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A Madagascar, la géographie et la démographie déterminent des besoins de santé particuliers. L’histoire a permis la création d’un système de soins moderne, que l’économie et la politique ont grandement affaibli. L’ethnologie a maintenu au fil du temps des pratiques de santé traditionnelles. La géographie de la santé fait le lien entre toutes ces disciplines. Ce travail est une plongée dans le milieu rural malgache. Madagascar est en effet resté un pays à prédominance rurale ; 75% de la population vit à la campagne où l’agriculture demeure la seule source de revenus des ménages. Le pays compte cent onze districts, entités administratives de référence ; ils marquent également l’échelle du découpage sanitaire. Deux districts ruraux, Mandritsara au Nord et Békily dans le Sud, sont retenus pour proposer une étude comparative des besoins de santé et du système de soins. Les besoins de santé sont largement dominés par les maladies infectieuses, au premier rang desquelles figure le paludisme. Il reste la cause d’une mortalité infantile élevée. Viennent ensuite la bilharziose, endémique, la tuberculose, maladie de la pauvreté puis toutes les infections de l’appareil digestif, diarrhées et autres dysenterie, parasitoses banales pour certaines, d’autres se montrant plus invalidantes. L’eau est un sujet de préoccupation permanent pour la population rurale ; cet élément vital peut rapidement se révéler létal. En cas d’excès, l’eau est un facteur favorisant le développement de certains germes ou autres vecteurs de maladies infectieuses. Si elle est insuffisante, apparaissent des problèmes majeurs d’hygiène publique. La malnutrition affecte les populations du Sud de Madagascar, qui deviennent à cet égard dépendantes de l’aide internationale. Le système de soins affiche des carences importantes, en terme de ressources humaines et d’accessibilité. A Mandritsara, une offre de soins privée pallie une partie des insuffisances du système public et une nouvelle offre de soins est en gestation : la formation de personnels paramédicaux. Le Sud semble vivre hors du temps ; les pratiques de santé traditionnelles y sont encore très largement répandues. / In Madagascar, geography and demography determine specific medical needs. History has permitted the creation of a modern health care system, which has greatly been weakened by economy and politics. Ethnology has maintained traditional medical practices. Health geography links up all these various disciplines. This work is an immersion in Malagasy rural environment. In fact, Madagascar is still mainly a rural country : 75 % of the population live in the country and agriculture remains the household only source of income. Madagascar is divided into one hundred and eleven administrative districts, which are sanitary divisions as well. Two rural districts, Mandritsara in the north and Békily in the south, have been chosen to make a comparative study of the medical needs and the health care system. On the whole, infectious diseases prevail and malaria ranks first. It is still the cause of high infant mortality. Bilharzia, which is endemic in Madagascar, comes next. After we find tuberculosis, the disease of poverty, and then all the infections of the digestive system, like diarrhea and dysentery, ordinary parasitosis or incapacitating ones. Water is a permanent cause for concern to the rural population. This vital element can quickly become lethal. The excess of water is a facilitating factor leading to the development of some germs or other infectious disease vectors. The lack of water causes major problems of public hygiene. People in the south of Madagascar suffer from malnutrition and get dependent on international aid. The health care system shows considerable deficiencies in terms of human resources and accessibility. In Mandritsara, a private health care service partly makes up for the inadequacies of the public system, and a new resource is emerging with the training of paramedics. The south seems to live in a different age : traditional health practices are still widely spread.

