This study explored doctor of physical therapy (DPT) students’ attitudes, perceived knowledge, and perceived competence specific to social and structural determinants of health (SDOH). Current students in a DPT program housed within a college of public health in an urban research institution served as the participants for this research. The primary purpose of this study was to explore students’ self-evaluation and perceptions of competence with SDOH in hopes of gaining insight into elements of their education that contributed to their preparedness and/or what strategies and resources are needed to foster competence in this area. A secondary aim of this study was to explore how individual student factors and curricular factors impact students’ awareness of SDOH. A mixed methods study design employed bivariate and multivariate analysis of participants’ responses to self-report Likert scale survey questions and analysis of semi-structured interviews using qualitative description and phenomenological principles. Quantitative data analysis revealed differences in perceived skills competence based on cohort (year one, two, or three in the program) with first-year students demonstrating lower perceived competence. Analysis of attitudes and knowledge demonstrated that all participants held a positive perspective regarding the importance of SDOH as well as perceived foundational knowledge for this content. Quantitative analysis also detected subtle differences in specific sample beliefs and behaviors based on demographic variables such as gender identity, race, and first-generation student status. Qualitative data supported the quantitative findings with participants articulating specific elements of their identities and the DPT curriculum that contributed to their understanding of SDOH. An iterative coding process identified two primary themes that corresponded to the research aims: 1) Learners’ perceived importance of social and structural determinants of health and factors that impact how to address them; and 2) Learning about social and structural determinants of health: What learners bring with them and what they gain throughout the curriculum. These findings shed light on the elements of this educational program that foster students understanding of SDOH and the types of experiences that help clinical learners appreciate the impact of these upstream drivers of health for patients and populations. / Policy, Organizational and Leadership Studies

Made available in DSpace on 2016-03-15T19:25:39Z (GMT). No. of bitstreams: 1 Leandro Rick.pdf: 426431 bytes, checksum: bd0b42ac2a96c4981f26a2e96b334742 (MD5) Previous issue date: 2011-08-10 / Fundo Mackenzie de Pesquisa / The Operational Working Capital Requirement (WCR) is the net investment needed to keep the operating cycle. There is no specific theory on Working Capital and, in Brazil; there are few studies about its operational and financial determinants. This empirical research test, in part, a model proposed by Hill, Kelly and Highfield (2009), with Brazilian companies, in the post-Real Plan. The results show differences in the regression coefficients that may be due to macro-economic specificity and typicality of Brazilian economic sectors. This study contributes to the management of working capital, and opens prospects for alternatives to traditional methods of quantification of the WCR. / A Necessidade de Capital de Giro (NCG) Operacional é o investimento líquido necessário para manter os ciclos operacionais. Embora haja bastantes estudos sobre Capital de Giro nos EUA e Europa, ainda não há uma teoria específica sobre o mesmo e, no Brasil, poucos estudos sobre seus determinantes operacionais e financeiros foram realizados. Esta dissertação testa, parcialmente, um modelo proposto por Hill, Kelly e Highfield (2010), com empresas brasileiras, no período pós-Plano Real. Os resultados evidenciam diferenças nos coeficientes das regressões que podem ser devidas à especificidade macroeconômica brasileira ou à tipicidade dos setores de atividade econômica. Este estudo contribui para a gestão do capital de giro e abre perspectiva para alternativas aos tradicionais métodos de quantificação da NCG.

