Magister Public Health - MPH / Sub-Saharan Africa is home to two thirds of the 33 million HIV infected individuals worldwide. In 2007 there were an estimated 1.5 million Kenyans infected with HIV, and 166 000 new infections in 2008. The introduction of antiretroviral therapy [ART] brought new hope to HIV patients. It has transformed a fatal disease to a chronic manageable condition. Kenya has made great strides in ensuring access to ART and by 2009, 308 610 patients in the country were receiving ART - which is the second highest number worldwide. The success of ART requires a sustained adherence rate to medication of more than 95% to prevent viral replication and the development of drug resistant HIV strains. Identifying the factors that influence adherence, is essential for the long-term success of public ART programmes. The current study explored patient, socio-economic, cultural, and religious and health systems factors that influence adherence to ART at the Coast Provincial General Hospital [CPGH] in Mombasa, Kenya. / South Africa

Magister Public Health - MPH / Aim: To obtain baseline data on adherence levels and the major determinants of adherence among patients on HAART at Rundu Hospital, Namibia. Results: Seventy-eight percent of the 97 participants included in the study were female, resulting in a female to male ratio of 4 :1. The mean age of the participants was 36.7 (SD: 9.00) years with 80% of the participants being in the 20-44 age group. The mean duration on ART treatment was 20 (SD: 10.3) months with 76% of the participants being on ART for 24 or less months. The average adherence rate reported by mean composite of the three measures was 95.1%, while the proportion of patients who achieved adherence levels of 95% and above was 64%. The main barriers to adherence to HAART reported by participants were forgetfulness (28%), lack of food (13%) and being away from the pills (11%): facilitators reported included counselling (19%) and treatment supporters (11%). Having knowledge of the consequences of failing to take HAART as prescribed was significantly associated with adherence (p = 0.03), as was being female (p = 0.04) while living further than 6 km from the hospital was significantly associated with non adherence (p = 0.018).

L’Afrique est confrontée à un vieillissement démographique sans précédent. L’âge étant le facteur principal dans la survenue des démences, l’Afrique devra affronter l’un des plus grands risques socio-sanitaire et économique du 21e siècle. Cette situation accentue la pression sur des systèmes nationaux de santé sollicités au-delà de leurs capacités. L’épidémiologie des démences est encore très peu connue en Afrique et la plupart des données existantes portent sur la prévalence. La démence étant une pathologie chronique et actuellement incurable, la prévention et l’amélioration de la qualité de la prise en charge des malades restent les meilleures armes pour la gestion de cette pathologie. Pour mieux aider les pays africains à bâtir des politiques de santé adaptées, il est important de fournir des données portant sur l’évolution (incidence et mortalité) de cette pathologie. L’objectif de nos travaux était d’estimer l’incidence des démences et le pronostic de ces pathologies en terme de survie. Notre travail a été réalisé à partir d’une cohorte de sujets âgés, habitant les zones urbaine et rurale de la République du Congo, recrutés lors de l’enquête de prévalence EPIDEMCA et suivis pendant deux ans entre 2012 et 2014. Dans un premier temps nous avons estimé la mortalité associée à la démence. La comparaison des taux de mortalité en fonction du statut cognitif a montré que les sujets déments avaient un risque de décès plus important. Ce risque était 2,5 fois plus élevé par rapport aux sujets normaux (HR= 2,53, IC95%: 1,42-4,49, p=0,001) et augmentait avec l’âge et la sévérité de la maladie. Concernant l’incidence, nous avons observé 23 (2,38%) nouveaux cas de démence et estimé une incidence brute