and overweight and obesity; and (d) examine relationships between body mass index (BMI), abdominal obesity, and inflammation. We analysed data from a nationally representative survey conducted in 3 geographic strata (North, South, and Yaoundé/Douala) in Cameroon in 2009 and a survey in Yaoundé/Douala in 2012. Participants selected for this analysis were nonpregnant women, ages 15-49 years (n = 704 in 2009; n = 243 in 2012). In 2009, ~8% of women were underweight (BMI < 18.5) and 32% overweight or obese (BMI ≥ 25.0). Underweight was most common in the North (19%) and overweight and obesity in the South (40%) and Yaoundé/Douala (49%). Prevalence of BMI ≥ 25.0 in Yaoundé/Douala did not differ in 2012 compared with 2009 (55.5% vs. 48.7%; P = 0.16). Residence in urban areas, greater maternal age, and TV ownership were independently related to overweight and obesity in national and stratified analyses. In Yaoundé/Douala in 2012, 48% (waist-to-hip ratio > 0.85) to 73% (waist circumference > 80 cm) had abdominal obesity. Body mass index was positively associated with abdominal obesity and inflammation. Though causal inferences cannot be drawn, these findings indicate population subgroups at greatest risk for overweight and associated health consequences in Cameroon.
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Affiliation(s)
- Reina Engle-Stone
- Department of Nutrition, University of California, Davis, California
| | - Martin Nankap
- Helen Keller International, Cameroon, Yaoundé, Cameroon
| | | | | | - Ann Tarini
- Helen Keller International, Cameroon, Yaoundé, Cameroon
| | - Kenneth H Brown
- Department of Nutrition, University of California, Davis, California.,Bill & Melinda Gates Foundation, Seattle, Washington
| | - Lucia Kaiser
- Department of Nutrition, University of California, Davis, California
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Engle-Stone R, Williams TN, Nankap M, Ndjebayi A, Gimou MM, Oyono Y, Tarini A, Brown KH, Green R. Prevalence of Inherited Hemoglobin Disorders and Relationships with Anemia and Micronutrient Status among Children in Yaoundé and Douala, Cameroon. Nutrients 2017; 9:E693. [PMID: 28671630 PMCID: PMC5537808 DOI: 10.3390/nu9070693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 06/19/2017] [Accepted: 06/26/2017] [Indexed: 02/06/2023] Open
Abstract
Information on the etiology of anemia is necessary to design effective anemia control programs. Our objective was to measure the prevalence of inherited hemoglobin disorders (IHD) in a representative sample of children in urban Cameroon, and examine the relationships between IHD and anemia. In a cluster survey of children 12-59 months of age (n = 291) in Yaoundé and Douala, we assessed hemoglobin (Hb), malaria infection, and plasma indicators of inflammation and micronutrient status. Hb S was detected by HPLC, and α⁺thalassemia (3.7 kb deletions) by PCR. Anemia (Hb < 110 g/L), inflammation, and malaria were present in 45%, 46%, and 8% of children. A total of 13.7% of children had HbAS, 1.6% had HbSS, and 30.6% and 3.1% had heterozygous and homozygous α⁺thalassemia. The prevalence of anemia was greater among HbAS compared to HbAA children (60.3 vs. 42.0%, p = 0.038), although mean Hb concentrations did not differ, p = 0.38). Hb and anemia prevalence did not differ among children with or without single gene deletion α⁺thalassemia. In multi-variable models, anemia was independently predicted by HbAS, HbSS, malaria, iron deficiency (ID; inflammation-adjusted ferritin <12 µg/L), higher C-reactive protein, lower plasma folate, and younger age. Elevated soluble transferrin receptor concentration (>8.3 mg/L) was associated with younger age, malaria, greater mean reticulocyte counts, inflammation, HbSS genotype, and ID. IHD are prevalent but contribute modestly to anemia among children in urban Cameroon.
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Affiliation(s)
- Reina Engle-Stone
- Department of Nutrition, University of California, Davis, CA 95616, USA; or
| | | | - Martin Nankap
- Helen Keller International, Cameroon, BP 14227 Yaoundé, Cameroon; (M.N.); (A.N.); (A.T.)
| | - Alex Ndjebayi
- Helen Keller International, Cameroon, BP 14227 Yaoundé, Cameroon; (M.N.); (A.N.); (A.T.)