SUMMARY BACKGROUND Human African trypanosomiasis (HAT), commonly named sleeping sickness, was under control to a certain extent at the beginning of the sixties. In fact, the prevalence rate had then decreased drastically (one case per 10.000 examined inhabitants) for four major reasons: 1. active and exhaustive classical medical prospecting 2. correct treatment administered to patients suffering from trypanosomiasis 3. post-therapeutic follow-up of treated patients 4. vector control involving the community at risk In the Democratic Republic of Congo (DRC), HAT left rural areas to extend to large cities, like Kinshasa. The incidence of HAT in Kinshasa has been increasing since 1996. Until now, there is no indication on knowledge, attitudes and conceptions of HAT in Kinshasa. The major objectives of this study are: to analyse the epidemiological, clinical, sanitary, demographic, socio-economic and socio-cultural characteristics of HAT in Kinshasa to assess the level of knowledge, the attitudes, practices, perceptions, behaviours and local beliefs related to HAT among people residing in Kinshasa endemic area to identify the sanitary, socio-economic, environmental or ecological, socio-demographic and socio-cultural variables forming HAT risk factors in Kinshasa to identify the main predictive factors independent of HAT in Kinshasa. METHODS Population of study and data collection Two methodologies were carried out: a quantitative method based on a structured and pre-tested questionnaire as well as a qualitative approach relying on focus groups discussions. The inquiry took place at two different periods: first, between February 9 and June 3, 2006, then between July 7 and 17, 2007. It is a descriptive and analytic case-control study. Cases were patients suffering from trypanosomiasis notified between January 1st, 2004, and December 31st, 2005, thanks to HAT declaration cards registered to the National Human African Trypanosomiasis Program (PNLTHA). Based on age, sex and living place, each case was paired with two controls declared as HAT-free after clinical examination and a negative Card Agglutination Test for Trypanosomiasis (CATT-Test) performed on total blood. Controls were sampled thanks to a stratified approach during campaigns carried out between February and June 2006. A total of 1,311 individuals, 437 cases and 874 controls, were included in the study. Statistical analysis of data The inquiry data were analysed with EPIINFO, version 3.3.2 (CDC, United States), STATISTICA and SPSS, version 13.0, softwares. A Chi-squared or Fishers exact test was used to compare proportions and a Student t-test allowed the comparison of means. The association between the different factors and HAT was determined by estimating the Odds Ratio (OR) with a 95%-confidence interval and a P value under 0.05. This was performed thanks to a uni- and multivariate logistic regression. RESULTS A great proportion of patients suffering from HAT (79.4%, n = 347) had reached a very advanced stage of the disease, the neurological stage. Among the 1,311 persons included in the study, 52.2% were men and 47.8% were women (not significant difference). They were aged between 10 and 74 years, with a mean of 34.2 ± 14.2 years. Professionally active persons, aged between 20 and 49 years (70.3%), and providing resources essential for the economic development were more frequently affected. The majority of HAT cases (53%; n=230) had recently migrated (migration of people province-born who later settled down in Kinshasa); they were residing in Kinshasa for 5 years. People suffering from trypanosomiasis presented the following clinical characteristics: sleep disorders, characterized by hypersomnia (89% of cases) cervical adenopathy was frequently observed (63% of cases) Fever (72% of cases) Only 37.5% of cases scrupulously respected the recommended post-therapeutic follow-up. Numerous case-patients and controls were illiterates: the optimal level of knowledge was of 44% among case-patients and 37% among controls, with a highly significant difference (P<0.0001). Case-patients and controls believe in the supernatural origin of HAT. They believe HAT might have a divine origin, come from sorcery, from a malediction, or from the transgression of forbidden practices (incest). The study shows 87% of cases vs. 86.3% of controls were in favour of passive screening, with a non significant difference (P>0.05). The multivariate statistical analysis (logistic