Tesi sul tema "Stratégie des ménages"
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Alobo, Sarah. "Options de survie, processus de changement et transformation structurelle. Diversification des moyens de subsistance chez les ménages agricoles des régions rurales de l'Afrique sub-saharienne". Electronic Thesis or Diss., Montpellier, SupAgro, 2017. http://www.theses.fr/2017NSAM0022.
Testo completoThe overall objective of this thesis is to understand the role of diversification at household level, its patterns, determinants and effects on rural smallholder farmers in SSA, as well as its implications for the process of structural transformation in SSA. In the thesis, I use a mixed methodology and combine different types of data on rural smallholders in SSA to answer the objectives – a review of previous literature, empirical data from quantitative surveys and qualitative fieldwork. The findings are presented in three articles:In the first article, I undertake a comprehensive review of the literature on the nature and evolution of rural livelihood diversification in SSA among smallholder farmers. It reveals mixed findings about the causes and consequences of livelihood diversification on the rural smallholders adopting this strategy. It shows that because of asset constraints increase in incomes and wealth based on livelihood diversification has not yet benefitted the large majority of smallholders in SSA. On the other hand, there are a lot of evidence from the literature suggesting that it is relatively better-off smallholders with sufficient assets, who achieve successful livelihood diversification, mainly by exploiting opportunities and synergies between farm and nonfarm activities. In the second article, I investigate the spatial and geographical patterns and determinants of income diversification using cross-sectional data on rural farm households from six regions in Senegal and Kenya. In addition, I supplement the analysis of the quantitative data with information from qualitative fieldwork. The findings show that the specific patterns and determinants of diversification differ significantly between regions, with push and pull factors sometimes acting concurrently. Although geographical location matters for income diversification, the context of the region seems to matter even more, as it influences the type of diversification households may engage in. In the third article, I use panel data to explore the geographical and gender dimensions of livelihood diversification and its determinants in two agricultural regions of rural Kenya (Kakamega and Nyeri). I complement the panel data with data from my own qualitative fieldwork. The empirical investigation into the dynamics and motivations for livelihood diversification shows that whether or not household fixed effects are included in the econometric panel data models, there is a positive and significant relationship between changes in household asset wealth and changes in livelihood diversification, ceteris paribus. In addition to asset wealth, other important determinants of positive changes in livelihood diversification over the study period include: the initial level of diversification, changes in demographic factors such as age, gender (being a female headed household) and level of education of the household head (in Kakamega), and increased use of hired labour
Arnaud, Brice. "Politiques de tarification, stratégies de différenciation et gestion optimale des déchets ménagers". Thesis, Bordeaux 4, 2013. http://www.theses.fr/2013BOR40030/document.
Testo completoThis thesis examines the effectiveness of two instruments for the management of household waste : unit-pricing systems and extended producer responsibility. In a first step, we analyze the effectiveness of these two instruments using a general equilibrium model. In this model, all markets are competitive but waste disposal generates environmental damage which is the source of externalities. In the case of a unit-pricing systems as an extended producer responsibility, optimal pricing policy involves a marginal social cost of waste disposal. To internalize the cost of environmental damage, a landfill tax seems the most effective tool. In a second step, we analyze the effectiveness of social marginal cost pricing of waste management by assuming that the final market is not competitive. We represent this market by a duopoly with vertical product differentiation. Each firm produces a different quality of the same good, and consumers have different preferences for quality. In the case of an extended producer responsibility, the social marginal cost pricing of waste management does not decentralize the social optimum. An optimal policy involves the modulation of the cost that is borne by producers based on consumer preferences for quality
Agoma, Mahikiwe-Blandine. "Les choix résidentiels à Lomé à Abidjan : entre opportunités spatiales, politiques delogement et stratégies des ménages". Thesis, Paris 10, 2014. http://www.theses.fr/2014PA100032/document.
