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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
11

The concept of restitution in South African economic policy documents between 1994 and 2014 : an ethical analysis

Nkosi, Mbhekeni Sabelo January 2016 (has links)
Magister Artium - MA / There is widespread concern in the democratic South African context over economic inequalities. However, given the problems of poverty, unemployment and inequality, there is a need to consider economic restitution. Restitution is used in public policy often without conceptual clarity. This study is situated in the field of economic ethics; therefore it will contribute to philosophical and more specifically ethical discourse on the concept of economic restitution. The focus of the study is on South African economic policy documents released by the government in response to current economic inequalities in the period between 1994 and 2014. Such policy documents include the Reconstruction and Development Programme (RDP, 1994); Growth Employment and Redistribution Programme (GEAR, 1996); Accelerated and Shared Growth Initiative South Africa (AsgiSA, 2005); Industrial Policy Action Plan (IPAP, 2007) and its iterations; New Growth Path (NGP, 2010); and the National Development Plan (NDP, 2012). This study focuses on how the concept of restitution is understood in South African policy documents in the period between 1994 and 2014 in response to current economic inequalities. It identifies implicit and explicit references to the concept of economic restitution; describes the scope of the term as used in such policy documents; analyses and compares how the term restitution is understood; and indicates any emerging patterns in this regard.
12

Comportamento alimentar, metabolismo ruminal e estabilidade do leite de vacas alimentadas com milho floculado e diferentes níveis de degradabilidade da proteína / Feeding behavior, ruminal metabolism and milk stability of cows fed steam flakes and different levels of protein degradability

