Problem: Zambia has one of the highest maternal mortality ratios in the world. Risks of serious complications during childbirth and associated maternal morbidity and mortality can be mitigated by improving access to skilled birth attendants and emergency obstetric and newborn care (EmONC) in facilities when complications arise. In 2012, the Saving Mothers Giving Life (SMGL) initiative was launched in Kalomo District, Zambia, to reduce maternal deaths. Methods: This study assessed the impact of SMGL in Kalomo District on rates of facility delivery, delivery with a skilled birth attendant, and facility-level changes in the provision of maternity and newborn care during the first learning phase, 2012–2013. Changes in neonatal mortality were also assessed. A mixed-methods approach utilized a quasi-experimental pre-post nonequivalent comparison group design using household data (n=21,680 women) and health facility assessments (n=77) including EmONC signal functions. Data were collected from February 2011–October 2013, before and during SMGL program implementation, in the intervention district and a comparison area. A qualitative inquiry with key informants (n=26) was then conducted in September 2014. Results: There was a 49% relative increase in the odds of facility-based birth during SMGL in Kalomo relative to comparison districts (OR 1.49, 95% CI: 1.21–1.77), controlling for covariates. There was no significant change in delivery with a skilled birth attendant. Newborn mortality in Kalomo decreased significantly (4.3% to 2.6%, p<0.01), even when controlling for covariates, with no change in comparison. EmONC signal functions increased from a mean of 2.7 to 3.9 (p=0.003) per facility in Kalomo, with no change in the comparison area. Most facility-level changes related to newborn care. Informants attributed impacts primarily to community mobilization by Safe Motherhood Action Group volunteers and clinical mentorship. Conclusion: SMGL positively influenced demand for facility deliveries. Data indicate a limited measurable change in supply-side indicators of provision of intra-partum maternity care, while improving neonatal survival. Interviews suggested that mentoring existing staff might be responsible for improved care and referrals. Phase 2 should focus on strengthening human resources to increase access to skilled delivery and strategies to improve communication and transport to facilitate timely referral of emergency cases.

Masters of Science / There is evidence of the rising incidence and prevalence of chronic diseases of lifestyle in developing countries. It is estimated that by 2020 chronic diseases of lifestyle in Sub-Saharan Africa will be almost 50% of the burden of disease. Rapid urbanization with changes in lifestyle, such as physical activity patterns could explain at least partially the ongoing epidemiological transition. The purpose of this study was to assess levels of participation in physical activity among working Rwandan women in Kigali, in relation to socio-economic demographic characteristics. A cross-sectional study design using both quantitative and qualitative methods was used. Participants' level of participation in physical activity and influence of socio-economic demographic factors on questionnaire adapted from Sub-Saharan African Questionnaire. A focus group discussion assessed the need for a health promotion program related to physical activity participation among working women. Data analysis, using Statistical analysis version 8e, was used to obtain frequency tables and histograms. Chisquare tests and Fisher's exact tests were utilized to test for association between variables. Focus group discussion data were transcribed and translated into English. Data were then coded and put into themes and categories. There were 352 participants, with a mean age of 33.4 years. 71.9% of the participants were classified as sedentary and only 28.1 % of the participants were classified as physically active. Participation in physical activity decreased with age, and there were more participants classified as sedentary people in the married group (77%) than in non-married group (63.2%). A lower level of education and income of participants, the higher the level of participation in physical activity. Among the reported prevalence of chronic diseases, high blood pressure and diabetes were only reported by participants classified as sedentary. During the focus group discussion, participants reported facilitators and benefits of physical activity including, routine, relaxation, socialization and fitness, managing obesity and health purposes. Barriers limiting the participants' ability to engage in physical activity included lack of time, lack of knowledge, laziness, domestic helper, lack of motivation and culture. The main themes, which were identified as important in the development of a health promotion program were: The education and encouragement of girl children; education of women in the community, finding facilities and appropriate venues, a suitable environment and the contribution of physical activity program towards unity and reconciliation was emphasised. The findings of this study demonstrate a problem concerning sedentary lifestyle among the working women in Kigali/Rwanda. It is alarming that the participants who are already classified as sedentary and who will probably experience the consequences of sedentary lifestyle in the future are already reporting chronic diseases like high blood pressure and diabetes. There is therefore an urgent need to design, implement and evaluate a health promotion intervention aimed at promoting a physically active lifestyle in Rwanda.