| | | | - Yannick Oyono
- Centre Pasteur du Cameroun, BP 1274 Yaoundé, Cameroon;
| | - Ann Tarini
- Centre Pasteur du Cameroun, BP 1274 Yaoundé, Cameroon;
| | - Kenneth H. Brown
- Department of Nutrition, University of California, Davis, CA 95616, USA; or
- Bill & Melinda Gates Foundation, Seattle, WA 98102, USA
| | - Ralph Green
- Department of Medical Pathology and Laboratory Medicine, UC Davis Medical Center, Sacramento, CA 95817, USA;
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Engle-Stone R, Nankap M, Ndjebayi AO, Allen LH, Shahab-Ferdows S, Hampel D, Killilea DW, Gimou MM, Houghton LA, Friedman A, Tarini A, Stamm RA, Brown KH. Iron, Zinc, Folate, and Vitamin B-12 Status Increased among Women and Children in Yaoundé and Douala, Cameroon, 1 Year after Introducing Fortified Wheat Flour. J Nutr 2017; 147:1426-1436. [PMID: 28592513 PMCID: PMC5483962 DOI: 10.3945/jn.116.245076] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 01/31/2017] [Accepted: 05/03/2017] [Indexed: 01/21/2023] Open
Abstract
Background: Few data are available on the effectiveness of large-scale food fortification programs.Objective: We assessed the impact of mandatory wheat flour fortification on micronutrient status in Yaoundé and Douala, Cameroon.Methods: We conducted representative surveys 2 y before and 1 y after the introduction of fortified wheat flour. In each survey, 10 households were selected within each of the same 30 clusters (n = ∼300 households). Indicators of inflammation, malaria, anemia, and micronutrient status [plasma ferritin, soluble transferrin receptor (sTfR), zinc, folate, and vitamin B-12] were assessed among women aged 15-49 y and children 12-59 mo of age.Results: Wheat flour was consumed in the past 7 d by ≥90% of participants. Postfortification, mean total iron and zinc concentrations of flour samples were 46.2 and 73.6 mg/kg (target added amounts were 60 and 95 mg/kg, respectively). Maternal anemia prevalence was significantly lower postfortification (46.7% compared with 39.1%; adjusted P = 0.01), but mean hemoglobin concentrations and child anemia prevalence did not differ. For both women and children postfortification, mean plasma concentrations were greater for ferritin and lower for sTfR after adjustments for potential confounders. Mean plasma zinc concentrations were greater postfortification and the prevalence of low plasma zinc concentration in women after fortification (21%) was lower than before fortification (39%, P < 0.001); likewise in children, the prevalence postfortification (28%) was lower than prefortification (47%, P < 0.001). Mean plasma total folate concentrations were ∼250% greater postfortification among women (47 compared with 15 nmol/L) and children (56 compared with 20 nmol/L), and the prevalence of low plasma folate values was <1% after fortification in both population subgroups. In a nonrepresentative subset of plasma samples, folic acid was detected in 77% of women (73% of those fasting) and 93% of children. Mean plasma and breast-milk vitamin B-12 concentrations were >50% greater postfortification.Conclusion: Although the pre-post survey design limits causal inference, iron, zinc, folate, and vitamin B-12 status increased among women and children in urban Cameroon after mandatory wheat flour fortification.
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Affiliation(s)
- Reina Engle-Stone
- Department of Nutrition, University of California, Davis, Davis, CA;
| | | | | | - Lindsay H Allen
- Department of Nutrition, University of California, Davis, Davis, CA
- USDA, Agricultural Research Service Western Human Nutrition Research Center, Davis, CA
| | - Setareh Shahab-Ferdows
- Department of Nutrition, University of California, Davis, Davis, CA
- USDA, Agricultural Research Service Western Human Nutrition Research Center, Davis, CA
| | - Daniela Hampel
- Department of Nutrition, University of California, Davis, Davis, CA
- USDA, Agricultural Research Service Western Human Nutrition Research Center, Davis, CA
| | - David W Killilea
- Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, CA
| | | | | | | | - Ann Tarini
- Helen Keller International, New York, NY
| | | | - Kenneth H Brown
- Department of Nutrition, University of California, Davis, Davis, CA
- Bill & Melinda Gates Foundation, Seattle, WA
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Nana-Djeunga HC, Tchouakui M, Njitchouang GR, Tchatchueng-Mbougua JB, Nwane P, Domche A, Bopda J, Mbickmen-Tchana S, Akame J, Tarini A, Epée E, Biholong BD, Zhang Y, Tougoue JJ, Kabore A, Njiokou F, Kamgno J. First evidence of lymphatic filariasis transmission interruption in Cameroon: Progress towards elimination. PLoS Negl Trop Dis 2017; 11:e0005633. [PMID: 28662054 PMCID: PMC5490934 DOI: 10.1371/journal.pntd.0005633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 05/10/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is among the 10 neglected tropical diseases targeted for control or elimination by 2020. For LF elimination, the World Health Organization (WHO) has proposed a comprehensive strategy including (i) interruption of LF transmission through large-scale annual treatment (or mass drug administration (MDA)) of all eligible individuals in endemic areas, and (ii) alleviation of LF-associated suffering through morbidity management and disability