Les aléas climatiques et environnementaux sont aujourd’hui au cœur des préoccupations et il est reconnu que les pays en développement et surtout ceux d’Afrique et d’Afrique subsaharienne sont les plus vulnérables à ces risques climatiques, mais sont paradoxalement les moins responsables du réchauffement climatique. L’adaptation de ces populations est ainsi primordiale, et peut prendre plusieurs formes dont la migration, qui, par ses retombées financières est une source non négligeable de fonds permettant aux ménages de faire face aux risques climatiques, aux désastres naturels, aux conflits et chocs d’autre type. Comparativement aux pays de la région ouest africaine tels que le Mali, le Sénégal ou le Nigéria, le Burkina Faso, n’a pas fait l’objet d’un grand nombre d’études sur le thème de la migration et les transferts de fonds. Le pays a cependant une histoire migratoire riche dans un contexte de fortes variabilités climatiques. Les conditions climatiques sont d’autant plus importantes dans ce pays que son économie est fortement ancrée dans l’agriculture.Les résultats du présent travail montrent que les transferts de fonds ont un impact sur la capacité des ménages à gérer les effets néfastes des aléas climatiques sur leurs conditions de vie, mais ils ont également leurs limites. Le premier chapitre cherche à évaluer l’impact des transferts et de la variabilité climatique sur la sécurité alimentaire des ménages Burkinabè. Nous proposons un indicateur de sécurité alimentaire prenant en compte les différents concepts de la sécurité alimentaire, et aussi un indicateur de variabilité interannuelle des précipitations. Après avoir contrôlé pour les problèmes d’endogénéité des transferts en utilisant des variables sur les caractéristiques démographiques des migrants et des variables de distance, nos résultats montrent que les transferts ont un impact positif sur la sécurité alimentaire, et trouvons le résultat inverse pour la variabilité des précipitations. Dans le deuxième chapitre, nous testons l’effet des transferts et des désastres naturels sur la pauvreté des ménages, représentée par un indicateur que nous construisons. Les résultats montrent l’effet négatif des transferts sur la pauvreté. De plus, une réinterprétation de l’indicateur montre que les ménages ayant subi des catastrophes naturelles par le passé sont plus à même de faire face à l’éventualité de futures catastrophes. Dans le dernier chapitre de ce travail, nous testons la capacité des ménages agricoles à diversifier leur portefeuille d’activité lorsqu’ils font face à des risques de sécheresse, et lorsqu’ils reçoivent des transferts. Les résultats montrent que les transferts ne sont pas, à eux seuls, suffisant pour permettre aux ménages de diversifier leurs activités. La diversification est toutefois possible lorsque le niveau de richesse des ménages est déjà élevé lorsqu’ils reçoivent les transferts. La présente recherche contribue à mettre en lumière l’importance des transferts dans la capacité d’adaptation des ménages qui font face à des risques climatiques. Les politiques nationales et internationales pouvant contribuer à un acheminement plus efficace et moins couteux de ces flux sont à encourager. Cependant, afin que ces transferts soient efficaces, ils doivent être accompagnés de politiques de réduction des inégalités afin de ne pas rendre les plus pauvres encore plus pauvres. Ils doivent être ainsi vus comme complémentaires et non substituts d’autres sources de revenus. / Environmental and climate issues constitute a predominant and much up to date topic in international discussions. It is broadly recognized that developing countries are the most vulnerable when it comes to climate issues, albeit, they are the least responsible. Finding ways for households’ of these countries to cope with the harmful effects of climate goes through the necessity to identify mechanisms that can help, such as migration and remittances. The latter have been found in the scientific literature to be a hedge against several shocks such as natural disasters, conflicts, and economic shocks.This research thesis explores the theme of remittances, and climate variability in developing countries, by focusing on a sub-Saharan African country, Burkina Faso. Compared to its neighbouring countries, Burkina Faso has not been subject to much research in the migration and remittances. The country however has a vast migration history that is worth studying. Climate issues are also rampant, and very important, as the country is practising subsistence agriculture. The findings of this dissertation show that remittances have a positive impact on households’ ability to cope with the negative effects of climate issues. Yet these important sources of inflows for developing countries might have some limitations. The first chapter assesses the impact of remittances and climate variability on the food security of households in Burkina