Rozprawy doktorskie na temat „Hébergement rural de qualité”
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Ye, Jin. "Vers un nouveau "modèle touristique chinois" ? : l'exemple du district de Songyang (province du Zhejiang en Chine)". Electronic Thesis or Diss., Amiens, 2022. http://www.theses.fr/2022AMIE0094.
Pełny tekst źródłaTourism development in China has been, and still is, based on a "quantitative" model. However, the situation is changing, especially in rural and mountainous areas, with the Chinese government's focus on rural revitalization and the increasing number of new generations of middle-class tourists. This thesis proposes to examine whether a new "Chinese tourism model" is emerging, using Songyang County as the subject of this study, a rural and mountainous region located in one of the wealthiest and most innovative provinces. This is a "qualitative" model of tourism development, moving away from the "quantitative" or "mass" logic of standardization that has been described around Chinese tourism in the past. This thesis begins by emphasizing the fundamental role of the Chinese national government and analyzes the construction of "stereotypical" tastes in tourists' landscape aesthetics to highlight the active political, cultural and aesthetic context in rural tourism development. The role of outsider urban investors and architects, as bearers of urban values and perspectives, in tourism and territorial image building has been discussed. However, we question the role of high quality rural accommodation and architecture as levers for the revelation and development of the territory. This thesis then analyzes the tourism practices of Chinese tourists in the countryside. We also question the "rusticity" and "authenticity" sought by tourists. This work is also relevant to show the exemplary and experimental value of the Songyang model to other rural areas facing development difficulties
Labarchede, Manon. "Les espaces de la maladie d’Alzheimer : conditions de vie, hébergement et hospitalité". Thesis, Bordeaux, 2021. http://www.theses.fr/2021BORD0030.
Pełny tekst źródłaInitially, the collective care of sick people suffering from Alzheimer’s disease was carried out within units dedicated to their unique behavioral characteristics. The accommodation options gradually expanded to improve their living conditions. Specialized establishments and, more recently, "innovative" projects developed that seek to promote a social and spatial integration logic.The aim of this research is to understand the link between the conditions of reception and care of sick people and the accommodation’s spatial and architectural characteristics intended for a specific population. Taking the concept of hospitality as a framework, the research is based on eight case studies: dedicated units (2), specialized EHPADs (2) and innovative projects (4). The methodology combines semi-directive interviews (42) and in-situ observations (200h). Three parts report the results of our work.The first part develops the idea that the need for collective housing adaptation to the affected people’s specificity progressively emerged under a triple pressure: that of professionals in the field; that of public policies with the implementation of Alzheimer's plans; that of gerontological institutions and their desire for change.The second part further puts in perspective the sociology of aging with spatial analysis. It provides a framework to understand the conditions in which patients are received and characterizes the hospitality in place. Hospitality appears to be controlled, within dedicated units; "autarcised" in the case of specialized EHPAD; and “included” in innovative projects.Finally, the last part crosses the patients’ residential trajectories with their living environment’s hospitality. The domestic frame of reference ends when home becomes an inhospitable. Then, the more or less anticipated transition to a collective accommodation establishment changes the reference point. This new, more adapted living environment, is nonetheless challenged by the progression of the disease.In conclusion, this thesis demonstrates the multiple tasks of architecture, operating as a grid for reading social processes; as a factor of change; as an inclusive element; and as a support for a rethought domesticity
Anaba, Ebanda Valéry Armel. "Contribution à l'analyse de la relation qualité perçue - satisfaction dans les services d'hébergement touristique". Phd thesis, Université de Bourgogne, 2010. http://tel.archives-ouvertes.fr/tel-00717829.
Pełny tekst źródłaGanne, Claire. "Le devenir des enfants accueillis en centre maternel : approche écologique du parcours et de la qualité de vie des enfants sept ans après la sortie d'un hébergement mère-enfant". Phd thesis, Paris 10, 2013. http://tel.archives-ouvertes.fr/tel-00923314.
Pełny tekst źródłaOussoulous, Nada. "L’émergence d’une destination de tourisme rural et rôle des résidents étrangers : le cas du pays d’Ouarzazate". Thesis, Montpellier 3, 2019. http://www.theses.fr/2019MON30004/document.
