Cardiovascular disease (CVD) worldwide has grown exponentially in the last two decades and while sub-Saharan Africa (SSA) has been grappling with the crippling effects of epidemic infectious diseases such as HIV/AIDS and malaria, cardiovascular disease is now emerging as a grievous concern. Research and resources have largely been directed toward understanding and curtailing infectious diseases in the African continent. But as the risk of cardiovascular disease reaching endemic proportions in sub-Saharan Africa becomes more evident, research is critically needed in order to understand how to manage it and more importantly to direct the development and implementations of culturally relevant prevention strategies. The risks and effects of CVD are present in both men and women across the globe, but there are differences in their occurrence based on gender that are worth considering. Women in sub-Saharan Africa, who are already burdened with the disadvantage of access to health care by virtue of their gender alone, are likely to be most adversely affected by CVD. Socioeconomic status (SES), epidemiologic transition and urbanization, lifestyle changes, and gender-based violence are all factors implicated in the compounded risk for CVD among women in this region. To understand how women in a sub-Saharan region perceive CVD and its risk factors, this descriptive phenomenological study set out to answer the following research question: How do Kenyan women perceive the modifiable risk factors for CVD? Furthermore, how do they perceive its effects on their lives and their families? Two samples from central Kenya representing an urban and rural area were selected and interviewed in a focus group setting. A number of themes were extrapolated from the interviews. The modifiable risk factors were perceived to be independent of CVD. Diet modification and physical activity were found to be helpful in controlling these diseases but clear understanding on their effects on overall cardiovascular health was lacking. Cigarette smoking generated the least discussion because none of the women were smokers. The effects of having either hypertension or type two diabetes included financial cost, emotional burden on the women and their families, and the concern of losing a breadwinner from disease or illness. These results have implications in nursing practice, public health, primary care provision, and national and global policies. They also shed light on areas of potential consideration in prevention program design and implementation. Awareness, though felt by the women to be slowly gaining in Kenya, is key to disease prevention. There is limited research on this subject matter in SSA and more studies are needed to understand the scope and effects of CVD in this region.

Markers on the non-recombining region of chromosome Y is a useful tool for study of diversity between populations. SNPs are the most commom polymorphisms in human genome. Mutation rate of SNPs is very low and so they may be used as genetic markers in evolutionary and population studies. We have analyzed 205 unrelated men from 11 Sub-Saharan Fulani's subpopulations. Fulani are an ethnic group of people spread over many countries, mainly in West Africa. Our samples are from Tindangou area, Banfora area (Burkina Faso), Bongor area, Linia area (Chad), Diafarabé area (Mali), Tcheboua area (Cameroon), Banfora area, Diffa area, Zinder area, Ader area and Abalak area (Niger). Using kit Signet Y-SNP Identification Systems and Luminex instrument with LabMAP Luminex Technology we detected particular Y chromosome's SNPs. LabMAP Luminex Technology is universal array platform, which as a probe using fluorescent polystyrene microspheres. We have observed 12 different haplogroups. Haplogroup E, which is typical African haplogroups, is determined with derivated allele in polymorfism M96. We have detected haplogroup E in maximum of 89,3% in the Fulani's subpopulations. In 7,8% we have detected haplogroup R, which is characteristic of populations in the Euroasia. Gene pool of Fulani's population is influenced with a...

Štěpánka Staňková Pedf UK, Aj - FJ Development aid in education in selected former French colonies of Sahel-Benin Union Abstract The following thesis on Development aid in education in selected former French colonies of Sahel-Benin Union presents the situation in Education of former French colonies in sub- Saharan Africa with the particular focus on Benin, Burkina Faso and Niger. The sources and the donors of the development aid are described; special attention has been paid to the international organisations, to the European Union and to the development aid provided by France and the Czech Republic. The aim of this thesis is to present the critical state of Education in former French colonies in Africa and the effort to solve the situation made by international organizations and France in particular. The main sources of information are the international studies and evaluation reports elaborated by the expert teams of the United Nations and the World Bank, together with direct personal experience made in the described countries. Key words: Development Aid, education, sub-Saharan Africa, Benin, Burkina Faso and Niger

