Ce travail vise à proposer une solution d’assainissement durable, digne, sécurisante, accessible à tous, permettant de réduire les maladies à transmission hydrique, adaptée aux populations vivant dans des conditions précaires en zones rurales de pays en développement. Il contribue ainsi à la lutte contre la défécation à l’air libre, une des cibles de l’Objectif de Développement Durable n°6 concernant l’eau et l’assainissement. Le choix s’est porté sur des toilettes sèches individuelles à litière biomaîtrisée et un mode de gestion communautaire des résidus, en lien avec une association paysanne locale. La mise en place s’est faite avec un accompagnement scientifique qui a donné lieu aux travaux présentés ici. Dans un premier temps, nous avons opéré selon une approche participative, visant à s’assurer de l’adhésion des utilisateurs. Puis nous avons mené un programme scientifique pour identifier les conditions permettant l’hygiénisation des résidus traités. Après 3 ans d’expérimentation, la filière d’assainissement mise en place est totalement adoptée par les ménages, qui apportent régulièrement leurs résidus sur le site de compostage. Une enquête a fait ressortir que les familles sont très satisfaites de ce mode d’assainissement à domicile et se sentent moins sujettes à des maladies féco-orales. Ces ménages se sont constitués en un groupe qui procède à présent à l’appui à la réplication. Les litières absorbantes utilisées, les résidus avant et après traitement par compostage ont été caractérisés. Des essais en pilotes ont permis de déterminer les conditions permettant de garantir une hygiénisation rapide, ce qui était un de nos principaux objectifs, afin de réduire les risques sanitaires. Nous sommes à présent à même de définir les « bonnes pratiques » pour que la filière d’assainissement par toilettes sèches à litière biomaîtrisée dans une zone rurale de pays en développement soit sûre et durable, sur les aspects sociaux, techniques, économiques, environnementaux et sanitaires. / This work aims at proposing a sustainable, dignified, safe, accessible to everyone sanitation solution, allowing to reduce water-borne diseases, adapted to populations living in precarious conditions in rural areas of developing countries. It thus contributes to the fight against open defecation, one of the targets of the Sustainable Development Goal n ° 6 concerning water and sanitation. The choice fell on individual dry toilets with biocontrolled litter and a way of community management of residues, in connection with a local peasant association. The implementation was done with a scientific accompaniment which gave rise to the work presented here. Firstly, we operated according to a participatory approach, aiming to ensure the adhesion of the users. Then we conducted a scientific program to identify the conditions allowing the sanitizing of treated residues. After 3 years of experimentation, the sanitation system set up is totally adopted by the households, who regularly bring their residues to the composting site. One survey found that the families are very satisfied with this type of home sanitation and feel less prone to disease. These households have formed into a group that now supports replication of the system. The absorbent litter used, the residues before and after composting were characterized. Pilot tests were conducted to determine conditions to ensure rapid sanitizing, which was one of our main objectives, in order to reduce health risks. We are now in position to assure safe and sustainable practices so that the sanitation by dry biocontrolled litter toilets in rural areas of developing countries satisfy social; technical; economical, environmental and health criteria.