Testo completoThis research sheds light on the issue of urban residential choices through social and institutional analyzers. It begins with the observation that housing characteristics (comfort, architectural quality, location, etc.) determine the choice of residence of individuals. Residential choices are also part of a complex relationship to the land and property policies, which will force households to adapt their decisions to their needs but also to the offer. The offer is a key element that will influence the profile of households to settle in one or another area of the city. Lomé and Abidjan, cities we have chosen to conduct this reflection, perfectly illustrate through their story, the ways of appropriation of space strategies derive both from voluntary and forced choices of citizens. Based on economic and social theories and by deconstructing a unique residential model, we propose a multi-faceted approach of determinants of residential choice among West African citizens.One of the challenges of this reflection is the comparison of two cities, which was very useful to understand how residential aspirations of households fit together urban policies comparison. Ivory Coast and Togo suggest different national habitat’s policies: interventionist country policy for the Ivorian and let-go policy for the Togolese. Thus, the involvement of Ivorian leaders in the production of housing has given more opportunities to Abidjan households in their residential course. However, the need for reforms in the housing sector imposed by the economic crisis that hit most of African countries will force the country to withdraw from 1982 direct production of housing. This withdrawal allowed the resurgence of traditional regulators and private real actors with divergent interests to impose a residential strategy in many households, especially in the poor households.Regarding Lome, the lack of residential opportunities due to the let-go policy of the country will lead residential choices of households to high constraints. It is therefore necessary to question the pertinent way to follow up the implementation of ascending residential stories of households through housing policies and adapted planning in an appropriate manner. It is probably on this last point that our contribution is quite original: the plurality of residential choice factors to take into account to understand, anticipate and meet households’ needs
Tillie, Pascal. "Restructuration de l'agriculture et stratégies des ménages agricoles : le cas des producteurs de lait au Mexique". Versailles-St Quentin en Yvelines, 2011. http://www.theses.fr/2011VERS017S.
Testo completoIn Mexico, agricultural markets have been deeply reformed since the 1980s. The purpose of this thesis is to assess the impacts of the agricultural reforms on the livelihood strategies of Mexican dairy farmers. Agricultural policies and their impacts on the dairy chain have been analysed, and a survey of 236 dairy farmers was conduced in order to determine their resource portfolio and their livelihood strategy. Faced with the opening of the national market, dairy households have adopted different diversification strategies, according to their resource endowment and their income: better off households have adopted more qualified strategies, such as migration or non agricultural employment, which reduce their risk exposure and allow them to invest profit in their farm, while the poorest households have adopted less qualified strategies, such as precarious and informal employments in construction or agriculture, which increase their vulnerability and offer few upgrading opportunities
Brossollet, Cécile. "Spécialisation et représentation économique du ménage : une perspective dynamique et stratégique". Paris, EHESS, 1990. http://www.theses.fr/1990EHES0001.
Testo completoBuisson, Marie-Charlotte. "Trois essais sur la vulnérabilité des ménages ruraux dans les pays en développement : risques, stratégies et impacts". Phd thesis, Université d'Auvergne - Clermont-Ferrand I, 2012. http://tel.archives-ouvertes.fr/tel-00686812.
Testo completoKahola, Tabu Olivier. "Ménages et pratiques de la solidarité à Lubumbashi: transfert des parents, stratégies de cohésion et vie conjugale". Doctoral thesis, Universite Libre de Bruxelles, 2013. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209509.
Testo completoAussi, la valorisation excessive de la solidarité cache plusieurs récriminations dans le vécu des ménages. En privé, les conjoints ne tarissent pas des dénonciations contre l’hébergement des parents. Certains informateurs disent que l’insertion est une charge supplémentaire (ni charge). Ils déplorent également des violences verbales et physiques dont sont victimes les parents hébergés et les conjoints. D’autres, décrient les frustrations conjugales. L’exiguïté du logement et le confinement des parents font que les conjoints n’ont presque pas d’espace intime. Les solutions au logement des parents sont trouvées dans la promiscuité. Pour leurs rapports sexuels, les conjoints recourent à plusieurs tactiques de dissimulation. De même, la proximité des parents de sexe opposé occasionne des rapports sexuels interdits par la coutume. Je relève aussi entre les conjoints des pratiques d’entraide souterraine qui posent la question des limites entre la moralité et l’immoralité dans l’assistance des proches parents/ The transfer of parents is considered to Lubumbashi as a manifestation of family solidarity. However, the exchange of the parents is not as extensive vehicle discourse on solidarity. Accommodation is elective and is exercised in accordance with certain rules. I find that spouses make priority benefits to parents who had helped in the course of their lives. This contradicts the logic of speech spontaneity and free support. It fits in with against the principle of gift-giving and cons.