Malgré plusieurs études montrant les avantages du bon contrôle glycémique, celui-ci reste insuffisant pour un nombre important d’adultes atteints de diabète type 2. Plusieurs facteurs de risque sont associés au mauvais contrôle glycémique. L'insuffisance de prise en compte par les patients des conséquences immédiates et à long terme du mauvais contrôle glycémique peut aussi jouer un rôle. Les objectifs de cette thèse étaient : de déterminer la fréquence du mauvais contrôle glycémique, défini par un taux d’hémoglobine glyquée (HbA1c) ≥ 7,0% chez des sujets diabétiques de type 2 en Afrique sub-saharienne ; de déterminer les associations entre le mauvais contrôle glycémique et les facteurs de risque potentiels chez les diabétiques de type 2 en Afrique sub-saharienne ; de déterminer la fréquence des symptômes d'anxiété et de dépression et les facteurs de risque associés à ces états chez les diabétiques de type 2 en Afrique sub-saharienne. Les données transversales à l’inclusion de l'étude "Amélioration de l’accès à l'HbA1c en Afrique sub-saharienne" conduite au Cameroun et en Guinée ont été utilisées. Les valeurs d'HbA1c ont permis de dichotomiser la population des diabétiques en deux groupes: ceux avec un bon (HbA1c < 7,0%) ou ceux avec un mauvais (HbA1c ≥ 7,0%) contrôle glycémique. Des modèles de régression logistique binaire ont été utilisés pour évaluer les relations entre les facteurs de risque potentiels et le contrôle glycémique. Les analyses ont été conduites en utilisant le logiciel SAS. Des modèles multi variés ajustés sur les variables sociodémographiques, cliniques et les variables psychosociales ont été produits. Les résultats ont révélé que le pourcentage de diabétiques de type 2 avec un mauvais contrôle glycémique est élevé au Cameroun (68% de sujets avec une HbA1c ≥ 7,0%) et en Guinée (84% de sujets). Les principaux facteurs prédictifs du mauvais contrôle glycémique mis en évidence étaient : l'inclusion en Guinée, l’âge inférieur à 65 ans, la durée du diabète connue supérieure à 2 ans, un traitement par anti diabétique oral associé ou non à l’insuline et l'absence de mesures précédentes de l'HbA1c. Les symptômes d'anxiété et de dépression chez les diabétiques de type 2 étaient fréquents en Guinée (respectivement 34,4% et 58,7% des sujets). Un niveau élevé d'HbA1c (supérieur à 9%), la résidence en zone urbaine et le niveau de statut socio-économique étaient significativement associés à un risque plus élevé d'anxiété ou de dépression. / Despite several studies showing the benefits of good glycemic control , it is insufficient for a significant number of adults with type 2 diabetes. Several risk factors are associated with poor glycemic control . Inadequate consideration by patients immediate and long-term poor glycemic control may also play a role. The objectives of this thesis were : determine the frequency of poor glycemic control , defined as a glycated hemoglobin ( HbA1c) ≥ 7.0% in diabetic subjects with type 2 in sub- Saharan Africa ; determine the associations between poor glycemic control and potential risk factors in type 2 diabetes in sub- Saharan Africa ; determine the frequency of symptoms of anxiety and depression and risk factors associated with these conditions in type 2 diabetes in sub- Saharan Africa. Cross-sectional data for inclusion in the study "Improving access to HbA1c in sub- Saharan Africa " conduct in Cameroon and Guinea were used. HbA1c values ​​have allowed the diabetic population dichotomized into two groups: those with good (HbA1c <7.0 %) or those with bad (HbA1c ≥ 7.0%) glycemic control. Models of binary logistic regression were used to assess the relationship between potential risk factors and glycemic control . Analyses were conducted using SAS software . Adjusted for sociodemographic variables , clinical and psychosocial variables varied multi models were produced . The results showed that the percentage of type 2 diabetics with poor glycemic control is higher in Cameroon (68% of subjects with HbA1c ≥ 7.0 %) and Guinea (84% of subjects) . The main predictors of poor glycemic control were highlighted : the inclusion in Guinea, less than 65 years age, duration of more than 2 years known diabetes , treatment with oral anti diabetic with or without insulin and the absence of previous measurements of HbA1c . Symptoms of anxiety and depression in type 2 diabetes were common in Guinea ( respectively 34.4 % and 58.7 % of subjects) . A high HbA1c level ( above 9% ) , the urban residence and level of socio -economic status were significantly associated with a higher risk of anxiety or depression risk.