de 15,79 (IC95% :10,25 – 23,32) pour 1000 Personne Année (PA). L’incidence standardisée à la population âgée d’Afrique Subsaharienne S était de 13,53 (IC95% 9,98 – 15,66). En tenant compte des différents facteurs analysés, l’âge (p=0,003) et un faible engagement social (p=0,028) (défini par un manque ou une faible participation aux activités communautaires) étaient les principaux facteurs associés à l’incidence de la démence en population congolaise. Globalement, nos résultats soulignent le fardeau que représente la démence pour l’Afrique et sont en parfaite adéquation avec ceux issus d’autres pays à faibles et moyens revenus et des pays à revenus élevés. Toutefois, il est difficile de généraliser nos résultats à la population africaine, car il s’agit d’un continent vaste avec des spécificités pour chaque population. La mise en place de programmes d’études multicentriques dédiés aux démences adoptant des méthodologies similaires serait souhaitable. Les politiques de santé relatives aux personnes âgées devraient intégrer la prise en charge des démences. / The African population is ageing at an unprecedented rate. In sub-Saharan Africa (SSA), the number of people aged 60 years and above is projected to rise to over 67 million by 2030 (representing a 100% increase in the 25 years since 2005). Incidence and mortality data help us understand the epidemiology and disease burden of dementia, and thereby improve policy planning. Although dementia prevalence have been reported for many countries of SSA, incidence and mortality related to dementia remain poorly described to date as only Nigeria had reported dementia incidence among older African adults. This study aimed to assess the dementia related incidence and mortality, and associated risk factors in Congolese people aged over 65 years recruited in EPIDEMCA survey. The baseline population was followed up during two years. Older participants were traced and interviewed annually in rural and urban Congo between 2012 and 2014. DSM-IV and NINCDS-ADRDA criteria were required for dementia and Alzheimer’s disease diagnoses. Data on vital status were collected throughout the follow-up. Cox proportional hazards model was used to assess the link between baseline dementia diagnosis and mortality risk. Risk factors for incident dementia were examined using a competing-risks regression model based on Fine and Gray methods. After two years of follow-up, 101 (9.8%) participants had died. Compared to participants with normal cognition at baseline, mortality risk was more than 2.5 times higher among those with dementia (HR= 2.53, 95% CI: 1.42-4.49, p=0.001). Among those with dementia, only clinical severity of dementia was associated with an additional increased mortality risk (HR=1.91; CI 95%, 1.23-2.96; p=0.004). Age (per 5-year increase), male sex and living in an urban area were independently associated with increased mortality risk across the full cohort. Among the dementia-free cohort, the crude incidence of dementia was estimated at 15.79 (95% CI 10.25 – 23.32) per 1000 Person Year. We estimated a standardised incidence (on the 2015 Sub-Saharan Africa population) of 13.53 (95% CI 9.98–15.66). Regarding baseline characteristics, old age (p=0.003) and poor social engagement (assessed by community activity) (p=0•028) at baseline were associated with increased dementia incidence among Congolese older adults.Our results, as previously described, support the ongoing demographic and epidemiologic transition in SSA. They highlight the need of longitudinal population-based studies dedicated to dementia incidence and mortality among African people. Given that Africa is a continent subject to unprecedented population ageing; our data highlight the need to address the burden of dementia in this region. Support should incorporate prevention plans based primarily on modifiable (cardiovascular) risk factors, education and social inclusion of the elderly, as well as support for patients and their relatives.