Depuis les années 1960, la Tunisie, a développé une politique de tourisme balnéaire demasse basée principalement sur les atouts climatiques du pays et la proximité avec l’Europe. Afin dedévelopper cette politique, l’Etat a joué un rôle central en créant les institutions nécessaires et enencourageant les investissements privés et le pays a ainsi trouvé sa place en tant que destinationtouristique de référence dans le bassin méditerranéen. Cependant, avec la multiplication des offres parles pays concurrents (Maroc, Croatie, Turquie, Egypte, Grèce…), le produit balnéaire tunisiens’essouffle. Il est donc important de diversifier cette offre afin de garder et de développer la clientèle.Dans cette optique, l’Etat avait créé dans les années 1980 le pôle touristique de Tabarka-Ain Drahamavec pour objectif de dynamiser le Nord-Ouest et notamment la Kroumirie, notre zone d’étude.Aujourd’hui, ce massif de moyenne montagne reste toutefois toujours isolé et marginalisé, malgrél’existence à proximité du pôle touristique balnéaire à Tabarka, qui n’a pas pu s’imposer réellementsur la carte touristique du pays à l’instar de la côte orientale (Djerba, Sousse, Hammamet). Le tourismerural n’en demeure pas moins une vraie piste d’action pour un développement durable de la région, vules potentialités locales, à travers notamment la richesse du patrimoine culturel, naturel et historique. / Tunisian balneal tourism, as it was planned, has loosen its motivity since few years and itshows its limitation since tourists are more and more unsatisfied with the environmental quality. Inaddition, Tunisian tourism can restrict to this unique product (balneal tourism) due to the highconcurrence (Turkey, Italy, Spain, Greece…). Moreover, the unstable international situation (attacks,wars…) let a part of customers to define orientations that they see it more secure; like Italy or Greece.Thus, Tunisia starts to diversify its touristic product in order to guarantee an important position for theecotourism. The appearance of this new touristic orientation allows evaluating the natural, socioculturaland popular resources of some regions. It guarantees employment and incomes to the localpopulation, money to the government without threatening natural resources. A well planned andcontrolled ecotourism allow to a region and all its local actors to develop. The ecotourism guaranteethe protection of the environment and the green and archeological spaces and at some time let theplace for tourism. With regard to the diversity of its natural landscape its remarkable fauna and flora,the Kroumirie region – located in Northwestern Tunisia – start to attract the “new tourist” who likenature. Since many years, this region has become the first interest of national and internationalassociations and organizations in order to make it an incontrovertible eco-touristic pole. In fact, theregion dispose of a multitude of natural potential as that mountains, seas, reserves, its natural park…We will introduce the region focusing its eco-touristic potentials.

Le Programme de Transferts Monetáries Conditionnel Bolsa Família complète une décennie d'existence et est considéré un succès dans la lutte contre la pauvreté au Brésil. Plusieurs études démontrent les effets de PBF sur les familles et en ce qui concerne l’ accomplissement des conditions imposées, sans, toutefois, examiner son importance pour le développement rural. Ce travail vise à comprendre dans quelle mesure le programme Bolsa Família contribue et peut être considéré comme une partie d'une vision de développement rural, par l'analyse de l'accès des bénéficiaires PBF à d'autres programmes publiques dans le milieu rural et les facteurs qui influent cet accès (objectif global). Les objectifs spécifiques poursuivis sont analyser quelles sont les facteurs qui contribuent et qui entravent pour les bénéficiaires du PBF pour accéder à d'autres types de politiques publiques pour les zones rurales; démontrer les interfaces entre les politiques de transfert conditionnel monetáries et les politiques de développement, tels que le crédit et la commercialisation (Pronaf et PAA) comme potentiels facteurs d'inclusion socio-économique des bénéficiaires du PBF; et comprendre qui sont et commant agissent les médiateurs du PBF et comment les actions atteignent les potentiels bénéficiaires du programme. L'hypothèse qui guide cette étude est que l'accès à ce programme peut contribuer à l'adhésion à d'autres politiques, en particulier Pronaf et PAA, favorisant les compétences et l'intégration socio-économique et contribuer au développement rural. La recherche s'appuie sur des données secondaires cédés par le partenariat avec Association Riograndense des entreprises technique et vulgarisation agricole (Emater) et de la recherche de terrain menée dans la région de l’Alto da Serra do Botucaraí. / O Programa de Transferência de Renda Condicionada Bolsa Família completa uma década de existência sendo considerado exitoso no combate à pobreza no Brasil. Diversos estudos demonstram os efeitos do PBF sobre