Efficient and accurate sensing of various parameters is needed for numerous applications. In this regard, different categories of sensors play a significant role and different applications require diverse sensing mechanisms owing to the operating conditions and field constraints. Among the several sensor methodologies available, optical fiber sensors have found significant attention, because of their advantages such as negligible foot print, small mass, immunity to Electromagnetic Interference, etc. In the category of optical fiber sensors, Fiber Bragg Grating (FBG) sensors have found importance in many fields such as health monitoring of civil structures, environmental monitoring involving gas & humidity sensing, monitoring parameters like pressure, tilt, displacement, etc. In the recent times, FBGs have found applications in biomedical, biomechanical and biosensing fields. A FBG is a periodic change of the refractive index of the core of a single mode optical fiber along its longitudinal axis. The periodic modulation in the index of refraction is obtained by exposing a photosensitive germanium-doped silica fiber to an intense UV laser beam. FBGs, in the basic form, can sense strain and temperature. However, in recent years, several newer sensing applications of FBGs have been demonstrated. Some of the main features of the FBG sensor which qualify them for diverse sensing applications are high sensitivity, large operational bandwidth, multiplexing & multi modal sensing capability, etc. In this thesis work, FBG sensor based devices have been developed for newer applications in bio-medical fields for the measurement of force, flow and temperature. Particularly, novel transduction methodologies have been proposed, in order to convert the measurand parameter into a secondary parameter that can be sensed by the FBG sensor. The evaluation of the force required for a spinal needle to penetrate various tissue layers from skin to the epidural space is vital. In this work, a novel technique for dynamic monitoring of force experienced by a spinal needle during lumbar puncture using Fiber Bragg Grating (FBG) sensor has been developed. The Fiber Bragg Grating Force Device (FBGFD) developed, measures the force on the spinal needle due to varied resistance offered by different tissue layers during its traversal. The effect of gauge of the spinal needle used for the lumbar puncture procedure affects the force required for its insertion into the tissue. The FBGFD developed, has been further utilized for a comparative study of the force required for lumbar puncture of various tissue layers with spinal needle of different gauges. The results obtained may serve as a guideline for selection of suitable gauge spinal needle during lumbar puncture minimizing post puncture side effects on patients. The pulmonary function test carried out using a spirometer, provides vital information about the functional status of the respiratory system of the subject. A Fiber Bragg Grating Spirometer (FBGS) has been developed which has the ability to convert the rate of air flow into a shift in wavelength that can be acquired by the FBG sensor. The FBGS can dynamically acquire the complete breathing sequence comprising of the inhalation phase, pause phase and exhalation phase in terms of the air flow rate along with the time duration of each phase. Methods are adopted to analyse and determine important pulmonary parameters using FBGS and compare these parameters with those obtained with a commercially available hospital grade pneumotachograph spirometer. Thermal imaging is one of the emerging non-invasive neuro-imaging techniques which can potentially indicate the boundaries of a brain tumor. The variation in tissue surface temperature is indicative of a tumor existence. In this work a FBG temperature sensor (FBGTS) has been developed for thermography of a simulated tissue using Agar material. The temperature of the embedded heater which mimics a brain tumor along with the surface temperature of the tissue model, is acquired using FBGTSs simultaneously. Further, the surface temperatures are studied for varying heater temperatures as well as varying positions of the heater in the simulated tissue model. To conclude, FBG based devices have been developed in this work, for applications in biomedical domain, with appropriate transduction methodologies for sensing different parameters such as force, flow and temperature.