Danielle de Cássia Martins da Fonseca 09 February 2018 (has links)
O presente estudo foi desenvolvido em dois experimentos: 1) Tipo de processamento do milho e a relação PDR:PNDR sobre a fermentação ruminal, comportamento alimentar e seletividade ingestiva de vacas leiteiras cujos objetivos foram: a) avaliar o efeito do tipo de processamento do milho (floculado ou moído) e a relação da proteína degradável (PDR) e não degradável no rúmen (PNDR) (alta ou baixa) sobre a fermentação ruminal, o comportamento alimentar e a seletividade ingestiva de vacas leiteiras durante o período experimental; b) avaliar o efeito a curto prazo da troca da dieta contendomilho moído ou floculado e alta ou baixa relação PDR:PNDR sobre o consumo de matéria seca, produção e estabilidade do leite (teste do álcool, pH, cálcio iônico, estabilidade térmica e alcoólica) de vacas leiteiras durante período de adaptação. Foram utilizadas 20 vacas da raça Holandesa, com 162 ± 70 DEL, 666 ± 68 kg de peso corporal, 3,15 ± 0,48 de escore de condição corporal e 36,0 ± 7,78 kg/vaca/ dia de produção de leite. Os resultados de metabolismo ruminal indicaram que o milho floculado reduziu a relação acetato:propionato e a concentração de ácido acético (%) e aumentou as concentrações dos ácidos valérico (µmol/L) e de propiônico (%) e o pH fecal em relação ao milho moído. Quanto ao comportamento alimentar, observou-se que o uso de milho floculado associado à alta relação PDR:PNDR e a utilização de milho moído associado à baixa relação PDR:PNDR reduziram os tempos de alimentação (TAL/ kg de MS ingerida) e de ruminação (TRU/ kg de MS ingerida) entretanto, o uso de milho floculado associado à alta ou à baixa relação PDR:PNDR aumentaram o tempo de ruminação (TRU/ kg de FDN consumido). Já para índice de seleção notou-se que a rejeição de partículas longas (> 19,0 mm) foi menor em vacas alimentadas com milho floculado em relação às alimentadas com moído. 2) Efeito a curto prazo da troca da dieta sobre a produção e estabilidade do leite de vacas da raça Holandesa que teve por objetivo avaliar o efeito do dia de troca da dieta com diferentes fontes de carboidrato não fibroso associado ou não a inclusão de tamponante/alcalinizante sobre CMS, produção e estabilidade do leite (teste do álcool, pH, cálcio iônico, estabilidade térmica e alcoólica). Foram utilizadas 16 vacas da raça Holandesa, com 130 ± 81 DEL, peso corporal de 660 ± 62 kg e produção média de leite de 28,5 ± 4,79 kg/vaca/dia. O milho moído associado à alta ou à baixa relação PDR:PNDR aumentou o CMS, entretanto o fornecimento de dieta contendo a alta relação PDR:PNDR associada ao milho moído ou floculado apresentaram redução na PL. O uso de milho floculado associado à alta relação PDR:PNDR aumentou o valor de pH das amostras de leite e em todos os tratamentos testados a concentração de Cai apresentou redução. O uso de milho floculado associado ao aumento da relação PDR:PNDR causou redução na estabilidade alcoólica do leite e o uso do milho moído associado a baixa relação PDR:PNDR aumentou a estabilidade do leite ao teste do álcool. O CMS foi a única variável que apresentou efeito da dieta, em que o uso de milho moído sem a inclusão de tamp/alc aumentou o CMS. Sendo assim, durante o período de adaptação, o efeito a curto prazo de troca foi mais nítido nas dietas contendo milho processado associado à proteínas de diferentes degradabilidades ruminal do que nas dietas contendo fontes de carboidratos não fibrosos associados à inclusão ou não de tamp/alc. / The present study was developed in two experiments: 1) Corn processing type and the RDP:RUP ratio on ruminal fermentation, feeding behavior and ingestive selectivity of dairy cows. The objectives were: to evaluate the effect of corn processing type (flocculated or ground) and the ratio (hight or low) of degradable (RDP) and non-degradable protein (RUP) on ruminal fermentation, feed behavior and ingestive selectivity of dairy cows during the experimental period. Indeed to evaluate the short-term effect of dietary exchange containing either ground or flocculated corn and high or low RDP: RUP ratio on dry matter intake, milk yield and stability (alcohol test, pH, ionic calcium, of dairy cows during adaptation period. Twenty Holstein cows were used, with 162 ± 70 DIM, 666 ± 68 kg body weight, 3.15 ± 0.48 body condition score and 36.0 ± 7.78 kg / cow / day of milk yield. The results of ruminal metabolism indicated that the flocculated corn reduced the acetate: propionate ratio and the acetic acid concentration (%) and increased the concentrations of valeric (µmol / L) and propionic acid (%) and fecal pH in relation to ground corn. As regards feed behavior, it was observed that the use of flocculated corn associated with high RDP:RUP ratio and the use of milled corn associated with low RDP:RUP ratio reduced feeding times (TAL / kg of intake DM) and rumination (TRU / kg of DM ingested). However, the use of flocculated corn associated with high or low RDP:RUP ratios increased rumination time (TRU / kg of NDF consumed). For the selection index, it was noted that the rejection of long particles (> 19.0 mm) was lower in cows fed flocculated maize than those fed with milled corn. 2) Short-term effect of the diet change on the production and stability of Holstein cows milk that aimed to evaluate the effect of the diet change day with different sources of non-fibrous carbohydrate associated or not with the inclusion of buffer / alkalinizing on DMI, milk production and stability (alcohol test, pH, ionic calcium, thermal and alcoholic stability). Sixteen Holstein cows, 130 ± 81 DIM, body weight of 660 ± 62 kg and mean milk yield of 28.5 ± 4.79 kg / cow / day were used. Ground corn associated with high or low RDP:RUP ratios increased of intake DM; however, the diet containing the high RDP:RUP ratio associated to ground or flocculated corn showed a decrease in milk yield. The use of flocculated corn associated with high RDP:RUP ratio increased the pH value of milk samples; and in all tested treatments; the concentration of Cai presented reduction. The use of flocculated corn associated with the increase of the RDP:RUP ratio caused a decrease in the milk alcoholic stability while the use of ground corn associated with a low RDP:RUP ratio increased this variable. The intake DM was the only variable that presented a dietary effect, in which the use of ground corn without the inclusion of buffer/alk increased intake DM. Thus, during the adaptation period, the short-term effect of exchange was more pronounced in diets containing processed corn associated with proteins of different ruminal degradability than in diets containing sources of non-fibrous carbohydrates associated with the inclusion of buffer/alk .
13

