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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
571

How South African banking sector facilitates South African foreign direct investment into Sub-Saharan Africa

Khumalo, Mahlomola 12 1900 (has links)
Thesis (MDF)--Stellenbosch University, 2008. / ENGLISH ABSTRACT: Currently, South Africa is a leading intra-continental foreign direct investor in Africa, in general, and in Sub-Saharan Africa, in particular. The internationalisation of South African enterprises has throughout the period following the advent of the new dispensation in 1994 assumed two forms: banking and non-banking cross-border expansions. These cross-border expansions have largely involved greenfield, merger and acquisition and joint venture types of investment. Increased trade between South Africa and the region and huge business and investment opportunities have been the pre-eminent motive forces behind the country's nonbanking and banking foreign direct investment drive into Sub-Saharan Africa. A number of studies have been conducted about South African general outward foreign direct investment, but none so specifically about the involvement of the South African multinational banks in this cross-border expansion by the country's multinational firms. In fact, no obvious and composite information is readily available about the "how" aspect of the involvement. It is the objective of this study therefore to investigate "how" South African banks with multinational behaviour have facilitated and continue to facilitate the way for South African foreign direct investment in Sub-Saharan Africa. The outcome of the research effort makes for an interesting discovery that demonstrates how South African banks indeed facilitate South African outward FDI flows into the Sub-Saharan region. A case study illustration in this research report clearly shows that banks, driven by their own foreign direct investment interests, were simultaneously facilitating and driving nonbanking foreign direct investment in the region. Benefits and costs are also accruing to firms and countries (host country and home country to a lesser degree) involved in the crossborder investment activities. South African outward foreign direct investment, although very important to Sub-Saharan Africa, has serious challenges to contend with in the region. Pockets of conflict and instability in some countries with lucrative opportunities continue to bedevil South African foreign direct investment. Policy and regulatory environments in some countries still remain to be a downside for the attraction of South African outward foreign direct investment, including banking foreign direct investment. Interestingly, South African govemment is keenly involved to ensure that trade and investment in Sub-Saharan Africa flow uninterruptedly without prejudicing any party. Trade and investment opportunities are indeed the key motives for South African outward foreign direct investment into Sub-Saharan Africa. The ''follow-your-client'' paradigm is largely responsible for the South African multinational banks' drive across the border into the region. This ''follow-your-client'' concept in the South Africa foreign direct investment context and other related concepts must be further researched in much greater detail and wider approach. But this does not take away the essence and significance of this study which, amongst other things, provides a good foundation for future research undertakings. / AFRIKAANSE OPSOMMING: Huidiglik is Suid-Afrika die voorstander in die intra-kontinentale vaste buitelandse investering in Afrika in die algemeen en spesifiek in Sub-Sahara Afrika. Die internasionalisering van Suid-Afrikaanse besighede het na 1994 twee vorme aangeneem, t.w. die uitbreiding van bank- en nie-bankinvestering. Die uitbreiding sluit in samesmeltings en venootskappe van investeringsgeleenthede. Verhoogde handel, investeringsgeleenthede en besigheid tussen Suid-Afrika en Sub-Sahara Afrika was die dryfkrag agter die land se vaste buitelandse beleggings. Aigemene studies is gedoen van Suid-Afrikaanse buitelandse beleggings, maar niks so spesifiek soos die samewerking van Suid-Afrikaanse banke met die banke van buitelandse multinasionale firmas nie. Daar is geen inligting vrylik bekombaar oor die 'hoe' van die buitelandse beleggings nie. Die doel van hierdie studie is om juis te bepaal hoe Suid-Afrikaanse banke tans en op die pad vorentoe te werk gaan om vaste buitelandse investerings met multinasionale besighede in Sub-Sahara Afrika uit te brei. 'n Teoretiese grondslag van die debat, definisies en begrip van die konsep "vaste buitelandse investering" vorm deel van die ondersoek, waar beide primere en sekondere data gebruik is. Moeite is gedoen om te verseker dat die data en inligting wat gebruik is, gebaseer is op die "global research methodology", wat insluit vraelyste en elektroniese onderhoude. Hierdie terugvoering wys daarop dat Suid-Afrikaanse banke inderdaad pro-aktief is in die veld van uitwaardse vaste beleggings in die Sub-Sahara area. Banke doen nie net hul eie vaste buitelandse investerings nie, maar fasiliteer dit vir nie-bank vaste buitelandse beleggings. Dit lei tot voordele en kostebesparings vir firmas in die proses van beleggingsaktiwiteite. Alhoewel Suid-Afrikaanse vaste beleggings belangrik is vir ander Afrikastate, is daar ook heelwat slaggate om in ag te neem. Onstabiliteite in lande met aansienlike investeringspotensiaal maak dit moeilik vir Suid-Afrika om te investeer. In baie lande het reels en regulasies nog steeds 'n negatiewe invloed op buitelandse investerings, wat banke insluit. Handel en beleggingsgeleenthede is die motief vir Suid-Afrikaanse investering in SubSahara lande. Die gesegde "follow your client" is die dryfkrag agter die Suid-Afrikaanse banke om te investeer. Daar moet meer ondersoek gedoen word oor die "follow your client" konsep. Hierdie verslag is dus slegs 'n begin punt waarop daar uitgebrei moet word deur verdere ondersoeke.
572