regression) showed the following variables were associated with HAT acquisition/infection in Kinshasa: residency in peripheral areas: rural areas (adjusted OR: 12.1, 95%IC: 5.7-21.7); eccentric areas (adjusted OR: 8.9, 95%IC: 2.1-38.8), family history of HAT (adjusted OR: 12.9, 95%IC: 7.9-20.8), ignorance regarding the mode of transmission (adjusted OR: 11.2, 95%IC: 5.8-21.7), and household water provision at natural/collective water points (adjusted OR: 6.9, 95%IC: 2.8-17.2) were also risk factors. CONCLUSION The surveillance and control of HAT pass obligatorily through the identification and knowledge of the main determinants of this recrudescent endemic-epidemic if one aims to establish an efficient fighting programme. Among these determinants, it is primordial to highlight: the unintentional ignorance of populations exposed to the HAT risk (obscurantist beliefs) the absence of participative education campaigns for populations residing in risk areas (rural and urban) the deficiency of management by sanitary authorities characterized by the lack of attention paid to the HAT endemic in political circles of decision. the drastic decrease in the budget assigned to health (less than 10 USD per inhabitant per year for healthcare). Once these determinants are known and suppressed, the fight against this plague should consist in: maintaining and reinforcing the surveillance of the endemic area, even in situations of low endemicity, by integrating the mass screening in fixed sanitary structures. This integration should go with the formation of healthcare staff not hardened to the screening and the fight against HAT. improving living conditions and population welfare in general, especially in rural areas. These results bring up different avoidable/modifiable determinants, on which one can act to reduce the morbidity and mortality charges caused by HAT, and involve Kinshasas residents in the fight against the disease./RESUME INTRODUCTION La Trypanosomiase Humaine Africaine (THA), communément appelée Maladie du Sommeil, avait été dans une certaine mesure, maîtrisée au début des années 1960. En fait, le taux de prévalence était alors tombé de façon spectaculaire à des niveaux très bas (un cas pour 10.000 habitants examinés) pour quatre raisons majeures : 1. les prospections médicales classiques actives et exhaustives, 2. le traitement correct administré aux patients trypanosomés, 3. le suivi post-thérapeutique strict des malades traités, 4. la lutte antivectorielle impliquant la communauté à risque. En République démocratique du Congo (RDC), la THA est sortie des milieux ruraux pour sétendre aux grandes villes, comme Kinshasa. Lincidence de la THA est croissante à Kinshasa depuis 1996. Jusquà présent, à notre connaissance, il nexiste pas dindication sur les connaissances, les attitudes et les conceptions de la THA à Kinshasa. Les objectifs majeurs de cette étude sont : analyser les caractéristiques épidémiologiques, cliniques, sanitaires, démographiques, socioéconomiques et socioculturelles de la THA à Kinshasa, évaluer le niveau de connaissances, les attitudes, les pratiques, les perceptions, les comportements et les croyances locales relatives à la THA chez les résidents de la zone endémique de Kinshasa, identifier les variables sanitaires, socioéconomiques, environnementales ou écologiques, sociodémographiques et socioculturelles constituant les facteurs de risque de la THA à Kinshasa, identifier les principaux facteurs prédictifs indépendants de la THA à Kinshasa. METHODES Population détude et collecte des données Deux focalisations méthodologiques ont été utilisées: la méthode quantitative basée sur un questionnaire structuré, prétesté et la méthode qualitative basée sur les focus groups discussions. Lenquête sest déroulée en deux périodes. Dabord du 9 février au 3 juin 2006. Ensuite, du 7 au 17 Juillet 2007. Il sagit dune étude cas-témoins descriptivo-analytique. Les cas étaient des patients trypanosomés identifiés entre le 1 janvier 2004 et le 31 décembre 2005 avec fiches de déclaration de THA au Programme National de Lutte contre la Trypanosomiase Humaine Africaine (PNLTHA). Chaque cas était apparié sur lâge, le sexe et le lieu dhabitation à deux témoins déclarés indemnes de THA après examen clinique et présentant une sérologie négative au Card Agglutination Test for Tryapnosomiasis (CATT-Test) sur sang total, tirés au sort par sondage stratifié au cours des campagnes actives de février à juin 2006. Au