Les déterminants de santé publique dans la prise en charge des personnes vivant avec une épilepsie en RDP Lao / Determinants of public health in the management of people with epilepsy in Lao PDR

Chivorakoun, Phetvongsinh 11 December 2015 (has links)
L’épilepsie est une des maladies neurologiques la plus fréquentes dans le monde. Cette maladie constitue un problème de santé publique dans les pays en développement où les ressources médicales et économiques sont faibles pour la prise en charge de cette pathologie. Ce travail de doctorat a été raisonné comme une recherche en santé publique qui vise à analyser la mise en place progressive de la prise en charge des personnes vivant avec une épilepsie (PVE) en République Démocratique Populaire Lao (RDP Lao). Nos travaux de recherche ont été conduits dans un premier temps par des recherches observationnelles,sanctionnées par 5 publications scientifiques concernant le personnel de santé, les médicaments antiépileptiques, l’adhérence au traitement antiépileptique et la prise en charge des enfants épileptiques. Dans un deuxième temps, des recherches interventionnelles ont expérimenté le dépistage actif des PVEs et un suivi à fréquence régulière par des visiteurs (personnels de santé) à domicile. Ce travail a identifié les enjeux de la prise en charge de l’épilepsie en RDP Lao : les croyances socioculturelles, la faible qualification des personnels de santé, le faible approvisionnement en médicaments antiépileptiques et leurs prix élevés. Nos interventions ont été efficaces et ont augmenté le nombre de PVEs traitées dans le système de soin. L’extension spatiale de la prise en charge efficace de l’épilepsie à l’échelle nationale nécessite le renforcement de la capacité des soins au niveau communautaire, d’une gouvernance dédiée, de la contribution de l’Association pour les Personnes avec une Epilepsie (APE) et des acteurs de recherches. / Epilepsy is one of the most common neurological diseases worldwide. It is a public health issuein developing countries, where the medical and economic resources are poor for the case management. This doctoral work was set-up as a public health research, assessing the progressive implementation of the management of people living with epilepsy (PWE) in Lao People’s Democratic Republic (Lao PDR). Our research was conducted first through observational research and produces five scientific publications on the health staff,antiepileptic drugs, management of pediatric cases and treatment adherence. Secondly, interventional research focused on a one-year PWE’s follow-up using active screening and domestic health visitors. This work has identified the challenges of the management of epilepsy in Lao PDR: the socio-cultural beliefs, the low qualification of health staff for epilepsy management, the low antiepileptic drug supply and the high price of the drugs. Our interventions were successful, increasing the number of PWEs treated in the healthcare system. The extension of effective management for epilepsy at a national level requires the strengthening of capacity of healthcare at community level, the governance, the contributions of civil society and research actors.
14

The implementation of the procurement policy with reference to the reconstruction and development housing programme in Limpopo Province

Magoro, Matloko Jan 16 September 2010 (has links)
This study examines the implementation of the procurement policy with reference to the reconstruction and development housing programme (RDP) in Limpopo Province. The research objective of this study is to assess the institutional capacity of the Department of Local Government and Housing (DLGH) in Limpopo Province in implementing the procurement policy in relation to the reconstruction and development housing programme. Further, the monitoring and evaluation mechanisms determined by the Department of Local Government and Housing to oversee the implementation of the procurement policy with reference to the RDP houses. In realising the research objectives of this study, the qualitative research methodology was adopted as the study seeks to understand the situation in its naturalistic form. Therefore, pre-determined interview questions were used to interview those who interact directly or indirectly with the implementation of the procurement policy with reference to the RDP houses. The purpose was to solicit relevant information and subjective experience from the agents of procurement policy implementation as well as the beneficiaries of the RDP houses. Not forgetting that qualitative research, studies phenomenon in its natural occurrence and it avoids simplifying, rather, it observes a subject on its multifaceted form. The data collected through interviews was useful in providing relevant policy information of which was unknown and instrumental for this study’s investigation. The study of Public Administration is regarded as the management of public programmes and as such that is possible through public policy, organising, finance, human resource, work standard and procedure, and control measures. It is therefore, indispensable for the Department of Local Government and Housing in Limpopo Province to embody these functions of public management. Thus this study focused on the institutional capacity in terms of procurement policy implementation, focusing on whether the Department of Local Government and Housing has sufficient resources such as human capital, equipments and material in implementing the procurement policy. An empirical study was conducted to collect insights and subjective experiences from those who constantly interact with the implementation of the procurement policy concerning the effectiveness and success of the procurement policy with reference to the RDP houses. The interview questions were directed to prospective members of the DLGH those responsible for procuring, implementing and those affected (beneficiaries). From the findings, the study proved that the Department of Local Government and Housing in Limpopo is confronted with many challenges as far as the implementation of the procurement policy with reference to the RDP houses is concerned. The study has suggested recommendations for the improvement of the institutional capacity of the Department of Local Government and Housing in implementing the procurement policy with reference to the RDP houses. Copyright / Dissertation (MPhil)--University of Pretoria, 2010. / School of Public Management and Administration (SPMA) / unrestricted
15

