Background: Highly Active Antiretroviral Treatment (HAART) has reduced the frequency of weight loss/wasting associated with HIV infection. However, weight loss remains a problem, even in the HAART era. Objectives: This study was carried out to assess weight change in a cohort of HIV-infected women on HAART in Rwanda, from 2005 to 2008, and to identify factors that predict weight loss in this cohort. Methods: Data from a cohort of 449 HIV-positive women on HAART enrolled in the Rwanda Women’s Inter-association Study and Assessment (RWISA), starting in May 2005, and followed at six monthly intervals until December 2008, were analysed. The outcome assessed in this study was change in weight, measured in kilograms at 6, 12 and 24 months after HAART initiation. Nutritional status was recorded and laboratory measurements (weight, height and CD4 cell count) were taken prior and after HAART initiation. All covariates were time dependent, except for the history of weight loss which was recorded at baseline only. Generalized Estimating Equation (GEE) using the linear link (Gaussian [normal]), exchangeable covariance structure and robust standard error was used to assess the factors associated with changes in weight (weight loss or weight gain) and to control for potential confounders. Results: Prior to HAART initiation, the mean weight of the study participants was 53.1 kg (SD 9.5). The mean BMI was 21.3 kg/m2 (SD 3.6) and the mean CD4 cell count was 222.9 cells/μL (SD 120.6) [47.6% had CD4 cell counts <200 cells/μL, 52.2% had CD4 cell counts ≥200 cells/μL]. Overall, the participants gained weight from baseline to 12 months after HAART initiation. The mean weight change was 1.9 kg (SD 7.8) (p<0.001) 6 months after HAART initiation, 2.9 kg (SD 5.9) (p <0.001) 12 months after HAART initiation, and 2.4 kg (SD 6.5) (p <0.001) 24 months after HAART initiation. Six months after HAART initiation, 48.3% of participants had gained weight, and 21.0% had lost weight. Twelve months after HAART initiation, 56.9% had gained weight, and 18.3% had lost weight, Twenty-four months after HAART initiation, 56.6% had gained weight, and 22.6% had lost weight. Participants with CD4 cell counts ≤ 200 cells/μL at baseline gained more weight than those with CD4 cell counts > 200 cells/μL at 6, 12 and 24 months after HAART initiation. Participants who were underweight (BMI <18.5 kg/m2) at baseline gained more weight than other participants three months after HAART initiation. Time-dependent diarrhoea for more than two weeks and a CD4 cell count of 200 - 350 cells/μL were significantly associated with weight loss (p≤ 0.05). Others factors, such as time-dependent education level (completion of secondary school), marital status (married legally and status other than married legally or widowed), and increases in CD4 cell counts, were associated with weight gain (p≤ 0.05). Conclusion: Although the majority of participants gained weight during the first 12 months of being on HAART, a significant proportion of participants lost weight while on HAART. The findings on the predictors of weight change in HIV-positive women on HAART can be used to promote weight gain in women who start HAART. Clinicians who take care of HIV-infected patients on HAART should pay attention to those who lose weight, and those who present with diarrhoea or with CD4 cell counts of <350 cells/μL at follow-up visits, since these factors are associated with weight loss in the HAART era.