as famílias e no tocante ao cumprimento das condicionalidades impostas, sem, no entanto, analisar sua importância ao desenvolvimento rural. Este trabalho busca compreender em que medida o programa Bolsa Família contribui para e pode ser considerado parte de uma visão de desenvolvimento rural, através da análise do acesso dos beneficiários do PBF à outros programas públicos destinados ao meio rural e dos fatores que influenciam nesse acesso (objetivo geral). Os objetivos específicos perseguidos são analisar quais são os fatores que contribuem e quais os que dificultam para que os beneficiários do PBF acessem outros tipos de políticas públicas para o meio rural; demonstrar as interfaces entre as políticas de transferência de renda condicionada e políticas de desenvolvimento, como crédito e comercialização (Pronaf e PAA) enquanto potenciais fatores de inclusão socioeconômica para beneficiários do PBF; e entender quem são e como atuam os mediadores do PBF e como as ações chegam aos potenciais beneficiários do programa. A hipótese que orienta esse trabalho é de que o acesso ao programa pode contribuir para a adesão a outras políticas, sobretudo Pronaf e PAA, favorecendo as capacitações e a inserção socioeconômica e contribuindo para o desenvolvimento rural. A pesquisa conta com dados secundários cedidos pela parceria firmada com a Associação Riograndense de Empreendimentos de Assistência Técnica e Extensão Rural (Emater) e pesquisa de campo realizada na região do Alto da Serra do Botucaraí. / The Conditional Cash Transfer Program Bolsa Família completes a decade of existence and it is considered successful in combating poverty in Brazil. Several studies demonstrate the effects of PBF on families and concerning to compliance of imposed conditionalities, without, however, examine its importance to rural development. This study seeks to understand to which extent the Bolsa Família Program contributes to and can be considered part of a vision of rural development, by analyzing the access of PBF beneficiaries to other public programs for rural areas and the factors that influence this access (general objective). The specific objectives to be achieved are to analyze what are the factors that contribute and which make it difficult for PBF beneficiaries to access other types of public policies for rural areas; demonstrate the interfaces between the policies of conditional cash transfer and policies of development, such as credit and marketing (Pronaf and PAA) as potential factors for socioeconomic inclusion of PBF beneficiaries; and understand who are and how act the mediators of the PBF and how actions reach the potential beneficiaries of the program. The hypothesis that guides this study is that access to the program can contribute to adherence to other policies, especially Pronaf and PAA, favoring the capabilities and socioeconomic integration and contributing to rural development. The research counts with secondary data provided by the partnership with Riograndense Association of Enterprises of Technical Assistance and Rural Extension (Emater) and field research conducted in the Alto da Serra do Botucaraí region.

Malaria is a major public health problem in under developed countries especially countries undergoing war or conflict due to breakdown of health system and exposure of the vulnerable population through displacement. The knowledge, practice and attitude (KAP) of community members have direct influences on malaria preventive measures. A quantitative, explorative and descriptive study was conducted among rural communities of Mundri East County using interview schedules to ascertain malaria related knowledge, practices and attitude and the common factors hindering the malaria control measures at house hold level. Data were collected from 68 respondents from the randomly selected household through personal interviews using a pre-tested interview schedule which was analysed using the SPSS version 15 computer soft ware program. Most of the respondents demonstrated some understanding of malaria as a disease, its transmission, prevention and treatment, although there is a need to improve this through the preferable and acceptable community channels as well as the methods of accessing the modern and scientifically proved and acceptable methods. Given the relatively moderate acceptability of malaria control measures used by the participants in Mundri East County, there is need to conduct further research on the practical implemented measure including the local herbs used for preventive and treatment of malaria Understanding the factors that inhibits or promotes the malaria control measures at community level is necessary for better planning and implementation of malaria intervention programme, which keeps complex and sensitive matters such as educational background, religious and cultural beliefs, and political affiliations in mind. / Health Studies / M.A. (Public Health)