Comparative analysis of private equity (PE) structures in Sub Saharan Africa (SSA) frontier markets versus South Africa (SA)

Sokhela, Sandile 12 1900 (has links)
Thesis (MDF)--Stellenbosch University, 2012. / This research paper analyses how asymmetry information impacts Private Equity (PE) investment deal structuring in Sub Saharan Africa excluding South Africa ((SSA (ex SA)) relative to SA. It asks the question: how are the risks faced by Africa frontier market private equity investors - reflected, mitigated and managed via contracting, monitoring and investment exiting activities? In so doing the research makes a number of hypotheses based on agency academic theory. A survey questionnaire was distributed to PE firms who invest in South Africa (SA) and in the Sub-Saharan Africa excluding SA (SSA ex SA). Under each segment of the survey (contracting, monitoring and exiting) a number of questions were posed for ranking according to likelihood or frequency of occurrence. Using the Wilcoxon Rank Sum test statistical methodology, to test for statistical differences between the two sub-samples of responses to the questionnaire provided by 32 PE firms. The results were interpreted in relation to existing financial agency theories related to contracting, monitoring and exiting investments. The results of the work achieved in this study largely suggest that PE investors use global best practices when investing in the sub Saharan Africa region. SSA (ex SA) PE investors employ the same sophisticated approaches and contracts provisions as investors in established markets. However given the levels of information asymmetries the use of instruments that do not give investors direct control rights are rare in SSA (ex SA) relative to SA. The results are consistent and support that view that there is a persistent scepticism regarding the many Africa jurisdiction legal systems’ ability to effectively protect debt investors and this is mainly reflected in choice of security, which also impacts the types contracting provisions in contracts.
573

A quantitative analysis of the economic incentives of sub-Saharan Africa urban land use planning systems : case study of Accra, Ghana

Baffour Awuah, K. G. January 2013 (has links)
The deficiency of sub-Saharan Africa urban land use planning regimes has received extensive discussion in the literature. As yet, little is known of the extent and magnitude of the economic impact of these planning regimes on the economic wellbeing of individuals and the society. This situation is further compounded by the lack of simplified and bespoke methodologies for calibrating economic impacts of planning policies even in the developed world where there are relatively huge volumes of organised data. This study aims to prescribe a simplified quantitative methodology, which is subsequently employed to gauge the economic impacts of these regimes. It proceeds on the central argument that planning regimes in the sub-region are weak with low compliance with planning regulations, partly because they do not provide incentives for property owners/developers/land users. The study adopts a cross-sectional survey strategywith questionnaires and administrative data extraction to procure the requisite data from Accra, Ghana to feed the devised methodological framework. The study establishes that Ghana’s urban land use planning regime, in its current form, imposes huge cost on residential property owners compared to its benefits; it creates a disincentive for property owners. A substantial amount of this cost emanates from pipe-borne water, and tarred roads and concrete drain infrastructural facilities. It is further established that the cost of title formalisation requirement constitutes a huge portion of the cost on express requirements under the planning regime. A major portion of this cost results from the cost other than official fees. However, on individual basis the requirement generates marginal net benefit. Incidental costs for the other express requirements, architectural design and building permit are also substantial. In terms of benefits, tarred roads and concrete drains, formalised title, electricity and pipe-borne water, individually, are found to generate the most benefits under the planning regime. The study makes a number of recommendations. These include formulation of planning policies on the basis of providing incentives to property owners/developer/land users, strategies for reduction of infrastructural and amenities costs, as well as incidental cost relating to compliance with the subject planning regime express requirements.
574