prevention. In Cameroon, once-yearly mass administration of ivermectin and albendazole has been implemented since 2008. The aim of this study was to assess progress towards the elimination goal, looking specifically at the impact of six rounds of MDA on LF transmission in northern Cameroon. METHODOLOGY The study was conducted in the North and Far North Regions of Cameroon. Five health districts that successfully completed six rounds of MDA (defined as achieving a treatment coverage ≥ 65% each year) and reported no positive results for Wuchereria bancrofti microfilariaemia during routine surveys following the fifth MDA were grouped into three evaluation units (EU) according to WHO criteria. LF transmission was assessed through a community-based transmission assessment survey (TAS) using an immunochromatographic test (ICT) for the detection of circulating filarial antigen (CFA) in children aged 5-8 years old. PRINCIPAL FINDINGS A total of 5292 children (male/female ratio 1.04) aged 5-8 years old were examined in 97 communities. Positive CFA results were observed in 2, 8 and 11 cases, with a CFA prevalence of 0.13% (95% CI: 0.04-0.46) in EU#1, 0.57% (95% CI: 0.32-1.02) in EU#2, and 0.45% (95% CI: 0.23-0.89) in EU#3. CONCLUSION/SIGNIFICANCE The positive CFA cases were below WHO defined critical cut-off thresholds for stopping treatment and suggest that transmission can no longer be sustained. Post-MDA surveillance activities should be organized to evaluate whether recrudescence can occur.
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Affiliation(s)
- Hugues C. Nana-Djeunga
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
- Parasitology and Ecology Laboratory, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé 1, Yaoundé, Cameroon
| | - Magellan Tchouakui
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
- Parasitology and Ecology Laboratory, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé 1, Yaoundé, Cameroon
| | - Guy R. Njitchouang
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
| | | | - Philippe Nwane
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
| | - André Domche
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
- Parasitology and Ecology Laboratory, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé 1, Yaoundé, Cameroon
| | - Jean Bopda
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
| | | | - Julie Akame
- Helen Keller International, Yaoundé, Cameroon
| | - Ann Tarini
- Helen Keller International, Yaoundé, Cameroon
| | | | | | - Yaobi Zhang
- Helen Keller International, Regional Office for Africa, Dakar, Senegal
| | - Jean J. Tougoue
- RTI International, Washington, D.C., United States of America
| | - Achille Kabore
- RTI International, Washington, D.C., United States of America
| | - Flobert Njiokou
- Parasitology and Ecology Laboratory, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé 1, Yaoundé, Cameroon
| | - Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- * E-mail:
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Gounoue-Kamkumo R, Nana-Djeunga HC, Bopda J, Akame J, Tarini A, Kamgno J. Loss of sensitivity of immunochromatographic test (ICT) for lymphatic filariasis diagnosis in low prevalence settings: consequence in the monitoring and evaluation procedures. BMC Infect Dis 2015; 15:579. [PMID: 26700472 PMCID: PMC4690254 DOI: 10.1186/s12879-015-1317-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 12/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diagnostic tools for lymphatic filariasis (LF) elimination programs are useful in mapping the distribution of the disease, delineating areas where mass drug administrations (MDA) are required, and determining when to stop MDA. The prevalence and burden of LF have been drastically reduced following mass treatments, and the evaluation of the performance of circulating filarial antigen (CFA)-based assays was acknowledged to be of high interest in areas with low residual LF endemicity rates after multiple rounds of MDA. The objective of this study was therefore to evaluate the immunochromatographic test (ICT) sensitivity in low endemicity settings and, specifically, in individuals with low intensity of lymphatic filariasis infection. METHODS To perform this study, calibrated thick blood smears, ICT and Og4C3 enzyme-linked immunosorbent assay (ELISA) were carried out by night to identify Wuchereria bancrofti microfilarial and circulating filarial antigen carriers. A threshold determination assay regarding ICT and ELISA was performed using serial plasma dilutions from individuals with positive microfilarial counts. RESULTS All individuals harbouring microfilariae (positive blood films) were detected by ICT and ELISA, but among individuals positive for ELISA, only 35.7 % of them were detected using ICT (Chi square: 4.57; p-value = 0.03), indicating a moderate agreement between both tests (kappa statistics = 0.49). Threshold determination analyses showed that ELISA was still positive at the last plasma dilution with negative ICT result. CONCLUSIONS These findings suggest a loss of sensitivity for ICT in low endemicity settings, especially in people exhibiting low levels of circulating filarial antigen, raising serious concern regarding the monitoring and evaluation procedures in the framework of LF elimination program.