Le Programme de Transferts Monetáries Conditionnel Bolsa Família complète une décennie d'existence et est considéré un succès dans la lutte contre la pauvreté au Brésil. Plusieurs études démontrent les effets de PBF sur les familles et en ce qui concerne l’ accomplissement des conditions imposées, sans, toutefois, examiner son importance pour le développement rural. Ce travail vise à comprendre dans quelle mesure le programme Bolsa Família contribue et peut être considéré comme une partie d'une vision de développement rural, par l'analyse de l'accès des bénéficiaires PBF à d'autres programmes publiques dans le milieu rural et les facteurs qui influent cet accès (objectif global). Les objectifs spécifiques poursuivis sont analyser quelles sont les facteurs qui contribuent et qui entravent pour les bénéficiaires du PBF pour accéder à d'autres types de politiques publiques pour les zones rurales; démontrer les interfaces entre les politiques de transfert conditionnel monetáries et les politiques de développement, tels que le crédit et la commercialisation (Pronaf et PAA) comme potentiels facteurs d'inclusion socio-économique des bénéficiaires du PBF; et comprendre qui sont et commant agissent les médiateurs du PBF et comment les actions atteignent les potentiels bénéficiaires du programme. L'hypothèse qui guide cette étude est que l'accès à ce programme peut contribuer à l'adhésion à d'autres politiques, en particulier Pronaf et PAA, favorisant les compétences et l'intégration socio-économique et contribuer au développement rural. La recherche s'appuie sur des données secondaires cédés par le partenariat avec Association Riograndense des entreprises technique et vulgarisation agricole (Emater) et de la recherche de terrain menée dans la région de l’Alto da Serra do Botucaraí. / O Programa de Transferência de Renda Condicionada Bolsa Família completa uma década de existência sendo considerado exitoso no combate à pobreza no Brasil. Diversos estudos demonstram os efeitos do PBF sobre as famílias e no tocante ao cumprimento das condicionalidades impostas, sem, no entanto, analisar sua importância ao desenvolvimento rural. Este trabalho busca compreender em que medida o programa Bolsa Família contribui para e pode ser considerado parte de uma visão de desenvolvimento rural, através da análise do acesso dos beneficiários do PBF à outros programas públicos destinados ao meio rural e dos fatores que influenciam nesse acesso (objetivo geral). Os objetivos específicos perseguidos são analisar quais são os fatores que contribuem e quais os que dificultam para que os beneficiários do PBF acessem outros tipos de políticas públicas para o meio rural; demonstrar as interfaces entre as políticas de transferência de renda condicionada e políticas de desenvolvimento, como crédito e comercialização (Pronaf e PAA) enquanto potenciais fatores de inclusão socioeconômica para beneficiários do PBF; e entender quem são e como atuam os mediadores do PBF e como as ações chegam aos potenciais beneficiários do programa. A hipótese que orienta esse trabalho é de que o acesso ao programa pode contribuir para a adesão a outras políticas, sobretudo Pronaf e PAA, favorecendo as capacitações e a inserção socioeconômica e contribuindo para o desenvolvimento rural. A pesquisa conta com dados secundários cedidos pela parceria firmada com a Associação Riograndense de Empreendimentos de Assistência Técnica e Extensão Rural (Emater) e pesquisa de campo realizada na região do Alto da Serra do Botucaraí. / The Conditional Cash Transfer Program Bolsa Família completes a decade of existence and it is considered successful in combating poverty in Brazil. Several studies demonstrate the effects of PBF on families and concerning to compliance of imposed conditionalities, without, however, examine its importance to rural development. This study seeks to understand to which extent the Bolsa Família Program contributes to and can be considered part of a vision of rural development, by analyzing the access of PBF beneficiaries to other public programs for rural areas and the factors that influence this access (general objective). The specific objectives to be achieved are to analyze what are the factors that contribute and which make it difficult for PBF beneficiaries to access other types of public policies for rural areas; demonstrate the interfaces between the policies of conditional cash transfer and policies of development, such as credit and marketing (Pronaf and PAA) as potential factors for socioeconomic inclusion of PBF beneficiaries; and understand who are and how act the mediators of the PBF and how actions reach the potential beneficiaries of the program. The hypothesis that guides this study is that access to the program can contribute to adherence to other policies, especially Pronaf and PAA, favoring the capabilities and socioeconomic integration and contributing to rural development. The research counts with secondary data provided by the partnership with Riograndense Association of Enterprises of Technical Assistance and Rural Extension (Emater) and field research conducted in the Alto da Serra do Botucaraí region.