Also, the excessive value of solidarity hides many recriminations lived in households. In private, spouses are full of denunciations against hosting parents. Some informants say that integration is an additional charge (or charges). They also complained of verbal and physical abuse suffered by parents and spouses hosted. Others decry the marital frustrations. The cramped housing and containment of parents do that spouses have almost no private space. Solutions to the housing Parents are found in promiscuity. Their sex, spouses use several tactics of concealment. Similarly, the proximity of the parents of the opposite sex causes sex forbidden by custom. I would also between spouses practices support underground raise the question of boundaries between morality and immorality in assisting relatives.
Doctorat en Sciences politiques et sociales
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Tini, Apollinaire. "La gestion des déchets solides ménagers à Niamey au Niger : essai pour une stratégie de gestion durable". Lyon, INSA, 2003. http://theses.insa-lyon.fr/publication/2003ISAL0084/these.pdf.
Testo completoThe simple analysis it self of the two cohabiting systems, shows the problems found in the town development control and mainly financial problems that the municipality experiment and endure. After the comparative study of these two systems which depicts differences and evident lacks concerning service organisation and stakeholders role, we think that it will be illusive to imagine in short term to establish a solid waste collect and elimination system, to the city as a whole, as usual as in developed countries. Based on this hypothesis, our thesis (the new strategy) proposes to cohabit in technical, economic, social and institutional coherence, the two collecting systems. This strategy aims at making coherent the efforts of all: populations, private sector, association and other stakeholders, municipal institutions, government, sponsors. We want it to be clear and simple to be understood by all, for stimulate everyone’s action and engage everyone in a behavioural changing process. Its practice needs nevertheless a real political will and a compromise of all stakeholders true dynamical stakeholders process
Razanaparany, Sohary Manambahy. "Innovation, liens sociaux et stratégies productives des ménages ruraux malgaches : une étude de cas dans la commune rurale d'Ambalavao". Thesis, Sorbonne Paris Cité, 2016. http://www.theses.fr/2016USPCB202/document.
Testo completoThe rural population of the Malagasy Central Highlands stands for by a lifestyle which maintains a very close relationship between cultural manners an customs, social links and household economy. However, despite the introduction of innovations, those rural household are suffering from a shortage of agriculture production, and a low access to basic public services. This situation has an impact on the household economic management and in its life quality. As a result, different parameters like harvest managing, mobilization of social links, new innovating practices system must be taken into consideration. In that case, this argument concerning the rural district of Ambalavao aims at bringing knowledge how much these families manage to gather those parameters in their productive strategy and their vision of development
Sperandio, Karine. "Identification des facteurs mobilisateurs des stratégies de gestion des déchets ménagers mises en oeuvre par les collectivités locales". Lyon, INSA, 2001. http://theses.insa-lyon.fr/publication/2001ISAL0075/these.pdf.
Testo completoThe aim of this thesis is to underscore the mobilizing factors of management strategies implemented by local authorities for household waste. These factors can be identified in the present context of the law of July, 13th 1992 and of its “2002” objective. Indeed, so as to respect this objective, the local authorities have been given ten years to carry out new management strategies for waste. It is shown in this thesis that the mobilizing factors can be viewed in technical, economical, statutory, but also socio-political terms: political and administrative organization of authorities and social acceptability of the processing techniques implemented. It is assumed in the thesis that the 1992 law may not be respected by most authorities insofar as it has been integrated enough in the “territorial” parameter. Soon after the 1992 law, some though that the intercom municipal links would be the obvious political and administrative response from authorities to the technical choice of incineration. It seems to use that, because of the territorial organization and the running of local authorities, the gigantic scale of the processing installation is at present doomed. The authorities chose to turn more towards medium size installations. Finally, the strong concerns of populations in terms of public health might condemn some waste processing channels for a new years. The whole political approach to waste will have to rethought. Instead of imposing drastic recovering objectives which are the same for all, one should first decentralize the waste policy at the local level, and secondly go for a real public control of the waste processing service. In our opinion, the prospects of the management strategies for household waste at first lead to a miniaturization of the processing installations network. This miniaturization rests on the most reassuring channels in terms of public health risks. Within this context, intercom municipal links would be better accepted and thus more effective
Drevon, Guillaume. "Mobilité quotidienne et stratégies d’adaptation spatio-temporelles des ménages : une approche comparée des espaces transfrontaliers et non frontaliers des métropoles luxembourgeoises et grenobloises". Thesis, Université Grenoble Alpes (ComUE), 2016. http://www.theses.fr/2016GREAH011/document.