Faso. We build a food security index using principal component analysis that encompasses the accessibility and utilization dimensions of the concept. We also compute an inter-annual rainfall index and the latter is found to have a negative impact on food security. After controlling for potential endogeneity issues using distance variables and migrant characteristics as instruments, remittances are found to enhance food security. Results are robust to alternative measures of food security and alternative calculations of rainfall variability. In Chapter two, we assess the impact of remittances and natural disasters on poverty in Burkina Faso. To do so, we construct a poverty index using household’s housing characteristics and Multiple Correspondence Analysis method. Propensity score matching method is used as an empirical strategy, and results show that remittances have a negative impact on poverty. Another important result is that remittances have a higher impact on the resilience of households, when they have experienced disasters in the past. Therefore, when it comes to natural disasters, these inflows act as an important tool for populations to be more resilient. Lastly in chapter 3, we assess the role of remittances and drought on diversification strategies of farm-households. This chapter uses the same database as chapter two, and also takes advantage of the climate database of the Climatic Research Unit (CRU) of University of Anglia . Results show that remittances by themselves are not sufficient to push households towards costly diversification strategies, and they need to be conditional to households’ wealth status to be effective. Climate conditions as well as soil properties have not surprisingly been found to significantly push households towards diversifying their income.This research sheds light on the undeniable importance of remittances in helping households to cope with harmful effects of climate, but also on its limitations. International and national policies that will contribute in a more efficient and less costly conveying of these inflows are to encourage. However in order for remittances to be efficient, reducing inequalities and poverty within populations is a necessity. Otherwise, they can contribute to dig further poverty gaps and extensively the vulnerably levels inside populations. Therefore, remittances should be seen as complementary to other sources of income, rather than substitute.

Nous avons souhaité accompagner des populations d’Afrique subsaharienne en France, sur une démarche de santé communautaire, afin d’agir sur les inégalités de santé. Ce travail permet une mesure des effets et conséquences sur le comportement de promotion de la santé sous l’angle des rapports interculturels. Cette démarche repose sur une méthodologie exploratoire constituée à la fois d’outils de recherche en psychologique, de protocoles d’intervention en santé publique et d’une problématique psycho-sociale d’interculturalité. Les évolutions de comportement en faveur d’actions de promotion de la santé sont liées de manière significative à cette démarche qui allie focus groupe et application de la théorie du comportement planifié (TCP). Une telle approche permet une réflexion sur les inégalités sociales en santé des communautés migrantes, et l’accompagnement vers les soins, en favorisant les relations entre habitants et professionnels de santé dans une démarche interculturelle. Les objectifs de l’étude étaient (i) de mieux comprendre l’intention des immigrants africains d’adopter une approche personnelle pour les problèmes de santé communautaire et (ii) d’évaluer la sensibilisation et le développement des compétences des membres de la communauté sur leur comportement de promotion de la santé. / We wanted to accompany sub-Saharan African population in France, on a community health approach, to act on health inequalities. This work allows to measure the effects and consequences of health behavior promotion from an inter-cultural relations angle. This approach is based on an exploratory methodology made up of both psychological research tools, protocols for intervention in public health with the psycho-social problematic of inter-culturality. Behavioral changes in favor of health promotion actions are significantly related to this approach, which will combine group focus and the application of planned behavior theory (PBT). Such an approach allows a reflection on the social inequalities in health of the migrant communities, and the accompaniment towards care, favouring relations between inhabitants and health professionals on an intercultural approach. The objectives of the study were (i) to better understand the intention of African migrants to adopt a personal approach to community health problems and (ii) to assess the influence of developing members’ awareness and skills of the community on their health promotion behavior.

No description available.