A Theoretical Model for Telemedicine : Social and Value Outcomes in Sub-Saharan Africa

Kifle Gelan, Mengistu January 2006 (has links)
<p>The Sub-Saharan Africa (SSA) region is faced with limited medical personnel and healthcare services to address the many healthcare problems of the region. Poor health indicators reflect the overall decline in socio-economic development. Shortages of access to health services in the region is further complicated by the concentration of health services in urban areas, the region’s multiple medical problems (over 70% of HIV/AIDS cases in the world); and the brain drain phenomenon – it is estimated one-third of African physicians emigrate to North America and Europe. The result is that the SSA region is left with about 10 physicians, and 20 beds, per 100,000 patients. Telemedicine has been found to offer socio-economic benefits, reduce costs, and improve access to healthcare service providers by patients, but previous attempts to move various information technologies from developers in the industrial world to the developing world have failed because of a clear neglect of infrastructural and cultural factors that influence such transfers. The objective of this study is to address key factors that challenge the introduction of telemedicine technology into the health sector in SSA in particular, and by extension, other developing countries with similar socio-economic structures.</p><p>This research offers a distinctive perspective, focusing on visually-based clinical applications in the SSA region, and considerable attention to the national infrastructure and cultural impact of telemedicine transfer (social and value) outcomes. Two research models and its associated hypotheses are proposed and empirically tested using quantitative data collected from SSA physicians and other health professionals. The study also contributes to the ongoing debate on the potential of telemedicine in improving access and reducing costs. This research can help to understand the socio-economic impact of telemedicine outcomes in a comprehensive way. The finding from the survey shows the rapid advances in telemedicine technology specifically, visual clinical applications may become an essential healthcare tool in the near future within SSA countries.</p>
575

La démocratisation au Togo et au Bénin : l'influence des stratégies des groupes d'opposition

Morency-Laflamme, Julien 10 1900 (has links)
Le Bénin et le Togo sont deux pays partageant plusieurs similitudes : ils ont tous les deux été colonisés par la France; leur niveau de développement économique est équivalent; leur histoire postcoloniale est marquée par les coups d’états et, à la fin des années 1980, par des vagues de revendications démocratiques. Celles-ci se sont soldées dans chaque cas par une conférence nationale et l’organisation d’élections générales. Malgré cette trajectoire similaire, seul le Bénin est devenu une démocratie consolidée. Pour expliquer cette différence, ce mémoire se penche sur l’influence des stratégies de l’opposition et sur les processus de transition. Ce mémoire démontre que le degré de cohésion des groupes d’opposition et les accords de ces derniers avec les gouvernements en place ont eu une profonde influence sur le succès ou l’échec des transitions démocratiques. / Benin and Togo have much in common: both countries are former French colonies; throughout the 20th century, both have achieved a comparable level of economic development; both are characterized by a postcolonial history marked by coups d’états and waves of protestations in favour of democracy in the 1980s. Moreover, in both cases, these waves of protestations resulted in National Conferences and multiparty elections in the early 1990s. Yet, in spite of these similarities, only Benin has succeeded in establishing a democratic state. This thesis attempts to determine why this is the cases. By examining the influence of the opposition parties’ strategies in the overall transition process of Benin and Togo, one concludes that the degree of unity among opposition groups and the various compromises made with the government exerts a critical influence on the success or failure of democratic transitions.
576

A Comparison of United States Network Television News Coverage of Sub-Sahara Africa Before and After the 1975-76 Angola Conflict

Ilegbodu, Fred O. 05 1900 (has links)
The proposition that American network television news coverage of sub-Sahara Africa increased substantially after the 1975-76 Angola conflict is examined in this study of the responsiveness of television to changing news values at the international level. News coverage for two thirty-month periods before and after the Angola conflict is compared using data derived from the Television News Index and Abstracts. The study finds that network news coverage of sub-Sahara Africa increased from 0.36 per cent of total news time before the Angola conflict to 4.46 per cent after, indicating that network news coverage is a reflection of the intensity of United States government activity at the international level.
577

Problématique d'une éducation à la sexualité en milieu scolaire dans les pays d'Afrique Subsaharienne : L'exemple du Cameroun / Issue of education about sexuality in schools in the countries of Sub-Saharan Africa : The example of Cameroon