Testo completoThe dominant residential model frequently implies living at a distance from the workplace. Economists, geographers and sociologists have shown the consequences of such a residential choice in terms of economic costs, modal choice, environmental impacts and the socio-spatial distribution of populations. The spatial-temporal approach presented here, which has been relatively little studied until now, aims to put into perspective the different ways in which long daily journey-to-work movements are managed, notably through programming activities. It examines the spatial-temporal equation of families who have to reconcile and articulate the different spheres of daily life (work, family, journeys) in situations where time-budgets are under severe strain due to the distances involved. This research is based on the gene- ral hypothesis that the solution to this equation requires putting into place social-spatial strategies and regular adjustments, both within households and within the close social and spatial environment. The daily mobility of Luxembourg’s frontier workers, characterised by long journey-to-work movements and the crossing of a state border, represents a relevant case for analysis, where the separation between places of work and residence takes on particular and accentuated forms. Although frontiers are tending to disappear within the Schengen area, the research hypothesises that borders retain an organisational influence on the daily routines of frontier workers. The heuristic analysis grid is based on the link between experiences and perceptions from which spatial-temporal associations emerge and correspond with particular spatial life-styles. The first level of analysis which considers spatial behaviour of all Luxem- bourg frontier workers, shows strong links with the place of residence and the constrained organisation of activities based on short distances. A comparison with the spatial-temporal behaviour patterns of non-frontier workers at Voiron (part of the Grenoble metropolitan area) confirms these results and demonstrates that the activities of frontier workers take place to a greater extent around the home. The qualitative analysis points to a particularly difficult lifestyle with tensions between family and professional lives. The time-distance involved can be supported if it is associated with other forms of proximity (spatial, social or family-related). Faced with such a lifestyle, differentiated strategies of adaptation are implemented by house- holds, based on temporal, economic and social resources in association with the neighbouring environment. In these spatially determined metropolitan life patterns, the associations between social proximity and work distances create a system. Borders remain a major organisational element in daily patterns of life due to the importance of the distance between places of work and residence and the persistence of complex perceptions of neighbouring country
Dupré, Mickaël. "De l'engagement comportemental à la participation : élaboration de stratégies de communication sur le tri et la prévention des déchets ménagers". Phd thesis, Université Rennes 2, 2009. http://tel.archives-ouvertes.fr/tel-00462107.
Testo completoEckhardt, Suzanne. "Stratégies familiales et négociations entre conjoints : les choix de contraception, les choix migratoires et le soutien aux parents âgés en Indonésie". Paris, Institut d'études politiques, 2002. http://www.theses.fr/2002IEPP0008.
Testo completoMbakidi, Toko Isabelle. "Résilience scolaire :stratégies d’accrochage scolaire des adolescents congolais dans un contexte socio-économique complexe". Doctoral thesis, Universite Libre de Bruxelles, 2021. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/331904.
Testo completoSummary of the thesis :The study questions the specific factors of dropping out of school in the Congolese context.Three studies were carried out as part of this work. The results made it possible to highlight the personal and environmental factors that lead young people to enter the process of dropping out of school. Theoretical research and the results of the various investigations allow us to discuss the factors classically studied in this research framework and to highlight the factors specific to Congolese mores and customs. The research also made it possible to identify the different strategies implemented by some young people (most of whom already constitute a population at risk of dropping out of school) in order to be able to stay in school despite the unfavorable conditions of their schooling. environment. This information was drawn from two different sources: from the population of those who still cling to the system and from a population of school dropouts.