Productivity in the South African Public Section: Analysis of current issues and future prospects

Layman, Timothy Paul January 1999 (has links)
Masters in Public Administration - MPA / This study examined the issues and concerns for improving productivity in the public sector in South Africa, aligned in particular with the processes of its fundamental transformation, and the aims and objectives of the Reconstruction and Development Programme (RDP). More than that, it provided the view, the approach, the strategies and techniques to bring about productivity improvement. Productivity is not presented as a panacea to solve all problems. It is presented mainly as an attitude about the importance of productivity that must be acquired followed by suggestions for how to bring about its development. To provide both a comprehensive and at the same time a focused approach to improving productivity in the public sector. A second objective was to describe new skills and proven strategies that could be used for productivity improvement. The study discusses various approaches to improving productivity in the public sector that can be implemented in a number of practical ways. A third and primary objective was to recommend a model that would effectively improve productivity in the public sector. This model deals with the quantification of productivity gains through the restructuring of budgets and thereby achieving significant savings that could be transferred to priority RDP programmes. This study used both qualitative and quantitative methods. The study reviewed both domestic and international published work and current research within universities, policy bodies, government departments and elsewhere, including a reconsideration of previous work. The following conclusions were reached and recommendations made: Substantial efficiency and productivity gains are envisaged through the introduction of various models for improving productivity which include a structured productivity improvement programme, the use of performance enhancing methods, performance measurements and performance related pay. Furthermore, savings, resources and capacity can be released by the RDP programmes through: Restructuring and reprioritizing the budget programmes by making small cuts in what were apartheid-serving programmes and reallocating the human, material and financial resources thus released for high priority RDP programmes/projects. International experiences show that a direct link between falls in public investment, physical infrastructure and decline in productivity exists. The effectiveness of the public sector to a large extent conditions economic development. The move towards a leaner and more cost effective public service in South Africa should be based, not on privatisation, but on the creation of effective partnerships between government, labour, business and civil society, and the building of high levels of community involvement in the local delivery of services.
16

Photorealistic visualisation of urban greening in a low-cost high- density housing settlement.

Donaldson-Selby, Gavin Hugh. January 2005 (has links)
Apartheid housing policies of the pre-1994 South African government, and the low-cost highdensity housing programmes of the post-1994 government, has given rise to numerous urban environmental problems, some of which could be addressed in a cost-effective and sustainable manner through urban greening, while simultaneously promoting biodiversity. Public participation in the planning of urban greening has been identified as being of vital importance, without which urban greening projects run a high, and expensive, risk of failure. Previous studies indicate that the greening priorities of residents in low-cost high-density housing settlements may differ considerably from those of managers and experts tasked with the protection and extension of the natural environment resource base. A system of participatory decision support is therefore required to reconcile the greening requirements of the community, and the ecological benefits of biodiversity. If language, literacy, map literacy and numeracy difficulties are to be avoided, and a sense of place or belonging is to be invoked, such a participatory decision support system should, ideally, be visually based, and capable of generating realistic eye-level depictions of the urban landscape. New computer-based landscape visualisation applications, which can directly utilise GIS, CAD and DEM data to produce detailed photo-realistic viewsheds, were deemed better suited to the task of visualising urban greening than existing GIS based mapping systems, CAD and traditional landscape visualisation methods. This dissertation examines the process of constructing a 3D computer model of the Mount Royal low-cost high-density housing settlement, situated in the eThekwini Municipality, KwaZulu-Natal, South Africa. Visualisations including terrain, natural features, indigenous vegetation, houses and roads were produced and submitted, with a questionnaire, to experts from different disciplines, Mount Royal residents and neighbors. Results from the expert survey indicate moderate support for visualisation in professional decision-making. However, both experts and residents expressed strong support for the accuracy and credibility ofthe visualisations, as well as for their potential in a participatory decision support system. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2005.
17