Student Number: 0514015W - MA research report - School of Social Sciences - Faculty of Humanities / This study aimed to investigate land tenure problems experienced by the youth of the rural areas of Rwanda. The study targeted the young men and women who have experienced several land problems in terms of land access and ownership, in the district of Kamonyi. The youth’s land tenure problems, their nature, their causes and their effects on youth’s lives were collected and analysed. The study also aimed to analyse the National Land Policy document of 2004 by looking at three aspects namely the land redistribution, group settlement, and the participation of other different government departments, civil society and youth in particular in the policy process in order to see how it deals with land tenure problems facing the rural youth. In order to collect and analyse data, this study used a qualitative method. The use of this method was motivated by its quality of providing information that one can not get with a questionnaire. Moreover, the qualitative method enables to collect and analyse in-depth information on a smaller group of respondents and enables the researcher to participate in data collection. Documentary analysis, observation, in-depth interviews and the focus group discussion were the techniques used to gather data. The study population was made of 20 young people who have experienced the land problems and 10 key informants. The concept of participation, the human needs, and the resource scarcity and conflict theories framed this work. Participation means that all the beneficiaries of a project must be involved in the decision-making, implementation and control process of the programme. As the concept of participation highlights that, problems of poverty among people, specifically young people, are solved when they are involved in planning and implementation of projects that affect their lives, the same concept was used in the current study to investigate whether rural young people have been involved in the land reform process. Youth participation should be taken into account for achieving positive development. When youth are involved in decision-making, they experience social justice as full citizens and their problems are quickly solved. Participation should be achieved from below whereby all members of the community participate in the decision-making on the projects that affect their lives. In other words, developmental projects must take into account the needs and views of beneficiaries and the latter must be empowered in order to achieve effective results. Many development policies fail in Africa and in Rwanda due to the lack of involving beneficiaries or taking into account their views. In addition, the natural resources must be equally shared by all the citizens without any social inequality, in order to avoid intractable-conflicts. People’s basic needs should be met because where some basic needs such as water, land, education, healthcare, shelter are not given, conflicts arise. Where resources are not sufficient to fit with all people in need, the properties’ ownership should be collective rather than individual. The key findings of the study show that the ways of land access and ownership in Kamonyi are mainly, land acquisition through inheritance, through land purchase through land gifted, and through land allocation by the government. Youth experience mainly the problem of landlessness due to the family land scarcity, inequalities between the elites and the poor in terms of land ownership, the increasing number of heirs since women have been included among heirs, the problem of polygamy and the lack of a known father. Many households have no title-deeds, some male children and their fathers become reluctant to recognise women’s inheritance rights, conflicts around land boundaries between neighbours and conflicts between children and their parents due to the lack of inheritance become endless. The national Land Policy of 2004 that intends to solve all the above land tenure problems bears contradictions related to its aim of achieving equity and equality and productivity at the same time. While the policy intends to establish a land tenure system that guarantees tenure security for all Rwandans, it also states that not every Rwandan will possess a plot of land of his own. In addition, it states that former refugees, professionals pastoralists and farmers, and those who will be able to apply for land showing interest in land development will be given land through the redistribution programme, which means that those who are not able to make a consistent application for land or do not belong to former refugees families will not acquire land. In addition the policy process has not been participative at large; rather it has been limited in the hands of elites, rural dwellers especially youth have not been consulted while they are familiar with land related problems. The group settlement is a good alternative but it bears ambiguity because it is silent on the youth’s lives and on who is accountable to build houses in villages.