Attualmente i prezzi agricoli sono evidenziate in combinazione con i presunti effetti collaterali, come la fame e la malnutrizione nell’Africa sub-sahariana (SSA), tuttavia, oggi, SSA ha circa 47,5 per cento della popolazione rurale in condizioni di povertà e tra il 1990 e il 2005 quando i prezzi dei prodotti alimentari erano stabile e con prezzi bassi l'estrema povertà rurale in SSA è stato circa 64,6 per cento. Abbiamo ipotizzato che la malnutrizione o fame continuano in SSA perché li, la miseria persistono. La riduzione della povertà è l'unico modo per porre fine alla fame in Africa. Altresì per un paese agricolo in SSA – senza significative riserve di risorse minerarie – il modo migliore per risolvere la povertà è attraverso lo sviluppo agricolo. Nel nostro campione, sono nove paesi in SSA - Burundi, Ghana, Malawi, Mozambico, Ruanda, Uganda, Tanzania, Zambia e Zimbabwe – il cosiddetto SSA – 9. Abbiamo utilizzato un modello ricorsivo nel periodo tra 1990 e il 2005. Come risultato si è visto che gli strumenti principali che hanno avuto forte relazione con la riduzione della povertà in SSA - 9 sono alcune implicazioni politiche come; il diritto di proprietà, l'accesso al sistema di crediti, il capitale umano e le infrastrutture. / Nowadays, agricultural prices are highlighted combined with, as alleged collateral effects, hunger and malnutrition in Sub-Saharan Africa (SSA). However, today, SSA has around 47,5 percent of rural population in extreme poverty and between 1990 and 2005 when the food prices was stable and with low prices, extreme poverty in SSA involved around 64.6 percent. We assumed that the undernourishment or starvation continued in SSA because there the misery persisted. Poverty reduction is the only way to the end the hunger in Africa. Also, for an agricultural country in SSA – without significant mineral resources – the best way to solve the problem of poverty is through agricultural development. Our sample are nine countries in SSA – Burundi, Ghana, Malawi, Mozambique, Rwanda, Uganda, United Republic of Tanzania, Zambia and Zimbabwe – the so called SSA – 9. Thus, we built up a recursive model that answered how the agricultural gears in SSA – 9 were moving between 1990 and 2005, as well as assessed how the agriculture could reduce rural poverty. As a result we saw that the main tools that had a strong relation with poverty reduction in SSA – 9 are some policies implications as; property rights, access to the credit system, human capital and infrastructure.

Girls’ education has been promoted by the international development community for over two decades; however, it has proven harder to promote gender equality through education than it has been to promote gender parity in education. Of significance is the global circulation and co-existence of two competing rationales for the importance of girls’ education: economic efficiency and social justice. The cost of ignoring how and why Southern governments and their development partners choose to promote girls’ education is high: an over-emphasis on economic efficiency can mean that the root causes of gendered inequalities in society remain unchallenged, and more social justice-oriented reforms become marginalized. This thesis uses a critical feminist lens to qualitatively investigate the role and significance of human capital, human rights, and human capabilities policy models in the context of the production and enactment of gender equality in education policy knowledge in The Gambia, a small, aid-dependent Muslim nation in West Africa. The purpose of the study was to assess the scope education policies provide for positive change in the lives of Gambian women and girls. Towards illuminating relations of power in and the politics of gender equality in education policy processes, the study compares and contrasts written texts with the perspectives of state and non-state policy actors. The study is based on data drawn from interviews, participant observation, and documentary analysis. The findings suggest that different gender equality in education ideas and practices have been selectively mobilized and incorporated into education policy processes in The Gambia. At the level of policy talk, girls’ education is framed as important for both national economic growth, and “women’s empowerment”. However, the policy solutions designed and implemented, with the support of donors, have tended to work with rather than against the status quo. Power and politics was evident in divergent interpretations and struggles to fix the meaning of key concepts such as gender, gender equality, gender equity, and empowerment. Religious beliefs, anti-feminist politics, and the national feminist movement were identified as important forces shaping gender equality in education knowledge and action in the country.