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Affiliation(s)
- Raceline Gounoue-Kamkumo
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaounde, Cameroon. .,Department of Animal Biology and Physiology, Laboratory of Animal Physiology, Faculty of Science, University of Yaounde 1, P.O. Box 812, Yaounde, Cameroon.
| | - Hugues C Nana-Djeunga
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaounde, Cameroon. .,Department of Animal Biology and Physiology, Parasitology and Ecology Laboratory, Faculty of Science, University of Yaounde 1, P.O. Box 812, Yaounde, Cameroon.
| | - Jean Bopda
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaounde, Cameroon.
| | - Julie Akame
- Helen Keller International, P.O. Box 14227, Yaounde, Cameroon.
| | - Ann Tarini
- Helen Keller International, P.O. Box 14227, Yaounde, Cameroon.
| | - Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaounde, Cameroon. .,Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P.O. Box 1364, Yaounde, Cameroon.
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Nana-Djeunga HC, Tchatchueng-Mbougua JB, Bopda J, Mbickmen-Tchana S, Elong-Kana N, Nnomzo’o E, Akame J, Tarini A, Zhang Y, Njiokou F, Kamgno J. Mapping of Bancroftian Filariasis in Cameroon: Prospects for Elimination. PLoS Negl Trop Dis 2015; 9:e0004001. [PMID: 26353087 PMCID: PMC4564182 DOI: 10.1371/journal.pntd.0004001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 07/21/2015] [Indexed: 11/18/2022] Open
Abstract
Background Lymphatic filariasis (LF) is one of the most debilitating neglected tropical diseases (NTDs). It still presents as an important public health problem in many countries in the tropics. In Cameroon, where many NTDs are endemic, only scant data describing the situation regarding LF epidemiology was available. The aim of this study was to describe the current situation regarding LF infection in Cameroon, and to map this infection and accurately delineate areas where mass drug administration (MDA) was required. Methodology The endemicity status and distribution of LF was assessed in eight of the ten Regions of Cameroon by a rapid-format card test for detection of W. bancrofti antigen (immunochromatographic test, ICT). The baseline data required to monitor the effectiveness of MDA was collected by assessing microfilariaemia in nocturnal calibrated thick blood smears in sentinel sites selected in the health districts where ICT positivity rate was ≥ 1%. Principal findings Among the 120 health districts visited in the eight Regions during ICT survey, 106 (88.3%) were found to be endemic for LF (i.e. had ICT positivity rate ≥ 1%), with infection rate from 1.0% (95% CI: 0.2–5.5) to 20.0% (95% CI: 10–30). The overall infection rate during the night blood survey was 0.11% (95% CI: 0.08–0.16) in 11 health districts out of the 106 surveyed; the arithmetic mean for microfilaria density was 1.19 mf/ml (95% CI: 0.13–2.26) for the total population examined. Conclusion/significance ICT card test results showed that LF was endemic in all the Regions and in about 90% of the health districts surveyed. All of these health districts qualified for MDA (i.e. ICT positivity rate ≥ 1%). Microfilariaemia data collected as part of this study provided the national program with baseline data (sentinel sites) necessary to measure the impact of MDA on the endemicity level and transmission of LF important for the 2020 deadline for global elimination. Lymphatic filariasis, commonly known as elephantiasis, is a parasitic disease caused by the filarial nematodes Wuchereria bancrofti, Brugia malayi and Brugia timori. It is widely distributed in the tropics where it results in a chronic and debilitating disease. Nearly 1.4 billion people in 73 countries worldwide are threatened by lymphatic filariasis, with an estimated 120 million people infected, and more than 40 million disfigured and incapacitated by the disease. Mass drug administration of appropriate chemotherapeutic agents has been successful in eliminating the infection in some endemic areas supporting the contention that global elimination of the infection has become feasible. Before targeting lymphatic filariasis for elimination, it is necessary to map its distribution in order to identify areas where treatment is required. In this present study, two surveys were carried out in each of eight Regions of Cameroon to assess the endemicity status and intensity of the infection. Lymphatic filariasis was found to be endemic in all Regions surveyed and in almost all the constituent health districts. As virtually all of these Regions and health districts were found to be eligible for MDA treatments, baseline data were also acquired that can be used by the national program for the evaluation of the success of mass drug administration on the endemicity and transmission of the disease.