Le Programme de Transferts Monetáries Conditionnel Bolsa Família complète une décennie d'existence et est considéré un succès dans la lutte contre la pauvreté au Brésil. Plusieurs études démontrent les effets de PBF sur les familles et en ce qui concerne l’ accomplissement des conditions imposées, sans, toutefois, examiner son importance pour le développement rural. Ce travail vise à comprendre dans quelle mesure le programme Bolsa Família contribue et peut être considéré comme une partie d'une vision de développement rural, par l'analyse de l'accès des bénéficiaires PBF à d'autres programmes publiques dans le milieu rural et les facteurs qui influent cet accès (objectif global). Les objectifs spécifiques poursuivis sont analyser quelles sont les facteurs qui contribuent et qui entravent pour les bénéficiaires du PBF pour accéder à d'autres types de politiques publiques pour les zones rurales; démontrer les interfaces entre les politiques de transfert conditionnel monetáries et les politiques de développement, tels que le crédit et la commercialisation (Pronaf et PAA) comme potentiels facteurs d'inclusion socio-économique des bénéficiaires du PBF; et comprendre qui sont et commant agissent les médiateurs du PBF et comment les actions atteignent les potentiels bénéficiaires du programme. L'hypothèse qui guide cette étude est que l'accès à ce programme peut contribuer à l'adhésion à d'autres politiques, en particulier Pronaf et PAA, favorisant les compétences et l'intégration socio-économique et contribuer au développement rural. La recherche s'appuie sur des données secondaires cédés par le partenariat avec Association Riograndense des entreprises technique et vulgarisation agricole (Emater) et de la recherche de terrain menée dans la région de l’Alto da Serra do Botucaraí. / O Programa de Transferência de Renda Condicionada Bolsa Família completa uma década de existência sendo considerado exitoso no combate à pobreza no Brasil. Diversos estudos demonstram os efeitos do PBF sobre as famílias e no tocante ao cumprimento das condicionalidades impostas, sem, no entanto, analisar sua importância ao desenvolvimento rural. Este trabalho busca compreender em que medida o programa Bolsa Família contribui para e pode ser considerado parte de uma visão de desenvolvimento rural, através da análise do acesso dos beneficiários do PBF à outros programas públicos destinados ao meio rural e dos fatores que influenciam nesse acesso (objetivo geral). Os objetivos específicos perseguidos são analisar quais são os fatores que contribuem e quais os que dificultam para que os beneficiários do PBF acessem outros tipos de políticas públicas para o meio rural; demonstrar as interfaces entre as políticas de transferência de renda condicionada e políticas de desenvolvimento, como crédito e comercialização (Pronaf e PAA) enquanto potenciais fatores de inclusão socioeconômica para beneficiários do PBF; e entender quem são e como atuam os mediadores do PBF e como as ações chegam aos potenciais beneficiários do programa. A hipótese que orienta esse trabalho é de que o acesso ao programa pode contribuir para a adesão a outras políticas, sobretudo Pronaf e PAA, favorecendo as capacitações e a inserção socioeconômica e contribuindo para o desenvolvimento rural. A pesquisa conta com dados secundários cedidos pela parceria firmada com a Associação Riograndense de Empreendimentos de Assistência Técnica e Extensão Rural (Emater) e pesquisa de campo realizada na região do Alto da Serra do Botucaraí. / The Conditional Cash Transfer Program Bolsa Família completes a decade of existence and it is considered successful in combating poverty in Brazil. Several studies demonstrate the effects of PBF on families and concerning to compliance of imposed conditionalities, without, however, examine its importance to rural development. This study seeks to understand to which extent the Bolsa Família Program contributes to and can be considered part of a vision of rural development, by analyzing the access of PBF beneficiaries to other public programs for rural areas and the factors that influence this access (general objective). The specific objectives to be achieved are to analyze what are the factors that contribute and which make it difficult for PBF beneficiaries to access other types of public policies for rural areas; demonstrate the interfaces between the policies of conditional cash transfer and policies of development, such as credit and marketing (Pronaf and PAA) as potential factors for socioeconomic inclusion of PBF beneficiaries; and understand who are and how act the mediators of the PBF and how actions reach the potential beneficiaries of the program. The hypothesis that guides this study is that access to the program can contribute to adherence to other policies, especially Pronaf and PAA, favoring the capabilities and socioeconomic integration and contributing to rural development. The research counts with secondary data provided by the partnership with Riograndense Association of Enterprises of Technical Assistance and Rural Extension (Emater) and field research conducted in the Alto da Serra do Botucaraí region.