Cette thèse, inspirée des travaux sur le développement du jeune enfant en conditions de vie défavorisées (Zaouche Gaudron, 2005), traite de la subjectivation d’enfants d’Afrique subsaharienne dans leurs rapports à l’eau. La subjectivation est ici le procès par lequel les enfants produisent leur singularité subjective dans le rapport aux réalités objectives de leur environnement (Malrieu, 2003). Notre approche revient sur la question, classique en psychologie, de l’activité du sujet sur l’objet. L’alternative des objectivations nous permet de montrer que les objets ne sont pas seulement déterminants pour les sujets mais peuvent, dans et par la médiation sociale, devenir des sujets (Marx, 1867 ; Vygotsky, 1930 ; Wallon, 1945 ; Meyerson, 1948, Sève, 2008). Le processus de subjectivation chez l’enfant ne nous renvoie donc pas directement à l’activité des enfants, mais aux objectivations sociales à partir desquelles, dans leurs rapports aux objets, ils deviennent sujets singuliers. Notre échantillon d’étude est constitué de 68 enfants, âgés de 4 à 7 ans, qui vivent dans les localités rurales de Bogué et de Bakel proches du fleuve entre la Mauritanie et le Sénégal puis à Tomè au Togo près de la rivière Egbi. Notre recherche a été menée à partir d’entretiens semi-directifs à destination des parents ou adultes significatifs, et de planches figuratives destinées aux enfants et permettant, à partir de scènes d’eau, d’en faire l’objectivation en trois phases successives : en situations "naturelle", concertée et rémanente. Nos principaux résultats montrent que lorsque les adultes s’impliquent dans l’objectivation de l’eau, en situation concertée, l’eau devient un objet social dans le rapport auquel les enfants sont davantage en état de réaliser leurs subjectivations. Le rapport à l’eau propice au développement des enfants se révèle alors irréductible à l’effet des déterminations naturelles, c’est-à-dire de leur zone d’habitation. Néanmoins, nos résultats spécifiques, par localités, mettent en évidence des disparités entre celles-ci dans le rapport à l’eau indiquant que l’implication sociale nécessaire à un rapport à l’eau propice au développement des enfants, est encore à construire et à développer en Afrique subsaharienne. Les résultats obtenus permettent de proposer des perspectives de recherche et des pistes d’intervention quant au rapport des enfants aux objets, notamment ceux de première nécessité et en milieux défavorisés. / This thesis is inspired by the work on the development of children growing up in disadvantaged living conditions (Zaouche Gaudron, 2005). It treats the subjectification of the African Sub-Saharan children in their relationship with water. In this study, subjectification is the process by which children produce their subjective uniqueness based on the relationship with objective realities in their environment (Malrieu, 2003). Our approach comes back to the classical question in psychology, about the Subject’s activity on the Object. The alternative of the objectification allows us to show that Objects are not only determining factors toward Subjects but, through social mediation, they could become Subjects themselves (Marx, 1867; Vygotsky, 1930; Wallon, 1945; Meyerson, 1948, Sève, 2008). The process of child subjectification does not refer directly to children activity, but to their social objectification, allowing them, through their relationship to objects, to become singulars subjects. Our study sample consists of 68 children, between 4 and 7 years old, who are living in the rural communities of Bogué and Bakel close to the river between Mauritania and Senegal as well as in the rural community of Tomè in Togo close to the river of Egbi. Our research has been based on semi-structured interviews targeting parents or significant adults, and figurative boards targeting children that allow, through water scenes, to be exploited as objectification of three successive phases: “natural” situation, concerted and retentive. Our main results show that when adults are involved in water objectification, through the concerted situation, water becomes a social object intervening in the relationship enabling children more and more to realize their subjectification. The relationship between suitable water and children's development proves that is irreducible to the impact of natural determinations, for example the areas where they live. However, our specific results for each community, highlight the disparities between them regarding to water. These results indicate that the necessary social implication in the relationship between the suitable water and the children development is yet to be built and developed in Sub-Saharan Africa. The obtained results allow to open up research perspectives and intervention areas regarding to the relationship between children and objects, notably those of basic needs for children living in disadvantaged environments.