[pt] Trabalhando na transversalidade entre memória e memorialização, esta tese propõe um engajamento com a materialidade a fim de explorar a memória como uma fusão de corpos (humanos e não-humanos se misturando), lugares (configurações espaço-temporais frágeis e provisórias) e práticas (ações sempre permeadas por performances e traduções), formando assemblagens mnemônicas (Freeman; Nienass; Daniell, 2016) em Ruanda no pós-genocídio. Como a memorialização em Ruanda está profundamente permeada por um tipo particular de matéria - restos humanos -, adotamos um foco corpóreo, olhando para os enredamentos entre pessoas e coisas, considerando seu embaçamento. Indo além das práticas de representação, exploramos os movimentos de fricção entre uma ampla gama de entidades que se agrupam (e desmontam) em memoriais, enfatizando seu caráter imprevisível e sublinhando suas configurações espaço-temporais provisórias. Com este movimento, esperamos energizar a paisagem com outras possibilidades além da concepção da matéria e do lugar como passivo ou estável e em direção a uma transformação mais fluida encenada no encontro entre essas entidades materiais-semióticas. Explorando encontros afetivos entre corpos e lugares, argumentamos que é apenas nesse processo que os lugares memoriais são encenados. Trabalhando sob a rubrica do novo-materialismo, sugerimos uma bricolagem de abordagens, dando conta do político em uma sensibilidade mais cooperativa-experimental (Thrift, 2008) em relação à materialidade generativa. Tal esforço nos permite lembrar e esquecer com e por meio de outros corpos, reconhecendo a importância das coisas/matéria e lugares nas práticas de memorialização em Ruanda, e convidando a participar do chamado para um envolvimento teórico e metodológico com a experiência vivida em Relações Internacionais. Mais especificamente, esta dissertação se engaja com o movimento e o fluxo dos lugares e da matéria por meio de memoriais como locais de fricção e da circularidade do corpo morto. Buscando compreender diferentes modos de agrupamentos de memória, oferecemos duas assemblagens para explorar essas diferenças: memoriais nacionais cuidadosamente projetados (Kigali, Murambi e Bisesero) e um lugar de memória espontâneo – o Rio Nyabarongo. A pesquisa destes espaços heterogêneos construídos como locais de memória é baseada em trabalho de campo realizado em Ruanda em 2011 e 2014. / [en] Working within the transversality of memory and memorialization, this dissertation proposes an engagement with materiality in order to explore memory as a fusion of bodies (human and nonhuman intermingling), places (fragile and provisional spatiotemporal configurations), and practices (actions always embedded in performances and translations), forming mnemonic assemblages (Freeman; Nienass; Daniell, 2016) in post-genocide Rwanda. As memorialization in Rwanda is deeply embedded in a particular type of matter – human remains –, we adopt a corporeal focus, looking into the entanglements between persons and things considering their blurriness. Going beyond practices of representation, we explore the movements of friction between a wide range of entities assembling (and disassembling) in memorials, stressing its unpredictable character and underlining their provisional spatiotemporal configurations. With this move, we hope to energize the landscape with other beyond the conception of matter and place as passive or stable and towards a more fluid transformation enacted in the encounter between these material-semiotic entities. Exploring affective encounters between bodies and places, we argue that it is only in this co-becoming that memorial places are enacted. Working under the rubric of new materialism, we suggest a bricolage of approaches, accounting for the political in a more co-operative-cum-experimental sensibility (Thrift, 2008) towards generative matter. Such effort enables us to remember and forget with and through other bodies, acknowledging the importance of things/matter and places in memorialization practices in Rwanda, and inviting to join the call for a theoretical and methodological engagement with the lived experience in International Relations. More specifically, this dissertation engages with movement and flux of places and matter through memorials sites as places of friction and through the circularity of the dead body. Trying to grasp different modes of memory gatherings, we offer two assemblages to explore these differences: carefully designed national-level memorial sites (Kigali, Murambi, and Bisesero) and a spontaneous place of memory – Nyabarongo River. The research on these heterogeneous spaces assembled as places of memory is based on fieldwork conducted in Rwanda in 2011 and 2014.