Urbanisation has had a profound impact in sub-Saharan Africa and can be attributed to the complex human-environment interaction. Knowledge on long-term urbanisation processes in sub-Saharan Africa is lacking. Besides, understanding the urbanisation process in sub-Saharan Africa necessitates to go beyond the global scale to the local scale to unravel the idiosyncrasies in the growth of each city. The perennial lack of data (or data meeting required specifications) is a bottleneck to such studies. Very often, the nature of the available data might present challenges to existing classification algorithms. Moreover, availability of adequate and well-curated reference datasets presents a bottleneck to the generation of accurate land-cover maps. The main aim of this research was to conduct a long-term analysis of urbanisation patterns in Central Africa by developing methodologies based on deep learning, a class of Artificial Intelligence. To this end, we address the main research question: “How can we understand long-term urbanisation patterns by applying deep learning on digital aerial images in Central Africa?” We used case-studies from three cities in Central Africa namely Goma and Bukavu in The Democratic Republic of Congo and Bujumbura in Burundi, to aid in understanding the urbanisation process in sub-Saharan Africa. We generate baseline data from an archive of historical panchromatic orthomosaics that allow for the capturing of the urbanisation before the onset of rapid urbanisation that was characteristic of Countries in sub-Saharan Africa after gaining independence from colonialism.The main contribution of this thesis is the 60-year long-term analysis of urbanisation patterns for three cities in Central Africa using a unique dataset of historical orthomosaics. The growth patterns and driving forces are analysed using spatial and qualitative data. The results show that social triggers such as wars drive urban expansion. On the contrary, biophysical drivers such as geohazards did not limit urban growth only slowing down settlements for a short time span of the analysis. As urbanisation levels increased, constraining effects of natural environment such as relief on urban expansion weakened. In addition, we make some methodological developments based on deep learning to generate land-cover from historical panchromatic orthomosaics (i.e. 1m spatial resolution) and sub-metric RGB aerial images (i.e. 0.175m). Results show that deep learning methods generally have high accuracy metrics, compared to standard machine learning baselines, but at the cost of high demand for a large and accurate, labelled dataset and computational resources. In addition, accurate and sufficient labelled data are still needed to guarantee accurate land-cover maps from deep learning algorithms and novel strategies need to be pursued in approaches investigating insufficient reference data. / L’urbanisation a eu un impact profond sur l’Afrique subsaharienne et peut être attribuée à l’interaction complexe entre l’homme et l’environnement. Les connaissances sur les processus d’urbanisation sur des temps longs font défaut. En outre, pour comprendre le processus d'urbanisation en Afrique subsaharienne, il faut aller au-delà de l'échelle mondiale et s'intéresser à l'échelle locale pour comprendre les particularités de la croissance de chaque ville. L'éternel manque de données (ou de données répondant aux spécifications requises) constitue des limitations de telles études. Très souvent, la nature des données disponibles peut présenter des défis pour les algorithmes de classification existants. De plus, la disponibilité d'ensembles de données de référence adéquats et fiables constitue un goulot d'étranglement pour la création de cartes précises de l'occupation des sols.L'objectif principal de cette recherche était de mener une analyse sur des temps longs des différentes modes d'urbanisation en Afrique centrale en développant des méthodologies basées sur le deep learning, une forme d'intelligence artificielle. A cette fin, nous répondons à la question de recherche suivante :"Comment pouvons-nous comprendre les modes d'urbanisation sur des temps longs en appliquant des approches de deep learning sur des images aériennes numériques en Afrique centrale ?". Nous avons étudié trois villes d'Afrique centrale, à savoir Goma et Bukavu en République démocratique du Congo et Bujumbura au Burundi, de manière à comprendre le processus d'urbanisation en Afrique subsaharienne. Nous pouvons générer des données de base à partir de mosaïques d'orthophotographies aériennes panchromatiques historiques qui permettent de saisir l'urbanisation avant le début de l'urbanisation rapide ayant caractérisé les pays d'Afrique subsaharienne depuis leur indépendance.La principale contribution de cette thèse est l'analyse, sur 60 ans, des modes d'urbanisation pour trois villes d'Afrique centrale en utilisant un ensemble unique d'orthomosaïques historiques. Les modes et les facteurs de croissance y sont analysés en utilisant des données spatiales et qualitatives. Les résultats montrent que les déclencheurs sociaux tels que les guerres étaient positivement corrélé à l'expansion urbaine. Au contraire, les facteurs biophysiques tels que les risques associés aux catastrophes naturelles n'ont pas empêché la croissance urbaine mais ont seulement ralenti les nouvelles implantations pendant une courte période de l'analyse. Par ailleurs, à mesure que les niveaux d'urbanisation augmentent, les effets contraignants de l'environnement naturel tels que le relief sur l'expansion urbaine s'affaiblissent.De plus, certaines avancées méthodologiques ont été accomplies en explorant et en développant une méthodologie basée sur le deep learning pour générer une carte de la couverture du sol à partir d’orthomosaïques panchromatiques historiques (1m) et d'images aériennes RVB sub-métriques (0.175m). Les résultats montrent que les méthodes de deep learning présentent généralement des indicateurs de précision élevés par rapport aux méthodes standard basée sur machine learning, mais au prix d'une grande demande en matière de données étiquetées et de ressources informatiques. En outre, des données étiquetées précises et en quantité suffisante sont toujours nécessaires pour garantir l'exactitude des cartes de l’occupation du sol établies par les algorithmes de deep learning, et de nouvelles stratégies doivent être mises en œuvre dans le cas de travaux ne disposant que de données de référence insuffisantes / Doctorat en Sciences / info:eu-repo/semantics/nonPublished