Philosophiae Doctor - PhD / The dissertation examines three military interventions in Sub-Saharan Africa which took place in the mid and late 1990s in Rwanda, the DRC and Lesotho. These interventions took place despite high expectations of international and regional peace on the part of most analysts after the collapse of cold war in 1989. However, interstate and intrastate conflicts re-emerged with more intensity than ever before, and sub-Saharan Africa proved to be no exception.The study sets out to analyse the motives and/or causes of military interventions in Rwanda in 1990, the DRC in 1996-7, and the DRC military rebellion and the Lesotho intervention in 1998. In analysing these interventions, the study borrows extensively from the work of dominant security theorists of international relations, predominantly realists who conceptualise international relations as a struggle for power and survival in the anarchic world. The purpose of this analysis is fourfold; firstly, to determine the reasons for military interventions and the extent to which these interventions were conducted on humanitarian grounds; secondly, to investigate the degree to which or not intervening countries were spurred by their national interests; thirdly, to assess the roles of international organisations like Southern African Development Community (SADC), the Organisation of African Unity (OAU) and the United Nations, in facilitating these interventions; as well as to evaluate the role of parliaments of intervening countries in authorising or not these military interventions in terms of holding their Executives accountable. In this context, the analysis argues that the intervening countries; Angola, Botswana, Burundi, Chad, Namibia, Rwanda, Sudan, South Africa, Uganda and Zimbabwe appeared to have used intervention as a realist foreign policy tool in the absence of authorisation from the United Nations and its subordinate bodies such as the OAU and SADC. / South Africa

Magister Public Health - MPH / Background: Namibia is one of the Southern African countries hardest hit by the HIV epidemic, with an estimated one out of every five people infected (MoHSS, 2004). Approximately 80,000 of the infected population currently require antiretroviral treatment (ART). In order to prevent the progression of the HIV infection to AIDS, patients are required to take antiretroviral medicines lifelong. This lifelong use exposes patients to toxicities of these medicines and the only available options of managing the toxicities of ARVs are to treat the toxicity or substitute or switch the offending medicines. Aim: The current study aimed to describe the extent and reasons for substituting and switching HAART at the Katutura Intermediate Hospital in Windhoek, Namibia. Methodology: A descriptive retrospective case series study, in which medical records were reviewed to determine the extent and reasons for substituting and switching HAART was conducted. Random sampling was used to draw a sample of 500 from 3477 adult HAART patients who commenced treatment between 1 January 2002 and 31 December 2006. A prepiloted data collection tool was used to collect the data. The following information was collected: baseline CD4 count, weight, initial ARVs, first and second ARV substitutions, ART switch and the reasons for substituting ARVs or switching ART during the indicated period. Epi Info version 6 was used to analyse frequencies, means and medians of all important variables in the data set. Results: The sample was made up of 500 HAART patients; 60% were females. The median age of the sample was 34 years (Inter-quartile range (IQR) 30 – 40) and the median CD4 cell count was 153 cells/mm3 (IQR 96 – 212) at initiation of therapy. The median time on treatment before first substitution was 28 months (IQR 24 – 34), whereas the median time before second substitution was 10 months (IQR 6 – 15) from the time of the first substitution. The median time before switching was 31 months (IQR 24 - 39). A total of 31% of the study subjects underwent a substitution once, whereas 1.8% underwent a second substitution. Only six (1.2%) patients switched to a second line treatment after the modification of the treatment. The most commonly recorded reason for the first substitution was toxicity (19%). As in other studies, stavudine (D4T), nevirapine (NVP) and efavirenz (EFV) were the ARVs associated with most of the recorded toxicities. High viral load (50%) was the most reported reason for switching. In almost half of the substitution cases the reasons for substitution were not stated, and in a third of the switch cases the reasons for switching were not stated. Conclusion: The rate of substitution at 31% was similar to that found in other resource poor settings, however, the rate of switching (1.2%) was much lower than was found in similar settings. The main reason stated for substituting antiretrovirals was “toxicity”. / South Africa