Ce travail aborde l’enjeu du vivrier marchand dans la lutte contre la pauvreté des ménages dans l’espace rural du département de la Mvila. L’agriculture vivrière est encore pratiquée par plus de 80% de la population active dans les villages de la Mvila. Pendant longtemps, les cultures vivrières sont exclusivement autoconsommées dans la cellule familiale. Aujourd’hui, s’il est vrai qu’une grande partie de leur production est encore destinée à cette fin, quelques ménages font progressivement du vivrier marchand une réelle ressource économique. L’augmentation de la commercialisation vivrière est souvent une réponse à la baisse du pouvoir d’achat de nombreux ménages agricoles ou à la croissance de la population urbaine non agricole. Cependant, indépendamment des motivations qui guident le choix du vivrier marchand, il semble souvent une opportunité financière qui peut contribuer à l’amélioration des conditions de vie dans les villages. Depuis 1960, l’État multiplie des tentatives visant à réduire les stéréotypes qui associent exclusivement l’agriculture vivrière à l’autoconsommation. Après la crise agricole de la fin des années 1980, la relance de la promotion du vivrier marchand s’intensifie. Pour atteindre cet objectif, il s’ensuit la légalisation des GIC et le financement de divers programmes de subventionnement et d’accompagnement des producteurs. Pourtant, dans les villages du département de la Mvila, la commercialisation vivrière évolue timidement. Et pour beaucoup de ménages, le vivrier marchand reste une source de revenus accessoire. Par conséquent, de façon générale, la contribution de cette activité à la réduction de la pauvreté rurale est encore insuffisante. De nombreuses raisons permettent de comprendre l’insuffisance des résultats de cette stratégie gouvernementale de lutte contre la pauvreté rurale. Il s’agit par exemple de la dépendance paysanne à la cacaoculture ou de la baisse des dynamiques des ménages ruraux autour de la commercialisation vivrière. Cette situation est aussi entretenue par l’absence de modernisation des appareils productifs et commerciaux des cultures vivrières. Un environnement qui entraîne une baisse des volumes, augmente les risques et diminue la rentabilité économique de cette activité. Et, malgré l’évidence de quelques dynamiques des organisations paysannes, l’ampleur des défis actuels restreint beaucoup la faisabilité des initiatives de lutte contre la pauvreté des ménages ruraux avec le vivrier marchand. / This research examines the role of food-producing trade in fighting against poverty in the rural households of Mvila division in Cameroon. Subsistence agriculture appears to be the principal production activity in the target villages 80% of the active population interviewed is involved in such activities. For a long time, self-consumption has been the main orientation of crop production. However, food-producing trade has gained a lot of economic importance these last years. By so doing farmers find alternative income source after cocoa price has dropped while the urban population, not involved in agriculture, has significantly increased. Regardless of the motivations behind the choice of farmers, food-producing trade leads to income diversification and financial power aiming at improving the living conditions of rural people. Since 1960, the central government of Cameroon has been trying to change believes that restrict food crop production to self-consumption in the households. The crucial economic crisis associated with agricultural export products led to Food-producing trade intensification. This objective has been accompanied by Common Group Initiative (CGI) encouragement and other financing subsidy bodies in the rural areas. It is however worthy noticing that, the villages of Mvila division are far to emerge in income generating activities as many households are still timid in adopting food-producing trade. Therefore, the contribution of such activities to poverty reduction is still insufficient. This kind of contradiction can be justified by several factors, including farmer dependence on cocoa farming or farmer fatigue on agriculture and marketing in general. This situation is also sustained by the lack of modernization of the productive and commercial food crop equipments. That global environment leads to decrease of agricultural production volumes and economic return while the risks increase in rural areas. Although some farmer organizations obtain good results, the scale of the current challenges greatly restricts the feasibility of rural households' poverty alleviation initiatives.