En Afrique sub-Saharienne, les femmes et les filles sont particulièrement vulnérables à l’infection parle VIH. L’infection par le VIH est une menace importante pour la santé reproductive de cettepopulation. Les études de recherche présentées dans le cadre de cette thèse ont été conduites enAfrique de l’Ouest et avaient pour objectifs principaux : i) Estimer la prévalence de la violenceperpétrée par le partenaire intime selon le statut sérologique ; ii) Estimer l’incidence de grossesseaprès la mise sous traitement antirétroviral ; iii) Déterminer l’effet de la grossesse après la mise sousARV sur le risque de décès, de progression de la maladie à VIH et d’être perdu de vue. Nos résultatsnous montrent que la prévalence de violence physique et sexuelle perpétrée par le partenaire intimeest plus élevée auprès des femmes VIH-positives qu’auprès de celles non-infectées (63,1 vs. 39,3%,p=0.01 and 69,7 vs. 35,3%, p=0.01, respectivement). De plus, l’incidence brute globale de premièregrossesse après la mise sous ARV en Afrique de l’Ouest est de 2,9 par 100 femmes-années(IC95% :2,7 – 3,0). Auprès des jeunes femmes âgées de 25-29 ans cette incidence peut être de 4,7per 100 femmes-années (IC95% :4,3 – 5,1). Finalement, la grossesse après la mise sous ARV réduitle risque de décès ou de progression de la maladie à VIH (aHR : 0,61, CI95% : 0,40-0,92) ainsi que lerisque de devenir perdue de vu (aHR : 0,74 ; CI95% : 0,60-0,92) des femmes ouest-africaines infectéespar le VIH. La prévalence de violence perpétrée par le partenaire intime est très élevée auprès desfemmes infectées par le VIH et cela pourrait entrainer des conséquences négatives de santé de cesfemmes. La grossesse est un évènement fréquent auprès des femmes VIH positives sous ARV qui ades répercussions importantes sur le statut de santé des femmes séropositives. L’intégration desprogrammes de prise en charge maternelle dans les services de prise en charge du VIH doit êtrepriorisé en Afrique sub-saharienne. / HIV infection in sub-Saharan Africa is a major public health threat particularly for girls and women ofreproductive age. The research presented in this thesis was conducted particularly in West Africa andthe specific objectives are i) to estimate the prevalence of intimate partner violence according to HIVserological status; ii) to estimate the incidence rate of pregnancy following ART initiation; iii) todetermine the effect of pregnancy after ART initiation on the risk of death, HIV-disease progressionand loss to follow-up. Firstly, in Togo, According to our findings, the prevalence rates of lifetimephysical and sexual violence (IPV) among HIV-infected women were significantly higher thanamong uninfected women (63.1 vs. 39.3%, p=0.01 and 69.7 vs. 35.3%, p=0.01, respectively).Secondly, Among HIV-infected West African women, the crude incidence of first pregnancy afterART initiation was 2.9 per 100 women-years [95% confidence interval (CI): 2.7 to 3.0] and it could beas high as 4.7 per 100 women-years (95% CI: 4.3 to 5.1) among women aged 25-29 years old. Finally,pregnancy after ART initiation appeared to reduce the risk of death or HIV-disease progression(Adjusted Hazard Ratio [aHR] =0.61; 95%CI: 0.40-0.92) and the risk of becoming LTFU at M48(aHR=0.74; 95%CI: 0.60-0.92) among West African HIV-infected women. Intimate partner violence ishighly prevalent among HIV-infected women and it may have negative repercussions on their healthstatus. Pregnancy is a common event after ART initiation and it might have repercussions on thehealth status of HIV-infected women. The design of safe motherhood programs addressed to HIVinfectedwomen and its integration within HIV care services must are a public health priority in sub-Saharan Africa.