<p>From long ago, rivers have always sustained livelihoods of the peoples through the utilisation of different natural resources available in the basin. All over the world, many rivers have been dammed in the spirit of performing various purposes: agricultural irrigation, domestic water supply and power generation or flood control.</p><p>By the year 2001, the World Commission on Dams brought into focus the debate on damrelated impacts on local economies, societal cultures, livelihoods security and environmental conservation. The outcome of the World Commission on Dams consultation strongly recommended the governments to involve all stakeholders to address appropriately all issues associated with dams.</p><p>The overall focus of this master thesis is the projected Rusumo Falls dam in the Kagera River Basin (East Africa). Based on literature documentation completed by on-ground observations and qualitative interviews at Rusumo, various issues connected with the dam are presented.</p><p>In the first part, the Kagera River Basin background information is provided. It gives an overview of the physical and human characteristics of the Kagera watershed and subcatchments. A brief history and socio-economic indicators are given to enlighten the outsiders about the development challenges of the riparian countries of Burundi, Rwanda, Tanzania and Uganda. Regional frameworks for the development and management of Kagera Basin natural resources are presented: The Kagera Basin Organisation and the Nile Basin Initiative.</p><p>Section two analyses the likely social problems around the Rusumo Hydro Electric Project resulting from the land issue and the electricity needs and posing a dilemma for the governments committed to reverse the poverty and developing the economies. Benefits and drawbacks of the dam as perceived by the beneficiaries are thoroughly listed.</p><p>Based on the overwhelming supports from the Rusumo people, the governments of Burundi, Rwanda and Tanzania together with the international community, a public participation scenario is suggested in the last chapter. It encourages the governments to come together with all interested groups and the affected people of Rusumo and address any matters associated to the dam management process.</p><p>The conclusion of this study draws some strategies and methods to ensure full popular participation in the dam management. It provides some ways to involve all stakeholders to address the related issues. As the Rusumo people perceptions of the dam possible effects might not be realistic, the popular participation can offer them a good opportunity to handle socio-economic problems such as the land issue, the economy restructure and the nature conservation. In this case study, the government of Rwanda is therefore responsible for the establishment of platforms for a broad popular consultation.</p>

INTRODUCTION: En l’an 2000, les Nations Unies ont adopté les Objectifs du Millénaire pour le Développement avec comme premier objectif l’éradication de l’extrême pauvreté et de la faim. La relation synergique entre une bonne nutrition et le développement économique est aujourd’hui indiscutable. La malnutrition et la pauvreté sont deux problèmes interdépendants et qui partagent les mêmes causes. On estimait en 2008 que le retard de croissance staturale affectait 195 millions d’enfants de moins de cinq ans dans le monde en développement dont 90% en Afrique et en Asie. Cette forme de malnutrition est la plus importante au niveau mondial. Dans beaucoup de pays en Afrique subsaharienne et en Asie, presque un enfant sur deux en souffre. La malnutrition est le résultat d’une alimentation insuffisante, des maladies fréquentes sans accès aux services de santé de base ainsi que de l’insuffisance des soins et pratiques à l’égard des enfants. Assez souvent on ne remarque que les cas de malnutrition sévère alors que les cas légers ou modérés sont de loin plus nombreux. Les estimations les plus récentes montrent que les formes légères ou modérées de malnutrition contribuent à plus d’un tiers des décès enregistrés chez les enfants dans les pays en développement. Les enfants survivants ont des conséquences à moyen/long terme qui comprennent une vulnérabilité accrue aux infections, une diminution des capacités intellectuelles et des capacités de production ainsi que des risques élevés de complications en cas d’accouchement pour les futures mères. L’intégration de la nutrition dans les stratégies de développement économique et de réduction de la pauvreté dans le cadre des OMDs témoigne que les pays en développement comprennent de plus en plus l’impact d’une bonne nutrition de la population sur le développement durable. Cependant l’efficacité avec laquelle de telles stratégies se mettent en œuvre pour cibler les milieux ruraux qui sont les plus touchés par la malnutrition reste faible dans beaucoup de pays. Les efforts fournis ne semblent pas correspondre à l’ampleur du problème de malnutrition. De plus, dans beaucoup de ces pays, les conditions nécessaires à la réussite de ces stratégies ne sont pas réunies. Le contexte sociopolitique n’est pas souvent favorable et les capacités de mise en œuvre sont faibles. Par ailleurs les principaux décideurs politiques à tous les niveaux du système ne sont pas suffisamment sensibilisés sur l’ampleur du problème de la malnutrition. Pourtant il y a des interventions simples de lutte contre la malnutrition infantile qui ont prouvé leur efficacité et efficience et qui sont à la portée des pays pauvres. Les pratiques d’alimentation optimale du nourrisson et du jeune enfant comprenant la mise au sein des nouveaux-nés endéans l’heure qui suit l’accouchement, l’allaitement