Pełny tekst źródłaThe project aims to analyze the processes and the mechanisms that are responsible of the emergence of an interior destination and also the relationship between tourism, that is considered here as a back-tourism countries, and also the other coastal destination. The principal objective is to evaluate how these territories tend to become autonomous in relation to urban and coastal destinations, The chosen land for the purposes of this research is the Draa oasis area of southern and valleys of the high atlas. This research also includes assessing the coherence and coordination mechanisms between the different actors involved in the light of the extreme diversity of representations of heritage, identity and economic challenges resulting from tourism developing process and patrimonialisation. Among the actors who are behind these dynamics in this land, investors have an important place. Our research proposes to discuss many questions through these investors who are foreign persons installed in the area and primarily invest in acquisitions or restore the old Kasbahs and ksours to use it as a guest house. Through their projects, the foreign investors develop a new activity. Through the holders of foreign projects, we propose addressing issues concerning the profile and role of these actors, the motivations of their installation and investment in the interior destination, mutual perceptions (indigenous and foreign population), and then the realization of tourism process through the foreign image
Issa, Carine. "Régime méditerranéen traditionnel et adiposité dans un échantillon rural au Liban, et qualité nutritionnelle des plats composés". Aix-Marseille 2, 2009. http://www.theses.fr/2009AIX20705.
Pełny tekst źródłaThe traditional Mediterranean (Med) diet has been widely documented for its benefits in the prevention of chronic diseases. Unfortunately, in Lebanon, as in other Med countries, the traditional diet is eroding toward a more westernized diet. This detrimental evolution is accompanied by an increased prevalence of obesity. However, rural areas seem to be experiencing a smoother nutrition transition. In this context, two complimentary studies were performed to document the diet characteristics of a rural sample in Lebanon and the relationship with adiposity. First, we aimed to test the hypothesis that adherence to a traditional Med diet was associated with a lower prevalence of body adiposity in this rural sample. Secondly, we aimed to determine the global nutritional quality of traditional Lebanese dishes as compared to dishes most consumed in France, based on the new concept of nutrient profiling. The findings demonstrated an inverse association between diet quality and adiposity markers (namely, Body Mass Index and Waist Circumference) when dietary quality was assessed with a new Composite Med score, including both positive components of the diet (i. E. Whole grain and cereal products, vegetables, fruit) and negative components adapted to our sample (i. E. Refined grain and cereal products, liquid sweets), along with positive key components of the Med diet (i. E. Legumes, olive oil, and fish). Results of the second part of our work showed that the mean of vegetable and unrefined starches contents combined represented more than 50% of total weight in composite dishes from Lebanon (LD) and only 25% in dishes consumed in France (FD). LD were significantly richer in vitamin C than FD and had significantly lower content in saturated fatty acids and sodium than FD. Thus, traditional Lebanese dishes were found to generally have a good nutritional quality with twice as many LD as FD belonging to the most favorable nutrient profile class. The nutrient profile perspective suggested that the rich traditional cuisine heritage of Lebanon has the potential to improve dietary diversity and healthy eating. Moreover, our results support the concept that adherence to a Mediterranean-type diet is associated with reduced general and abdominal adiposity. Overall, our work suggests that the reintroduction of traditional dietary habits in Mediterranean countries could slow down the increasing trend toward overweight and obesity, and thus prevent detrimental health consequences in populations of this region
Chamodot, Mathilde. "Pour un habitat écoresponsable de qualité et financièrement accessible en Saône-et-Loire". Phd thesis, Université de Grenoble, 2013. http://tel.archives-ouvertes.fr/tel-00967898.
Pełny tekst źródłaMoalla, Mehdi. "La différenciation des produits et services touristiques par la qualité et le territoire : une application aux services touristiques et environnementaux territorialisés". Grenoble 2, 2005. http://www.theses.fr/2005GRE21027.
Pełny tekst źródłaGranval, Philippe. "Approche écologique de la gestion de l'espace rural : des besoins de la Bécasse (Scolopax rusticola L.) à la qualité des milieux". Rennes 1, 1988. http://www.theses.fr/1988REN1A002.
