My feelings

my feeling

The internet is changing professional approaches in medicine and more generally the scientific knowledge and procedures. Using more speed and better information sharing

But the real threat remains the security isues.

Djihoua Domngue Bertrand
Ecole de Santé Publique ULB BRUXELLES

c/o : Jean Jacques KOUEMBEU

Avenue de Longwy, 185, 6700 Arlon Belgique

Cell: 00 237 77 25 41 50 (inactif pour le moment)        00 32 486 636 503 (actif )

References

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Ammaniti, M., A. M. Ambruzzi, et al. (2004). "Malnutrition and Dysfunctional Mother-Child Feeding Interactions: Clinical Assessment and Research Implications." Journal of the American College of Nutrition 23(3): 259–271.

Baker-Henningham, H., C. Powell, et al. (2005). "The effect of early stimulation on maternal depression: a cluster randomised controlled trial." Arch Dis Child 90: 1230–1234.

Be'gin, F., J.-P. Habicht, et al. (1997). "The Deterioration in Children's Nutritional Status in Rural Chad: The Effect of Mothers' Influence on Feeding." Am J Public Health 87: 1356-1359.

Bégin, F., J. E. A. Frongillo, et al. (1999). "Caregiver Behaviors and Resources Influence Child Height-for-Age in Rural Chad." Journal of Nutrition (JN) 129: 680-686.

Black, R. E., L. H. Allen, et al. (2008). "Maternal and child undernutrition: global and regional exposures and health consequences." Lancet 371: 243–260.

Casapı´a, M., S. A. Joseph, et al. (2007). "Parasite and maternal risk factors for malnutrition in preschool-age children in Belen, Peru using the new WHO Child Growth Standards." British Journal of Nutrition 98: 1259–1266.

Delpeuch, F., P. Traissac, et al. (1999). "Economic crisis and malnutrition: socioeconomic determinants of anthropometric status of preschool children and their mothers in an African urban area." Public Health Nutrition 3(1): 39-47.

El-Sayed, N., A. G. Mohamed, et al. (2001). "Malnutrition among Pre-school Children in Alexandria, Egypt." J Health Popul Nutr 19(4): 275-280.

Engle, P. L., P. Menon, et al. (1999). "Care and Nutrition: Concepts and Measurement." World Development 27(8): 1309-1337.

Galloway, A. T., L. M. Fiorito, et al. (2006). "‘Finish your soup’." Appetite 46(3): 318–323.

Golden, M. H., M. P. Samuels, et al. (2003). "How to distinguish between neglect and deprivational abuse." Archives of Disease in Childhood 88: 105-107.

Gragnolati, M., M. Shekar, et al. (2005). India’s Undernourished Children: A Call for Reform and Action. Washington, DC USA, Health, Nutrition, and Population Family - World Bank.

Harpham, T., S. Huttly, et al. (2005). "Maternal mental health and child nutritional status in four developing countries." J Epidemiol Community Health 59: 1060–1064.

Hassan, H., W. Moussa, et al. (2006). Assessment of dietary changes and their health implications in countries facing the double burden of malnutrition: Egypt, 1980 to 2005. The double burden of malnutrition Case studies from six

Conclusion

Undernutrition among under five years is still a major public health issue in Cameroon regardless the efforts registered during the past decades. It is the result of a combination of well known socioeconomic and biological factors, in association with psychological factors that are under estimated and contextual factors.


Rural areas are more at risk than urban zones and poverty is a grounded matrix with complex infractions between a wide range of factors including; child’s characteristics, mother’s features, household and family attributes and psychological determinants.

Thus the national program implementation is likely to be succesfull if this considerations are well integrated at the central level, at the operational level with a strong commitment of all the stakeholders; it is suitable to incorporate psychological approach combine with socio economical activities to improve efficiency of strategies against undernutrition

Operational research  should be part of the interventions in order to timely trace significant changes for capitalisation of good practices and improvment of less satisfactory ones.

Further studies should carry out to better highlight the psychological determinants as well as others new vision about under five year undernutrition; aiming to buld a comprehensive Infant and child survival interventions.

A Sample of Parteners

Local NGOs active in health sector


African Program for Onchocerciasis Control (APOC)
Canadian International Development Agency (CIDA)
Lions Club International Foundation (LCIF) and Sight First Program
Population Services International (known as ACMS in Cameroon)
Red Cross
Rotary International
United States Agency for International Development (USAID)
Medecins Sans Frontière (MSF)



UNICEF

UNICEF Goodwill Ambassador Ms. Farrow visited a UNICEF-supported nutrition centre in Bazzama village, eastern Cameroon



Plan Cameroon

Plan Cameroon is active in more than 14 health districts




HKI

Helen Keller International during a community based deworming (onchocerchiais)

Operational level

The 178 District Health Services whose mission is to implement national health policy and interventions in their Health District catchement area, constitute the operational level of the"ENA Appraoach". They offer health care and services according to the national health policy describe in the Sectorial Health strategy 2001 - 2015.