total, létude a touché 1311 individus dont 437 cas et 874 témoins. Analyse statistique des données Les données ont été encodées et analysées avec les logiciels EPIINFO version 3.3.2 (CDC, Etats-Unis), STATISTICA version 7.1 et SPSS version 13.0. Le test de Chi-carré et le Fisher exact ont été utilisés pour comparer les proportions et le t de student pour la comparaison des moyennes. Lassociation entre les différents facteurs étudiés et la THA a été déterminée en estimant lOdds Ratio (OR) avec un intervalle de confiance (IC) de 95% et un p inférieur à 0,05. Ceci a été réalisé en utilisant la méthode de régression logistique univariée et multivariée. RESULTATS Une grande proportion des patients trypanosomés (79,4%, n=347) était en phase très avancée de leur infection, au stade neurologique. Parmi les 1311 sujets retenus dans létude, il y avait 52,2% dhommes et 47,8% de femmes, différence non significative (p>0,05). Leur âge variait entre 10 et 74 ans avec une moyenne de 34,2±14,2 ans. Les personnes professionnellement actives âgées de 20-49 ans (70,3%) et pourvoyeuses de ressources nécessaires au développement économique étaient les plus atteintes. La majorité des patients trypanosomés (53% ; n=230) étaient des migrants (migration interne des personnes nées en province et venues sinstaller à Kinshasa) récents dont la durée de séjour à Kinshasa ne dépassait pas 5 ans. Les patients trypanosomés présentaient les caractéristiques cliniques suivantes : les troubles du sommeil caractérisés par lhypersomnie diurne dans 89% des cas, les adénopathies cervicales sont fréquentes, soit 63% des cas observés, la fièvre se retrouve dans 72% des cas. Seuls 37,5% des cas avaient scrupuleusement respecté le suivi post-thérapeutique recommandé. Bon nombre des cas et témoins étaient analphabètes : le niveau optimum de connaissance était de 44% chez les cas et 37% chez les témoins avec une différence hautement significative (p<0,0001). Les cas et les témoins croient à lorigine surnaturelle de la THA. Ils pensent que la THA peut être dorigine divine, provenir de la sorcellerie, dune malédiction, ou encore de la transgression des interdits (inceste). Létude montre que 87% des cas vs 86,3% des témoins étaient favorables au dépistage passif, différence non significative (p>0,05). En analyse statistique par la régression logistique multivariée, les variables suivantes étaient significativement associées à lacquisition/infection de la THA à Kinshasa. la résidence en zones périphériques : zones rurales (OR ajusté 12,1 ; IC à 95% : 5,7-21,7) ; zones excentriques (OR ajusté 8,9 ; IC à 95% : 2,1-38,8), lhistoire familiale de THA (OR ajusté 12,9 ; IC à 95% : 7,9-20,8), lignorance du mode de transmission (OR ajusté 11,2 ; IC à 95% : 5,8-21,7) et lapprovisionnement en eau de ménage dans des points deau naturels/collectifs (OR ajusté 6,9 ; IC à 95% : 2,8-17,2) sont aussi des facteurs de risque. CONCLUSION La surveillance et le contrôle de la THA passent obligatoirement par lidentification, et la connaissance des principaux facteurs déterminants de cette endémo-épidémie en recrudescence si lon veut établir un plan de lutte efficace contre ce fléau. Parmi ces déterminants, il importe de noter notamment : lignorance involontaire (croyances obscurantistes) des populations exposées au risque de THA, labsence des campagnes éducatives participatives des populations résidant dans les zones à risque (rurales et citadines), la mauvaise gestion des autorités sanitaires caractérisée par le peu dattention accordée à lendémie de THA dans les milieux politiques de décision, la diminution drastique du budget alloué à la santé (moins de 10$USA par habitant par an pour les soins de santé). Une fois que ces déterminants sont connus et jugulés, la lutte contre ce fléau devrait consister à : maintenir et renforcer la surveillance de la zone endémique, même en situation de faible endémicité par lintégration du dépistage de masse dans les structures sanitaires fixes. Cette intégration devrait être accompagnée de la formation des personnels soignants non aguerris au dépistage et à la lutte contre la THA, améliorer les conditions de vie et du bien-être de la population en général, et plus particulièrement la population rurale. Ces résultats mettent en évidence divers déterminants contrôlables, sur lesquels on peut agir pour réduire la charge de la morbidité et mortalité attribuée à la THA, et impliquer les habitants de Kinshasa dans la lutte contre cette maladie.