Wafo, François 07 June 2012 (has links)
L’éducation à la sexualité est une réponse opposable au comportement sexuel à risque desjeunes. Plusieurs instances internationales (Unesco, OMS, Onusida, Unicef) encouragent sonintégration à l’école, notamment dans les pays d’Afrique subsaharienne où la prévalence desITS et VIH/sida demeure élevée. Toutefois, l’absence d’un corpus littéraire de référence enéducation à la sexualité rend difficile cette intégration. L’implémentation de cette éducation àl’école dans les pays d’Afrique subsaharienne nécessite une prise en compte des spécificitéssocioéconomiques, culturelles, institutionnelles et des conceptions individuelles des jeunessur la sexualité, qui sont des déterminants de leurs comportements sexuels. La mobilisationdes enseignants sur cette tâche n’est pas acquise, notamment en raison de multiplesrésistances dont ils font preuve, et dont il convient d’isoler les origines.Cette thèse est consacrée d’une part à l’étude des conceptions des élèves sur l’éducation à lasexualité et leurs besoins éducatifs exprimés et d’autre part, à l’étude des conceptions et despratiques professionnelles des enseignants en éducation à la sexualité au Cameroun. Dans laperspective d’élaborer des modèles théoriques d’intervention, et des dispositifs de formationdes enseignants en éducation à la sexualité qui soient adéquats au contexte africain, notrerecherche explore les facteurs susceptibles d’influer tant sur la mise en œuvre que la réussitede cette action à l’école dans les pays d’Afrique subsaharienne en s’appuyant sur l’exempledu Cameroun. Elle repose sur une enquête par questionnaire menée auprès des élèves desclasses de quatrième et de troisième d’enseignement général (n=3071), et des enseignants dupremier cycle de l’enseignement général (n=368) du Cameroun.Cette recherche montre que les conceptions individuelles des élèves sont plutôt favorables àl’éducation à la sexualité à l’école et qu’ils considèrent l’école et les enseignants comme desacteurs légitimes de cette éducation. Discutant peu de sexualité avec leurs parents, leursprincipales sources d’information est la télévision, l’école et Internet. Les élèves émettent desbesoins éducatifs s’articulant autour des cinq dimensions de la sexualité.Contrairement aux élèves, les enseignants ont des conceptions plutôt défavorables àl’éducation à la sexualité à l’école, renforcées par le peu de pratique qu’ils ont en éducation àla sexualité et le manque de formation. Près de la moitié des enseignants se dédouanent decette mission et remettent en cause son inclusion à l’école. Ils affichent une méconnaissancetant des besoins et des attentes réelles des élèves en éducation à la sexualité que des effets decette action éducative sur la santé des jeunes. Ils entretiennent également un fort sentimentd’incompétence pour cette action éducative. Pourtant, ces enseignants sont majoritairement enaccord avec le fait que l’éducation à la sexualité des jeunes est vraiment nécessaire. / Education on sexuality or “sex education” aims to reduce risky sexual behaviour amongadolescents and young adults in particular. Several international organisations (UNESCO,WHO, UNAIDS, UNICEF) encourage sex education in schools, particularly in countries ofsub-Saharan Africa where sexually transmitted infections (STI) and HIV/Aids remainfrequent. However the lack of literature on sex education in schools makes implementing suchpolicies difficult. Developing sex education in schools of sub-Saharan Africa requires takinginto account the specific socio-Economic, cultural and institutional contexts of these countries,as well as the individual conceptions that young people have of sexuality and whichdetermine their sexual behaviour. Teacher involvement in this task is not evident either, asteachers tend to resist implementing sex education for various reasons that should beidentified and analyzed.These PhD thesis studies pupil conceptions of sex education and the needs they identify inthis domain on one hand, and the conceptions and professional practices of teachers in sexeducation on the other hand, in the country of Cameroon. With the purpose of contributing thedevelopment of theoretical models of intervention and a framework for teacher training in sexeducation adapted to the African context, our research attempts to identify the factors thataffect the implementation and the success of sex education in sub-Saharan Africa via the caseof Cameroon. Our study is based on a survey of middle-School pupils (n=3071) and a surveyof general education teachers (n=368) in Cameroon.Results show that pupil individual conceptions are favourable to sex education in schools, andthat pupils consider their teachers and their schools to be legitimate providers of sexeducation. Pupils rarely discuss sexuality with their parents, whereas their main sources ofinformation on sexuality are the television, school, and the internet. The pupils expressededucational needs encompassing the five dimensions of sexuality.In contrast, we found that teachers do not tend to perceive sex education in schoolsfavourably. This position appears to be to be linked to their limited experience of teachingsexual education, and the lack of training they have received in the teaching of sex education.Nearly half of the teachers interviewed do not feel concerned by the subject and feel that sexeducation should not be taught in schools. Also teachers demonstrated an overall lack ofunderstanding of pupil needs and expectations as well as the impact that sex education couldhave on the health of their pupils. Many teachers maintain the position that they are notcompetent and in sex education and even that it is not their role. However the majority of theteachers investigated do agree that there is a real need for sex education for adolescents and young adults.
578