This thesis deals with rural development actors' social networks and individual social capital of mayors in municipalities belonging to local action groups Rozvoj Krnovska and Rýmařovsko. In my work I examine if there is any correlation between evaluation of funcionality of local action groups and degree of individual social capital of mayors in municipalities belonging to local action groups and between certain characteristics of actors' social networks. In the first part of the thesis I deal with rural areas' problems, development factors, social capital and social network in general. In the second part of the thesis I analyze results of survey, which took part in March 2017 between 34 mayors of municipalities belonging to local action group Rozvoj Krnovska and Rýmařovsko respectively. On the basis of survey results I continue with analyzing of mayors' individual social capital and types of social capital - bonding, bridging, linking. The study confirmed the key role of individual social capital (and bonding and bridging social capital) of rural municipality mayors for funcionality of local action groups. Key words: social capital - networks - development actors - rural area - mayors - local action group - MAS Rýmařovsko - MAS Rozvoj Krnovska.

Abstract Sparsely populated Finland is an interesting area for studying the effects of population density and distance on health. Previous studies indicate health problems in rural and remote areas. Aim is to study the importance of local residential area to health of young adults: how the residential area is associated with health, what is the role of geographical distance and how health is associated with moving. Study utilises the 31-year follow-up data from the Northern Finland Birth Cohort 1966 study, initially including all children born in the provinces of Oulu and Lapland in 1966. Local residential area is defined with 1 km² population density grid data. Distances to municipality centre or health centre are calculated using Finnish road network data (Digiroad). Perceived health in rural and urban areas is studied with ordinal logistic regression; body mass index (BMI) and overweight in relation to distance to municipality’s centre and population density using a generalised additive model. Role of distance in health centre use and distance-related inequity are studied with negative binomial regression and concentration indices, and health’s association with moving in multinomial logistic regressions. Poor perceived health increased from densely to sparsely populated areas. Among rural men adverse psychosocial and lifestyle factors were behind the associations, among women reasons for poor health in scattered settlement areas remained unclear. BMI and overweight increased at distances greater than 5 kilometres from municipality centre and with decreasing population density. No barrier effects of distance or distance-related inequity in the health centre use was found. Dissatisfaction with life and history of morbidity were associated with rural-urban moves, activity limiting illness with rural-rural moves, and frequent use of health services with all urban moves. Geographical distance was not a major barrier in health service use among young adults. Individual’s health status was linked with moving and may be relevant for rural-urban health inequalities. Local health variations within small administrative areas can be identified by grid-based data, indicating the need of customised interventions. Urban sprawl may affect people’s bodyweight, also urging health-based planning of residential areas. Longitudinal perspective would improve predictive value of findings. / Tiivistelmä Harvaan asuttu Suomi on kiinnostava alue väentiheyden ja etäisyyden terveysvaikutusten tutkimiselle. Aiempien tutkimusten mukaan maaseutumaisilla ja syrjäisillä alueilla on monia terveysongelmia. Tutkimuksen tarkoituksena on selvittää asuinympäristön merkitystä nuorten aikuisten terveydelle: miten asuinympäristö on yhteydessä terveyteen, mikä rooli etäisyydellä on ja miten terveys on yhteydessä muuttamiseen. Aineistona on Pohjois-Suomen syntymäkohortti 1966:n 31-vuotisseuranta-aineisto, sisältäen alkujaan kaikki vuonna 1966 Oulun ja Lapin läänissä syntyneet lapset. Asuinympäristö määritettiin 1 km2 väestöruutuaineiston avulla. Etäisyydet kunta- ja terveyskeskuksiin laskettiin Suomen tie- ja katuverkkotietokantaa (Digiroad) käyttäen. Koettua terveyttä tutkittiin maaseutu-kaupunkijatkumolla ordinaalisella logistisella regressiolla; painoindeksin (BMI) ja ylipainon yhteyttä kuntakeskusetäisyyteen ja väentiheyteen yleistetyllä additiivisella mallilla. Terveyspalvelujen käyttöä ja käytön oikeudenmukaisuutta etäisyyden suhteen tutkittiin negatiivisella binomiregressiolla