Pełny tekst źródłaHoarau, Christelle. "Contribution à l’analyse de la qualité environnementale d’un projet d’aménagement périurbain/rural en milieu tropical : méthodes et outils d’aide à la décision". Thesis, La Réunion, 2017. http://www.theses.fr/2017LARE0042/document.
Pełny tekst źródłaSignificant industrial development, strong population growth, intensive urbanization,expansion of road, air and sea transports are all factors that contribute to the exhaustion of natural resources, land and climate change. The combination of the 3 strategic pillars of sustainable development : environment, economy and social, in the deployment of complementary policies contributes to the reduction of greenhouse gases emissions and environmental impacts.The standardization of the sustainable development principles is difficult to implement. It depends on the context of a the studied country or territory. The ecological and energy transition requires a eco-mangement frame of reference adapted to the specificities and stakes of the concerned territories. This work contributes to the development of a surburban site in a tropical islandenvironment, around activities in the primary, secondary, and tertiary sectors. In this context, several analysis tools have been developed to meet the requirements of an eco-management scheme, including technical and environmental analyzes and the overall evaluation of an eco-management scheme. These tools provide local and regional actors to analyze the environmental impacts of a project and to evaluate different development alternatives. In addition to the decision-supporttools, a methodological approach is proposed in this thesis, based on the systemic and typological approaches and the ISO 14044 normative framework relating to Life Cycle Assessment
Xue, Chaoyang. "Les sources de HONO atmosphérique rural et leur impact sur la qualité de l'air régional dans la Plaine de Chine du Nord". Electronic Thesis or Diss., Orléans, 2020. http://www.theses.fr/2020ORLE3107.
Pełny tekst źródłaAir pollution is still an environmental problem that urgently needs to be solved in the North China Plain (NCP). With the aim to explore nitrous acid (HONO) formation and its impact on regional air quality in the NCP, the development and systematic assessment of instruments to measure atmospheric HONO concentration and soil HONO emission flux were realized. Based on field measurements, a 3D chemistry-transport model (the Community Multiscale Air Quality Modeling System, CMAQ) and a box (0D) model (Master Chemical Mechanism, MCM) were used to explore the HONO budget and its impact on regional air pollution, e.g., summer ozone (O3) pollution and winter haze pollution. We found that agricultural soil was an important HONO source with a significant impact on regional O3 pollution in the summertime. A new soil HONO emission mechanism related to nitrification was proposed. HONO also plays an important role in atmospheric oxidizing capacity and deteriorating regional air quality in the wintertime
Foti, Ludovic. "Évaluation des effets de la pression urbaine sur la qualité des sols de la région Île-de-France sous deux types de végétations (pelouses et bois)". Thesis, Paris 6, 2017. http://www.theses.fr/2017PA066481/document.
Pełny tekst źródłaIn a world where more than half of the world's population lives in cities, green spaces are a fundamental component of the urban landscape, providing many environmental services (e.g. air and water purification, wind and noise filtering, urban heat island attenuation), but also social and psychological services (e.g. development of social bonds, stress reduction) which are of crucial importance for the habitability of modern cities and the well-being of urban dwellers. The effectiveness of ecological services provided by green areas in the city depends on the quality of their soils and their general functioning, but also on the abiotic and biotic conditions in which they are located. Numerous studies have highlighted the direct and indirect impact of human activities on urban soils. The anthropogenic pressures they undergo alter their characteristics in a complex way, thus affecting their quality. Urban soil quality is therefore a major challenge for the sustainability of the cities of tomorrow. This thesis project sought to assess the urban pressure effects on the soil quality components of the Paris region public green spaces through the use of an innovative urban pressure gradient, and according to two land-use types (lawns and woods). Secondly, this work also sought to determine whether differential scanning calorimetry coupled with evolved gaz analyzer (DSC–EGA) was a suitable method for assessing the organic matter of urban soils (SOM), and on a regional scale. All soils selected in this thesis project are classified as Anthrosol
Cheyns, Emmanuelle. "Identification et construction sociale de la qualité de produits agro-alimentaires : Le cas de l'alimentation urbaine au Burkina Faso". Montpellier, ENSA, 1998. http://www.theses.fr/1998ENSA0022.
