Factors Affecting the Performance of Community Volunteers during Child Health Days in Douala, Cameroon.

Objectives: In the Littoral region of Cameroon, targeted awareness and social mobilization has increased coverage of vitamin A supplementation (VAS) during Child Health Days (CHDs) from 52.9%% in 2011 to 71.6% in 2012. Following this increase, coverage stagnated for the 2nd round of 2012 (71.0%) and the first round in 2013 (71.4%) thus falling short of the national target of 90% coverage of children 6-59 months. Methods: To determine barriers to high VAS coverage, targeted interviews were conducted with community volunteers participating in CHDs to identify factors contributing to CHD performance. Community volunteers were categorized as having "acceptable performance" or "poor performance" based whether their team met the daily target of reaching at least 120 children per day. Results: Interviews were conducted with 61 community volunteers with poor performance and 39 with acceptable performance from 6 health districts. The main factors found to influence performance were caretakers' awareness of the event and age of the volunteer (p<0.10). When asked how the campaign could be improved to reach all children, the most common response among both groups was better sensitization of parents (57%), ensuring stock (14%) and increasing the volunteer's allowance (12%). 37% of volunteers cited resistance by parents as the barrier that prevented teams from achieving universal coverage. Conclusions: Although door-to-door distribution is used to deliver services during CHDs to facilitate delivery, interviews with community volunteers indicate that better sensitization of caretakers prior to CHDs is still critical to achieving high coverage.

Vitamin A and Iron Status of Women and Young Children in Major Cities of Cameroon before and after Vitamin A Fortification of Vegetable Oil and Iron Fortification of Wheat Flour.

Objectives: Few data are available on the effectiveness of large-scale food fortification programs. We conducted representative surveys 2 y before and 1 y after introduction of vitamin A (VA)- fortified cooking oil and iron-fortified wheat flour to assess program impact on VA and iron status in urban Cameroon. Methods: In each survey, 10 different households were selected within each of the same 30 clusters in Douala and Yaoundé (n=~300/survey). Indicators of VA (retinol-binding protein, pRBP) and iron (ferritin; soluble transferrin receptor, sTfR) status, adjusted for presence of inflammation (CRP, AGP) and malaria, were assessed among women 15-49 y and children 12-59 mo. Staple food intake was measured by 1-week FFQ, and post-fortification oil and flour samples were collected. Results: Oil and flour were each consumed by >80% of participants. Post-fortification, 44% of oil (85% of "branded" oil) and 76% of flour samples were fortified. Controlling for inflammation and malaria, there was no change in pRBP between pre- and post-fortification values among women (1.41 to 1.40 μmol/L) and children (0.87 to 0.88 μmol/L), but ferritin increased (women: 37 to 47 μg/L; children: 39 to 51 μg/L, both P < 0.05) and sTfR decreased (7.7 to 6.2 and 10.6 to 8.2 mg/L, P < 0.01). Prevalence of anemia decreased among women (46 to 38%, P < 0.05) but not children. Conclusions: After 1 year of a national program, adequately-fortified products are available. Iron status indicators have increased since the initial survey; plausibility analyses will determine whether these changes are attributable to the fortification program.

Consumption of Red Palm Oil and Relationships with Vitamin A Status, Region, and Household Characteristics in a National Survey of Women and Young Children in Cameroon.

Objectives: Red palm oil (RPO) is an important plant source of vitamin A (VA) in Cameroon, where ~210,000 tons were produced in 2011. We conducted a national survey of children and women to assess the prevalence of VA deficiency, frequency and amount of RPO consumption and factors associated with RPO consumption. Methods: 1002 households, each with a child 12-59 mo and a woman 15-49 y, were enrolled in a nationally-representative cluster survey with 3 strata (North, South, Cities). VA status was assessed by inflammation-adjusted plasma retinol-binding protein (RBP). RPO consumption was measured by FFQ and 24 h recall. Results: 35% of children had low adjusted RBP. 54.9% of children and 57.8% of women consumed RPO the previous week, with a mean frequency of 12.2 times/week and 8.7 times /week among consumers, respectively. Median RPO consumption (among consumers) on the previous day was 10.7 g/d for children and 21.4 g/d for women, contributing ~1/3 of total VA intake nationally. RPO consumption was greater among women and children in the South compared with the North and Cities, but did not vary by socio-economic group. Weekly frequency of RPO intake was positively correlated with adjusted RBP among women and children nationally; however, at the regional level, the relationship was significant only among women in the South. Conclusions: Promoting RPO consumption is a potential strategy to increase VA intakes in Cameroon without increasing the risk of excessive intake. Formative research is needed to understand barriers to RPO consumption.

Predicted Impact of Large-scale Fortification on Adequacy of Vitamin A Intakes among Women and Young Children in Cameroon: Simulations Using Nationally-representative 24-h Recall Data.

Objectives: WHO recommends using information on dietary intakes to design food fortification programs, but nationally-representative, individual dietary data are rarely available in low-income countries. Prior to initiating a fortification program in Cameroon, we assessed intakes of vitamin A (VA) and fortifiable foods (vegetable oil, sugar, wheat flour, and bouillon cube), to simulate the effects of fortification with different foods and VA levels on VA intakes. Methods: In a nationally-representative, cluster survey with 3 strata (North, South, Cities), we conducted 24-h dietary recalls among 912 women 15-49 y and 883 children 12-59 mo (with duplicates in a subset). Results: Among women, 50% had usual VA intakes < 500 μg RAE/d (17% South, 99% North, 44% Cities); 58% of non-breastfeeding children had VA intake < 210 μg RAE/d (41% South, 86% North, 60% Cities). Oil fortification with 12 mg VA/kg, as currently mandated, would decrease the prevalence of inadequate intakes to 33% among women and 34% among children (73% and 55% in the North region, where VA deficiency is most common). Increasing the VA in oil or fortifying a second food would further decrease the prevalence of inadequate intakes, but would also increase the prevalence of retinol intakes above the UL, mainly among children. Conclusions: The current food fortification program can be expected to improve dietary VA adequacy among women and children in Cameroon. Modifications to the program must balance the potential to further increase VA intakes with the risk of retinol intake above the UL among children.