Le paludisme, la tuberculose et les infections respiratoires aiguës constituent un enjeu majeur de santé publique à Madagascar, les deux premières de ces maladies faisant l’objet de programmes nationaux de lutte largement inspirés et financés par des organisations internationales. Les méthodes diagnostiques, thérapeutiques et de prévention recommandées officiellement dans le système de santé conventionnel sont standardisées et reposent sur un corpus de connaissances scientifiques solidement établi. Parmi d’autres maladies, elles font explicitement partie des cibles des objectifs du développement durable (ODD). Pour les atteindre, les nations unies recommandent la mise en œuvre d’une Couverture Sanitaire Universelle (CSU). Madagascar a adopté les ODD et s’est engagé dans la voie de la mise en œuvre d’une CSU. Ces travaux sur le paludisme, la tuberculose et les infections respiratoires aiguës ont été menés dans le cadre de cette thèse de sociologie, en utilisant une approche qualitative (auprès de 83 individus) et quantitative (auprès d’environ 26.000 personnes interrogées, par enquêtes en populations), sur plusieurs terrains de Madagascar, impliquant des soignants, des soignés et des acteurs institutionnels. L’acceptation et la mise en œuvre des méthodes de prise en charge des maladies dépendent de facteurs logistiques et organisationnels, mais aussi des croyances et pratiques adoptées par les individus, les familles et les groupes sociaux ou professionnels. En pratique, les obstacles sont nombreux sur la voie d’un accès effectif des populations aux soins contre les maladies ciblées par les ODD et la CSU, y compris celles faisant déjà l’objet de programmes de lutte verticaux et soutenus internationalement. Les éléments représentatifs des zones étudiées dans cette thèse apportent un éclairage qui peut être utile pour la mise en œuvre d’une CSU à l’échelle du pays. Ils révèlent aussi les défis, pas seulement financiers, qui restent à surmonter. / Malaria, tuberculosis and acute respiratory infections constitute a major public health issue in Madagascar, the first two of which are the subject of national control programs largely inspired and financed by international organizations. The diagnostic, therapeutic and preventive methods recommended officially in the conventional health system are standardized and are based on a solid corpus of scientific knowledge. Among other diseases, they are explicitly targeted by the universal sustainable development goals (SDG). To reach them, the United nations recommend the implementation of an universal health coverage (UHC). Madagascar has adopted the SDG and is committed to the implementation of a UHC. The acceptance and implementation of these disease management methods depend on logistical and organizational factors, but also on the beliefs and practices of individuals, families and social or professional groups. In practice, there are many obstacles in the way of effective access to health care for diseases targeted by SDG and UHC, including those already covered by vertical and internationally supported control programs. These works on malaria, tuberculosis and acute respiratory infections were carried out within the framework of this sociological thesis, using a qualitative methods (among 83 individuals) and quantitative methods (with about 26,000 people interviewed), by population surveys, on several fields in Madagascar, involving caregivers, cared population and institutional actors. The acceptance and implementation of these disease management methods depend on logistical and organizational factors, but also on the beliefs and practices of individuals, families and social or professional groups. In practice, there are many obstacles in the way of effective access to health care for diseases targeted by SDGs and UHC, including those already covered by vertical and internationally supported control programs. The representative elements of the studied zones of Madagascar presented in this thesis provide an insight that could be useful for the implementation of a CSU across the country. They also reveal the challenges, not just financial, that remain to be overcome.