Pełny tekst źródłaLoudiyi, Salma. "Les hébergements touristiques dans les campagnes d'Auvergne". Clermont-Ferrand 2, 2003. http://www.theses.fr/2003CLF20003.
Pełny tekst źródłaFor the study of tourism in rural areas, the author made up one's mind to analyse the tourist accomodations in Auvergne's countryside and its spatial dynamics. She is supposing at first, that tourism can really regenerate rural areas by its attraction ability. Theme after theme, she's clearly showing opposite facts so as theories about tourism development becomes unsound reasoning. The main argument is assuredly the presence of a well-structured, recognised tourism and not "rurality". Tourist accommodations spatial dynamics show a progressive concentration in the West after tourism had neglected eastern rural areas, specifically the ancient bastions. Tourism as a "panacea" became therefore out of question
Rousseau, Guillaume. "Analyse de l'isolement social, de la sociabilité et de la qualité du soutien social chez les jeunes agriculteurs québécois". Thesis, Université Laval, 2010. http://www.theses.ulaval.ca/2010/27038/27038.pdf.
Pełny tekst źródłaSabbah, Ibtissam. "Etat de santé et qualité de vie au sud Liban en fonctiondu lieu d'habitation et du genre : adaptation et validation du SF-36 en arabe et d'un index de précarité". Besançon, 2003. http://www.theses.fr/2003BESA3089.
Pełny tekst źródłaDuring year 2000, a study was conducted in South Lebanon on a representative sample with a dual objective: l) adapt into Arabic and validate the SF36 and an index of deprivation. 2) describe the self reported morbidity and the quality of life and analyze the determinant factors, in particular the area of residency (urban vs. Rural) and gender. 1632 persons residing in 347 houses were analyzed and 524 randomly picked to study their quality of life and self reported morbidity. The cultural adaptation and validation of the SF36 followed the International Quality of Life Assessment methodology. The psychometric features of reliability and validity of the Arabic version of SF36 are satisfactory and similar to the original English version. The validation of the Living Condition Index Modified (LCIM), deprivation index was performed on the sample of 347 houses. Multivariate analysis shows that the self reported morbidity is related to different sociodemographic and environmental factors, the area of residency having minor influence, the quality of life of women as well as their health was less than those of men, whatever was their age. The results of the study show that the use of simple and robust instruments of evaluation on populations is an essential prerequisite to elaborate health programs, particularly in countries in an epidemiological transition like Lebanon
Ouedraogo, Nikiema Laetitia. "Efficacité d'une approche de counseling centré sur le patient dans la prévention et le traitement de la malnutrition aiguë modérée du jeune enfant, en milieu rural, au Burkina Faso". Doctoral thesis, Universite Libre de Bruxelles, 2017. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/261993.
Pełny tekst źródłaDoctorat en Sciences de la santé Publique
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Ngirabega, Jean de Dieu. "La malnutrition et la santé de l'enfant en milieu rural au Rwanda: gestion du suivi de la croissance à base communautaire". Doctoral thesis, Universite Libre de Bruxelles, 2010. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/210105.
Pełny tekst źródłaLes enfants survivants ont des conséquences à moyen/long terme qui comprennent une vulnérabilité accrue aux infections, une diminution des capacités intellectuelles et des capacités de production ainsi que des risques élevés de complications en cas d’accouchement pour les futures mères. L’intégration de la nutrition dans les stratégies de développement économique et de réduction de la pauvreté dans le cadre des OMDs témoigne que les pays en développement comprennent de plus en plus l’impact d’une bonne nutrition de la population sur le développement durable.