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Affiliation(s)
- Hugues C. Nana-Djeunga
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
- Parasitology and Ecology Laboratory, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé 1, Yaoundé, Cameroon
| | | | - Jean Bopda
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Steve Mbickmen-Tchana
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Nathalie Elong-Kana
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Etienne Nnomzo’o
- NTD Control Program, Ministry of Public Health, Yaoundé, Cameroon
| | - Julie Akame
- Helen Keller International, Yaoundé, Cameroon
| | - Ann Tarini
- Helen Keller International, Yaoundé, Cameroon
| | - Yaobi Zhang
- Helen Keller International, Regional Office for Africa, Dakar, Senegal
| | - Flobert Njiokou
- Parasitology and Ecology Laboratory, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé 1, Yaoundé, Cameroon
| | - Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- * E-mail:
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Engle‐Stone R, Nankap M, Ndjebayi A, Friedman A, Tarini A, Brown K. Overweight is Prevalent among Cameroonian Women and is Associated with Increased Waist Circumference, Region, and Household Characteristics. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.579.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Martin Nankap
- NutritionHelen Keller InternationalNew YorkNYUnited States
| | - Alex Ndjebayi
- NutritionHelen Keller InternationalNew YorkNYUnited States
| | | | | | - Kenneth Brown
- Department of NutritionUniversity of CaliforniaDavisCAUnited States
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Tchuem Tchuenté LA, Dongmo Noumedem C, Ngassam P, Kenfack CM, Gipwe NF, Dankoni E, Tarini A, Zhang Y. Mapping of schistosomiasis and soil-transmitted helminthiasis in the regions of Littoral, North-West, South and South-West Cameroon and recommendations for treatment. BMC Infect Dis 2013; 13:602. [PMID: 24365046 PMCID: PMC3878270 DOI: 10.1186/1471-2334-13-602] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 12/17/2013] [Indexed: 11/19/2022] Open
Abstract
Background The previous nationwide mapping of schistosomiasis and soil-transmitted helminthiasis (STH) in Cameroon was conducted 25 years ago. Based on its results, mass drug administration (MDA) of praziquantel was limited to the three northern regions and few health districts in the southern part of Cameroon. In 2010, we started the process of updating the disease distribution in order to improve the control strategies. Three of the ten regions of Cameroon were mapped in 2010 and the data were published. In 2011, surveys were conducted in four additional regions, i.e. Littoral, North-West, South and South-West. Methods Parasitological surveys were conducted in March 2011 in selected schools in all 65 health districts of the four targeted regions, using appropriate research methodologies, i.e. Kato-Katz and urine filtration. Results The results showed significant variation of schistosomiasis and STH prevalence between schools, villages, districts and regions. Schistosoma haematobium was the most prevalent schistosome species, with an overall prevalence of 3.2%, followed by S. mansoni (3%) and S. guineensis (1.2%). The overall prevalence of schistosomiasis across the four regions was 7.4% (95% CI: 6.7-8.3%). The prevalence for Ascaris lumbricoides was 19.5% (95% CI: 18.3-20.7%), Trichuris trichiura 18.9% (95% CI: 17.7-20.1%) and hookworms 7.6% (95% CI: 6.8-8.4%), with an overall STH prevalence of 32.5% (95% CI: 31.1-34.0%) across the four regions. STH was more prevalent in the South region (52.8%; 95% CI: 48.0-57.3%), followed by the South-West (46.2%; 95% CI: 43.2-49.3%), the North-West (35.9%; 95% CI: 33.1-38.7%) and the Littoral (13.0%; 95% CI: 11.3-14.9%) regions. Conclusions In comparison to previous data in 1985–87, the results showed an increase of schistosomiasis transmission in several health districts, whereas there was a significant decline of STH infections. Based on the prevalence data, the continuation of annual or bi-annual MDA for STH is recommended, as well as an extension of praziquantel in identified moderate and high risk communities for schistosomiasis.
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Affiliation(s)
- Louis-Albert Tchuem Tchuenté
- National Programme for the Control of Schistosomiasis and Intestinal Helminthiasis, Ministry of Public Health, Yaoundé, Cameroon.