Droit international et règlement des crises constitutionnelles en Afrique noire francophone / International law and international settlement for constitutional crises in Subsaharian African french speaking countries

Agbo, Ayawa Aménuvévé 02 July 2012 (has links)
Le droit international intervient dans un contexte de multiplication des crises constitutionnelles auxquelles les mécanismes internes des gestion des crises, n'arrivent pas à trouver de solution. En effet, les constitutions étant directement la cause des crises que connaissent les États africains, elles se trouvent disqualifiées pour jouer leur rôle de règlement de ces crises et d'apaisement de la vie politique. L'intervention de la communauté internationale dans la gestion des crises constitutionnelles trouve ainsi sa justification. L'implication du droit international dans le règlement des crises constitutionnelles prend la forme une assistance constitutionnelle ou d'une assistance à la mise en œuvre du jeu démocratique. L'intervention du droit international dans le domaine constitutionnel, normalement une compétence réservé aux États, emporte des conséquences sur le contenu des constitutions. Celles-ci désormais, s'alignent sur les standards internationaux de démocratie, de pluralisme politique, d’État de droit et de protection des droits et des libertés fondamentales. L'internationalisation des constitutions en Afrique noire francophone, consécutive au règlement international des crises constitutionnelles, entraîne la formation de nouveaux rapports entre le droit international et le droit constitutionnel. Les constitutions deviennent protectrices des valeurs internationalement reconnues et universalisées, tandis que le droit international s'occupe de gérer non plus seulement les rapports interétatiques mais consacre des normes d'application intraétatique. On assiste ainsi à un renforcement mutuel des deux ordres juridiques. L'efficacité dans la durée du règlement international des crises constitutionnelles en Afrique reste toutefois à améliorer. En effet, les valeurs démocratiques ainsi imposées par le sommet, courent le risque de ne pas correspondre aux aspirations des peuples. Le règlement international se doit de s'appuyer sur les constitutions et de prendre en compte, l'ensemble des mécanismes et techniques institutionnels nationaux, voire traditionnels, de règlement des crises constitutionnelles dans les États d'Afrique noire francophone. / Constitutional law in French speaking African sub-Saharan countries is progressing under pressure from different elements. In fact, more than twenty years of practice of a new constitutionalism in these states, reveals many lacunas and failures that raised up on the continent, in almost every states, numerous constitutional crisis. Being the factor of these crisis, the constitutions have disqualified themselves to provide solution for the crisis. The intervention of the international community to settle these constitutional crisis, through international law is thus justified. The international settlement of constitutionnal crisis is a political mechanism by which the international community come to backup the constitutional practice in a state, in order to help solving the crisis. This intervention of international law in the area of competence reserved for the states, is based on the principle of the agreement of the legitimate public authorities of the state and it borrows some different forms, especially the constitutional assistance and the democratic assistance. As result, the international settlement of constitutional crisis led to an internationalization of the constitutions of the assisted states. The process of internationalization pass by the definition of the political regime of the states, particularly, the promotion of constitutional states and also by the proclamation and protection of individual rights. But the main question remain to determine the efficiency of the intervention of international law in the settlement of constitutional crisis. The practice of constitutional law in French speaking African sub-Saharan countries can take advantage on the international settlement of constitutionnal crisis, to be improved and become a source of national cohesion.
579

Utilisation du modèle CEPAC en appui à la recherche clinique dans le domaine de la prise en charge des adultes infectés par le VIH en Afrique sub-saharienne / The use of the CEPAC model to support clinical research in the era of the care of HIV-infected adults in sub-Saharan Africa