Cependant l’efficacité avec laquelle de telles stratégies se mettent en œuvre pour cibler les milieux ruraux qui sont les plus touchés par la malnutrition reste faible dans beaucoup de pays. Les efforts fournis ne semblent pas correspondre à l’ampleur du problème de malnutrition. De plus, dans beaucoup de ces pays, les conditions nécessaires à la réussite de ces stratégies ne sont pas réunies. Le contexte sociopolitique n’est pas souvent favorable et les capacités de mise en œuvre sont faibles. Par ailleurs les principaux décideurs politiques à tous les niveaux du système ne sont pas suffisamment sensibilisés sur l’ampleur du problème de la malnutrition. Pourtant il y a des interventions simples de lutte contre la malnutrition infantile qui ont prouvé leur efficacité et efficience et qui sont à la portée des pays pauvres. Les pratiques d’alimentation optimale du nourrisson et du jeune enfant comprenant la mise au sein des nouveaux-nés endéans l’heure qui suit l’accouchement, l’allaitement maternel exclusif pendant les 6 premiers mois, l’allaitement jusqu'à au moins deux ans et une bonne utilisation des aliments de complément constituent un bon exemple. Elles peuvent avoir un impact sur la survie des enfants en prévenant à elles seules jusqu’à 19% des décès survenant avant cinq ans dans les pays en développement.
Néanmoins de telles informations ne sont pas toujours connues par ceux qui auraient le pouvoir d’opérer les changements au niveau des communautés. L’objectif général de ce travail est de fournir les informations sur l’ampleur de la malnutrition chez les enfants en milieu rural au Rwanda et de documenter le processus de mise en oeuvre du suivi de la croissance à base communautaire, une des stratégies de promotion d’une bonne nutrition et d’une bonne santé des enfants.
METHODOLOGIE:
Le présent travail est basé sur une série d’études réalisées depuis l’année 2004 dans la zone de rayonnement de l’hôpital rural de Ruli au Rwanda. Il a regroupé les études suivantes:
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Doctorat en Sciences médicales
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Plain, Nicolas. "Micro-réseaux d'électricité 100% solaire et isolés en Afrique. Eléments de dimensionnement, coût de l'électricité, dépendance au climat régional et au profil de demande Accounting for low solar resource days to size 100% solar microgrids power systems in Africa". Thesis, Université Grenoble Alpes, 2020. http://www.theses.fr/2020GRALU013.
Pełny tekst źródłaThe joint achievement of the United Nations sustainable development goal n°7 aiming at access to clean and reliable energy for all by 2030 and the climate objectives of the Paris agreement requires the development of microgrids (MG) powered by local renewable energy resources for isolated areas that cannot be connected to the grid. This is particularly the case in Sub-Saharan Africa where 600 million people, mainly in remote rural areas, do not have access to electricity. This thesis focuses on the analysis of solar MG not connected to the grid to meet the challenges of electricity generation in isolated areas in Africa. The socio-technical feasibility specific to these MG is based on a strong temporal adequacy between the solar resource and the demand while limiting the cost of the electricity supplied to the consumers.We first explore the multiscale temporal variability of the local solar resource in Africa and its implication on the MG sizing, using high-resolution satellite data of global horizontal irradiance for a 21-year period (1995-2015). The low percentile values of the solar resource give a first guess on the size of the solar panels surface required for the microgrid to achieve a given quality service. We show that the usual sizing of microgrids based on the average solar resource is underestimated. Taking into account low resources periods leads to oversizing the photovoltaic (PV) surface by a factor of 1.3 to 4. With such an oversizing, it is possible to ensure a good quality of service without relying on a large amount of storage. For certain areas, some demand flexibility during low resource periods would make it possible to reduce significantly the sizing.We then analyze how the potential seasonality of electricity demand impacts the size of fully solar-powered microgrids, through the analysis of the co-variability structure between solar resource and demand. We consider that the MG has to meet total daily demand at least 95% of days and a seasonal variation in demand of up to 30%. While in some parts of Africa the size required to meet seasonal demand is 20% lower than what is needed to meet non-seasonal demand, it may also be 20% higher. We also explore to what extent the effect of PV panels tilt angle could reduce the resource supply-demand mismatch and the sizing. Usually the tilt angle is equal to the latitude. For a constant daily demand, the gain in size achieved by optimizing tilt angle is generally less than 4%, but for specific seasonal demand patterns, it may reach 9%. In a number of locations, focused surveys and analysis to estimate the temporal structure of demand would nevertheless yield significant gains in MG size.Finally, the cost of electricity required to ensure a good quality of service is a determining