Girls’ education has been promoted by the international development community for over two decades; however, it has proven harder to promote gender equality through education than it has been to promote gender parity in education. Of significance is the global circulation and co-existence of two competing rationales for the importance of girls’ education: economic efficiency and social justice. The cost of ignoring how and why Southern governments and their development partners choose to promote girls’ education is high: an over-emphasis on economic efficiency can mean that the root causes of gendered inequalities in society remain unchallenged, and more social justice-oriented reforms become marginalized. This thesis uses a critical feminist lens to qualitatively investigate the role and significance of human capital, human rights, and human capabilities policy models in the context of the production and enactment of gender equality in education policy knowledge in The Gambia, a small, aid-dependent Muslim nation in West Africa. The purpose of the study was to assess the scope education policies provide for positive change in the lives of Gambian women and girls. Towards illuminating relations of power in and the politics of gender equality in education policy processes, the study compares and contrasts written texts with the perspectives of state and non-state policy actors. The study is based on data drawn from interviews, participant observation, and documentary analysis. The findings suggest that different gender equality in education ideas and practices have been selectively mobilized and incorporated into education policy processes in The Gambia. At the level of policy talk, girls’ education is framed as important for both national economic growth, and “women’s empowerment”. However, the policy solutions designed and implemented, with the support of donors, have tended to work with rather than against the status quo. Power and politics was evident in divergent interpretations and struggles to fix the meaning of key concepts such as gender, gender equality, gender equity, and empowerment. Religious beliefs, anti-feminist politics, and the national feminist movement were identified as important forces shaping gender equality in education knowledge and action in the country.

Syfte: Att identifiera behovet för arbetsterapi i Nehemiah Autism Center genom att utföra en behovsanalys. Metod: Mixad-metod användas för att utveckla en passande behovsanalys för att identifiera behovet för arbetsterapi. Resultat: Alla områden där en arbetsterapeut kan bidrag till valdes. Kommunikation och sociala färdigheter rapporterades mest frekvent och beteende förvaltning rankades som viktigast bland vårdnadshavare. Bland anställda, fritid och lek rapporterades mest frekvent och stresshantering rankades som viktigast. Utbildningsmöjligheter, kommunikation mellan anställda och medarbetare relation identifierades som stödjande faktorer för att uppnå målet på Nehemiah Autism Center. Stigma, religion och kulturell mångfald rapporterades som icke-stödjande faktorer för att uppnå målet på Nehemiah Autism Center. Slutsats: Det finns ett behov för arbetsterapi för att möta behovet hos barn med autism på Nehemiah Autism Center i Addis Ababa, Etiopien. / Aim: To identify the occupational therapy needs at the Nehemiah Autism Center by completing a needs assessment. Method: A mixed-methods design was adopted to construct a comprehensive needs assessment to identify the occupational therapy needs. Result: All areas of what an occupational therapist could assist with were selected as an area of need. Communication and social skills were most frequently reported and behavior management was ranked as most important among caregivers. Among staff members, leisure and play was reported most frequently and stress management was ranked as most important. Training opportunities, communication among staff members, and co-worker relationship were identified to be supporting factors in achieving the goal at Nehemiah Autism Center. Stigma, religion, and cultural diversity were reported to be unsupportive factors in achieving the goal at Nehemiah Autism Center. Conclusion: There is a great need for occupational therapy services to attend to children with autism spectrum disorder at Nehemiah Autism Center in Addis Ababa, Ethiopia.