maternel exclusif pendant les 6 premiers mois, l’allaitement jusqu'à au moins deux ans et une bonne utilisation des aliments de complément constituent un bon exemple. Elles peuvent avoir un impact sur la survie des enfants en prévenant à elles seules jusqu’à 19% des décès survenant avant cinq ans dans les pays en développement. Néanmoins de telles informations ne sont pas toujours connues par ceux qui auraient le pouvoir d’opérer les changements au niveau des communautés. L’objectif général de ce travail est de fournir les informations sur l’ampleur de la malnutrition chez les enfants en milieu rural au Rwanda et de documenter le processus de mise en oeuvre du suivi de la croissance à base communautaire, une des stratégies de promotion d’une bonne nutrition et d’une bonne santé des enfants. METHODOLOGIE: Le présent travail est basé sur une série d’études réalisées depuis l’année 2004 dans la zone de rayonnement de l’hôpital rural de Ruli au Rwanda. Il a regroupé les études suivantes: Une étude qualitative d’analyse de la situation du programme de nutrition à base communautaire mis en œuvre dans toute la zone de rayonnement de l’hôpital de Ruli depuis l’année 2004. Elle avait pour l’objectif l’identification des forces et des faiblesses du programme afin d’améliorer le processus de sa mise en œuvre. Une enquête nutritionnelle ayant pour but de déterminer la prévalence de la malnutrition dans la zone et d’en identifier les déterminants ainsi que d’évaluer la fiabilité des mesures anthropométriques faites par les agents communautaires de nutrition. Quatre études descriptives issues du monitoring des activités du suivi et promotion de la croissance à base communautaire dont l’objectif était la description des déterminants de la couverture de ces activités et la description du parcours des enfants référés par la communauté dans les centres de santé. Une étude descriptive ayant pour but de déterminer la prévalence de la malnutrition dans les services de santé de la zone de rayonnement. Une étude de cohorte dont l’objectif était de déterminer l’influence de la malnutrition sur la mortalité et la durée de séjour des enfants en hospitalisation. Une étude incluant la conception, l’instauration et la documentation d’une intervention d’assurance qualité du processus du suivi de la croissance à base communautaire Une étude quasi-expérimentale d’évaluation de l’impact d’une intervention d’assurance qualité sur les déterminants de la couverture du suivi de la croissance à base communautaire. RESULTATS: L’enquête nutritionnelle de l’année 2006 a montré que les enfants de 12-35 mois couraient le plus grand risque de malnutrition. L’émaciation était présente chez 6,3% (IC95%: 4,2-9,0) des enfants, l’insuffisance pondérale chez 26,1% (IC95%: 22,1-30,4) et le retard de croissance staturale chez 46,2% (IC95%: 41,5-51,0). La proportion d’enfants présentant des oedèmes était de 2,3% (IC95%: 1,2-4,3). Les facteurs de risque de la malnutrition étaient la fréquence de maladies chez l’enfant, l’âge de l’enfant supérieur à 12 mois, les antécédents de malnutrition dans le ménage, une mère enceinte, l’absence de moustiquaire dans le ménage, un nombre insuffisant de personnes actives dans le ménage, un ménage dirigé par un homme seul ou par un orphelin, un bas revenu mensuel du ménage et une famille qui ne pratique pas d’élevage. Parmi les enfants ayant fréquenté les services de consultation externes des centres de santé entre janvier 2008 et juin 2009, la prévalence de l’émaciation était de 10,6 %, celle de l’insuffisance pondérale de 27,6% et celle de retard de croissance staturale de 48,3%. L’oedème était présent chez 0,3 % des enfants. Dans le service de pédiatrie de l’hôpital, la malnutrition aiguë touchait 16,9 % des enfants hospitalisés, l’insuffisance pondérale 37,5%, le retard de croissance staturale 57,3%. Certains signes cliniques à l’admission étaient associés à une prévalence élevée de malnutrition. Les enfants ayant un bon état nutritionnel avaient une médiane de séjour en hospitalisation de 4 jours, ceux dont les mesures anthropométriques mettaient en évidence une émaciation, une insuffisance pondérale ou un retard de croissance avaient une médiane de séjour de 6 jours. La différence était statistiquement significative. Le risque de décéder à l’hôpital pour les enfants en insuffisance pondérale était 5 fois plus élevé que chez les enfants avec un bon état nutritionnel. Concernant le programme de nutrition à base communautaire, le taux d’utilisation mensuelle moyen des services du suivi de la croissance avait varié de 53,2% à 79,7% entre janvier 2004 et juin 2009. Il s’était stabilisé au tour de 75% à partir de l’année 2007. Le taux d’utilisation adéquate des services était de 11,7%; dans les tranches d’âge, il variait de 51,8 % pour la tranche d’âge de 0-6 mois à 19,4% pour celle de 55-60 mois. Le suivi du parcours des enfants référés par la communauté a montré que 20% des enfants référés par la communauté n’étaient pas arrivés au centre de santé. Une campagne de dépistage de la malnutrition aiguë organisée au mois de mai 2009 a montré que le taux de couverture semestriel des enfants par la campagne était de 85,4%; le taux