The rights and responsibilities of parents are viewed very seriously in South Africa in that they are emphasised by the Act of Parliament. The South African Schools Act, No 84 of 1996, places the governance of every school in the hands of parents. The parents are in this way required to perform their roles within the orbit of this Act of parliament. This study is therefore directed at analysing the Schools Act and those sections of the law are discussed which have a direct bearing on the responsibilities and the rights of parents when involved with the school. A comparison is drawn between the national determinants of yesteryears regulating parental involvement as well as the new paradigm statutes regulating parental involvement in the school system. The findings of the literature study led to the empirical study. A questionnaire on this study comprising 46 items was developed. The subjects of this study were made up of 150 parents in the Lichtenburg District of the Department of Education in the North-West Province. The results of 137 respondents were statistically analysed. The study revealed that parents lack knowledge on the statutes relating to their involvement in the schools. Also, there are no measures taken by the schools to capacitate the parents to understand and apply the laws correctly. Finally, parents are not performing their roles adequately as is expected by the law. The findings of this study led to the recommendations on how parents could be helped to do what the law requires. / Thesis (M.Ed.)--North-West University, Potchefstroom Campus, 2005.

Cardiovascular diseases (CVDs) are the leading cause of death and disability around the world. The purpose of this thesis is to investigate the impact of socio-environmental determinants of CVDs at the neighbourhood scale in order to inform actionable interventions, which may lead to large-scale reductions in preventable CVDs. Drawing on 2411 surveys carried out in Toronto, Canada, this thesis employs multilevel models to estimate the magnitude of socio-environmental influences on the risk of CVD while adjusting for individual-level risk factors. To advance current research methodology, strategies and innovations were developed to 1) improve the characterization of neighbourhoods by empirically testing a full range of socio-environmental influences; 2) account for non-residential exposures by including a combined analysis of work and home contexts; 3) account for variations in the duration of exposure through the use of time-weighted models; 4) deal with problem of spatial data aggregation by developing and testing a novel method of neighbourhood zone design, and 5) account for the spatial scales of different socio-environmental determinants by modeling at multiple scales. The thesis demonstrated that land use decisions are inextricably public health decisions. It found that living in neighbourhoods with inadequate access to food stores and areas for physical activity, burdened by violent crimes and fast food restaurants, and over-dependent on automobiles (leading to air pollution), with a high level of noise may significantly increase the risk of CVDs, over and above individual-level risks. The thesis also found that working in neighbourhoods that are socio-economically disadvantaged or have high-traffic may significantly increase CVD risk. The thesis developed and demonstrated novel methods to reduce the measurement error of neighbourhood exposures through 1) the use of “amoeba buffers” to improve neighbourhood zone design to better reflect participants’ local neighbourhoods and 2) the use of duration of exposure weights to adjust for individual differences in the time spent across different contexts. Finally, it found that the significance of socio-environmental factors depends on the scale of data aggregation; thus, investigation of multiple scales may be required to identify the relevant scale that matches the specific contextual factor in future research.

Cardiovascular diseases (CVDs) are the leading cause of death and disability around the world. The purpose of this thesis is to investigate the impact of socio-environmental determinants of CVDs at the neighbourhood scale in order to inform actionable interventions, which may lead to large-scale reductions in preventable CVDs. Drawing on 2411 surveys carried out in Toronto, Canada, this thesis employs multilevel models to estimate the magnitude of socio-environmental influences on the risk of CVD while adjusting for individual-level risk factors. To advance current research methodology, strategies and innovations were developed to 1) improve the characterization of neighbourhoods by empirically testing a full range of socio-environmental influences; 2) account for non-residential exposures by including a combined analysis of work and home contexts; 3) account for variations in the duration of exposure through the use of time-weighted models; 4) deal with problem of spatial data aggregation by developing and testing a novel method of neighbourhood zone design, and 5) account for the spatial scales of different socio-environmental determinants by modeling at multiple scales. The thesis demonstrated that land use decisions are inextricably public health decisions. It found that living in neighbourhoods with inadequate access to food stores and areas for physical activity, burdened by violent crimes and fast food restaurants, and over-dependent on automobiles (leading to air pollution), with a high level of noise may significantly increase the risk of CVDs, over and above individual-level risks. The thesis also found that working in neighbourhoods that are socio-economically disadvantaged or have high-traffic may significantly increase CVD risk. The thesis developed and demonstrated novel methods to reduce the measurement error of neighbourhood exposures through 1) the use of “amoeba buffers” to improve neighbourhood zone design to better reflect participants’ local neighbourhoods and 2) the use of duration of exposure weights to adjust for individual differences in the time spent across different contexts. Finally, it found that the significance of socio-environmental factors depends on the scale of data aggregation; thus, investigation of multiple scales may be required to identify the relevant scale that matches the specific contextual factor in future research.