Background South Africa has experienced the most severe consequences of the HIV/AIDS pandemic. Every community has been affected in some way, many experiencing huge increases in mortality,particularly before antiretroviral therapies (ART) were readily available. However, the micro-level understanding of the HIV epidemic in South Africa is weak, because of a lack of detailed data for most of the population. This thesis is based on detailed individual follow-up in the Agincourt Health and Demographic Surveillance Site (HDSS) located in the Agincourt subdistrict of Mpumalanga Province and investigates micro-level determinants of HIV epidemiology and the impact of treatment provided. Methods The Agincourt HDSS has followed a geographically defined population since 1992,approximately the time when the HIV/AIDS epidemic first became apparent. This population based surveillance has included capturing details of all deaths, with cause of death determined by verbal autopsy, as well as the geographical location of individual households within the overall Agincourt area. Background information on the roll-out of ART over time was also recorded. Results A comparison immediately before and after the major roll-out of ART showed a substantial decrease in HIV-related mortality, greater in some local communities within the area than others. Individual determinants associated with a decreased risk of HIV/AIDS mortality included proximity to ART services, as well as being female, younger, and in higher socioeconomic and educational strata. There was a decrease in the use of traditional healthcare sources and an increase in the use of biomedical healthcare amongst those dying of HIV/AIDS between periods before and after the roll-out of ART. Conclusions Understanding micro-level determinants of HIV/AIDS infection and mortality was very important in terms of characterising the overall epidemic in this community. This approach will enable public health interventions to be more effectively targeted towards those who need them most in the continuing evolution of the HIV/AIDS epidemic.

Après des années d’efforts, l’Afrique Sub-saharienne n’a connu qu’une faible amélioration de ses indicateurs de santé maternelle. Assurer l’accès aux soins obstétricaux d’urgence (SOU) pour toutes les femmes est une stratégie efficace pour réduire la mortalité maternelle. Cependant, ces soins sont dispendieux et ces dépenses peuvent être « catastrophiques ». Afin d’en réduire le fardeau, le Mali a instauré la gratuité de la césarienne et un système de référence-évacuation. L’objectif de cette étude est d’examiner la prévalence et les facteurs contribuant aux dépenses catastrophiques liées aux SOU dans la région de Kayes, Mali. Elle vise aussi à étudier les conséquences socioéconomiques de ces dépenses au sein des ménages. L’étude a révélé que les dépenses lors d’urgences obstétricales sont en moyenne de 71535 FCFA (US$ 152). Entre 20.7% et 53.5% des ménages ont encouru des dépenses catastrophiques supérieures à 15% et 5% de leur revenu annuel respectivement. Les ménages de femmes sans éducation, du milieu rural et ayant souffert d’infection post-partum sont les plus à risque d’encourir des dépenses catastrophiques. La césarienne n’est pas associée à une probabilité réduite de dépense catastrophique malgré la gratuité. Faire des dépenses élevées ne garantie pas la survie de la mère puisque entre 19,4% et 47,1% des décès maternels ont encouru des dépenses catastrophiques. Enfin, les ménages s’endettent et vendent fréquemment des biens pour faire face aux dépenses ce qui créé des difficultés financières importantes à long terme. La création de nouvelles politiques de financement sera nécessaire à l’amélioration de la santé maternelle au Mali. / After years of efforts, countries in sub-Saharan Africa have seen little to no improvement in their maternal health indicators. Ensuring access to emergency obstetric care (EmOC) for all women is a strategy proven to reduce maternal mortality. However, EmOC in sub-Saharan Africa can be extremely costly and can generate ‘’catastrophic’’ expenses. In order to reduce the economic burden of EmOC in Mali, user fees for caesareans were abolished and a maternity referral-system was created. The aim of this study is to investigate the incidence of and the factors associated with catastrophic EmOC expenditure in the region of Kayes, Mali. It also aims to identify the well-being consequences of high EmOC expenses. This study brings forth the following points. Firstly, the average EmOC expenditure was 71535 FCFA (US$ 152). Secondly, between 20.7% and 53.5% of households faced catastrophic expenditures greater than 15% and 5% of their annual income respectively. Women with no education, living in rural areas and with a postpartum infection had a higher propensity of catastrophic spending. Having a caesarean was not associated with a reduced risk of catastrophic expenditures despite the abolition of user fees for caesareans. Between 19.4% and 47.1% of households of maternal deaths also had catastrophic spending. Finally, households often had to borrow money and sell assets to pay for EmOC which led to considerable long-lasting financial difficulties. As long as policies fail to protect households from catastrophic EmOC expenditures, we cannot expect to see any great progress in reducing maternal mortality in Mali.