de couverture des enfants dans le cadre du suivi de la croissance de routine était de 74,7% au mois de mai 2009. La valeur prédictive négative de l’indice poids pour âge utilisé dans le suivi de la croissance à base communautaire pour dépister la malnutrition aiguë était de 98,4%. Le suivi des indicateurs de pénétration d’une intervention instaurée pour assurer la qualité du processus du suivi de la croissance à base communautaire a montré que les centres de santé avaient pu organiser 76,2 % des réunions de coordination des activités et que le taux de supervision de la communauté par les centres de santé s’élevait à 60,6%. L’évaluation de l’impact de cette intervention sur les déterminants de la couverture du suivi de la croissance à base communautaire après 18 mois a montré que le taux de disponibilité des ressources était passé de 58,7% à 86,5%, le taux de couverture adéquate des enfants était passé de 51,8 % à 75,5 %, de 45,6 % à 66,8 %, de 45,7 % à 61,7 %, de 39,3 % à 56,1 % , de 38,2 % à 54,2% et de 37,7 % à 50,4 % respectivement pour les tranches d’âge 0-6 mois, 7-12 mois, 13-18 mois, 19-24 mois, 25-30 mois et 31-36 mois. CONCLUSION: Il ressort des travaux menés dans le cadre de cette thèse les conclusions suivantes:  Au niveau de l’importance de la malnutrition dans la zone de rayonnement Les différents travaux ont réaffirmé le fait que la malnutrition dans la zone de rayonnement a des niveaux inquiétants. Si on se réfère aux normes de l’OMS, l’émaciation a un niveau de sévérité moyen, l’insuffisance pondérale un niveau de sévérité élevé et le retard de croissance staturale très élevé. La malnutrition touche spécialement les enfants à partir de 12 mois. Parmi les enfants qui consultaient les services ambulatoires des centres de santé ou les enfants qui étaient admis en hospitalisation, les taux de malnutrition étaient plus élevés que parmi les enfants suivis au niveau de la communauté. La malnutrition augmentait la durée de séjour en hospitalisation et le risque de décéder à l’hôpital chez les enfants ayant une insuffisance pondérale ou un retard de croissance staturale était plus élevé que chez les enfants avec un bon état nutritionnel. Ces informations ont été utilisées dans la mobilisation de la population en général et des décideurs politiques en particulier, pour la promotion des activités de lutte contre la malnutrition dans la zone de rayonnement.  Au niveau du suivi de la croissance à base communautaire Les mesures anthropométriques faites par les agents communautaires de nutrition dans le cadre du suivi de la croissance étaient fiables. Le taux de couverture réalisé par une campagne semestrielle de dépistage de la malnutrition ne semblait pas justifier l’utilité de la campagne dans le contexte du suivi de la croissance à base communautaire qui atteint un taux d’utilisation mensuelle moyen de 75%. L’utilisation adéquate était très basse et diminuait à partir de 6 mois alors que c’est à cet âge que le risque de malnutrition commence. L’étude du parcours des enfants référés par la communauté a montré que 20% de ces enfants n’arrivaient pas dans les centres de santé. Le suivi continu des indicateurs de processus et de résultats des activités communautaires a conduit à l’instauration d’une intervention d’assurance qualité pour améliorer les déterminants de la couverture du suivi de la croissance à base communautaire. Cette intervention a pénétré de façon satisfaisante dans les structures de gestion des activités communautaires mais l’organisation des réunions de coordination des activités et la supervision par les centres de santé se sont montrés insuffisantes. L’évaluation de l’impact de cette intervention sur les déterminants de la couverture du suivi de la croissance à base communautaire a montré qu’en suivant les principes d’assurance qualité, il est possible d’améliorer certains de ces déterminants en particulier la couverture adéquate, sans devoir recourir à des moyens financiers supplémentaires. La combinaison du recueil d’information pour conscientiser la population et les décideurs politiques sur le problème de malnutrition dans la zone et du suivi/évaluation de la mise en œuvre des activités ont permis d’améliorer la gestion du suivi de la croissance à base communautaire. Il est important d’exploiter davantage les nouvelles opportunités pouvant améliorer l’impact du suivi de la croissance à base communautaire. Dans ce cadre, l’intégration dans les activités du suivi de la croissance à base communautaire de l’approche de déviance positive, de la démarche d’assurance qualité à tous les niveaux, de l’approche contractuelle avec la communauté par le financement basé sur les performances et des activités de mobilisation des ménages pour l’adhésion à la mutuelle de santé, est une perspective pour l’amélioration de la nutrition et de la santé des enfants/ INTRODUCTION: In 2000, the United Nations adopted the Millennium Development Goals (MDGs). The first objective of these goals is the eradication of the extreme poverty and hunger. Today, the synergistic relation between good nutrition and economic development is indisputable. Malnutrition and poverty are two interdependent conditions, and they