Doctorat en Sciences psychologiques et de l'éducation
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Zanuso, Claire. "Natural Disasters, Coping Strategies and Labour Market - Evidence from the 2010 Earthquake in Haiti". Thesis, Paris 9, 2015. http://www.theses.fr/2015PA090072.
Testo completoFrequency and intensity of natural and environmental disasters are on the rise worldwide. Up to 325 million extremely poor people will be living in the 49 most hazard-prone countries in 2030. Haiti proudly claims to the distinction of being the only nation whose slave population defeated a colonial power to become free and the second-oldest republic in the Western Hemisphere, yet persists as the poorest country in Latin America and Caribbean region one of the poorest and weakly governed countries in the world. Output of both an extensive fieldwork and academic research, the present thesis attempts to shed some light on the situation in Haiti after the devastating earthquake, offering four insights on the interlinkages between natural disaster, labour market and coping strategies. The introductive chapter draws the general motivation and some background information common of the four essays of this doctoral work. The first chapter presents the most up-to-date diagnosis of the labour market situation in Haiti almost 3 years after the earthquake (2012) and provide whenever possible a comparison with the situation prevailing 3 years before (2007), with a specific focus on youth. This descriptive analysis offers an overview of the general economic trends. In the following three chapters, we explore in depth the microeconomic foundations and implications of channels at play. Chapter 2 analyses the impact of earthquake on the households' decision on children's time allocation. In chapter 3, we investigate interlinkages between transfers and labour supply in the aftermath of the earthquake. Finally, chapter 4 takes the analysis of the impact of the earthquake a step forward by using longitudinal data and focuses on the long-lasting impact of the 2010 earthquake on population's livelihoods
Ngouhouo, Poufoun Jonas. "Livelihoods strategies, deforestation and biodiversity conservation : a micro econometric analysis using rural households survey in the Tridom transboundary conservation landscape". Thesis, Université de Lorraine, 2016. http://www.theses.fr/2016LORR0324/document.
Testo completoThis thesis investigates the key drivers of rural households’ choices of livelihoods, and how these choices impact forest clearing and biodiversity conservation under a landscape approach. Using a novel and unique database obtained from a face-to-face survey with a representative sample of 1035 households in the Dja-Odzala-Minkébé trinational transboundary conservation landscape (Tridom-TCL)- Congo basin , this PhD thesis address three main questions investigated in three chapters. Using a spatial probit model, the first chapter investigates “how do local and indigenous households formulate their preferences among livelihoods strategies?” Using a spatial lag model, the second chapter investigates “how and how much do these livelihoods strategies, given wildlife constrains such as human-wildlife conflicts, impact smallscale deforestation?” Using corner solution models, the third chapter investigates "how the nature of the interactions among households and wildlife, the households’ main activities as well as their land holdings impact their willingness to pay to prevent endangered forest elephant extinction?”Among other, we find that livelihoods strategies are determined by autochthonous status, financial assets (money transfer and access to loan), distance to market and larger crop losses resulting from human-wildlife conflicts. Further, we show that livelihoods strategies are important for deforestation. Therefore, the commitments to reducing small-scale deforestation may be favored by a good consideration of factors that drive households’ livelihoods strategies. We find out that spatial issues seem to be important. Proximity among households yields spatial shift effects and spatial spillover effects that are likely to amplify small-scale deforestation. We also argue that, cross-cutting solutions towards a sustainable landscape considering these three crucial issues involve optimizing trade-off between households’ livelihoods strategies, forest and the natural habitats of fauna. Therefore, the issues of community land security, of where natural habitat is needed and of how it should be managed are at the core of the problem. For example, decision-makers should proceed with the integration of large mammals mobility corridors far away from the community settlements in order to enhance zero-conflict-oriented elephant habitats; corridors should be consistently placed relatively to high elephant-concentration zones without crossing into zones with denser human populations
Lutumba-Tshindele, Pascal. "Contribution à la prise des décisions stratégiques dans le contrôle de la trypanosomiase humaine africaine". Doctoral thesis, Universite Libre de Bruxelles, 2005. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/210979.