Les objectifs de l’étude de l’évolution du risque cardiométabolique (RCM) sur une période de quatre ans (2006-2010) chez des adultes béninois consistaient à: • Examiner les relations entre l’obésité abdominale selon les critères de la Fédération Internationale du Diabète (IFD) ou l’insulino-résistance mesurée par le Homeostasis Model Assessment (HOMA) et l’évolution des autres facteurs de RCM, • Examiner les liens entre les habitudes alimentaires, l’activité physique et les conditions socio-économiques et l’évolution du RCM évalué conjointement par le score de risque de maladies cardiovasculaires de Framingham (FRS) et le syndrome métabolique (SMet). Les hypothèses de recherche étaient: • L’obésité abdominale telle que définie par les critères de l’IDF est faiblement associée à une évolution défavorable des autres facteurs de RCM, alors que l’insulino-résistance mesurée par le HOMA lui est fortement associée; • Un niveau socioéconomique moyen, un cadre de vie peu urbanisé (rural ou semi-urbain), de meilleures habitudes alimentaires (score élevé de consommation d’aliments protecteurs contre le RCM) et l’activité physique contribuent à une évolution plus favorable du RCM. L’étude a inclus 541 sujets âgés de 25 à 60 ans, apparemment en bonne santé, aléatoirement sélectionnés dans la plus grande ville (n = 200), une petite ville (n = 171) et sa périphérie rurale (n = 170). Après les études de base, les sujets ont été suivis après deux et quatre ans. Les apports alimentaires et l’activité physique ont été cernés par deux ou trois rappels de 24 heures dans les études de base puis par des questionnaires de fréquence simplifiés lors des suivis. Les données sur les conditions socioéconomiques, la consommation d’alcool et le tabagisme ont été recueillies par questionnaire. Des mesures anthropométriques et la tension artérielle ont été prises. La glycémie à jeun, l’insulinémie et les lipides sanguins ont été mesurés. Un score de fréquence de consommation d’« aliments sentinelles » a été développé et utilisé. Un total de 416 sujets ont participé au dernier suivi. La prévalence initiale du SMet et du FRS≥10% était de 8,7% et 7,2%, respectivement. L’incidence du SMet et d’un FRS≥10% sur quatre ans était de 8,2% et 5%, respectivement. Le RCM s’était détérioré chez 21% des sujets. L’obésité abdominale définie par les valeurs seuils de tour de taille de l’IDF était associée à un risque plus élevé d’insulino-résistance: risque relatif (RR) = 5,7 (IC 95% : 2,8-11,5); d’un ratio cholestérol total/HDL-Cholestérol élevé: RR = 3,4 (IC 95% : 1,5-7,3); mais elle n’était pas associée à un risque significativement accru de tension artérielle élevée ou de triglycérides élevés. Les valeurs seuils de tour de taille optimales pour l’identification des sujets accusant au moins un facteur de risque du SMet étaient de 90 cm chez les femmes et de 80 cm chez les hommes. L’insulino-résistance mesurée par le HOMA était associée à un risque élevé d’hyperglycémie: RR = 5,7 (IC 95% : 2,8-11,5). En revanche, l’insulino-résistance n’était pas associée à un risque significatif de tension artérielle élevée et de triglycérides élevés. La combinaison de SMet et du FRS pour l’évaluation du RCM identifiait davantage de sujets à risque que l’utilisation de l’un ou l’autre outil isolément. Le risque de détérioration du profil de RCM était associé à un faible score de consommation des «aliments sentinelles» qui reflètent le caractère protecteur de l’alimentation (viande rouge, volaille, lait, œufs et légumes): RR = 5,6 (IC 95%: 1,9-16,1); et à l’inactivité physique: RR = 6,3 (IC 95%: 3,0-13,4). Les sujets de niveau socioéconomique faible et moyen, et ceux du milieu rural et semi-urbain avaient un moindre risque d’aggravation du RCM. L’étude a montré que les relations entre les facteurs de RCM présentaient des particularités chez les adultes béninois par rapport aux Caucasiens et a souligné le besoin de reconsidérer les composantes du SMet ainsi que leurs valeurs seuils pour les Africains sub-sahariens. La détérioration rapide du RCM nécessité des mesures préventives basées sur la promotion d’un mode de vie plus actif associé