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Today, researchers and policy makers alike are increasingly concerned about the “double burden of malnutrition” in low and middle income countries (LMICs). This ‘double burden’ is understood to be the coexistence of under- and overnutrition within one population. The definition of a ‘double burden’ relies upon the existence of chronic undernutrition among children (indicated by stunting – where children are shorter than expected for their age) and the existence of overnutrition in children or adults (child overweightness as indicated by a greater weight than expected for a given height and adult overweightness/obesity as indicated by a greater weight than height). However, research has failed to consider that children can be concurrently stunted and overweight – known here as ‘stuntingoverweightness’. In failing to consider stuntingoverweightness, the prevalence of stunting and overweightness among children has been overestimated at the population level. Stuntedoverweight children have been ‘double counted’ – once as stunted and once as overweight. This has severe implications for our understanding of malnutrition in LMICs today. The polarisation of malnutrition among children of under- and overnutrition has been exaggerated and a whole group of children have become hidden – the stuntedoverweight. This research addresses this issue. Recalculating stunting and overweightness prevalence accounting for stuntingoverweightness this research shows that, today in LMICs, up to 10.42% of children under-five are stuntedoverweight – yet no policies or programmes exist to understand the determinants of stuntingoverweightness, its effects or how to alleviate them. An individual level analysis of Albania shows stuntedoverweight children are a separate socioeconomic group and should thus be targeted for interventions separately from their stunted and overweight peers. Furthermore, failing to recognise stuntingoverweightness has led to overestimations of the burden of stunting by up to 88.54% (in Albania) and of overweight by up to 295.26% (in Benin) and skewing our understanding of the ‘burden of malnutrition’ in LMICs. The thesis shows that for nutritional strategies to be effective – research needs to consider the diverse burden of malnutrition observed in LMICs today.

Thesis (M.Cur.) --University of Limpopo, 2013 / All pregnant women who seek antenatal health care at the public clinics are offered HIV counselling and testing. Those who agree to test and who test positive, often fail to bring their infants for polymerase chain reaction (PCR) HIV testing after delivery, despite the fact that they have been advised to do so during delivery. There are very few studies which have assessed the women’s knowledge with regard to the PCR HIV testing of infants. In this study; a qualitative, exploratory, and descriptive methodology was applied to explore and describe the knowledge of pregnant women with regard to PCR HIV testing of infants in the Molemole Municipality of the Limpopo Province, Capricorn District. Purposive sampling was used and semi-structured interviews were conducted until saturation of data was reached. Qualitative data analysis design of Marshall and Rossman was used. The study indicated that the participants had knowledge with regard to the PCR HIV testing of infants. The nurse and lay counsellors knew about the different modes of prevention of mother-to-child transmission (PMTCT) and they used every contact opportunity with pregnant women to share its benefits. Mother to mother support groups for HIV positive pregnant and lactating women should be established for continuous support and counselling with the purpose of achieving an HIV-free generation.

La notion d’instauration rapide d’un traitement efficace et agressif dans la polyarthrite débutante a renforcé la nécessité de disposer de mesures d’utilité validées afin d’optimiser l’évaluation médico-économique de ces traitements. Actuellement, il n’y a pas de consensus sur le choix du questionnaire multi-attributs à utiliser pour le calcul des utilités. L’objectif de cette thèse est donc d’étudier les niveaux, les performances et les déterminants des 2 outils indirects de mesure d’utilité (EQ-5D et SF-6D) dans la polyarthrite débutante, au travers des données de la cohorte ESPOIR, cohorte multicentrique française de polyarthrites débutantes. En conclusion, l’EQ-5D et le SF-6D ne sont pas interchangeables dans la polyarthrite débutante : ils ont des échelles, des distributions, une reproductibilité et une sensibilité au changement différentes. Ils ne donnent pas les mêmes résultats surtout quand les patients ont un mauvais état de santé et plus particulièrement une incapacité fonctionnelle importante. La distribution bimodale de l’EQ-5D, sa moins bonne reproductibilité, le fait qu’il soit moins sensible à l’amélioration, sa plus grande variabilité dans l’estimation du gain d’utilité et donc des QALYs, les problèmes soulevés par la signification d’un état « pire que la mort » (qui n’est pas celle du patient), favoriseraient plutôt l’utilisation du SF-6D dans les essais sur les nouvelles biothérapies dans la polyarthrite débutante / The explosion of drug development for rheumatoid arthritis and the revolution of early aggressive therapy for the disease have fuelled the search for better approaches to establish cost-effectiveness in early arthritis (EA), but consensus is lacking on the choice of utility instrument. We aimed to compare the EQ-5D and SF-6D, 2 indirect utility measures widely used to calculate quality-adjusted life-years (QALYs), in terms of their utility values, their performance and their determinants in a large prospective cohort of patients with EA. In conclusion, the EQ-5D and SF-6D are not interchangeable: their scales, distributions, reliability and responsiveness are different. There is systematic disagreement between the EQ-5D and SF-6D in EA especially in patients with worse clinical outcomes and more specifically with high functional disability. Several elements suggest that the SF-6D may be more appropriate for clinical trials of biologics in patients with EA: the bimodal distribution of the EQ-5D, its lower reliability and responsiveness for EA improvement than the SF-6D, its high variability in the estimation of the utility gains and thus QALYs gains and the problems raised by the meaning of a state labeled " worse than the death " (which is not the one from the patient)