factor of the potential deployment of solar MG. We evaluate the sensitivity of the levelized cost of electricity (LCOE) and of the MG optimal configuration (i.e. with the lowest LCOE) to solar panels and battery costs and to other economic parameters. If the sensitivity of the LCOE to updated costs is obviously large, the optimal configuration (surface of PV panels and storage capacity) is very robust. The optimal configuration is almost only determined by the temporal co-variability structure between the resource and the demand. It is thus dependent on the one hand on the regional climate, and on the other hand on the temporal structure of the demand. The adjustment variable is essentially the PV panels oversizing, which is based on the low solar resource days while storage has the main function of managing the resource-demand mismatch at sub daily level. One interesting result is the significantly lowest LCOE to ensure productive uses compared to domestic uses only because of the lower storage capacity required for productive uses. Such results have direct implications for all operational and institutional actors involved in the deployment of energy access in remote areas in Africa
Verger, Antonia. "Pauvreté des ménages et pauvreté de l'école face aux objectifs de l'éducation primaire universelle : étude de cas de deux villages et deux écoles publiques des Hautes Terres Malgaches". Thesis, Sorbonne Paris Cité, 2017. http://www.theses.fr/2017USPCB209/document.
Pełny tekst źródłaMadagascar is one of the poorest country in the world regarding its GPD per capita. Most of its population lives under the poverty line. The government is committed in the education for all plan since 1990. However, the quality of education is still low. In 2012, only 68.8% of the children achieved the primary school cycle, there are high repetition rates and few students access to the secondary school cycle. Most of international institution and NGO's oppose child labor and schooling. Child labor remains important, in 2010, 21% of the children aged from 5 to 17 years old work. We have conducted a survey about the households living in the rural zones. Most of them live from subsistence farming activities. Their children must participate to the domestic chores and economic activities and combine school at the same time. This work aims to understand the process of schooling and child work in a rural zone. We have collected quantitative data on 246 household and we made an ethnography in a primary state school for 14 months. Then, we have conducted semi-structured interviews with mothers, teachers and children aged from 8 to 14 years old. The quantitative data helped to analyze the relationship between the household demographic structures and the children school attainment. The ethnography shown the impact of a weak quality of education on the children learning process and on the school demand. The interviews conducted with the children shown how their perception of work and schooling and their aspiration could influence the reproduction of their economic and social position. To conclude, we question how the primary education for all can be reached when most of the household live in poor life conditions and the education sector suffers from a lack of funds. Can the school system stop the transmission of social and economic inequalities and break the poverty cycle?
Schoemaker-Marcotte, Camille. "La qualité des soins obstétricaux en milieu rural malien : une étude exploratoire". Thèse, 2013. http://hdl.handle.net/1866/9853.
Pełny tekst źródłaTo improve maternal health, it is essential to implement interventions that act on the intrapartum period, interventions that consist essentially in improving access to obstetric and neonatal emergency care (EmOC). Nevertheless, several countries that have turned to such interventions encounter significant challenges in their implementation and the high rates of maternal mortality persist. This study aims to identify characteristics of structure and process in community health centers (CSCOM) where maternal deaths have occurred and to compare these characteristics with those of CSCOM where no maternal deaths have occurred. We opted for an exploratory comparative approach of CSCOM with patients with different outcomes and different human resources configuration. The study population corresponds to CSCOMs of Kayes region in which obstetric emergencies were managed. The main focus of this study is on human resources, availability of equipment, supply and medicine, and on the level of knowledge of health care providers in these health centers. Our data analysis revealed that there are large disparities in resources available at the CSCOM level. Yet, these resources are needed in order to adequately manage obstetric emergencies. Although none of the CSCOM characteristic can be associated with adverse outcomes, the accumulation of deficits in human and material resources as well as the lack of knowledge of certain categories of staff suggests that the poor quality of obstetric care may threaten the parturient survival.
Bédard, Sylvain. "Espace, qualité de vie et quête d'authenticité : l'attractivité des territoires ruraux québécois". Mémoire, 2009. http://www.archipel.uqam.ca/2183/1/M10819.pdf.