"Elections form a key component of democratic governance. Democracy denotes a political system that, among other things, allows citizens to freely choose their government over time through credible, legitimate and acceptable elections; a system which accords them adequate participation in national affairs and a system in which the national affairs are run in a transparent and accountable manner. Democracy as a concept rests upon the consideration that a political leadership in a country must be chosen through an electon governed by fair rules under which social groups and political forces may compete on equal terms. Research has shown that HIV and AIDS may have adverse effects on democracy in Southern Africa. Electoral systems, voter participation, electoral management and administration and political institutions are among the areas of democratisation most affected by HIV/AIDS. ... Chapter one introduces the topic, the research questions to be answered by the research and the research methodology. It also contains a brief literature survey of the research on this topic so far. Chapter two sets out the legal framweork, it gives an analysis of states obligations to ensure political participation based on international and regional standards. The rights of HIV/AIDS infected and affected persons to participate in government and the meaning of [the] right to vote is discussed. The application of the international law obligations to promote and fulfill [uman rights] are discussed and the question 'Do governments have a duty to set up special mechanisms to address the HIV/AIDS pandemic within the electoral context?' is answered. Chapter three is an examination of the relationship between HIV/AIDS and political participation. A brief overview of current electoral statistics and statistics of the trend of the HIV/AIDS pandemic are given. The chapter examines the possible reasons for lack of participation by HIV/AIDS infected and affected persons. Chapter four is a critical analysis of some responses that can be adopted to address the situation. It focuses on mechanical and structural reforms to the electoral process: amending electoral laws and policies to include postal, proxy and other special voting mechanisms; providing for specific legal obligations, for example to have mobile registration and polling stations, to ensure that there is a polling station within a specific distance so that people do not have to walk far and stand in long queues in order to vote. The failure to meet such obligations must have specific legal consequences. Chapter five suggests a more controversial reform of lowering the voting age to address the impact of HIV/AIDS on democracy and children. Chapter six [includes the] conclusion and recommendations." -- Introduction. / Thesis (LLM (Human Rights and Democratisation in Africa)) -- University of Pretoria, 2005. / Prepared under the supervision of Dr. Naz K. Modirzadeh at the Department of Law, American University in Cairo, Egypt / http://www.chr.up.ac.za/academic_pro/llm1/dissertations.html / Centre for Human Rights / LLM

This study investigates the relationship between official development assistance (ODA) and human development indicators (HDIs) in 49 sub-Saharan African countries over the period of 1995 to 2017 using 3-stage least squares (3SLS). The four key sub-classes of HDIs considered for this research include education, health, government and civic society, as well as environmental indicators. Of all these HDIs, the results of the analysis show that health aid is the most effective form of aid, significantly reducing the incidence of HIV, the infant mortality rate and the maternal mortality rate, as well as leading to improved life expectancy. Education aid has a significant effect on the progression to secondary school followed by adult literacy rates. Government and civil society aid significantly affects the ability of girls to access education at primary, secondary and tertiary levels while environmental aid is found to increase the carbon efficiency of production. Hence, this study demonstrates that aid is most effective on the health, education and environmental human development indicators.

Aims The purpose of this study is to explore the possibilities for video-based learning of computer systems in the field of medical education in rural sub-Saharan Africa. Background Low-income countries are forced to perform healthcare services with resources already spread too thin. The use of electronic medical records can increase the cost-effectiveness of delivering healthcare services, but the low computer literacy in sub-Saharan Africa is an obstacle necessary to overcome. E-learning and video-based learning has the potential to partially solve this problem. Methods User observations were conducted on five healthcare workers in rural Uganda. The users watched an instruction video, after which they performed an assessment test of an electronic medical record system. Results Some effectiveness was perceived – but it was slight, and varied greatly between the test subjects. Computer experience is an important prerequisite for the success of e-learning initiatives. Effectiveness was higher for more simple tasks. Conclusion This paper does not propose video-based learning as the only source of training for the target group. However, there is a possibility to envision video-based learning as a building block in a blended-learning strategy – utilising video-based learning for easier tasks and knowledge retention for users who are already familiar with the system.