Destination management became the key to a successful development of tourism sector in the last decades. Its role is not only in enhancing the competitiveness of the country's tourism sector on the international market but also in maximazing the net benefits from tourism for the host country. These tasks are exceptionaly important in developing countries. These countries often have unique potential in the presence of tourism atractivities but lack the so needed resources for exploiting this potential. Low level of socio/economic and technological development further limits the market opportunities of developing countries. A natural part of the tourism sector is the local population. However, local inhabitants are often reduced to a tourist atraction and thus do not gain profits from tourism in their region. On the other hand, local people bear substantial costs induced by tourism activities. To avoid this situation, the destination management should seek for more equal participation of local inhabitants in the tourism sector. This thesis will conduct an analysis of destination management in three relatively successful countries of the Sub-Saharan Africa region: Kenya, Ghana and the Republic of South Africa. The tested hypothesis is that destination management has the power to actively affect the situation of local inhabitants with regard to tourism activities in their region. The analysis is conducted in two ways. First, the programming documents of responsible tourism authorities will be compared to the actual activities of this authorities. Second, the conducted activities will be contrasted with the curent situation and problems of the particular countries. The results will then be applied on Ethiopia which is one of the least developed countries in the world but has one of the biggest tourism potentials in the Sub-Saharan Africa region.

This thesis analyses French foreign policy towards former colonies in Sub-Saharan Africa since 1960. Particular emphasis is given to informal relations, predominating in this policy. Although the countries gained independence, they remained under French influence and control for another three decades. France achieved this through skillful combination of formal and informal instruments, which are described in the thesis. Furthermore, the work deals with factors that predetermined the development of the new African policy and examines its goals and changes of instruments stemming from changes of international and domestic context. The thesis concludes with a case study specifically illustrating the development of relations between France and Gabon.

Este trabalho tem como objetivo avaliar o papel da autoridade estatal e do desenvolvimento na estabilidade dos Estados da África Subsaariana e a influência que têm nos processos de falência estatal e de eclosão de guerras intraestatais. Desde o fim da Guerra Fria, a corrente de pensamento que fundia segurança e desenvolvimento tornou-se predominante para analisar as causas e fornecer sugestões de políticas para impedir que os Estados sucumbissem a dinâmicas de violência, fomentadas por necessidade, ganância e agravo - todos gerados e intensificados em situações de subdesenvolvimento. Palco de boa parte dos países menos desenvolvidos (PMDs) do mundo e da grande maioria dos conflitos intraestatais que ocorreram nos últimos trinta anos, a África Subsaariana foi retratada como locus immutabilis, cujos problemas tinham poucas ou nenhuma solução possível. Desta forma, o subdesenvolvimento endêmico da região foi usado como guarda-chuva conceitual uma vez que intensificaria as consequências nocivas de certos tipos de regimes políticos, da distribuição desigual das riquezas e oportunidades econômicas e da incompatibilidade étnica que existiria em seus países. Seguindo esta linha de pensamento, bastaria resolver a situação do subdesenvolvimento nos Estados da África Subsaariana que seus processos de falência seriam revertidos e as guerras civis não mais aconteceriam. No entanto, é possível questionar esta relação entre segurança e desenvolvimento dado que países que têm o mesmo nível de subdesenvolvimento diferiram em seus destinos, tendo alguns sucumbido às dinâmicas violentas e outros não. Este trabalho pretende, portanto, identificar as causas das guerras civis e da falência de Estados na região. Este trabalho argumenta que é a baixa autoridade estatal (e não o subdesenvolvimento) a condição determinante para o advento de guerras civis e da falência de Estado na África Subsaariana. Para chegar a tal resultado, analisou-se os dados de 44 Estados da região fornecidos pelo Worldwide Governance Indicators do Banco Mundial e os mesmos dados utilizados pela ONU para classificar os PMDs. Também se utilizou análise qualitativa sobre a história dos países onde a paz imperou desde a independência para avaliar as fundações da autoridade estatal. / This thesis looks forward to assessing the role of state authority and development in the stability of Sub-Saharan African states and their influence on state failure processes and on the outbreak of intra-state wars. Since the end of the Cold War, the current of thought that merged security and development has become prevalent in analysing the causes and in providing policy suggestions to prevent states from succumbing to dynamics of violence fuelled by need, greed, and grievance - which are generated and intensified in situations of underdevelopment. As the stage for most of the world\'s least developed countries and the largest number of intrastate conflicts that have taken place over the last thirty years, Sub-Saharan Africa has been portrayed as locus immutabilis, whose problems had few or none feasible solutions. In this regard, the region\'s endemic underdevelopment was used as a conceptual umbrella since it would intensify the harmful consequences of certain types of political regimes, of the unequal distribution of wealth and economic opportunities, and the ethnic incompatibility that would exist in their countries. Following this line of thought, resolving the situation of underdevelopment in Sub-Saharan African states would suffice to reverse processes of state failure and civil wars would no longer happen. However, it is possible to question this relationship between security and development since countries that have the same level of underdevelopment had different outcomes, having some of them capitulated to violent dynamics and others not. This thesis therefore aims to identify the causes of civil wars and state failure in the region. It argues that it is the low level of state authority (and not underdevelopment) that is the determining factor for the advent of civil wars and state failure in Sub-Saharan Africa. In order to achieve this result data from 44 countries in the region provided by the World Bank\'s Worldwide Governance Indicators and the same data used by the UN to classify the LDCs were analysed. Qualitative analysis was also conducted about the history of countries where peace has prevailed since independence to assess the foundations of state authority.