Peer to peer systém pro vzdálené ovládání počítače

LEJTNAR, Michal January 2017 (has links)
This thesis deals with creating of decentralized peer to peer system designed for remote control of computers. P2P network and single nodes in this network is inspired by hybrid peer-to-peer network architecture used by Skype application. The application uses terminal services available in operation system Windows for remote control of computers. Namely, MS Remote Desktop and MS Remote Assistance is used. The entire application is created in programing language C#.
18

Social workers in the transition of social welfare : A descriptive-dialogical enquiry

Ntebe, Ann Beatrice January 1994 (has links)
Magister Artium (Social Work) - MA(SW) / The time period of this study is the contemporary first half of the Nineties, a momentous time in the history of South Africa. The country is passing from apartheid (the "old" South Africa) to the hope of democracy (the "new" South Africa). Nelson Mandela was inaugurated as President of South Africa in May 1994. Social workers, too, find themselves in transition. What is the thinking of experienced progressive social workers at this historical moment, concerning themselves and their profession within its context of social welfare as societal institution? This is the question I explore, specifically with reference to senior social workers within the area of greater Cape Town It is important to note that in terms of the research philosophy underlying this enquiry, the methodological process of the thesis is integral to its substance. My approach, along "New Paradigm" lines, is descriptive dialogical. Implicit in it is a "confrontation of the positivistic epistemology of 'The Scientific Method' in the misguided sense of an 'absolute and only' method of science, which unfortunately is still prevalent in standard practices of enquiry inside and outside the university" (see Note [i] at the end of this Summary). My thesis therefore offers not only outcomes but, as much as possible, also the process of the enquiry. A descriptive-dialogical approach also takes the idea of narrative seriously, "narrative being a mode that makes room for in fact, that insists on more than merely written presentation" (see Note [ii] at the end of this Summary). My research philosophy and methodology accommodate as far as possible "the whole academic and professional potential of a student, rather than just the student's writing potential" (see Note [iii] at the end of this Summary). In line with this, I submit as an accompaniment to this writing -- and as holistically intrinsic to this thesis -- a relevant video-recording and audio recordings illustrating myself at work in the execution of this study. In conclusion of this Summary I must indicate my promoter's and my own serious commitment to the possibility of creative indigenousness of academic style and presentation. This must be viewed within African and South African context, and it explains much of the "humanistically holistic" tenor of this study. This, of course, is in no way intended to discount the worthwhileness and substantiality, in fact the necessity for us, of recourse to the best tenets of European and Euro-American university tradition.
19

Nation building and globalisation in the visual arts: A case study of art projects of the Greater Johannesburg Metropolitan Council (GJMC)