Thesis (MScEng)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The various applications of Information and Communication Technologies (ICTs) in healthcare are increasingly effective to improve the cost-effectiveness and quality of healthcare service delivery. Telemedicine is such an application, using ICTs to provide health services over a distance. Since 1997, the South African Department of Health has invested large amounts of capital to implement telemedicine systems in South Africa. Unfortunately, telemedicine programs have had little success since, leading to many workstations standing dormant. Telemedicine implementation decision making that is based on insufficient evidence is identified as one of the underlying problems that cause telemedicine programs to fail. It is proposed that implementation decisions should be based on quantifiable evidence regarding the potential benefits of telemedicine. A decision support system is developed that can be used to quantify potential benefits and plan telemedicine implementation programs accordingly. The decision support system is modelled and demonstrated using data from the Eastern Cape public health sector. The first phase of the system guides decision makers to identify potential telemedicine benefits as well as data sources that can be used to measure these benefits. The system is scoped to focus on the application of telemedicine to support patient referrals between hospitals. Data sources are considered accordingly, with electronic health record (EHR) data proving to be a feasible primary source for needs assessments, however limiting the benefits that can be quantified. The analysis of the needs assessment is included in the second phase of the decision support system. Data are extracted, transformed and loaded into a data warehouse from where it can be analysed. The system includes three analysis steps to: map referral patterns, analyse potential benefits of telemedicine programs and determine cost-effective telemedicine solutions by allocating equipment at different hospitals. Analysis techniques used in the system include Pareto analysis, economic analysis, linear programming and the use of a genetic algorithm. It is proposed that the potential benefit results and equipment allocation algorithm be used to plan telemedicine programs for continuous evaluation. The final phase of the system therefore guides decision makers to use the results for implementation planning as well as evaluability assessments, for future management and evaluation of telemedicine programs. The decision support system is validated using patient referral data from the Western Cape public health sector. The case study proved that the system is applicable to the real-world and could be a valuable tool for decision makers to base telemedicine implementation planning on quantifiable evidence. The limitation on size and quality of both the Eastern Cape and Western Cape data sets, caused that the full potential of the system could not be demonstrated and validated. It is recommended that the quality standards of EHR referral reports be improved, to ensure more accurate benefit results. Future work is recommended to include qualitative needs assessments in the scope of the decision support system, hereby increasing the amount of benefits to be assessed. Although it is expected that the developed system is capable to support even better resolution decisions with more detailed data sets, the system developed in this study proved already adequate for improved implementation decision making. This could lead to higher success rates of telemedicine programs and ultimately better quality healthcare for all. / AFRIKAANSE OPSOMMING: Die verskillende toepassings van Informasie en Kommunikasie Tegnologie (IKT) in gesondheidsorg, speel ʼn rol in toenemende doeltreffendheid om die koste-effektiwiteit en kwaliteit van gesondheidsorg dienslewering te verbeter. Tele-geneeskunde is een van hierdie toepassings, wat IKT gebruik om gesondheidsdienste oor ʼn afstand te kan voorsien. Die Suid-Afrikaanse Departement van Gesondheid belê sedert 1997, groot bedrae kapitaal in die implementering van tele-geneeskunde stelsels, in Suid-Afrika. Ongelukkig het tele-geneeskunde programme min sukses