Les cohortes cardiovasculaires en Afrique subsaharienne (ASS) sont rares. Sa diversité génétique et environnementale en suggère la nécessité pour mieux appréhender les spécificités des MCV et de leurs facteurs de risque (FDR). Méthodes : Une cohorte pilote a été mise en place en 2015 en milieu rural au Bénin. Les FDR ont été collectées à l’inclusion en porte à porte et les événements recueillis au quotidien par une double surveillance sanitaire et communautaire. La prévalence de l’artériopathie oblitérante des membres inférieurs (AOMI), le retentissement électrocardiographique de l’hypertension artérielle et les représentations sociales des MCV ont également été étudiés. Résultats : La participation élevée (>95%), l’attrition faible (<8%) et la bonne adhésion de la communauté ont confirmé la faisabilité de la cohorte. L’incidence des MCV était de 5,4 pour 1000 pers-années avec un taux de mortalité à 79,2%. La prévalence de l’AOMI était de 5,5% avec une prédominance chez les hommes et les sujets de 55 ans et plus. L’hypertrophie ventriculaire gauche était 2 à 5 fois plus fréquente chez les sujets hypertendus. Les représentations sociales des MCV associaient des explications biomédicales et surnaturelles. Conclusion : Une cohorte de MCV est faisable en ASS et met en relief les spécificités des MCV au sein de la cible. / Few cohorts have been conducted in sub-Saharan Africa (SSA). Its genetic and environmental diversity suggests the need of cohorts to better understanding the specificities of CVD and their risk factors (RF). Method: A pilot cohort was set up in 2015 in a rural setting of Benin. Data for RF were collected at inclusion during a door-to-door survey and events daily through dual health and community surveillances. Prevalence of lower extremity artery diseases (LEAD), electrocardiographic impact of high blood pressure and the social representations of CVD were also studied. Results: The high participation rate (>95%), low attrition (<8%) and good community participation confirmed the feasibility of the cohort. Incidence of CVD was 5.4 cases per 1000 persons-years and the mortality rate 79.2%. Prevalence of LEAD was 5.5% and higher among men and people aged 55 years and above. Left ventricular hypertrophy was 2 to 5 times more frequent among people with hypertension. Social representations of CVD combined biomedical with supernatural explanations. Conclusion: A cohort of CVD is feasible in SSA and highlights CVD’s specificities.