Made available in DSpace on 2016-08-17T18:39:38Z (GMT). No. of bitstreams: 1 3709.pdf: 10453405 bytes, checksum: e58384df9cb0940e97fe5a0f8206ade2 (MD5) Previous issue date: 2011-06-10 / Universidade Federal de Minas Gerais / Mechanical injuries are a major cause of post-harvest losses, since they may cause metabolic and physiological changes in fruit and vegetables. However there are few studies that characterize the state of the tissue after injury and during the reaction of the tissue, which was called "Period of Instability (PI). In this work the objective was to characterize the "Period of Instability (PI) of tomatoes (Solanum lycopersicum L.) and kale leaves (Brassica oleracea v. acephala L.) after harvest, injured by puncture with different diameters. So, it was realized a tissues histological study of and plants water status analysis subjected to injury by puncture with diameters of 1.5 and 3.5 mm. Analysis of the structure of kale leaf and tomato injured tissues was performed using techniques of light microscopy during 9 and 24 days after harvest, respectively. The water status was evaluated by firmness of tomatoes, turgor pressure and firmness of the kale leaves. They were examined for 19 days in tomatoes and for seven days in kale leaves. Healthy tissues of tomatoes 'Carmen' showed uniform arrangement until the 16th day after harvest. In the tomato injured tissues PI there was adherence to the dead cell walls on the healthy cells. Puncture injuries with diameters of 1.5 and 3.5 mm did not change the firmness of tomatoes in 'Carmen' stored at 25°C, but the tomatoes firmness decreased after two days of post-harvest. The healthy leaves of kale showed degradation of cellular structures after nine days of harvest. The injured leaves by puncturing the 1.5 and 3.5 mm exhibited PI with physiological response, characterized by the accumulation of mucilage in the damaged region. Firmness and turgor pressure were not altered in the kale leaves injured stored at 5°C. However, healthy and injured leaves had a water recovery from the first to the second day after harvest, when stored in refrigerator at 5°C. After the water recovery, the treatments have a decreased of firmness and turgor pressure, and the injured groups showed variation in the values of firmness between the fourth and seventh day of post-harvest. / As injúrias mecânicas são a maior causa de perdas pós-colheita, uma vez que podem causar alterações metabólicas e fisiológicas em frutos e hortaliças. No entanto são escassos estudos que caracterizam o estado do tecido logo após a lesão e durante a reação do tecido lesionado, ao qual denominamos Período de Instabilidade (PI). Neste trabalho o objetivo foi caracterizar o Período de Instabilidade (PI) de tomates (Solanum lycopersicum L.) e folhas de couve-manteiga (Brassica oleracea v. acephala L.), após a colheita, submetidos à lesão mecânica por punção com diferentes diâmetros. Para isso foi realizada a análise histológica dos tecidos e um estudo do estado hídrico desses vegetais submetidos a lesão por punção com diâmetros de 1,5 e 3,5mm. A análise da estrutura dos tecidos da folha de couve-manteiga e de tomate lesionados foi realizada por meio de técnicas usuais de microscopia de luz durante 9 e 24 dias após a colheita, respectivamente. A avaliação do estado hídrico foi feita pelo estudo da firmeza de tomates, e da pressão de turgescência celular e firmeza das folhas de couve-manteiga. As medidas foram realizadas durante 19 dias para tomates e sete dias para as folhas de couve-manteiga. Os tecidos sadios de tomates Carmen apresentaram disposição uniforme até o 16° dia após a colheita. Durante o PI nos tecidos lesionados de tomates verificou-se a adesão das paredes celulares mortas às células sadias quatro dias após a colheita. As lesões por punção com diâmetros de 1,5 e 3,5 mm não alteram a firmeza em tomates Carmem armazenados a 25°C, no entanto os tomates apresentam decaimento da firmeza dois dias após a colheita. As folhas sadias de couve-manteiga apresentaram degradação tardia das estruturas celulares, após o 9° dia de colheita. As folhas lesionadas por punção de 1,5 e 3,5mm apresentam PI com resposta fisiológica, caracterizada pelo acúmulo de mucilagem na região danificada. A firmeza e a pressão de turgescência também não são alteradas nas folhas de couvemanteiga lesionadas por punção de 1,5 e 3,5mm, e armazenadas a 5°C. Porém, folhas sadias e lesionadas apresentam recuperação hídrica do primeiro para o segundo dia após a colheita, quando armazenadas em refrigerador a 5°C. Após a recuperação hídrica, todos os tratamentos apresentam diminuição gradativa da firmeza e da turgescência celular, sendo que os grupos das lesões mostram oscilações nos valores de firmeza entre o quarto e sétimo dia após a colheita.