The rights and responsibilities of parents are viewed very seriously in South Africa in that they are emphasised by the Act of Parliament. The South African Schools Act, No 84 of 1996, places the governance of every school in the hands of parents. The parents are in this way required to perform their roles within the orbit of this Act of parliament. This study is therefore directed at analysing the Schools Act and those sections of the law are discussed which have a direct bearing on the responsibilities and the rights of parents when involved with the school. A comparison is drawn between the national determinants of yesteryears regulating parental involvement as well as the new paradigm statutes regulating parental involvement in the school system. The findings of the literature study led to the empirical study. A questionnaire on this study comprising 46 items was developed. The subjects of this study were made up of 150 parents in the Lichtenburg District of the Department of Education in the North-West Province. The results of 137 respondents were statistically analysed. The study revealed that parents lack knowledge on the statutes relating to their involvement in the schools. Also, there are no measures taken by the schools to capacitate the parents to understand and apply the laws correctly. Finally, parents are not performing their roles adequately as is expected by the law. The findings of this study led to the recommendations on how parents could be helped to do what the law requires. / Thesis (M.Ed.)--North-West University, Potchefstroom Campus, 2005.

Economic and political reforms have been introduced in Ethiopia and these have boosted private investment over the last two decades. Reforms have brought about measurable improvements, but the progress of the status of private investment has remained slow. This study was conducted with the objective of investigating the microeconomic level determinants of private investment in the manufacturing sector. These micro-level determinants of private investment in the State of Tigray, Ethiopia, were analysed using both descriptive and econometric methods. Thus, an econometric method of data analysis using a duration model was applied to analyse the microeconomic data collected. In addition, descriptive analysis was employed to analyse the survey data. Here, a chi-square test and factor analysis were used to analyse the relationship between variables and their constraints on the operations of the manufacturing sector. The major microeconomic determinants of private investment status in the State of Tigray were found to be investment areas, access to credit, infrastructure facilities, the judicial system, corruption, investment incentives and bureaucratic red tape. The econometric result revealed that infrastructure facilities, the judicial system, and investment areas negatively and significantly delayed the entire private investment status. However, interest rates and investment location were positively and significantly supported to continue their status of the entire private investors in the manufacturing sector. Infrastructure facilities, investment incentives, and investment areas were negatively and significantly related to the started group of investors’ progress. However, investment location was related positively and significantly to the started group and the ability of the implementation and operation statuses of private investors to proceed to operation status. In the case of the non-started group, infrastructure facilities and investment areas are related significantly and negatively to investment status delay. By contrast, interest rates and investment location significantly and positively affect private investment status delay. According to the descriptive analysis, access to credit, bureaucratic red tape and corruption were the additional major factors that hinder private investment from progressing from one xii status to the next. The investor’s level of education, access to land and political instability risks in the survey were not determinants of private investment status. In addition, the survey of private investors for those who have already started production shows that infrastructural, technological, and economic and financial factors have the highest absolute value of the loading factors that hinders operations in the manufacturing sector. The results of this study revealed that most of the problems encountered in the manufacturing sector were institutional but some were related to the private investors themselves. Thus, the government should take measures to establish a true, independent and efficient institution so as to create access to credit and provide infrastructure facilities to the private sector. This could be done by minimising corruption and ensuring transparent investment regulations. Thus, the State of Tigray, Ethiopia, must attract and encourage private investors by applying and improving policies which promote private investment. In this way they will actively contribute to the overall development and growth of the Ethiopian economy. Finally, as this study is made on the causes of delay in each phases of investment, it contributes a new knowledge to all investment sectors in the developing countries as whole and particularly to all regions of Ethiopia for advanced polices and strategies development on investment decisions. Then, based on the results of the study and solving these identified problems of investment phases, all actors of investment can retain and encourage the existing and attract new private investors to enhance the economic development of the society. The findings from this study have important implications for prospective business owners, lenders, and policy makers on how to improve private investment and create conducive business environment. / Business Management / D.B.L.