Testo completoLa Trypanosomiase Humain Africaine (THA) demeure un problème de santé publique pour plusieurs pays en Afrique subsaharienne. Le contrôle de la THA est basé essentiellement sur la stratégie de dépistage actif suivi du traitement des personnes infectées. Le dépistage actif est réalisé par des unités mobiles spécialisées, bien que les services de santé fixes jouent un rôle important en détectant « passivement » des cas. Le dépistage reposait jadis sur la palpation ganglionnaire mais, depuis le développement du test d’agglutination sur carte (CATT), trois possibilités se sont offertes aux programmes de contrôle à savoir: i) continuer avec la palpation ganglionnaire ii) combiner la palpation ganglionnaire avec le CATT iii) recourir au CATT seul. Certains programmes comme celui de la République Démocratique du Congo (RDC) ont opté pour la combinaison en parallèle de la palpation ganglionnaire avec le CATT. Toute personne ayant une hypertrophie ganglionnaire cervicale et/ou un CATT positif est considéré comme suspecte de la THA. Elle sera soumise aux tests parasitologiques de confirmation à cause de la toxicité des médicaments anti-THA. Les tests parasitologiques classiques sont l’examen du suc ganglionnaire (PG), l’examen du sang à l’état frais (SF), la goutte épaisse colorée (GE). La sensibilité de cette séquence a été estimée insuffisante par plusieurs auteurs et serait à la base d’une grande perte de l’efficacité de la stratégie dépistage-traitement. D’autres techniques de concentration ont été développées comme la mini-Anion Exchange Concentration Technique (mAECT), la Centrifugation en Tube Capillaire (CTC) et le Quantitative Buffy Coat (QBC), mais ces techniques de concentration ne sont pas utilisées en routine.
En RDC, une interruption des activités de contrôle en 1990 a eu comme conséquence une réémergence importante de la maladie du sommeil. Depuis 1998 les activités de contrôle ont été refinancées de manière structurée.
Ce travail vise deux buts à savoir le plaidoyer pour la continuité des activités de contrôle et la rationalisation des stratégies de contrôle. Nous avons évalué l’évolution de la maladie du sommeil en rapport avec le financement, son impact sur les ménages ainsi que la communauté. L’exercice de rationalisation a porté sur les outils de dépistage et de confirmation. Nous avons d’abord évalué la validité des tests, leur faisabilité ainsi que les coûts et ensuite nous avons effectué une analyse décisionnelle formelle pour comparer les algorithmes de dépistage et pour les tests de confirmation.
Pendant la période de refinancement structurel de la lutte contre la THA en RDC (1998-2003), le budget alloué aux activités a été doublé lorsqu’on le compare à la période précédente (1993-1997). Le nombre des personnes examinées a aussi doublé mais par contre le nombre des nouveaux cas de THA est passé d’un pic de 26 000 cas en 1998 à 11 000 en 2003. Le coût par personne examinée a été de 1,5 US$ et celui d’un cas détecté et sauvé à 300 US$. Pendant cette période, les activités ont été financées par l’aide extérieure à plus de 95%. Cette subvention pourrait laisser supposer que l’impact de la THA au niveau des ménages et des communautés est réduit mais lorsque nous avons abordé cet aspect, il s’est avéré que le coût de la THA au niveau des ménages équivaut à un mois de leur revenu et que la THA fait perdre 2145 DALYs dans la communauté. L’intervention par la stratégie de dépistage-traitement a permis de sauver 1408 DALYs à un coût de 17 US$ par DALYs sauvé. Ce coût classe l’intervention comme « good value for money ».