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Noa Noatina B, Kagmeni G, Mengouo MN, Moungui HC, Tarini A, Zhang Y, Bella ALF. Prevalence of trachoma in the Far North region of Cameroon: results of a survey in 27 Health Districts. PLoS Negl Trop Dis 2013; 7:e2240. [PMID: 23717703 PMCID: PMC3662655 DOI: 10.1371/journal.pntd.0002240] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 01/02/2013] [Indexed: 12/05/2022] Open
Abstract
Background Cameroon is known to be endemic with trachoma. To appreciate the burden of the disease and facilitate the national planning of trachoma control in the integrated control program for the neglected tropical diseases, an epidemiological mapping of trachoma was conducted in the Far North region in 2010–11. Methodology A cross-sectional, cluster random sampling survey was carried out. The survey focused on two target populations: children aged 1 to 9 years for the prevalence of active trachoma and those aged 15 and over for the prevalence of trichiasis (TT). The sample frame was an exhaustive list of villages and neighborhoods of Health Districts (HDs). The World Health Organization simplified trachoma grading system was used for the recognition and registration of cases of trachoma. Principal Findings 48,844 children aged 1 to 9 years and 41,533 people aged 15 and over were examined. In children aged 1–9 years, the overall prevalence of trachomatous inflammation–follicular (TF) was 11.2% (95% confidence intervals (CI): 11.0–11.5%). More girls were affected than boys (p = 0.003). Thirteen (13) of 27 HDs in the region showed TF prevalence of ≥10%. The overall TT prevalence was 1.0% (95% CI: 0.9–1.1%). There were estimated 17193 (95% CI: 12576–25860) TT cases in the region. The prevalence of blindness was 0.04% (95% CI: 0.03–0.07%) and visual impairment was 0.09% (95% CI: 0.07–0.13%). Conclusions/Significance The survey confirmed that trachoma is a public health problem in the Far North region with 13 HDs qualified for district-level mass drug administration with azithromycin. It provided a foundation for the national program to plan and implement the SAFE strategy in the region. Effort must be made to find resources to provide the surgical operations to the 17193 TT cases and prevent them from becoming blind. Trachoma is the leading infectious cause of blindness in the world, which is caused by repeated eye infections with the bacterium Chlamydia trachomatis. The global objective of trachoma control is to eliminate trachoma as a blinding disease worldwide by Year 2020, using the World Health Organization-endorsed SAFE strategy (Surgery to correct trichiasis, Antibiotics to treat infection, Facial cleanliness and Environmental improvement to interrupt transmission). In order to implement the control program, the knowledge of the disease distribution and prevalence in each district is essential. Disease mapping surveys were conducted in 27 health districts in the Far North region in Cameroon. Thirteen health districts have a prevalence of trachomatous inflammation–follicular ≥10% in children aged 1–9 years and qualify for district-level mass antibiotic treatment as well as intensive implementation of other components of SAFE. There are estimated to be 17193 trichiasis cases in the region, which need surgical operations to prevent from being blinded. The survey provided a foundation for the national program to plan and implement the SAFE strategy in the region.
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Affiliation(s)
- Blaise Noa Noatina
- Programme National de Lutte Contre la Cécité, Ministère de la Santé, Yaoundé, Cameroun.
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Tchuem Tchuenté LA, Kamwa Ngassam RI, Sumo L, Ngassam P, Dongmo Noumedem C, Nzu DDL, Dankoni E, Kenfack CM, Gipwe NF, Akame J, Tarini A, Zhang Y, Angwafo FF. Mapping of schistosomiasis and soil-transmitted helminthiasis in the regions of centre, East and West Cameroon. PLoS Negl Trop Dis 2012; 6:e1553. [PMID: 22413029 PMCID: PMC3295801 DOI: 10.1371/journal.pntd.0001553] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 01/18/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Schistosomiasis and soil-transmitted helminthiasis (STH) are widely distributed in Cameroon. Although mass drug administration (MDA) of mebendazole is implemented nationwide, treatment with praziquantel was so far limited to the three northern regions and few health districts in the southern part of Cameroon, based on previous mapping conducted 25 years ago. To update the disease distribution map and determine where treatment with praziquantel should be extended, mapping surveys were conducted in three of the seven southern regions of Cameroon, i.e. Centre, East and West. METHODOLOGY Parasitological surveys were conducted in April-May 2010 in selected schools in all 63 health districts of the three targeted regions, using appropriate research methodologies, i.e. Kato-Katz and urine filtration. PRINCIPAL FINDINGS The results showed significant variation of schistosomiasis and STH prevalence between schools, villages, districts and regions. Schistosoma mansoni was the most prevalent schistosome species, with an overall prevalence of 5.53%, followed by S. haematobium (1.72%) and S. guineensis (0.14%). The overall prevalence of schistosomiasis across the three regions was 7.31% (95% CI: 6.86-7.77%). The prevalence for Ascaris lumbricoides was 11.48 (95% CI: 10.93-12.04%), Trichuris trichiura 18.22% (95% CI: 17.56-18.90%) and hookworms 1.55% (95% CI: 1.35-1.78%), with an overall STH prevalence of 24.10% (95% CI: 23.36-24.85%) across the three regions. STH was more prevalent in the East region (46.57%; 95% CI: 44.41-48.75%) in comparison to the Centre (25.12; 95% CI: 24.10-26.17%) and West (10.49%; 95% CI: 9.57-11.51%) regions. CONCLUSIONS/SIGNIFICANCE In comparison to previous data, the results showed an increase of schistosomiasis transmission in several health districts, whereas there was a significant decline of STH infections. Based on the prevalence data, the continuation of annual or bi-annual MDA for STH is recommended, as well as an extension of praziquantel in identified moderate and high risk communities for schistosomiasis.