ja konsentraatioindekseillä, ja terveyden yhteyttä muuttamiseen multinomiaalisella logistisella regressiolla. Huono koettu terveys lisääntyi kaupunkikeskustoista haja-asutusalueille. Maalla asuvien miesten huono koettu terveys selittyi psykososiaalisilla ja terveyskäyttäytymistekijöillä; naisilla syy huonoon koettuun terveyteen haja-asutusalueella jäi epäselväksi. BMI ja ylipainoisten osuus alkoivat kasvaa kuntakeskusetäisyyden ylittäessä viisi kilometriä ja väentiheyden vähetessä. Etäisyys ei vähentänyt terveyskeskuspalvelujen käyttöä, eikä etäisyyteen liittyvää epäoikeudenmukaisuutta havaittu. Elämään tyytymättömyys ja elämänaikainen sairastavuus olivat yhteydessä maaseutu-kaupunkimuuttoihin, haittaava sairastavuus maaseudun sisäisiin muuttoihin ja terveyspalvelujen käyttö kaikkiin kaupunkimuuttoihin. Maantieteellinen etäisyys ei estänyt nuorten aikuisten terveyspalvelujen käyttöä. Yksilön terveys oli yhteydessä muuttamiseen, millä voi olla merkitystä myös terveyden alue-eroille. Ruutuaineiston avulla voidaan löytää terveyseroja hallinnollisten alueiden sisältä, mikä kannustaa toimenpiteiden räätälöintiin eri alueille. Kaupunkirakenteen hajautuminen voi vaikuttaa yksilön painoon, joten terveysnäkökulma tulisi huomioida aluesuunnittelussa. Pitkittäinen tutkimusote parantaisi löydösten ennustavuutta.

Waste resulting from healthcare activities is hazardous due to its potential risk of infection to healthcare workers, waste workers and the public. Many tools and approaches have been applied in waste management in developed countries, but are not suitable for application in developing countries due to their complexity and extensive data and resource requirements. WasteOpt was therefore developed and applied as an appropriate decision-making tool in the developing country context. WasteOpt comprises of the Analytical Hierarchy Process (AHP), costing and Life cycle management (LCM). The purpose of this study was to identify environmentally sound technologies (ESTs) that minimise the risk of infection by healthcare waste (HCW) in rural clinics. Rural clinics were selected because apart from financial constraints, they are challenged by the lack of procedure, infrastructure and technologies to develop reasonable waste management plans that can be implemented within a practicable time frame. WasteOpt was applied to aid in identifying ESTs in relation to the infection risks and costs of the technologies. Experts in waste management in Lesotho were involved in a workshop for the ranking of technologies. The overall weighting values of the rankings were converted to risk factors for individual options and for alternatives (combination of options). Risk factors were classified as low, medium and high risk. The technologies within a single class were differentiated by analysing the cost of acquiring and running the technology to qualify as ESTs. The ESTs identified for Lesotho are Engineered containers, Refrigerated engineered facility, engineered wheeled transport, detailed procedures, multi chamber incinerator, engineered pit and landfill. Ten (10) clinics in Lesotho were also assessed as case studies using the WHO RAT. The RAT was first modified to include questions on financial management at the clinics. The calculated risk factors were applied to the case studies to assess the risk under which healthcare workers operate in those clinics. The additive minimum risk for the overall life cycle of waste was 4.0 (excluding central treatment and disposal). The clinic workers were found to be at a risk of between 1.1 x 10-4 and 7.8 x 10-5, which proves that rural clinics in Lesotho are still using inappropriate technologies. In terms of financing for waste management, public clinics were found to have little decision-making powers over funds and had less accountability measures. CHAL clinics which are managed by churches in Lesotho had more control of funds and exhibit more accountability. All clinics had no targets for saving funds from waste management activities. WasteOpt can be applied as a decision-making tool for HCW in Lesotho since it overcomes the barriers that inhibit environmentally sound management of HCW in developing countries. In conclusion: WasteOpt can be applied as a decision-making tool for different types of waste by replacing HCW options with respective ones and designing a relevant questionnaire for qualitative data capture. WasteOpt can then be applied in a developing country to aid sustainable waste management decision-making. Informed decision-making helps resource poor managers to select cost-effective but low-risk options, which will be sustainable in the future. / Dissertation (MSc (Environmental Technology))--University of Pretoria, 2007. / Chemical Engineering / unrestricted