Doctor Educationis / Background: In an attempt to avert the HIV/AIDS epidemic, more research has been conducted to determine why the epidemic is more devastating in Southern African countries than anywhere else in the world. Heterosexual transmission is believed to be driving the epidemic in many sub-Saharan African countries. Recent research has indicated that having concurrent sexual partners is one of the factors contributing to the fast spread of HIV transmission in this region.Aim: This study aimed to describe the level of knowledge about the risk of HIV transmission posed by concurrent sexual partnering as well as beliefs and practices about concurrent partnering among education students at the Rundu College of Education(RCE) in the Kavango region of Namibia. Concurrent partnering was defined as a situation where a person has more than one sexual partner at the same time, during the twelve months preceding the study.Methodology: There were 374 students registered for the 2009 academic year at RCE.All registered students were targeted for the study and 278 completed the questionnaire,yielding a response rate of 73.4%. The survey described prevalence of concurrent partnering, knowledge about risk posed by concurrent partnering as well as beliefs about concurrent partnering.Data collected was analyzed using Statistical Programs for Social Sciences (SPSS).Descriptive statistics were used to describe the prevalence of sexual concurrency,knowledge about risk posed by concurrent partnering and beliefs about concurrent partnering among the study population. Frequency of concurrency was cross tabulated with demographic variables like age group, sex and year of study as well as by knowledge and beliefs about sexual concurrent partnering.Results: The prevalence of concurrency in this sample was 9.4% with significantly higher prevalence (13.0%) among male students compared to females (5.3%). Males reported knowledge levels of 85.7% to 88.4% while females reported knowledge levels of 89.3% and 93.1%. More men (28.8%) than women (10.7%) agreed with the statement that sexual concurrency is a sign of manhood (p=0.00). Further, more male students(27.9%) compared to female students (6.1%) agreed with the statement that sexual concurrency is part of African culture and should continue (p=0.00).Conclusion: The study results show a high knowledge of risk posed by concurrency. It further reveals that a high number of people believe that concurrency is acceptable especially among men.HIV prevention activities promoting partner reduction and mutual fidelity should be implemented. Such activities should focus more on behavior change rather than on information giving. There is a need to create platforms for community members to debate on cultural beliefs about sexual concurrency.

In recent years, physical activity and fitness transitions, described as declines in physical activity and aerobic fitness, coupled with increased sedentary behaviour, have been observed among school-aged children. Consequently, the prevalence of childhood overweight/obesity has also increased considerably. While there is a wealth of evidence supporting such behavioural transitions in higher income countries, there exists a paucity of data on the situation in lower income countries, such as those in Sub-Saharan Africa (SSA). The premise of this thesis was to investigate the robustness of these relationships in other global regions. The first objective was to investigate the evidence for an overweight/obesity, physical activity, and fitness transition among SSA’s school-aged children. Systematic review methodology was used to examine temporal trends and correlates of overweight/obesity, physical activity, fitness, and sedentary behaviour in apparently healthy or population based samples of children (5 - 17 years). The second objective of this thesis was to determine the prevalence and correlates of overweight/obesity and physical activity among Kenyan children aged 9 to 11 years, having contextualised Kenya within the broader situation in SSA. Further, the relationships between self-reported and directly assessed measures of physical activity and sedentary time by weight status in Kenyan children were investigated. The third objective was to examine moderate-to-vigorous physical activity (MVPA) patterns accrued by time of day among Kenyan children using the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE)-Kenya data. Activity patterns in the Kenyan setting were then compared to similar ISCOLE-Canada data from Canadian children, revealing differences and similarities in the accumulation of MVPA, light physical activity, and sedentary time. Systematic review data syntheses revealed a trend towards increasing proportions of overweight/obesity among Sub-Saharan Africa’s school-aged children. Further, urbanization and higher socioeconomic status (SES) were associated with decreased physical activity and aerobic fitness, and increased sedentary behaviours and body composition measures. ISCOLE-Kenya data analyses found a prevalence of childhood overweight/obesity of 20.8% in Nairobi, with few children meeting global physical activity guidelines (12.6%). Mean daily sedentary time was 398 minutes, time spent in light physical activity was 463 minutes, and time spent in MVPA was 36 minutes. Higher SES and parental education attainment were associated with a higher likelihood of children being overweight/obese and a lower likelihood of children meeting the physical activity recommendations. Data analyses also revealed considerable discrepancies in both self-report and direct measures of physical activity by weight status, and weak to moderate correlations between self-report and direct measures of physical activity. Under/healthy weight children had significantly higher directly measured mean daily minutes of MVPA compared to overweight/obese children (39 verses 20 minutes); had lower mean weekend-day minutes of sedentary time (346 verses 365 minutes); and had a higher proportion who met physical activity guidelines (15.5% versus 2.6%). Lastly, while MVPA patterns among urban Kenyan children were largely similar to those of urban Canadian children with regard to relationships by sex, BMI category, and weekday/weekend days; in the Kenyan sample, much unlike many higher income countries, lower SES was associated with higher MVPA.