Duncan, Jane 19 May 2008 (has links)
This thesis explores the tensions between nation building and globalisation in relation to state-sponsored visual arts projects, focusing on the Biennale project of the Greater Johannesburg Metropolitan Council (GJMC). It explores the extent to which this project - aimed initially at internationalising and then globalising South Africa’s art world following the demise of apartheid in 1994 - was compatible with key nation building objectives for state funding of the arts, captured imperfectly in the country’s Reconstruction and Development Programme (RDP). It is found that the Biennale project was largely not compatible with the RDP’s objectives for state funding, namely to promote national unity while respecting the country’s cultural diversity, redress imbalances of the past in access to the arts, and promote culture as a component of South Africa’s development, in spite of the GJMC’s statements to the contrary. Rather the Johannesburg Biennale reproduced the dialectic of economic inclusion and exclusion endemic to the political project of globalisation, leading to the creation of economic and artistic ‘insiders’ and ‘outsiders’ akin to the ‘First World’ and ‘Third World’ divide that the RDP warned against in its principle on nation-building, and proved to be an inappropriate use of state resources given the divided nature of the South African artworld. Furthermore, the GJMC imported uncritically an exhibition form associated with the discourse of internationalisation in the first Biennale, and then globalisation in the second, from other Biennales, based on contestable theoretical positions on nationalism and globalisation. This they did in an attempt to address a growing financial crisis in the city by using a ‘one size fit all’ set of policy prescriptions falling under the rubric of neo-liberalism, including culture-led methods of enhancing a city’s global status to attract foreign revenue. In particular, the Biennale did not learn the lesson that the shift in focus in other Biennales from internationalisation to globalisation, was also accompanied by growing discontent in these countries about the elitist nature of these events. I also consider whether it is possible to devise an alternative Biennale project that uses international contact to unite the South African artworld, rather than dividing it.
20

Molecular epidemiology of Mycobacterium tuberculosis and antibiotic resistance in Lao PDR / Epidémiologie moléculaire de Mycobacterium tuberculosis et sa résistance aux antibiotiques en RDP Lao