La situation d’insécurité alimentaire et nutritionnelle récurrente dont souffrent environ 155 millions d’enfants dans le monde dont 59 millions en Afrique et particulièrement ceux du Sahel et de la Corne de l’Afrique, constitue un problème majeur de santé publique, de développement et de conscience collective mondiale dans ce nouveau contexte de globalisation de la prospérité, des droits de survie, d’éducation et de protection des enfants.La malnutrition des enfants de moins de cinq ans caractérisée par le rachitisme, l’insuffisance pondérale ou l’émaciation, augmente leurs risques de décès, handicape le développement psycho moteur de même que leurs réussites scolaires et professionnelles et impacte négativement le développement économique des pays entrainant un cercle vicieux de pauvreté familiale et sociétale et d’émigrations.Parmi les pays les plus touchés par la malnutrition des enfants, les cinq pays ayant fait l’objet de cette thèse (le Burkina Faso, le Niger, le Sénégal, l’Ethiopie et le Ghana), sont fragilisés à des degrés variés, par un environnement climatique et géo-écologique austère, une instabilité du régime politique, un faible développement économique et social ainsi qu’une gouvernance nutritionnelle déficiente causée par le déficit d’engagements politiques, législatifs et financiers réels et les faiblesses des capacités institutionnelles.En plus de l’insécurité alimentaire, les enfants et leurs familles sont confrontées au manque de disponibilité et d’infrastructures sociales et de santé communautaires, à la pauvreté du ménage, au statut social précaire, au fardeau démographique, aux inégalités de genre entre hommes et femmes, aux contraintes de normes sociales, culturelles et de croyances traditionnelles, à l’ignorance qui entretiennent des pratiques comportementales inappropriées d’alimentation et de nutrition des enfants ainsi que l’environnement insalubre vecteur de maladies.Le réveil politique, l’investissement multi sectoriel et l’éducation de masse en faveur de la nutrition des enfants sont requis pour l’atteinte des engagements mondiaux pour 2030 visant le développement, la prospérité pour tous, l’élimination de la faim et de la malnutrition. / Continuous food and nutrition insecurity that affect lives of 155 millions of children in the world including about 59 million in African countries mostly in the Sahel and horn of Africa represent a critical public health and underdevelopment problem which creates a deep worldwide collective moral issue within the new global transformative agenda for the universal prosperity (no one is left behind) and child rights for survival, development and protection.Under five child malnutrition characterized by stunting, underweight or wasting increase the risk of child morbidity and mortality, handicap readiness of learning and professional skills and impact on economic development of the country resulting to a vicious circle of poverty and fragility of the family and causing international migrations.Four countries mostly affected by child malnutrition in the Sahel and horn of Africa that we have selected for this study (Burkina Faso, Niger, Senegal and Ethiopia) in comparison to Ghana are facing the severity of climatic and geo-ecologic environment, political instability, weak economic and social development and the gap of nutritional governance undermined by the lack of political, legal and financial commitments of Government and the limited institutional capacities to combat strongly undernutrition.In addition to food insecurity, malnourished children and their families are confronted to bottlenecks of supply and demand of access and use of community based basic social services, to the household poverty, the poor family social status, to demographic burden, gender based inequality, heavy social norms, traditional cultural and believes and ignorance of malnutrition which cause inadequate behavioral practices of child feeding and nutrition, child health care including unsafety water & sanitation conditions that facilitate diseases & malnutrition.Strengthening effective political engagement, accountable governance and massive financial investment for multi sector integrated interventions, promoting social protections systems and massive community based social and behavior changes in favor of child and mother nutrition are required for achieving SDG of “no one left behind prosperity, ending hunger, malnutrition… by 2030” and achieving child rights.

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