As such,they plan all the activities related to the health sector. They organize, implement and follow up “fight against disease” programs. they organize, implement and follow up health promotion programs. They organize the supervision of the activities of the district health service, public and private health facilities, meanwhile and the reference counter reference system. They organize, implement and follow up care in Hospitals. On a periodic base, They monitor and report the activities of all actors in the health sector of the District. They ensure epidemiological awareness in the Health District. They follow up the command and the management of pharmaceutical products and medical devices by the Health facilities. They execute and follow up investment projects. They collect, analyze and use health data. They ensure maintenance of biomedical equipments. They manage human resources. They manage vehicles. They mobilize all actors and resources for Health issues.

Overall, the health District services are key component of the hole approach and their leadership, competences, planning and management skills, coordination inovative mobilisation capacities,  as well as their expertise is a must for onership of implementation actions and sustanability of achievments.

Fight aigainst malnutrition in Cameroon

The pathway for national program

The sites of activities

National Program "Essential Nutrition Actions"

Cameroon's Ministry of Public Health is implementing a national program with the following team:

Okala Georges, Ndongmo N. Augustin, Toumamiko Barthelémy, Amadou Boukari, Nankap Martin

"ESSENTIAL NUTRITION ACTIONS" (ENA) is an operational oriented program integrating mother and child nutritional status and national environment, sumarized in the following framework.

Its specificities is:

An Integrated Program for:

Infant and young child nutrition

Mother nutrition

Micronutrient completion.

As such the following issues should be adressed:

Promotion of optimal breasfeeding

• Initiate breastfeeding within 30 minutes after birth
• Breastfeed exclusively up to 6 months
• Breastfeeding on demand, day and night, at least 10 times
• Practicing latch and position correct
• Empty one breast before switching to anotherPromotion of complementary feeding

Promotion of adequate complementary feedind

• Start complementary feeding at 6 months
• Breastfeeding until 24 months and beyond
• Increase the number of meals and variety of food with age
• Increase the density and volume with age
• Practice active feeding
• Practice good hygiene (water, food, clean hands)
• Use fortified complementary foods 

Provide nutrition care of sick and malnourish children

0 to 6 months:

• Increase frequency of breastfeeding during and after illness
• Giving zinc and vitamin A, according to the national protocol (IMCI)
• Rehydrate orally, as needed

Over 6 months:

• Increase frequency of breastfeeding during and after illness and
• Increasing the supply during and after illness
• Give an extra meal each day for 2 weeks
• Giving zinc and vitamin A, according to the national protocol (IMCI)
• Rehydrate orally, as needed
• Caring for severely malnourished children according to national protocolStart complementary feeding at 6 months

Promotion of mothers nutrition

During pregnancy and lactation:

• Increasing dietary intake: (1 meal per day during pregnancy, 2 during breastfeeding)
• Supplementing iron-folic acid (6 months)
• Preventing and treating malaria
• Deworming during pregnancy
• Take Vitamin A post within 8 weeks after childbirth 

Fight aigainst vitamine A deficiencies

• Promoting breastfeeding as a source of Vitamin A
• Promote the consumption of rich foods and foods rich in Vit A (industrial or household)
• Supplementing women after childbirth
• Supplementing the children twice a yearFight aigainst anemia

Fight aigainst anemia

• Supplementing iron-folic acid for women
• Deworming during pregnancy and children 2 times per year
• Preventing and treating malaria
• Promote the consumption of rich foods and foods fortified with iron (industrial or household)
• Delaying the umbilical cord ligation (after 2 minutes)Fight aigainst iodine deficiency disorders

 Fight aigainst iodine deficiency disorders

• Promote consumption of iodized salt by all families

Signs & Management

Clinical signs

Main characteristic: Weight for age, height for age, weight for height or BMI are below -2 z score.

Secondary characteristic: 

• Oedema
• Skin nail and hair changes
• Enlargement or tenderness of liver, jaundice
• Abdominal distension, bowel sounds, “abdominal splash” (a splashing sound in the abdomen)
• Severe pallor
• Signs of circulatory collapse: cold hands and feet, weak radial pulse, diminished consciousness
• Temperature: hypothermia or fever
• Thirst
• other signs of infections eventually

 Biological signs

They are specific to associated diseases that are usually associated

Treatment

Treatment in health facilities for severe cases

Balanced diet and treatment of secondary diseases for acute and non severe cases

Nutritional rehabilitation for the child, empowerment of families and comunities in low income settings, psychological interventions for families in chronic and endemic settings.

Conflicts and disaster management for basic causes.