En Afrique sub-saharienne (ASS), l'agriculture de conservation (AC) est diffusée afin de d'améliorer durablement la productivité de l'agriculture familiale. Cette AC est basée sur les principes de travail réduit du sol, d'une couverture permanente et de rotations introduisant des légumineuse. Parmi tous les bénéfices potentiels de l'AC, le mulch peut améliorer le bilan hydrique et tamponner le stress hydrique, et donc sécuriser les rendements, lorsque les pluies sont limitées et/ou aléatoirement distribuées. A Madagascar, la région du lac Alaotra connaît une forte expansion de la riziculture pluviale. Etant caractérisée par une distribution des pluies très erratique, la pratique de l'AC semble pertinente pour sécuriser la production pluviale. L'objectif de cette étude est donc d'évaluer dans quelle mesure cet aléa climatique est tamponné par l'AC. Tout d'abord, à travers revue de la littérature scientifique, nous avons ouvert à une problématique plus large. En effet, au regard des projections de croissance démographique et de changement climatique (CC) en ASS, l'AC est proposée comme solution ‘climate-smart' ; i.e. une agriculture capable d'augmenter la productivité et de s'adapter au CC tout en l'atténuant. Les études identifiées en ASS montrent une capacité de l'AC à augmenter les rendements sur le long-terme, et à plus court-terme dans les contextes climatiques où les pluies sont faibles et/ou mal distribuées. Cela suggère donc une capacité de l'AC à s'adapter au CC qui prévoit une augmentation de la variabilité de la distribution des pluies en ASS. La capacité de l'AC à atténuer le CC en séquestrant du carbone (C) dans les sols reste en suspens car le stockage du C se fait principalement en surface et la stabilité de ce C est questionnée. Nous nous sommes ensuite recentrés sur le sujet et la zone de cette étude afin d'évaluer le potentiel de l'AC à tamponner l'aléa pluviométrique. En se basant sur les données de suivi de parcelles en transition vers l'AC sur quatre saisons contrastées, nous avons constaté une augmentation des rendements moyens en riz pluvial dès la première année de pratique, avec une augmentation progressive des rendements et une diminution de la variabilité. Les données ont également suggéré une sécurisation des semis précoces et tardifs en AC. Nous avons constaté un poids important du climat sur la variabilité des rendements dans la zone d'étude. Cette analyse exploratoire nous a donc permis d'observer des effets positifs de l'AC dans le contexte climatique du lac Alaotra, suggérant notamment un effet potentiel sur la ressource hydrique. Mais les informations à notre disposition ne nous ont pas permis de vérifier cette hypothèse. Nous nous sommes donc intéressés à l'impact du mulch sur le bilan hydrique et les rendements en riz pluvial dans les conditions agro-climatiques de la zone d'étude. Nous avons effectué une expérimentation virtuelle, en utilisant le modèle PYE-CA. Nous avons confirmé la capacité du mulch à réduire le ruissellement. Nous avons identifié les dates de semis pour lesquelles le riz pluvial est le moins impacté par le stress hydrique dans la région. Les résultats nous ont indiqué que pour les dates de semis majoritairement pratiquées par les agriculteurs, et dans un éventail de conditions de sol, la disponibilité en eau est très peu affectée par une modification du ruissellement. Les bénéfices d'une réduction du ruissellement apparaissent dans des conditions hydriques plus stressantes telles que des dates de semis précoce ou une intensification, en diminuant la variabilité des rendements. Cette étude nous a permis de mieux appréhender les impacts de l'AC sur le bilan hydrique dans le contexte climatique de notre zone d'étude. Pour faire sens, ces résultats sont à intégrer à l'échelle exploitation, voire plus large, pour identifier les contraintes et avantages induits par les systèmes en AC dans le contexte socio-économique du lac Alaotra. / Conservation agriculture (CA) is widely disseminated at large scale in sub-Saharan Africa (SSA) in order to restore soil fertility and sustainably increase crop production of family farming. As defined by the FAO, CA is based on the three principles of minimal soil disturbance, permanent soil cover, and complex crop rotation. Among all the beneficial functions of CA, its