To provide empirical basis for mental health interventions in the deprived sub-Saharan African region, this study explored the perspectives of the Igbo people of south-eastern Nigeria on four dimensions of mental illness: causal beliefs, attitudes towards sufferers, preferred treatment pathways and perceived barriers to accessing formal psychiatric care. Mixed sampling methods were used to select participants who completed quantitative questionnaires. The number of participants varied between 200 and 706 in the exploratory studies but remained constant (n = 1127) in the confirmatory studies. The study found mixed endorsements of the supernatural, biological and psychosocial causal explanations with supernatural causations being significantly more endorsed. The study also found mixed treatment preferences with formal psychiatric care being significantly more preferred to the spiritual pathway which was in turn significantly more preferred to the traditional pathway. Significant negative attitudes and desire for social distance from persons with mental illness were observed across groups. Barriers to accessing mental healthcare were also significantly perceived with ideological barriers being significantly more perceived than instrumental barriers. Systematic associations were found between causal beliefs and treatment preferences: supernatural causal belief predicted preference for the spiritual and traditional treatment pathways while psychosocial causal belief predicted preference for both formal psychiatric care and the traditional treatment pathway. Mixed causal attributions and treatment preferences reflect holistic view of health and healing and calls for the evolution of complementary model of care that would incorporate people's spiritual and cultural needs. The prospect is supported in psychosocial causal beliefs being associated with preference for the traditional treatment pathway. Significant negative attitude is a contradiction in the traditionally communitarian and predominantly Christian culture, and is deserving of intervention in the context where the solidarity of the social network should compensate for the inadequate mental healthcare. Significantly more ideological than instrumental barriers have crucial policy implication; improved conceptualizations of mental illness should precede improvement of facilities and services or else these could be underused. Demographic correlates of causal beliefs, negative attitudes, pathway preferences and barriers to accessing formal mental healthcare care were determined for targeted interventions.

En Afrique, les métropoles fleurissent sur le continent, avec leur florilège d’espérance et de défis. Le rural est en crise et les taux de croissance urbaine explosent, posant l’inévitable problème de l’alimentation des urbains. L’agriculture urbaine et périurbaine est très présente car elle répond à nombre d’enjeux des villes africaines : elle pourvoit des revenus à despopulations formées aux pratiques agricoles, notamment les migrants; elle fournit des produits alimentaires périssables adaptées aux urbains, en autre des légumes et de la viande ; et elle permet l’aménagement de zones inconstructibles ou périurbaines alors que l’intervention publique est insuffisante dans ce domaine. L’agriculture urbaine et périurbaine des villes du Sud est multifonctionnelle. Cependant elle est peu reconnue par les institutions et rarement incluse dans les plans de développement urbains, ce qui grève son avenir et sa durabilité. La particularité de cette agriculture est d’être en concurrence avec les activités urbaines pour les ressources, notamment pour le foncier. Dans deux villes, Yaoundé et Accra, l’activité agricole trouve sa place dans des espaces spécifiques, des bas-fonds, des open space, des terrains inconstructibles, des jardins et des cours, des parcelles qui attendent d’être construites, des villages périurbains menacés, etc. Elle se déploie sur des espaces intermédiaires, entre le rural et l’urbain, entre le droit coutumier et le droit légal, entre la tradition et la modernité. En fonction de l’âge, du genre et de la position dans la hiérarchie coutumière etfamiliale, les droits sont différents, que ce soit pour cultiver, pour prêter ou louer ou pour vendre, sans oublier les procédures légales qui octroient un titre foncier. Les stratégies de production dépendent grandement de l’accès au foncier et contrairement à ce qui se passe généralement en milieu rural, ce ne sont pas forcément ceux qui ont le plus de sécuritéfoncière qui sont le plus innovants. / In sub-saharan Africa, metropolises propser bringing chanllenges and hope. The rural regions are in crisis and the rates of urban growth explode, raising the inevitable problem of the food supply of the urban population. The urban and periurban agriculture is very present because she answers number of issues of the African cities: it provides income to agricultural populations, in particular the migrants; it supplies perishable foodstuffs adapted to the urban market, like vegetables and meat; and it allows the development of unbuildable or periurban zones while the public intervention is insufficient inthis domain. The urban and periurban agriculture in the South is multifunctional. However it is little recognized by institutions and rarely included in the urban plans of development, what burdens its future and its durability. The peculiarity of this agriculture is to be in competition with the urban activities for the resources, in particular for the land. In two cities, Yaounde and Accra, the agricultural activity tooks place in specific spaces, shoals, open space, unbuildable grounds, gardens andbackyards, plots of land which wait to be built, threatened periurban villages, etc. It deploys on intermediate spaces, between the rural and the urban, between the common law and the legal right, between the tradition and the modernity.According to the age, to the genre and to the position in the customary and family hierarchy, the rights are different, whether it is to cultivate, to give or rent or to sell, without forgetting the legal procedures which grant a land title. The strategies of production depend largely on the access to the land and contrary to what takes place generally in rural areas, it are not necessarily the ones which have most land security which are the most innovative.