Submitted by Rafael Santana (rafael.silvasantana@ufpe.br) on 2017-05-12T19:28:01Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO FINAL.pdf: 1123375 bytes, checksum: 76fd5903a85541f0f73442c541e6326f (MD5) / Made available in DSpace on 2017-05-12T19:28:01Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO FINAL.pdf: 1123375 bytes, checksum: 76fd5903a85541f0f73442c541e6326f (MD5) Previous issue date: 2016-07-19 / Introdução: A assistência de enfermagem deve ser guiada por uma anamnese que aborde diversos aspectos essenciais ao planejamento de cuidados. Na maior parte das especialidades, os modelos de anamnese foram gradativamente aprimorados para ganho de objetividade dos dados. Todavia a saúde mental carece de um protocolo sistematizado para atendimento e definição do plano de cuidados sistematizado para pacientes em sofrimento psíquico. Objetivo: Elaborar um protocolo que aproprie o profissional de enfermagem para construção do perfil do estado de saúde mental de drogaditos com base nas teorias do cuidar em enfermagem. Método: Por meio de estudo do tipo metodológico, não experimental para desenvolvimento, validação e avaliação de ferramentas e métodos de pesquisa, foi construído o protocolo de Avaliação de Enfermagem das Necessidades do Adicto, com base no método de Fitzpatrick e de Rattray e Jones. Cinco etapas foram obedecidas: a) construção de revisão integrativa, sob tema: “Teorias de Enfermagem”, na qual foram abordadas as teorias que mais ofereceram subsidio para as condutas de enfermagem nos cuidados a pacientes com dependência química, nos itens de anamnese, contexto social, exame físico, identificação de necessidades e avaliação de saúde mental e emocional, como fundamentação teórica; b) construção dos itens do protocolo, relativos ao histórico de enfermagem (inicial e sequencial durante o tratamento) buscando avaliar aspectos atitudinais e comportamentais; c) submissão do protocolo à avaliação de quatro juízes empregando o modelo Delphi nesse processo de avaliação de conteúdo, segundo grade de avaliação com três domínios; d) adequação consensual do protocolo às evidências de Enfermagem e de Psiquiatria; e) definição da escala de mensuração empregada em cada item do protocolo. Foram admitidas a escala do protocolo ASSIST, versão 2.0, a de Thurstone e a de Guttman. Resultado: O protocolo está voltado à avaliação do adicto, mas pode ser um instrumento de avaliação do paciente em saúde mental, empregado por profissionais de saúde. Conclusão: O emprego do protocolo pode favorecer a intervenção da equipe multidisciplinar junto ao paciente e sua família. / Background: Nursing care should be guided by an anamnesis that addresses several key aspects to planning care. In most specialties, the models of anamnesis were gradually improved for data objectivity gain. However mental health lacks a systematic protocol for care and definition of systematic care plan for patients in psychological distress. Objective: To develop a protocol that appropriates the nursing professional to build the profile of mental health status of drug addicts based on the theories of nursing care. Methods: Through a methodological, not experimental study, for development, validation and assessment tools and research methods, it was built the Nursing Assessment Protocol of Addict's Needs, based on Fitzpatrick and Rattray and Jones method. Five steps were followed: a) construction of an integrative review on theme "Nursing Theories", in which we discussed the theories that offered more subsidies for nursing behaviors in caring for patients with substance abuse, in anamnesis, social context, physical examination, needs identification and assessment of mental and emotional health items, as theoretical foundation; b) construction of items relating to nursing anamnesis (initial and sequential, during treatment) seeking to assess attitudinal and behavioral aspects; c) submission protocol for the evaluation of four judges using the Delphi model in the process of evaluation of content, according to a evaluation grid with three domains; d) consensus adequacy of the protocol to the evidences of Nursing and Psychiatric; e) definition of measurement scales for each item of the protocol. The admitted scales were that of the ASSIST protocol, version 2.0, the Thurstone scale and Guttman scale. Results: The protocol is aimed at evaluating the addict, but it can be a tool to assess the patient with mental disease, employed by health professionals. Conclusion: Using the protocol may favored the intervention of a multidisciplinary team with the patient and his family.

The number of African immigrants in the United States is increasing. The incidence of children diagnosed with autism spectrum disorder in the United States is also on the rise. Despite these increases, little information exists about the adequacy of care for African immigrants with autistic children in the United States. The purpose of this grounded theory study was to understand the factors that affect use of care for African immigrants with autistic children in the United States. Using Aday-Anderson model of health care utilization framework, this study focused on African immigrants in the United States who had children with Autism Spectrum Disorder from age 2- to 15-years-old. I used open, axial and selective coding to analyze my data and come up with a theory about utilization of care for African immigrants with autistic children. The results of this study showed a need for education to influence African immigrants to use care for their autistic children. Despite cultural stronghold, the use of care for African immigrant with autistic children was influenced by education, experience, need and recommendation. The African immigrant ASD Utilization of Care Model emerged. The positive social change implication of this study is improving the use of care for African immigrants with autistic children. African immigrants with autistic children in the United States will benefit from this study.

Thesis (M. Sc.)--University of Hong Kong, 1997. / Includes bibliographical references.

Thesis (M.Sc.)--University of Hong Kong, 1997. / Includes bibliographical references. Also available in print.