The thrive to achieve Sustainable Development Goal 7 is never been easy, and numbers are still showing that Sub-Saharan Africa is lagging in access to electricity index. Most of the energy poor communities residing in the rural part of the region, this by itself is a conundrum with multifaceted implications. The high capital expenditure for renewable energy technologies, the low paying ability of the society in Sub-Saharan Africa, the unavailability of anchor customer’s and so on needs new means of approaching the access problem. This study aims to enlighten policy makers on promoting energy as input to production than merely focusing on the access issue. In the report, a renewable mini-grid powering a local economic activity of a remote agrarian village in Ethiopia is discussed. Through a simulation study using PVsyst and Homer Pro tools, a yearly optimized PV diesel hybrid system with rounded up lowest LCOE of $0.17/kWh is obtained for the village in the case study. The LCOE of the mini-grid with lead acid battery and Li-ion battery is also studied at a yearly average operating temperature range of 10 to 40 ℃. The simulation-based study demonstrated that mini-grid systems with lead acid and Li-ion battery have fairly comparable LCOE between 10 to 20 ℃, however the Li-ion battery results in a lower LCOE for operating temperature beyond 25 ℃. The study has shown that mini-grids with productive energy can be cost effective option for powering areas where the grid-connection is cost and time intensive to address the energy poverty issue by 2030 or after.

Cervical cancer rates in Sub-Saharan Africa (SSA) are amongst the highest in the world. The World Health Organization currently estimates that worldwide, cervical cancer will kill more than 443,000 women per year by 2030, of which 90% of deaths are predicted to occur in SSA. The Human Papillomavirus (HPV) vaccine provides primary protection against the most common cancer-causing strains of HPV that are responsible for cervical cancer. Over the last five years, there has been a slow increase in the number of African countries that have introduced the HPV vaccine via demonstration and pilot projects, and a minority of African countries that have incorporated the HPV vaccine into their National Immunisation Programmes. As part of this systematic review, a literature review was conducted and revealed that research has been conducted on top-down barriers and facilitators to HPV vaccine uptake and have found that poor health system capabilities, inaccessibility to medical care, low cervical cancer screening levels, inadequate infrastructure, finances, and health worker training are significant systemic barriers to HPV vaccination success in SSA. Little research has been conducted on demand-side or end-user perspectives of, and decisions around, the HPV vaccine. In order to complement existing research, and inform current and future implementation approaches, this qualitative systematic review explored stakeholder understandings of the HPV vaccine in SSA. This review searched the following databases: Embase (via Scopus), Scopus, MEDLINE (via PubMed), PubMed, EBSCOhost, Academic Search Premier, Africa-Wide Information, CINAHL, PsycARTICLES, PsycINFO, SocINDEX, Web of Science, and the Cochrane Controlled Register of Trials (CENTRAL) and found a total of 259 articles. Of these, 31 articles met the inclusion and exclusion criteria and were included in the review. Braun and Clarke’s six step process for conducting a thematic analysis was used for analysis and studies were assessed for quality using the Critical Appraisal Skills Programme (CASP) checklist. Three major themes emerged from the thematic analysis: knowledge is intertwined with misinformation; fear shapes contradictory perceptions about the HPV vaccine; and social norms and gender dynamics are relevant factors in how stakeholders understand the HPV vaccine in SSA. This review iterates the importance of first working with communities to gauge understandings of the HPV vaccine, before trying to implement change through education, sensitization and behavior change.

African business leaders may not be effective because of a lack of transformational leadership skills. Business leaders applying transformational leadership skills can strengthen relationships with followers and enhance organizational performance. The purpose of this phenomenological study was to explore the experiences and perspectives of Liberian business leaders regarding transformational leadership skills needed to lead profitable organizations. Building on a conceptual framework of transformational leadership theory, data were obtained from open-ended interviews of 20 Liberian business leaders operating in the capital city of Monrovia. Interviews were transcribed, coded, validated through transcript review, and analyzed to generate themes. The most prominent themes were the need for Liberian business leaders to act as role models, to attend to individual employee's needs, and to demonstrate ethical conduct. The findings indicated that Liberian business leaders may adopt transformational leadership to help a company gain a competitive advantage, make profits, and enhance employees' commitment and organizational performance. These findings may contribute to positive social change by creating awareness among Liberian business leaders about the benefits of transformational leadership to expand company operations, create employment opportunities, and contribute to poverty reduction in Liberia. Research findings may be useful information to Liberian policymakers, business leaders, and scholars seeking to understand business leadership challenges in a postconflict economy.