[pt] O ensaio de impulso para perfuração de isoladores é um ensaio normalizado descrito na IEC 61211:2004 e é fundamental para verificar em laboratório a qualidade de isoladores de vidro ou porcelana utilizados no sistema elétrico de potência. A norma IEC 60060-2:2010 recomenda que a calibração dos Sistemas de Medição utilizados em ensaios para Perfuração de Isoladores (SMIP) deve ser realizada por comparação com um padrão. Contudo, embora o ensaio de perfuração seja normalizado, ainda não existem padrões para rastrear esse sistema de medição na maioria dos institutos de pesquisas em âmbito global. Quantificar a amplitude de um impulso de perfuração, com todas as garantias metrológicas, não é uma tarefa trivial, por se tratar de um sinal impulsivo com amplitude de centenas de kilovolts e durações da ordem de 200 ns. Além disso, divisores de tensão com alto desempenho dinâmico para essa aplicação especifica também não estão disponíveis comercialmente. Deste modo, o objetivo desta dissertação foi projetar e desenvolver um SMIP. O divisor de tensão, integrante do sistema de medição, foi construído a fim de garantir uma mínima indutância e um alto desempenho dinâmico. Também foi desenvolvido um filtro para a remoção de interferências eletromagnéticas baseado na transformada wavelet, integrado a um software que controla aquisição, condicionamento do sinal, determinação e análise dos parâmetros do impulso de perfuração. O desempenho do sistema de medição foi avaliado em baixa tensão e em alta tensão, bem como foi estimada sua incerteza de medição, sendo então capaz de atender às exigências normativas e metrológicas do Laboratório de Referência em medição do Cepel. / [en] Impulse testing for puncture insulator is a standardized test described in IEC 61211:2004 and is essential for laboratory testing of the quality of glass or porcelain insulators used in the electrical power system. IEC 60060-2:2010 recommends that calibration of Measurement Systems used in Impulse Puncture Test on insulators (IPMS) should be performed by comparison against a standard. However, although the impulse puncture testing is standardized, there are still no standards for traceability of this measurement system at most research institutes globally. Quantifying the amplitude of an impulse puncture test, with all metrological guarantees, is not a trivial task, since it is an impulsive signal with amplitude of hundreds of kilovolts and durations of the order of 200 ns. In addition, high dynamic performance voltage dividers for this specific application are not commercially available either. Thus, the objective of this dissertation was to design and develop an IPMS. The voltage divider, which is part of the measuring system, is designed to ensure minimum inductance and high dynamic performance. A filter for electromagnetic interference removal based on the wavelet transform was also developed, integrated with software that controls acquisition, signal conditioning, determination and analysis of the impulse puncture testing parameters. The performance of the measuring system was evaluated at low voltage and high voltage, as well as its measurement uncertainty was estimated, being able to meet the normative and metrological requirements of the Cepel s Measurement Reference Laboratory.

RESUME La 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.

Made available in DSpace on 2014-07-29T15:03:41Z (GMT). No. of bitstreams: 1 David Rosa Rodrigues.pdf: 6647846 bytes, checksum: 0949b9b9e50ce27a724b92ea2943c5d1 (MD5) Previous issue date: 2009-09-29 / This research presents the results of an experimental comparison between the types of shear reinforcement "stud rails" and "double headed studs" to combat the punching shear of a reinforced concrete flat slabs. It also presents a comparison of experimental results with those provided under the ACI 318/2005, CEB-FIP MC/1990, EUROCODE 2/2004 and NBR 6118:2003. The motivation was to investigate the efficiency of these shear reinforcement for the differences between them. It was tested six slabs of concrete to concentric load, with dimensions of 2400 mm x 2400 mm x 150 mm. It was concreted a column of section 500 mm x 200 mm to 850 mm total height next to the slab. The main variables were the type of shear reinforcement "stud rails" x "double headed studs, the "studs" diameter and the shear reinforcement area per layer. The slabs were tested until the failure. It was monitored the deflection, reinforcement deformation of bending and shear. All slabs failed by punching with internal surface rupture. The experimental results after being compared with the expected standard in each individual calculation showed conservative values. Slabs of Group 1 with "stud rails" presented failed loads greater than those in Group 2 