à de meilleures habitudes alimentaires. / The objectives of this study on four-year trends (2006-2010) in cardiometabolic risk (CMR) in Benin adults were: • To examine whether abdominal obesity according to International Diabetes Federation (IDF) waist circumference cut-offs, or insulin resistance measured by the homeostasis model assessment (HOMA) was associated with more unfavourable changes in other CMR factors, • To examine the effects of diet, physical activity and socioeconomic status including place of residence on the evolution of CMR assessed by both the Framingham risk score for cardiovascular diseases (FRS) and the metabolic syndrome (MetS). We hypothesized that: • Abdominal obesity as currently defined by IDF anthropometric criteria is weakly associated with unfavourable changes in other CMR factors while IR exacerbates other CMR factors in sub-Saharan Africans, • Medium income status, less urbanized place of residence (rural or semi-urban), physical activity and healthy eating patterns (higher score of consumption of foods that may protect against CMR) contribute to more favourable evolution of CMR. The study included initially 541 apparently healthy adults aged 25-60 years and randomly selected in a large city (n = 200), a small town (n = 171) and its surrounding rural area (n = 170). After baseline survey, subjects were followed-up after two and four years. Dietary intake and physical activity were assessed by two or three 24-hour recalls in baseline studies and then by short frequency questionnaires at follow-ups. Data on alcohol intake and smoking patterns were collected in personal interviews. Anthropometric data, blood pressure, insulin resistance based on homeostasis model assessment (HOMA), blood glucose and blood lipids were measured. Education, income (proxy) and place of residence were the socioeconomic variables appraised in interviews. A food score based on consumption frequency of “sentinel foods” was developed and used. Complete data at last follow-up was available in 416 subjects. Baseline prevalence of MetS and FRS ≥ 10% was 8.7% and 7.2%, respectively. The incidence of MetS, and a FRS ≥ 10% over four years was 8.2% and 5%, respectively. The CMR deteriorated in 21% of subjects. Abdominal obesity as defined by IDF thresholds of the waist circumference was associated with a higher likelihood of insulin resistance: relative risk (RR) = 5.7 (CI 95%: 2.8-11.5), high total cholesterol/HDL-Cholesterol ratio: RR = 3.4 (CI 95%: 1.5-7.3). However, abdominal obesity was not associated with a significantly increased risk of high blood pressure or high triglycerides. In the study population, the optimal cut-offs of waist circumference that predicted at least one component of MetS were 90 cm in women and 80 cm in men. Insulin resistance measured by HOMA was associated with an increased risk of hyperglycemia: RR = 5.7 (CI 95%: 2.8-11.5). However, the insulin resistance was not associated with a significant risk of high blood pressure and high triglycerides. The combination of MetS and the FRS depicted more at-risk subjects than the use of either tool alone. Diet and lifestyle mediated location and income effects on CMR evolution. Low “sentinel food” scores (foods that may reflect the protective effect of the diet against CMR): meat, poultry, milk and milk products, eggs and vegetables; and inactivity increased the likelihood of CMR deterioration: RR = 5.6 (CI 95%: 1.9-16.4) and RR = 6.3 (CI 95%: 3.0-13.4), respectively. Subjects with medium or low socioeconomic levels, and those living in the rural and semi-urban areas had a lower risk of CMR deterioration. The study showed some differences in the relationship between abdominal obesity, insulin resistance and other CMR factors in Blacks compared to Caucasians and it also highlighted the need to reconsider MetS components and their cut-offs for sub-Saharan Africans. Combining MetS and FRS might be appropriate for surveillance purposes in order to better capture CMR. The results of the present study call for urgent measures to reduce CMR deterioration focusing on more active lifestyle and dietary inadequacies.