Pełny tekst źródłaAdjiwanou, Visseho. "Contexte de genre, autonomie des femmes et utilisation des services de santé maternelle en milieu rural africain : analyse par modèles d’équations structurelles". Thèse, 2013. http://hdl.handle.net/1866/10336.
Pełny tekst źródłaIn Africa, the lives of women and their offspring continue to be threatened at every birth because of the underuse of maternal health care. It is estimated that every year about a quarter of a million the number of maternal deaths and nearly four million children die before age five. Comparing the health patterns in sub-Saharan Africa with other contexts helps to better understand the reality of sub-Saharan Africa, where the risk of death in pregnancy is of the order of 1 to 31, while it is only 1 per 4300 in industrialized countries. This situation is preventable and most often is the result of under or non-use of maternal health services, lack of adequate health care facilities or skilled health personnel. This thesis seeks to understand how gender inequality within the household and in the community reinforces inequalities in the use of maternal health services, as well as the empirical relationship linking the various types of maternal health care uptakes. Specifically, it aims to 1) provide a measure of gender norms favorable to violence against women and to analyze its influence on women’s decision-making authority within the household, 2) simultaneously analyze the impact of these gender norms along with the women’s decision-making authority on the use of antenatal care and delivery assistance, and finally, 3) determine the influence of antenatal care on the use of assisted delivery. Each of these objectives faces substantial methodological issues, either measurement or selection bias, which the structural equation modeling approach we adopted overcomes. The results of our analysis, in the form of scientific articles, are based on the data from Demographic and Health Surveys (DHS) of Ghana, Kenya, Uganda and Tanzania and are related to women living in rural areas. Our first article provides a measure of gender norms and, more specifically, those related to violence against women by using the approach of latent variables. The five questions of the DHS on women's attitudes about the legitimacy of violence allowed measuring these gender norms at contextual level. The results suggest that this measure has good validity criteria as the Cronbach's alpha ranged from 0.85 to 0.94 for Kenya to Ghana, the chi-square is insignificant everywhere, the RMSEA is below 0.05 and the CFI above 0.96 and saturation are mostly higher than 0.7 in all countries. On the other hand, using multilevel structural equation modeling, we found that beyond their own attitude toward violence against women, women who live in an environment where gender norms are more favorable to violence are more likely to be of low or no decision-making autonomy (compared to high decision-making autonomy) in all the countries studied. The second Article documents the influence of the gender inequality identified at the contextual level by the gender norms favorable to violence against women and at the individual level by the women’s autonomy of decision-making within the household, on the occurrence of antenatal care during the first quarter, and the use of at least four antenatal care and assisted delivery with skilled professional. Also using multilevel structural equation modeling on the same data of article 1, we find that each of these dependent variables is strongly influenced by the cluster in which the woman lives. In other words, her place of residence determines the maternal health behavior she adopts. Similarly, controlling for other variables, our results show that women who live in an environment where gender norms related to violence against women are higher, have on average, a greater chance of not giving birth with a qualified staff in Ghana and Uganda, of not starting their antenatal care in the first trimester in the same countries, and of not reaching at least four antenatal care visits in Tanzania. By cons, this contextual variable does not significantly affect the use of maternal health care in Kenya. Finally, the results show that norms in favor of gender violence against women are more critical to understand the use of maternal health care in the countries studied than the women’s decision-making autonomy. Chapter VII is the last empirical paper of the thesis and examines the effects of prenatal care on the use of skilled birth attendance and also investigates the role of the content of prenatal care in this relationship. Previous studies on the topic have failed to control for possible endogeneity biases, limiting the validity of their conclusions. Our findings point to the existence of important biases in Kenya and Tanzania, where the estimated effect of prenatal care on the use of skilled birth attendance is highly biased downwards when endogeneity is not taken into account in the statistical model. Furthermore, with the exception of Ghana and, to a lesser extent, of Tanzania, our findings indicate that the beneficial effects of prenatal health care are completely mediated by the content of services that women receive. This study emphasizes the role of healthcare providers who, to effectively reach populations, must also act as leaders in their community.