behaal sedertdien, wat veroorsaak dat vele werkstasies dormant is. Die basering van implementeringsbesluite op onvoldoende getuienis, is geïdentifiseer as een van die onderliggende probleme wat veroorsaak dat tele-geneeskunde programme misluk. Daar word voorgestel dat implementeringsbesluite gebaseer moet word op kwantifiseerbare getuienis ten opsigte van die potensiële voordele van telemedisyne. ʼn Besluitnemingsondersteuning stelsel is ontwikkel wat gebruik kan word om die potensiële voordele te kwantifiseer en dienooreenkomstig implementering van tele-geneeskunde programme te beplan. Die stelsel is gemodelleer en gedemonstreer aan die hand van data uit die Oos-Kaap publieke gesondheidsektor. Die eerste fase van die stelsel begelei besluitnemers om potensiële voordele van telegeneeskunde, sowel as data-bronne wat gebruik kan word om hierdie voordele te meet, te identifiseer. Die stelsel is beperk tot ʼn fokus op die ondersteuning wat tele-geneeskunde aan hospitaal pasiënt verwysingstelsels, kan bied. Data bronne is dienooreenkomstig oorweeg: elektroniese mediese rekords (EMR) word erken as ʼn gunstige primêre databron, maar veroorsaak egter beperkings op die aantal voordele wat gekwantifiseer kan word. Die behoeftebepaling word uitgevoer in die tweede fase van die besluitnemingsondersteuning stelsel. Data is onttrek, getransformeer is en gelaai in 'n data stoor, vanwaar dit ontleed kan word. Die stelsel sluit drie analisestappe in: verwysingspatroon analise, berekening van potensiële voordele vir tele-geneeskunde programme en die bepaling van koste-effektiewe oplossings deur toekenning van toerusting by verskillende hospitale. Die analise tegnieke wat in die stelsel gebruik word, sluit die volgende in: Pareto analise, ekonomiese analise, lineêre programmering en 'n genetiese algoritme. Die gebruik van potensiële voordeel resultate en die toerusting toekenning algoritme word voorgestel vir die beplanning vir deurlopende evaluering in tele-geneeskunde programme. Die finale fase van die stelsel is gestruktureer, om besluitnemers te begelei in die gebruik van analise resultate, vir implementering beplanning sowel as evalueerbaarheid studies, wat sodoende deurlopende evaluering en bestuur van tele-geneeskunde programme sal verbeter.Die besluitnemingsondersteuning stelsel is gevalideer deur pasiënt verwysings data van die Wes-Kaap publieke gesondheidsektor, te gebruik. Die gevallestudie het bewys dat die stelsel toepaslik is in die werklike wêreld en kan as ʼn waardevolle hulpmiddel vir besluitnemers dien om tele-geneeskunde implementering beplanning op kwantifiseerbare bewyse te baseer. Die beperkings op die grootte en gehalte van beide die Oos-Kaap en Wes-Kaap datastelle het veroorsaak dat die stelsel nie tot sy volle reg gedemonstreer en gevalideer kon word nie. Verbeterings in kwaliteit standaarde van EMR verwysing data word aanbeveel om meer akkurate resultate te bekom. Verdere studies wat die byvoeg van kwalitatiewe meetings in die stelsel ondersoek, sal die omvang van potensiële voordele verbeter en dus die algehele waarde van die stelsel verbeter. Alhoewel die ontwikkelde stelsel in staat is om beter resolusie besluite te kan ondersteun met meer gedetailleerde data, is dit bewys dat die huidige stelsel reeds voldoende is om besluitneming te verbeter. Beter besluitneming gevolglik lei tot hoër sukseskoerse van tele-geneeskunde programme en uiteindelik verbeterde gehalte gesondheidsorg vir almal.

277 f. / Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2013-04-25T19:31:59Z No. of bitstreams: 1 Dissertacao - Cristina Lucon.pdf: 5028886 bytes, checksum: 4af3ac865863a7bf99d47bd33c3af3a4 (MD5) / Approved for entry into archive by Maria Auxiliadora Lopes(silopes@ufba.br) on 2013-06-10T18:18:16Z (GMT) No. of bitstreams: 1 Dissertacao - Cristina Lucon.pdf: 5028886 bytes, checksum: 4af3ac865863a7bf99d47bd33c3af3a4 (MD5) / Made available in DSpace on 2013-06-10T18:18:16Z (GMT). No. of bitstreams: 1 Dissertacao - Cristina Lucon.pdf: 5028886 bytes, checksum: 4af3ac865863a7bf99d47bd33c3af3a4 (MD5) Previous issue date: 2010 / A presente pesquisa teve por objetivo identificar as representações sociais que adolescentes em tratamento do câncer fazem acerca da prática pedagógica do professor de classe