Ouattara, Eric 17 December 2012 (has links)
Dans la première partie de ce travail, nous passons en revue les sujets qui ont fait l’objet d’essais thérapeutiques randomisés dans le domaine de la prévention et de la prise en charge de l’adulte infecté par le VIH en Afrique sub-saharienne. Nous en tirons deux conclusions : (i) que beaucoup de questions de recherche n’ont pas été explorées par des essais, soit parce qu’elles n’ont pas été jugées prioritaires, soit parce qu’un essai pour répondre à la question n’était pas jugé possible ; (ii) que les essais ayant des résultats positifs débouchent souvent eux même sur de nouvelles questions, notamment sur l’interprétation à donner à leurs résultats, les implications pratiques, les projections à long terme, et la réplicabilité dans différents contextes. Il arrive que ces questions paralysent les décisions. La question se pose donc d’utiliser au mieux les outils complémentaires aux essais thérapeutiques, incluant l’outil « modélisation ». Dans la deuxième partie, nous situons les modèles multi-états d’histoire naturelle de la maladie dans le spectre des différents modèles mathématiques utilisés en recherche médicale, et nous décrivons en détail un de ces modèles, le modèle « Cost Effectiveness of Preventing Aids Complication » (CEPAC) conçu aux USA, et développé puis appliqué ensuite dans la collaboration « CEPAC international » avec des équipes françaises, ivoirienne, Sud-Africaine et indienne pour des analyses cout-efficacité. Dans la troisième partie, nous utilisons le modèle CEPAC pour explorer deux questions : La première question porte sur le choix entre efavirenz, potentiellement tératogène, et la névirapine, pouvant être responsable d’une toxicité sévère, pour servir de base à la première ligne de traitement antirétroviral chez les femmes en âge de procréer en Afrique subsaharienne. En projetant à 10 ans la survie chez la mère et le nombre cumulé de malformations chez l’enfant, nous montrons que la tératogénicité de l’efavirenz devrait être 2,3 fois plus élevée que celle de la nevirapine pour que le nombre de malformations chez les enfants dont les mères ont pris de l’efavirenz soit supérieur au nombre de décès chez les femmes qui ont pris de la nevirapine. La deuxième question porte sur l’efficacité et le coût-efficacité de plusieurs stratégies thérapeutiques après l’échec de la deuxième ligne de traitement ARV chez des adultes en Côte d’Ivoire. Cette analyse montre que l’utilisation des médicaments ARV de troisième ligne serait dores et déjà non seulement efficace mais également coût-efficace en Côte d’Ivoire, si elle était utilisée dans une stratégie comportant une phase de renforcement intensif de l’adhérence avant décision de changement de ligne. En conclusion, nous proposons de définir en quatre groupes les situations dans lesquelles la modélisation peut aider la recherche clinique : (i) pour aider à la conception d’un essai clinique ; (ii) pour mettre en perspective les résultats d’essais cliniques, en les projetant à plus long termes ou dans différents contextes ; (iii) pour étudier une question pour laquelle un essai clinique n’est pas faisable ; (iv) pour stimuler la réflexion sur de nouvelles questions sur lesquelles il n’y a pas encore eu d’essai. En même temps qu’on expérimente l’utilisation pratique de ces modèles, il y a également une réflexion à avoir sur les aspects de validation, de transparence et de standardisation, notamment au moment de la publication des études, pour les rendre accessibles aux cliniciens et aux chercheurs qui ne sont pas familiers avec la modélisation. / In the first part of this work, we review the issues that have been the subject of randomized clinical trials in the field of prevention and care of HIV-infected adults in sub-Saharan Africa. From this research, we draw two conclusions: (i) many research questions have not been explored with clinical trials, either because they were not considered as a priority, or because conducting a trial was not a feasible way to answer the question; (ii) trials with positive results often lead to new issues, especially regarding interpretation of results, practical implications, long-term projections, and replication in different contexts. At times, these issues paralyze health decisions. The question therefore becomes how to best use tools that complement clinical trials, including "disease modelling" tools. In the second part of this work, we place multi-state models of natural history of disease within different mathematical models used in medical research. We describe, in detail, one of these models--the “Cost Effectiveness of Preventing Aids Complication” (CEPAC) model, designed in the USA and then developed and implemented by the “CEPAC-International” collaboration, which includes French, Ivorian, South African and Indian teams, to conduct cost-effectiveness analyses. In the third part, we use the CEPAC model to explore two questions: The first question is concerned with whether to use efavirenz, which is potentially teratogenic, or nevirapine, which can induce severe toxicity, in first-line antiretroviral regimen for women of child-bearing age in sub-Saharan Africa. Projecting at 10 years the survival of the mothers and the cumulative number of malformations in their children, we show that the teratogenicity of efavirenz would have to be 2.3 times higher than that of nevirapine for the additional number of defects in children whose mothers are taking efavirenz to be greater than the number of additional deaths among women who are taking nevirapine. The second question focuses on the effectiveness and cost-effectiveness of different treatment strategies after the failure on second-line antiretroviral therapy (ART) in HIV-infected adults in Côte d'Ivoire. This analysis shows that the use of third-line ART would be effective and cost-effective in Côte d'Ivoire, if used within a strategy that mandated an intensive adherence reinforcement intervention before deciding to switch patients to third-line. In conclusion, we define four situations within which modelling can help inform clinical research: (i) to assist the design of clinical trials, (ii) to put in perspective the results of clinical trials, by projecting the results in the long term or in different contexts, (iii) to study any questions for which a clinical trial is not suitable, (iv) to fuel the discussion on new issues for which testing has not yet be done. While we experiment with the practical use of these models, we also have to reflect on the validation, standardization, and transparency of the model, especially at the time of publication, to make sure studies are accessible to clinicians and researchers who are not familiar with modelling.
580