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Affiliation(s)
- Louis-Albert Tchuem Tchuenté
- National Programme for the Control of Schistosomiasis and Intestinal Helminthiasis, Ministry of Public Health, Yaoundé, Cameroon
- Laboratory of Parasitology and Ecology, University of Yaoundé I, Yaoundé, Cameroon
- Centre for Schistosomiasis and Parasitology, Yaoundé, Cameroon
- * E-mail:
| | | | - Laurentine Sumo
- Centre for Schistosomiasis and Parasitology, Yaoundé, Cameroon
| | - Pierre Ngassam
- Laboratory of Parasitology and Ecology, University of Yaoundé I, Yaoundé, Cameroon
| | | | | | - Esther Dankoni
- Centre for Schistosomiasis and Parasitology, Yaoundé, Cameroon
| | | | | | - Julie Akame
- Helen Keller International, Yaoundé, Cameroon
| | - Ann Tarini
- Helen Keller International, Yaoundé, Cameroon
| | - Yaobi Zhang
- Helen Keller International, Regional Office for Africa, Dakar, Senegal
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Hampshire RD, Aguayo VM, Harouna H, Roley JA, Tarini A, Baker SK. Delivery of nutrition services in health systems in sub-Saharan Africa: opportunities in Burkina Faso, Mozambique and Niger. Public Health Nutr 2007; 7:1047-53. [PMID: 15548343 DOI: 10.1079/phn2004641] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractBackground:In sub-Saharan Africa, underweight and micronutrient deficiencies account for an estimated 25% of the burden of disease. As the coverage of national health systems expands, increased opportunities exist to address the needs of children and women, the most vulnerable to these deficiencies, through high-quality nutrition services.Objectives:To assess health providers' knowledge and practice with regard to essential nutrition services for women and children in Burkina Faso, Mozambique and Niger, in order to assist the development of a standard guide and tools to assess and monitor the quality of the nutrition services delivered through national health systems.Findings:The three surveys reveal the extent of missed opportunities to deliver nutrition services during routine prenatal, postnatal and child-care consultations for the prevention and treatment of highly prevalent nutritional deficiencies.Conclusion:A commitment to improving the quality of facility-based nutrition services is necessary to impact on the health outcomes of women and children ‘covered’ by national health systems. Rigorous assessment and monitoring of the quality of nutrition services should inform health programme and policy development. Building on the lessons learned in these three assessments, Helen Keller International has developed a standard Guide and Tools to assess the quality of the nutrition services delivered through national health systems. These tools can be adapted to assess ongoing nutrition services in health facilities, provide a framework for nutrition programming, inform the development of pre-service as well as in-service nutrition training curricula for providers, and evaluate the impact of nutrition training on providers' practices.
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Zagré NLM, Delisle H, Tarini A, Delpeuch F. [Changes in vitamin A intake following the social marketing of red palm oil among children and women in Burkina Faso]. Sante 2002; 12:38-44. [PMID: 11943637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
This paper focuses on changes in vitamin A (VA) intakes as part of the evaluation of a pilot project on social marketing of red palm oil (RPO) as a VA supplement for mothers and children in central-north Burkina Faso. The objectives of the 30-month project are to demonstrate the feasibility and effectiveness of introducing RPO in non-consuming areas. RPO is collected from women in the South-West region and it is sold in project sites by village volunteers. RPO is promoted by community workers trained in persuasive communication and social marketing. The target population is free to buy and consume RPO. Evaluation design includes data collected at onset, then 12 and 24 months later, from the same sample of 210 mothers and their children randomly selected in seven project sites. Children were 1 to 3 years old at onset. Blood samples were collected at baseline from mothers and children for serum retinol determination by HPLC. VA intakes are estimated by a semi-quantitative food frequency questionnaire, using the conventional beta-carotene to retinol conversion factors and the newly revised lower factors. VA deficiency is a major public health problem in the area: 64% of mothers and 85% of children had serum retinol concentrations < 0,70 mumol/l at baseline. VA came mainly from plant foods, particularly fruits and dark green vegetables which provided more than 90% of the dietary VA at onset of the project. Mean vitamin A intakes are low. We found 138 106 mug ER for the children and 302 +/- 235 microg ER for the mothers with conventional factors and 64 +/- 58 microg ER and 133 +/- 162 microg ER, respectively, with the revised factors. One year later, one third of respondents had consumed RPO in the previous week, and it supplied around 56% of the VA intake of children and 67% of mothers (36% and 46% respectively for the whole group). VA intakes were significantly increased at 510 +/- 493 microg ER and 801 +/- 913 microg ER for the children and their mothers respectively (347 +/- 443 microg ER and 568 +/- 803 microg ER respectively, with the revised factors). Analyzing serum retinol and dietary data collected at baseline, it was found that VA intakes < 62,5% of safe level of intake were highly sensitive to low serum retinol (< 0,70 micromol/l) and using revised conversion factors to assess total VA intake slightly enhanced sensitivity. The proportion of mothers and children at risk of inadequate VA intake changed from nearly 100% at baseline to 60% one year later. The results show that promoting RPO (and other VA rich foods) was effective in improving VA intakes. This improvement will hopefully be sustained and even further enhanced during the remaining 12 months of the project, after which repeated measurement of serum retinol and VA intakes will allow the actual impact of the project to be truly assessed.