Le recours au CATT seul s’est avéré comme la stratégie la plus efficiente pour le dépistage actif. Le gain marginal lorsque l’on ajoute la palpation ganglionnaire en parallèle est minime et n’est pas compensé par le coût élevé lié à un nombre important des suspects soumis aux tests parasitologiques. Les techniques de concentration ont une bonne sensibilité et leur faisabilité est acceptable. Leur ajout à l’arbre classique améliore la sensibilité de 29 % pour la CTC et de 42% pour la mAECT. Le coût de la CTC a été de 0,76 € et celui de la mAECT de 2,82 €. Le SF a été estimé très peu sensible. L’algorithme PG- GE-CTC-mAECT a été le plus efficient avec 277 € par vie sauvée et un ratio de coût-efficacité marginal de 125 € par unité de vie supplémentaire sauvée. L’algorithme PG-GE-CATT titration avec traitement des personnes avec une parasitologie négative mais un CATT positif à un seuil de 1/8 devient compétitif lorsque la prévalence de la THA est élevée.
Il est donc possible dans le contexte actuel de réduire la prévalence de la THA mais à condition que les activités ne soient pas interrompues. Le recours à un algorithme recourant au CATT dans le dépistage actif et à la séquence PG-GE-CTC-mAECT est le plus efficient et une efficacité de 80%. La faisabilité et l’efficacité peut être différent d’un endroit à l’autre à cause de la focalisation de la THA. Il est donc nécessaire de réévaluer cet algorithme dans un autre foyer de THA en étude pilote avant de décider d’un changement de politique. Le recours à cet algorithme implique un financement supplémentaire et une volonté politique.
SUMMARY
Human African Trypanosomiasis (HAT) remains a major public health problem affecting several countries in sub-Saharan Africa. HAT control is essentially based on active case finding conducted by specialized mobile teams. In the past the population screening was based on neck gland palpation, but since the development of the Card Agglutination Test for Trypanosomiasis (CATT) three control options are available to the control program: i) neck gland palpation ii) CATT iii) neck gland palpation and CATT done in parallel .Certain programs such as the one in DRC opted for the latter, combining CATT and neck gland palpation. All persons having hypertrophy of the neck gland and/or a positive CATT test are considered to be a HAT suspect. Confirmation tests are necessary because the screening algorithms are not 100 % specific and HAT drugs are very toxic. The classic parasitological confirmation tests are lymph node puncture (LNP), fresh blood examination (FBE) and thick blood film (TBF). The sensitivity of this combination is considered insufficient by several authors and causes important losses of efficacy of the screening-treatment strategy. More sensitive concentration methods were developed such as the mini Anion Exchange Concentration Techniques (mAECT), Capillary Tube Centrifugation (CTC) and the Quantitative Buffy Coat (QBC), but they are not used on a routine basis. Main reasons put forward are low feasibility, high cost and long time of execution.
In the Democratic Republic of Congo, HAT control activities were suddenly interrupted in 1990 and this led to an important re-emergence or the epidemic. Since 1998 onwards, control activities were financed again in a structured way.
This works aims to be both a plea for the continuation of HAT control as well as a contribution to the rationalization of the control strategies. We analyzed the evolution of sleeping sickness in the light of its financing, and we studied its impact on the household and the community. We aimed at a rationalization of the use of the screening and confirmation tools. We first evaluated the validity of the tests, their feasibility and the cost and we did a formal decision analysis to compare screening and confirmation algorithms.
The budget allocated to control activities was doubled during the period when structural aid funding was again granted (1998-2003) compared with the period before (1993-1997). The number of persons examined per year doubled as well but the number of cases found peaked at 26 000 in 1998 and dropped to 11 000 in the period afterwards. The cost per person examined was 1.5 US$ and per case detected and saved was 300 US$. The activities were financed for 95 % by external donors during this period. This subvention could give the impression that the impact of HAT on the household and the household was limited but when we took a closer look at this aspect we found that the cost at household level amounted to one month of income and that HAT caused the loss of 2145 DALYs in the community. The intervention consisting of active case finding and treatment allowed to save 1408 DALY’s at a cost of 17 US$ per DALY, putting the intervention in the class of “good value for money”.