share common roots. Estimates for malnutrition in the developing world show that stunting affected 195 million children under five years of age in 2008. Of these children, 90% were from Africa and Asia. In most sub-Saharan African and Asian countries, nearly one out of every two children suffers from this form of chronic malnutrition. Malnutrition is the result of insufficient or inadequate food, lack of access to basic health care services to treat common illnesses, as well as insufficient child care practices. While medical services often identify severe cases of malnutrition, mild and moderate cases are much more prevalent and often go undiagnosed. The most recent estimates show that mild and moderate forms of malnutrition contribute to more than one third of the deaths recorded amongst children in Developing countries. Children who survive are at risk of long term sequelae such as increased vulnerability to infections, reduction in cognitive function, increase in physical disabilities, and increased risk of ante partum complications amongst future mothers. The integration of nutrition policies into national strategic plans that have been created to reach Millennium Development Goals is a testament to the growing realization that good nutrition is essential for sustainable development in developing countries. The effectiveness with which such strategies are implemented, however, remains low in many countries. Efforts to reach rural areas, often the most impacted by malnutrition, do not seem to correspond to the magnitude of the problem of malnutrition. Moreover, in many of these countries, the resources needed for the success of these strategies are not available. The sociopolitical environment is often unfavorable, and the capacity for implementation is low. In addition, the political decision makers at all levels of the system are not adequately sensitized to the magnitude of the problem of malnutrition. Simple interventions against infant and childhood malnutrition do exist, however, and have proven to be effective and cost efficient in resource-limited countries. The practice of optimal infant and childhood feeding, including the initiation of breastfeeding within one hour of birth, exclusive breast-feeding for the first six months, continued breastfeeding for at least two years and correct use of additional safe food, illustrates one good example. In developing countries, these practices alone can prevent up to 19% of deaths that occur in children under five years of age. Unfortunately, such information is not necessarily understood by those who have the capacity to facilitate change at the community level. The overall objective of this thesis is to provide information regarding the magnitude of malnutrition amongst children in rural Rwanda, as well as to document the implementation process of a community based growth-monitoring program that was developed as a strategy to promote good nutrition and good health for children. METHODS: This work is based on a series of studies that began in 2004 in the rural catchment area of Ruli District Hospital in Rwanda. It includes the following studies: A qualitative analysis of the community based nutrition program implemented in 2004 throughout the catchment area of Ruli hospital. The objective is to identify the strengths and the weaknesses of the program in order to improve the program. A nutritional survey that was initiated to determine the prevalence of malnutrition in the area, to identify local risks factors of malnutrition, and to evaluate the reliability of the anthropometric measurements made by the Community nutrition workers. Four descriptive studies that resulted from evaluating the determinants of children’s participation in the community based growth monitoring programs and the outcomes of the children referred by the community nutrition workers to the health centers. A descriptive study evaluating the prevalence of malnutrition in the catchment area of Ruli District Hospital. A cohort study whose objective was to determine the influence of malnutrition on the mortality and length of stay of hospitalized children. A study that describes the design, the implementation and the documentation of a quality assurance intervention to improve the process of the community based growth-monitoring program. A quasi-experimental study to assess the impact of a quality assurance intervention on the indicators of the coverage of the community based growth monitoring program. RESULTS: The nutritional survey carried out in 2006 showed that children between 12-35 months of age had the greatest risk of malnutrition. Wasting affected 6.3% (IC95%: 4.2-9.0) of the children, underweight 26.1% (IC95%: 22.1-30.4) while stunting affected 46.2% (IC95%: 41.5-51.0). The proportion of children with oedemas was 2.3% (IC95%: 1.2-4.3). Risk factors for malnutrition included low monthly income of the household, concurrent illness of the child, household that does not practice birth control, age of child greater than 12 months of age, mother of the child being pregnant, history of malnutrition in the household, absence of a mosquito net in the household, insufficient number of