with "double headed studs. Codes/standards 318/2005 ACI, CEB-FIP MC/1990, EUROCODE 2 / 2004 and NBR 6118:2003 safely predict the failed loads of all slabs. The base of the shear reinforcement type "stud rails" moving inside the column may have reduced the failed load of the slab L3. Shear reinforcement type stud rails it is easer of assembly and play than the type double headed studs . / Esta pesquisa apresenta os resultados de uma comparação experimental entre os tipos de armadura de cisalhamento stud rails e double headed studs para combate à punção em lajes cogumelo de concreto armado. Apresenta, também, uma comparação dos resultados experimentais com os previstos segundo o ACI 318/2005, CEB-FIP MC/1990, EUROCODE 2/2004 e a NBR 6118:2003. A motivação foi investigar a eficiência destas armaduras de cisalhamento a procura de diferenças entre elas. Foram ensaiadas seis lajes maciças de concreto armado à punção centrada, com dimensões 2400 mm x 2400 mm x 150 mm. Foi concretado junto à laje um pilar de seção 500 mm x 200 mm com altura total 850 mm. As principais variáveis foram o tipo de armadura de cisalhamento: stud rails x double headed studs , o diâmetro dos studs e a área de armadura de cisalhamento por camada. As lajes foram ensaiadas até a ruptura. Foram monitoradas as flechas, deformações da armadura de flexão e cisalhamento. Todas as lajes romperam por punção com superfície de ruptura interna. Os resultados experimentais após serem comparados com os esperados segundo cada norma de cálculo apresentaram valores conservadores. As lajes do Grupo 1 com stud rails apresentaram cargas de ruptura maiores que as do Grupo 2 com double headed studs . Os códigos/normas ACI 318/2005, CEB-FIP MC/1990, EUROCODE 2/2004 e a NBR 6118:2003 previram com segurança as cargas de ruptura de todas as lajes. A base da armadura de cisalhamento tipo stud rails avançando dentro do pilar pode ter reduzido a carga de ruptura da Laje L3. A armadura de cisalhamento tipo stud rails apresenta maior facilidade de montagem e execução que a tipo double headed studs .

Los objetivos de la presente tesis fueron comparar el efecto de tres técnicas de cocción en varios vegetales y su selección para cada producto estudiado. Para ello, los trabajos realizados han considerado los cambios en las propiedades físico-químicas, nutricionales, sensoriales y la microestructura. Asimismo, como respuesta al reto de aplicar tratamientos equivalentes en firmeza con diferentes técnicas de cocción se ha propuesto una metodología que combina los diseños experimentales de superficie respuesta (RSM) con análisis instrumentales y sensoriales. Los tratamientos térmicos estudiados fueron la cocción tradicional (TC¿ agua hirviendo a 100 °C) junto con dos tratamientos que utilizan el vacío en el procesado: el cook-vide (CV¿ cocción a vacío continuo donde los alimentos están en contacto con agua hirviendo a baja presión) y el sous-vide (SV¿ cocción de alimentos previamente embolsados a vacío donde el alimento está separado del agua de cocción). Los vegetales objeto de estudio fueron la patata morada (Solanum tuberosum L. var. Vitelotte), la judía verde (Phaseolus vulgaris L. cv. Estefania), la zanahoria (Daucus carota L. cv. Nantesa) y la col lombarda (o repollo colorado) (Brassica oleracea convar. capitata var. capitata f. rubra). Considerando muestras con firmeza instrumental similar y las propiedades nutricionales y sensoriales (especialmente aroma y sabor), incluyendo la aceptación del consumidor, se recomienda la cocción SV para los vegetales estudiados, excepto para la zanahoria. En el caso de este vegetal el cocinado tradicional (100 °C) mantiene la aceptabilidad del consumidor y aumenta la extracción de los ß-carotenos por lo que se considera más recomendable que el SV. / Iborra Bernad, MDC. (2013). Comparison of vacuum treatments and traditional cooking in vegetables using instrumental and sensory analysis [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/32953 / TESIS

RESUME<p>La 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. <p>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. <p>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.<p>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 ».<p>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.<p>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. <p><p><p>SUMMARY<p>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. <p>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.<p>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. <p>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”. <p>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. <p>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.<p><p> / Doctorat en Sciences de la santé publique / info:eu-repo/semantics/nonPublished