ability to improve water balance through mulching can buffer water stress during crop cycle, and hence secure yields when rainfall are limited or poorly distributed. In the Lake Alaotra region of Madagascar, the area under rainfed upland rice has expanded lately. The region being characterized by an erratic rainfall distribution, intra- and inter-annually, CA practice seems appropriate to secure rainfed production. The main objective of this study is to evaluate to which extent this climate hazard can be buffered through the practice of CA. Firstly, we ran a review of the scientific literature to better understand the impact of CA in a wider context. Regarding the projections of population growth and climate change for SSA, CA is considered as a climate-smart option, i.e. an agriculture able to simultaneously mitigate climate change, adapt to this change, and sustainably increase productivity. The different studies illustrated the capacity of CA to maintain, or even increase production in the long-term, and in the shorter-term under limited or poorly distributed rainfall African contexts. These results suggested an ability of CA to adapt to climate change, predicting an increase in rainfall variability in SSA. However, the climate change mitigation through carbon sequestration under CA remained unclear because of a superficial storage which may be unsteady. Then, we focused on the study area to evaluate the potential of CA to buffer rainfall hazard. Using a 4-year dataset monitoring farmers' fields transitioning to CA, we observed a gradual increase in upland rice average yield with a decrease in variability over the consecutive years of CA practice. The data also suggested a capacity of CA to secure early or late sowing. But agro-environmental factors were mainly impacting yields in the region. This exploratory analysis allowed us to observe positive impacts of CA under the climate conditions of the Lake Alaotra region, suggesting an impact on water balance but no information was available to validate this hypothesis. Finally, we focused more precisely on the impact of mulch on water balance and upland rice yields under the climate conditions of the region, using a modeling approach. We ran an virtual experiment with the model PYE-CA to simulate a range of soil and climate conditions met in the region. We confirmed the ability of mulch to reduce, or even suppress, efficiently surface water runoff. We identified the sowing period within which rice growing would be the least impacted by water stress in the region. The results indicated that water availability for rice cropping was slightly impacted by a decrease in runoff for the majority of soil conditions and farmers' usual sowing dates. Beneficial effects of runoff reduction appeared under higher water stress conditions such as early sowing date or crop intensification and yield variability was decreased. This study allowed us to better apprehend the impacts of CA on water balance in the specific climate context of the study area. It would be interesting to integrate these results at the farm-level to identify the pros and cons of adopting CA under the socio-economic context of the Lake Alaotra region of Madagascar.

Trade liberalization has different impacts on groups of individuals in the society. Some of them improve their situation, the other ones get worse. Due to the existing gender inequali-ties the distribution of benefits from trade liberalization between women and men is dis-proportional. The paper indentifies main areas, in which are the gender inequalities the most significant. African women are limited in their access to education, productive resources and to technologies, but also to the means of financing. These limits prevent women from full participation in trade and therefore also in economic growth of the country. The creation of new jobs in export-oriented sectors presents the main contribution of trade liberalization for African women. The income they are getting form those jobs are usually used to finance the education and health care for children, that is why their quality of life may improve. The paper concentrates on the reciprocal relation between liberalization and gender equality, which is demonstrated on the status of women in trade and in export-oriented sectors.