Somphavong, Silaphet 18 December 2018 (has links)
La tuberculose (TB) reste parmi les 10 premières causes de décès dans le monde ; l’émergence/réémergence de la TB résistante aux antituberculeux aggrave la situation et représente un défi majeur pour l’éradication de la TB. Le Laos est entouré par des pays fortement touchés par la TB et la TB multi-résistante (MDR) et cette maladie représente une priorité en termes de santé publique dans ce pays. Il n’existe encore aucune donnée sur la structure génétique et la résistance aux antibiotiques de la population de M. tuberculosis au Laos.Dans ce contexte, ce travail avait pour but d’analyser la diversité génétique et la structure des populations de M. tuberculosis ainsi que les déterminants génétiques associés à la résistance à partir d’échantillons collectés lors de l’enquête de prévalence nationale de la Tuberculose (TBPS) 2010-2011, l’enquête de résistance aux antituberculeux (DRS) 2016-2017 et chez les cas suspects de MDR-TB au Laos (2010-2014). Plusieurs techniques d’analyses ont été utilisées, comprenant les tests de sensibilité aux médicaments (phénotypique et génotypique), le séquençage et le génotypage par spoligotypage et MIRU-VNTR. Les données ont été analysées par des méthodes statistiques et phylogénétiques.Premièrement, ce travail s’est focalisé sur la diversité des familles de M. tuberculosis circulant au Laos. Les familles EAI et Beijing (76.7% et 14.4% respectivement) ont été principalement observées dans les échantillons de TBPS, alors que la famille Beijing était plus fréquente dans les échantillons de DRS et chez les patients suspectés de MDR-TB (35% et 41% respectivement). La transmission récente était non-négligeable avec un taux de « clustering » global de 11.9%, et des taux pour Beijing de 20 % et EAI de 11 %. Deuxièmement, les résultats ont révélé des profils de résistance très diverses allant de la mono-résistance jusqu’à la pré-XDR (ultrarésistance). Les mutations associées aux profils de résistance ont montré une grande diversité, avec cependant certaines mutations majeures dans les gènes rpoB, katG, et rpsL. Le gène pncA a montré un pattern différent avec de la diversité sans mutations prééminentes. En plus des mutations détectées, des délétions et insertions de bases ont été également observées. Le séquençage a montré son utilité pour la détection de la résistance aux antibiotiques dans les trois échantillons à l’étude. Enfin, la famille Beijing, famille la plus problématique au niveau mondial en termes de résistance et de transmissibilité, a été identifiée de manière significative dans le groupe de patients <35 ans, principalement dans les provinces du Nord, dans les cas de transmissions récentes et chez les isolats très résistants. Tous ces points suggèrent un risque d’émergence de la MDR-TB accrue au Laos dû à la famille Beijing.En conclusion, cette étude permet d’avoir pour la première fois un aperçu de la structure des populations de M. tuberculosis au Laos. Les résultats soulignent le risque d’augmentation du nombre de cas infectés par la famille Beijing et donc des cas de résistance. Pour empêcher une dégradation de la situation, il est essentiel d’améliorer les stratégies pour le dépistage des résistances et de développer des tests moléculaires capables de couvrir un large nombre de mutations qui soit simple à implémenter dans les pays à ressources limités. Les résultats de ce travail serviront de base en termes de famille/sous-famille/génotype et de mutations associées à la résistance au Laos. Ces données pourront être comparées avec de futures études/analyses pour étudier l’évolution de la TB et de la TB résistante et ainsi d’évaluer l’efficacité des politiques de contrôle mises en place. La description des mutations associées aux résistances est utilisée pour créer une base de données régionale en collaboration avec le Vietnam et le Cambodge pour développer un outil de diagnostic basé sur la technologie des puces à ADN pour améliorer la détection de la résistance dans la région. / Tuberculosis (TB) is still one of the top 10 leading causes of death worldwide; the emergence/re-emergence of drug resistant TB aggravates the situation globally and challenges the prospect of ending TB by 2035. Lao PDR is surrounded by TB and MDR-TB high burden countries and TB continues to be one of the priority infection diseases in this country. The prevalence of TB in 2010 was almost twice as high than previous estimates and little is known about drug resistance. Up to now, M. tuberculosis population data regarding drug resistance and genetic structure are totally absent. In this context, we aimed to study the diversity and the structure of M. tuberculosis population and the genetic determinants associated to drug resistance using clinical samples collected from the TB prevalence survey (TBPS), 2010-2011; from the Drug resistance survey (DRS), 2016-2017 and from presumptive MDR-TB cases in Lao PDR (2010-2014). Various methods and analyses were used, including drug susceptibility testing (phenotypic and genotypic), DNA sequencing and genotyping of M. tuberculosis using spoligotyping and MIRU-VNTR. The data were analyzed by statistical and phylogenetic analyses.Firstly, this work was focused on the diversity of M. tuberculosis families circulating in Lao PDR. According to the result form TBPS, EAI and Beijing family (76.7% and 14.4% respectively) were mainly observed, while Beijing family was more observed in DRS, and presumptive MDR-TB cases (35% and 41% respectively). The level of recent transmission in Lao PDR was non-negligible with a global clustering rate of 11.9% and in Beijing and EAI of 20% and 11%, respectively. Secondly, the results demonstrated the diversity of drug resistant patterns from mono-resistance to pre-extensively drug resistance (pre-XDR). A high diversity of mutations associated with drug resistance was also observed, however common mutations were mainly found (e.g: mutations in rpoB gene, katG and rpsL). The pattern was different for pncA gene, we observed a diversity of mutations without preeminent ones. Besides the number of known and unknown mutations associated with anti-TB drug resistance, deletion and insertion of bases were also observed. The sequencing showed its usefulness for drug resistance detection. Lastly, Beijing family, which is the more problematic family in the world in terms of resistance and transmissibility, was observed on a significant manner in young age group, mainly in the northern provinces, in recent transmission cases and among highly drug resistant isolates, suggesting an increasing risk of highly drug resistance TB due to highly transmissible Beijing strains in Lao PDR.In conclusion, this study provides the first genetic insights into the M. tuberculosis population in Lao PDR. The results underline the risk of increase of Beijing and drug resistant TB in the country. In order to prevent a more serious situation in the future regarding drug resistance as observed in neighboring countries, there is an urgent need of effective strategy improvement for drug resistance screening and the development of rapid molecular tests that cover a large number of drug resistance simultaneously with a feasible implementation in the limited resource countries. The results of genotyping from our study will be the baseline of families/subfamilies/genotype of M. tuberculosis population and of the mutations associated with drug resistance in Lao PDR. These data will be compared with further study/analysis to evaluate the trend of TB and drug resistant TB in the country and to determine if the drug resistance is under control after the set-up of new policies. The data of drug resistance associated mutations are used to build a regional database in collaboration with Vietnam and Cambodia in order to develop a diagnostic tool based on DNA chip technology to improve the drug resistance detection in the region.

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