Les organisations secrètes criminelles et le management par la terreur : cas des réseaux de proxénétisme subsahariens / Criminal secret organizations and management by terror : the case of sub-Saharan pimping networks

Amedegnato, Akakpo 25 April 2014 (has links)
Une organisation, c'est avant tout des hommes et des moyens pour atteindre desobjectifs, et les réseaux subsahariens de proxénétisme ne dérogent pas à cette règle. Comme touteorganisation ils structurent et mobilisent des acteurs, mettent en place des stratégies pour arriver àleurs fins. En même temps la question de l'organisation suscite entre autre celle de l'environnementorganisationnel, car toute organisation vit et évolue dans un environnement donné avec lequel secréent des interactions. La problématique de la dynamique organisationnelle des réseauxsubsahariens de proxénétisme soulève celle de leur visibilité et de leur légitimité dans cetenvironnement, car ce sont des organisations criminelles, secrètes, et donc ne pouvant bénéficierd'aucune publicité. Pourtant, ces réseaux fonctionnent bel et bien, et les conséquences de leursactions sont bien perceptibles. Comment comprendre cette possibilité de fonctionnement dans detelles circonstances ? Il est certain que les jeunes femmes recrutées par les proxénètes subsaharienssubissent un management par la terreur. Cependant un élément déterminant laisse supposer que cesjeunes femmes vivent dans une peur qui va au-delà de la simple peur du proxénète : le phénomène« vaudou », propre aux réalités socioculturelles des sociétés subsahariennes. L'environnementinstitutionnel des réseaux subsahariens de proxénétisme inspirerait-il leur fonctionnement ? Cettethèse se propose d'apporter un éclairage sur le fonctionnement et les pratiques organisationnellesdes réseaux subsahariens de proxénétisme, à la lumière de la théorie du néo-institutionnalisme etcelle de la contingence. Ces deux théories mettent en évidence la relation d'influence possible entrel'environnement d'une organisation et son comportement. / An organization, it is primarily men and means to achieve goals, and sub-Saharanpimping networks are no exception to this rule. Like any organization they structure and mobilizestakeholders, implement strategies to achieve their goals. At the same time the question of theorganization causes including that of the organizational environment as an organization exists andevolves in a given environment with which interactions are created. The problem of organizationaldynamics of sub-Saharan pimping networks, raises the question of their visibility and legitimacy inthis environment, because they are criminal, secret organizations and therefore not eligible for anyadvertising. However, these networks do work well and the consequences of their actions areperceived. How to understand the possibility of operating in such circumstances ? It's certain, thatyoung women recruited by sub-Saharian pimps undergo management by terror. A key elementsuggests that these women live in fear that goes beyond the simple fear of the pimp. It's the« voodoo », a phenomenon linked to the socio-cultural realities of sub-Saharan communities. Doesthe institutional environment of sub-Saharan pimping networks inspire their operation ? This thesisaims to shed light on organizational practices and the operation of sub-Saharan pimping networks,in the light of two theories : neo-institutionalism and contingency. Both theories emphasize therelationship with the environment that can affect an organization and its behavior.

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