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Affiliation(s)
- No l-Marie Zagré
- Département de nutrition, Université de Montréal, CP 6128, succ. centre-ville, Montréal Qc H3C 3J7, Canada
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Tarini A, Bakari S, Delisle H. [The overall nutritional quality of the diet is reflected in the growth of Nigerian children]. Sante 1999; 9:23-31. [PMID: 10210799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Childhood malnutrition is widespread in the Sahel region of Africa. In Niger, the 1992 Population and Health Survey found that 32% of children under the age of five years had stunted growth and 16% had muscle wasting. Vitamin A deficiency and anemia are major health problems and it is thought that the rate of zinc deficiency is also high. However, very little is known about the dietary intakes of children. The aim of this study was to assess food consumption, energy and nutrient intake in weaned, preschool age children and to assess their risks of deficiency. Three surveys were conducted in periods of food shortage. Two of the surveys were carried out one year apart, in the rainy season (August to September). The third was conducted at the end of the subsequent dry season (July). Sixty children from rural areas (30 girls and 30 boys) aged 2 to 4 years of age at the start of the study (mean age 36.8 + 7.0 months) from the Ouallam district (western Niger) were studied in surveys 1 and 2, and thirty of these children were then studied in the third survey. Food intake was assessed using a modified weighed intake technique. All foods and beverages consumed by the child at each meal were recorded over three days. The raw ingredients of homemade family meals were weighed and the final cooked weight was also recorded. If the child ate from a shared bowl, the number of mouthfuls was counted and three mouthful samples were weighed. Total serving size was then calculated based on the number of mouthfuls and the mean mouthful weight. Snacks and meals eaten away from home were assessed by questioning the mother. Energy, protein, vitamin A, iron and zinc intakes were compared using the most relevant food composition data and the adequacy of the diet was determined from international recommendations for intake. Energy, iron and zinc requirements were adjusted for diets with a low level of digestibility. Protein requirements were adjusted according to the protein mix quality score (67%). The frequency of inadequate intake was calculated using the probability approach of Beaton (1985) or cutoff values roughly corresponding to the mean requirements for particular age/sex groups. Two overall diet scores were used: a nutritional quality score (NQS) and a diversity score (DS). The relationships between dietary intakes and scores, children's weights and heights were investigated. As expected, the children included in the study had monotonous diets, with few animal products, fats, fruits and vegetables other than green leaves (Figure 1). Cereals made up 80 to 90% of total energy, protein, iron and zinc intake. Green leaves supplied most of the vitamin A intake. Intakes were chronically inadequate, particularly during the rainy season, with only vitamin A intake being adequate (Table 1). Almost all the children were at high risk of zinc deficiency. Diet quality and diversity scores were correlated (Tables 2 and 3). About half the children had stunted growth (Table 4). Energy, protein and zinc intakes were highly and significantly correlated with the anthropometric status of the child one year later, particularly with height-for-weight Z scores, and with dietary NQS (Table 5). Both dietary scores were positively correlated with weight and height indices. However, only NQS was significantly associated with weight-for-height index, higher NQS scores being associated with higher growth indices. Diet quality also predicted the anthropometric status of the child one year later. Our findings suggest that both dietary scores are relevant but that the diversity of food eaten may be a better determinant of growth status if energy intake is close to meeting dietary requirements. Multiple dietary inadequacies are frequent among children from developing countries so scores of overall dietary quality may be more appropriate indicators than the intakes of specific nutrients. (ABSTRACT TRUNCATED)
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Affiliation(s)
- A Tarini
- Département de nutrition, Faculté de médecine, Université de Montréal CP 6128 succursale centre-ville, Montréal (Qc), Canada H3C 3J7
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