The use of CATT alone as screening test emerged as the most efficient strategy for active case finding. The marginal gain when neck gland palpation is added is minor and is not compensated by the high cost of doing the parasitological confirmation test on a high number of suspected cases. The concentration methods have a good sensitivity and acceptable feasibility. Adding them to the classical tree improves its sensitivity with 29 % for CTC and with 42 % for mAECT. The cost of CTC was 0.76 US$ and of mAECT was 2.82 US$. Sensitivity of fresh blood examination was poor. The algorithm LNP-TBF-CTC-mAECT was the most efficient costing 277 Euro per life saved and a marginal cost effectiveness ratio of 125 Euro per supplementary life saved. The algorithm LNP-TBF-CATT titration with treatment of persons with a negative parasitology but a CATT positive at a dilution of 1/8 and more becomes competitive when HAT prevalence is high.
We conclude that it is possible in the current RDC context to reduce HAT prevalence on condition that control activities are not interrupted. Using an algorithm that includes CATT in active case finding and the combination LNP-TBF-CTC-mAECT is the most efficient with an efficacy of 80 %. Feasibility and efficacy may differ from one place to another because HAT is very focalized, so it is necessary to test this novel algorithm in another HAT focus on a pilot basis, before deciding on a policy change. Implementation of this algorithm will require additional financial resources and political commitment.
Doctorat en Sciences de la santé publique
info:eu-repo/semantics/nonPublished
Girard, Christian. "Vulnérabilité et stratégies de subsistance des microentrepreneurs et de leurs ménages dans les quartiers populaires du centre de Yaoundé, au Cameroun". Thèse, 2017. http://hdl.handle.net/1866/21115.
Testo completoFiawumor, Senyo. "Dynamiques résidentielles dans une ville ouest-africaine : déterminants du statut d'occupation du logement à Lomé (Togo)". Thèse, 2016. http://hdl.handle.net/1866/18421.
Testo completo«Adequate shelter for all and sustainable settlements development in an urbanizing world», strategy adopted in 1996 at the World Summit Habitat II of Istanbul and expressed in the Millennium Development Goals and now in Sustainable Development Goals, aims to provide a decent housing for the greatest number of households in the world and especially in sub-saharian African towns. Since then, access to adequate housing becomes an important issue for housing research in developing and sub-Saharan African countries where most of households still live in abject conditions of lack adequate water and sanitation services which, among others, typify the acute housing crisis they are facing up to. Housing policies and literature generally promote homeownership as the panacea to solve this size of the housing shortage. Assuming that this housing crisis in West Africa, especially in Lomé the capital of Togo, should be explained by the residential behavior of the households, who are self-help promoters in majority, this doctoral thesis try to answer the following general research question: Are the residential choices in Lomé, especially tenure choice, exclusively influenced by the occupier households’ characteristics? By a mixed approach of urban ecology based on multinomial logistic regression cross-study analyses applied to three data sources (RGPH4 2010, QUIBB 2011 and 2013 field survey data) supported by the life histories concerning the residential strategies of a sample of 411 households in four areas of Lomé chosen as empirical basis, the research confirms more or less the assumptions made, by the following main results: In connection with the general low residential mobility that characterizes the residential patterns in Lomé, households make their tenure choices through especially upward trajectories by developing strategies of «small steps», more according to their demographic profile (stage of life cycle, age, gender, migratory and marital status, type, size) than their socioeconomic status (income, employment, education). These residential choices are also determined by the characteristics of the existing residential parks (typology, location, access to basic services of housing). We find that owner-occupiers are often bi-parental households headed by men, older and larger than renter and free-holder households in Lomé. Native and long-term migrant households are more likely to be homeowners and long-term sharers than those who recently migrate. Homeowner households are overall well-off than free-holders, but they are not necessary wealthier and better educated than the renters. The thesis also shows that family house which mainly makes up the residential park of Lomé, is especially kept for renters, although it shelters households of all the tenures. We suggest that steady programmes of housing finance systems extended to all the sectors of the society, concentrated on the access of the current housing stock to basic services and on the supply, with the public technical support, of an improved version of family house, will largely contribute to offer a decent housing to most of the households in Lomé as elsewhere in West African cities, whether they are owner-occupiers, renters or sharers.