Le paysage associatif français de lutte contre le VIH/sida voit émerger dès la fin des années 1990 un ensemble d'associations d'immigrant-e-s, en particulier porté par des personnes nées en Afrique Subsaharienne. Lourdement affectées par l'épidémie et longtemps oubliées des programmes de lutte contre le VIH/sida, les femmes immigrantes devenues une cible prioritaire des autorités sanitaires y occupent une position particulière. L'objectif de cette thèse est d'éclairer le rôle spécifique joué par les femmes nées en Afrique Subsaharienne dans la lutte contre le VIH/sida en France et d'analyser les conséquences d'un tel engagement associatif sur les différentes sphères de leur vie. Une enquête socio-ethnographique a été réalisée en Île-de-France, entre 2011 et 2013, à partir de l'observation du quotidien de six associations, d'actions et d'événements associatifs divers. Quatre-vingt-six entretiens ont été conduits auprès de femmes rencontrées dans douze associations, afin de reconstituer leur trajectoire biographique, et auprès de médecins et assistantes sociales hospitalières pour saisir leurs représentations de ces actrices associatives. Le care et l'agency forment le cadre analytique émergeant des matériaux empiriques. L'enquête montre que les projets associatifs menés par les femmes nées en Afrique Subsaharienne répondent de manière sensible aux besoins des immigrant-e-s les plus vulnérables mais également aux besoins de soutien des professionnel-le-s de l'action sociale et de santé. Majoritairement féminins, ces collectifs s'inscrivent dans une grammaire associative du care reposant sur l'auto-support et la rencontre entre deux profils : les usagères en situation de liminalité et les aidantes aux ressources diverses. Les usagères puisent dans ces espaces les supports nécessaires à la sortie du statut liminal, tandis que les aidantes développent une expertise du terrain qui leur permet de s'insérer dans les sphères professionnelles et politiques du VIH/sida. Les analyses pointent le processus d'agence des femmes engagées au sein de ces associations. Les usagères négocient les modalités de leur insertion sociale en France en recourant de manière tactique aux associations qu'elles fréquentent. Les aidantes s'appuient sur la lutte contre le VIH/sida pour dépasser la place traditionnellement réservée aux immigrant-e-s en France et accéder à l'espace public. De plus, le positionnement spécifique des femmes aux sein des associations d'immigrant-e-s leur offre une opportunité particulière de s'approprier stratégiquement les normes de genre intégrées au fil de leur socialisation. Cependant, les enjeux sociaux de la lutte contre le VIH/sida articulés à la position sociale de ces femmes dans le contexte migratoire freinent la voix/e différente qui semble leur être ouverte par la lutte contre l'épidémie en France. / The French associative landscape against HIV/AIDS sees at the end of the 1990s the emergence of a set of immigrant organizations, especially led by persons born in sub-Saharan Africa. Heavily affected by the epidemic and long forgotten by the programs to combat the epidemic, immigrant women became a priority target of the health authorities and now occupy a particular position within immigrant organizations. The objective of this thesis is to shed light on the specific role played by women born in sub-Saharan Africa in the fight against HIV/AIDS in France and to analyze the consequences of such an associative commitment on various spheres of their lives. A socio-ethnographic survey was conducted in the Ile-de-France region, between 2011 and 2013, from the observation of the daily lives, actions and events of six organizations. Eighty-six interviews were conducted among women met in twelve organizations, in order to reconstruct their biographical trajectory, and among doctors and hospital social workers in order to seize their representations of these associative players. Theories of care and agency form the analytical framework emerging from the empirical materials. The survey shows that the associative projects led by women born in sub-Saharan Africa respond sensitively to the needs of the most vulnerable immigrants but also to the needs of the social and health professionals. Predominantly female, these groups fit into an associative grammar of care based on self-support and the meeting between two profiles: the female users in a liminal position and the caregivers with diverse resources. The female users draw on these spaces the necessary supports to get out of the liminal status, while the caregivers develop a field expertise which allows them to fit into HIV/AIDS policies and professional spheres. The analyses point out the agency process of the women engaged within these organizations. The female users negotiate the mode of their social integration in France tactically resorting to the associations they frequent. The caregivers rely on the fight against HIV/AIDS to exceed the position traditionally assigned to immigrants in France and to have access to the public space. Furthermore, the specific positioning of women within immigrant organizations offers them a special opportunity to strategically appropriate the gender norms integrated over their socialization. However, HIV/AIDS social issues linked to the social position of women in the migration context hamper the different voice/way which seems to be open to them in the fight against the epidemic in France.