hospitalar. Para desenvolver a pesquisa foram observados os princípios da pesquisa qualitativa e do estudo de caso, tomando como orientação teórico-metodológica a teoria das representações sociais. Participaram do estudo dez adolescentes em tratamento do câncer, hospedados no Grupo de Apoio à Criança e ao Adolescente com Câncer (GACC), localizada na cidade de Salvador-BA. Desses adolescentes, cinco eram do sexo masculino e cinco do sexo feminino, e tinham idades entre 15 e 18 anos. Como instrumentos de coleta de dados foram utilizados a observação livre e entrevistas semiestruturadas. Após a coleta, todo material foi analisado à luz da análise do conteúdo, tendo como resultado as representações sociais sobre a prática pedagógica do professor de classe hospitalar, que se ancoram em: professor não convencional, prática pedagógica mais lúdico-educativa do que escolar; o papel da classe hospitalar no resgate do prazer de estudar; O papel da classe hospitalar na reafirmação da importância da escola regular em suas vidas. Dentre os resultados alcançados, constatou-se que os adolescentes pesquisados percebem que a prática pedagógica do professor de classe hospitalar ajuda a melhorar sua saúde e a minimizar o estresse do tratamento. Ela promove o aprendizado com uma abordagem individualizada que, muitas vezes, contribui para que ele aprenda melhor, mas não é considerada como responsável pela continuidade dos seus estudos escolares, pois, na percepção dos adolescentes, essa continuidade somente será alcançada no retorno à escola regular. Esses achados demonstram a importância da classe hospitalar enquanto um lócus de transitoriedade, que resgata a identidade escolar do alunopaciente por gerar expectativas positivas de retorno à escola regular para que os estudos sejam retomados. Reforçam também que a prática pedagógica do professor é um ponto de apoio para que ele persista na luta pela saúde e pela vontade de viver. / Salvador

Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2013-04-30T16:51:36Z No. of bitstreams: 1 Maria Celeste Silva.pdf: 3515847 bytes, checksum: 5129a3f1d736f88f950b6bcb1847e212 (MD5) / Approved for entry into archive by Maria Auxiliadora Lopes(silopes@ufba.br) on 2013-06-11T16:22:31Z (GMT) No. of bitstreams: 1 Maria Celeste Silva.pdf: 3515847 bytes, checksum: 5129a3f1d736f88f950b6bcb1847e212 (MD5) / Made available in DSpace on 2013-06-11T16:22:31Z (GMT). No. of bitstreams: 1 Maria Celeste Silva.pdf: 3515847 bytes, checksum: 5129a3f1d736f88f950b6bcb1847e212 (MD5) Previous issue date: 2009 / A presente pesquisa consistiu em analisar as representações de professores da Rede Regular de Ensino de Salvador (municipal, estadual e privada), acerca das possibilidades de ensino-aprendizagem de crianças e adolescentes enfermos que necessitem ou não de hospitalização. Metodologicamente, enquadrou-se como pesquisa qualitativa inspirada por pressupostos da etnografia de concepção fenomenológica analisada por André, da etnopesquisa crítica referenciada nos estudos de Macedo e na abordagem das Representações Sociais, de Moscovici e Jodelet. Utilizou-se como instrumento a entrevista semi-estruturada aplicada a oito professores. Dentre os resultados alcançados constatou-se que os professores manifestam descrédito nas reais possibilidades de ensino aprendizagens ofertáveis a crianças e adolescentes hospitalizados que são ou que se tornarão alunos potenciais das escolas regulares, principalmente em razão das condições emocionais e físicas daqueles indivíduos. Além disso, constatou-se que os professores desconhecem a classe hospitalar enquanto modalidade de atenção dirigida a crianças e adolescentes hospitalizados, assim como não reconhecem esses indivíduos como sujeitos de direito da Educação Especial. Estes achados atestam a necessidade de maior e melhor interação e diálogo (intra e extra- instituições), entre profissionais da Educação (professores, coordenadores, diretores e técnicos da classe hospitalar e escola regular) e da Saúde (profissionais e técnicos). Reforçam também a importância de permitir que uma criança ou adolescente embora doente, exercite sua condição – intrínseca – de sujeito aprendente e seja assim reconhecido como alvo legítimo das políticas educacionais inclusivas. / Salvador