working adults in the household and a household managed by a single man or by an orphan. Among children having attended the outpatient clinics of the health centers between January 2008 and June 2009, the prevalence of wasting was 10.6%, underweight was 27.6% and stunting was 48.3%. Edema was present in 0.3% of the children. In the pediatrics wards of the hospital, acute malnutrition affected 16.9% of the hospitalized children, underweight affected 37.5%, and stunting affected 57.3%. Certain clinical signs at admission were associated with a high prevalence of malnutrition. Children with good nutritional status had median length of hospital stay of 4 days whereas those whose anthropometric measurements highlighted wasting, underweight or stunting had a median length of hospital stay of 6 days. The difference was statistically significant. The relative risk of death during hospitalization for children with underweight was 5 times higher than for children with a good nutritional status. In regards to the community based nutrition program, the average monthly utilization rate of the growth monitoring services varied from 53.2% to 79.7% between January 2004 and June 2009. This rate reached a plateau at 75% in 2007. The overall adequate utilization rate of the services was 11.7%; amongst specific age groups, this rate varied from 51.8% amongst the 0-6 month age group to 19.4% amongst 55-60 month age group. An evaluation of the outcomes of children seen by community nutrition workers showed that 20% of the children referred by the community did not arrive at the health centers. A national campaign to screen for acute malnutrition organized in May 2009 revealed a semi-annual coverage rate of the children of 85.4%; the coverage rate of children by routine community based growth was 74.7% in the same month. The weight-for-age index used in community based growth monitoring showed a negative predictive value of 98.4% to detect acute malnutrition. Evaluation of the indicators that were designed to assure the quality of the community based growth monitoring program showed that the health centers organized 76.2% of the expected coordination meetings and that the supervision rate of the community by health centers amounted to 60.6%. Assessment of the impact of this intervention on the determinants of the community based growth monitoring coverage after 18 months showed that the availability rate of the resources increased from 58.7% to 86.5%, the adequate coverage rate of the children increased from 51.8% to 75.5%, 45.6% to 66.8%, 45.7% to 61.7%, 39.3% to 56.1%, 38.2% to 54.2% and 37.7% to 50.4% respectively for the 0-6 months age group, 7-12 months age group, 13-18 months age group, 19-24 months age group, 25-30 months age group and 31-36 months age group. CONCLUSION: The following conclusions can be made based upon the work undertaken within the framework of this thesis:  On the level of the magnitude of malnutrition in the catchment area: Various work reaffirmed the fact that malnutrition in the catchment area is high. According to World Health Organization classification of severity of malnutrition in a community by prevalence, the situation is poor for wasting, serious for underweight and critical for stunting. Malnutrition particularly affects children at 12 months of age and older. Among the children who consulted outpatient services at the health centers or who were admitted as inpatients in the pediatrics services of Ruli hospital, malnutrition prevalence was higher than among the children followed at community level. Malnutrition increased the length of hospital stay and the relative risk of dying at the hospital in the children with underweight or stunting was higher than in the children with good nutritional status. This information is being used to mobilize the general population and political decision makers to promote effective utilization of community based activities in the fight against malnutrition.  On the level of the community based growth monitoring: The anthropometric measurements made by the community nutrition workers within the framework of the community based growth monitoring were reliable. The coverage rate achieved by a semi-annual campaign to screen malnutrition did not seem to justify the utility of such campaigns in a context where the community based growth monitoring has an average monthly utilization rate of 75%. The adequate coverage utilization rate was very low and decreased from 6 months whereas it is at this age that the risk of malnutrition starts. An evaluation of the outcomes of children referred by the community showed that 20% of these children never arrived at the health centers for further evaluation and treatment. The continuous evaluation of process indicators for community activities has led to the introduction of a quality assurance intervention that was designed to improve the impact of community based growth monitoring. This intervention penetrated successfully in the management structures of the community activities, but activity coordination meetings and supervision by the health centers were insufficient. The impact of this intervention on the coverage indicators of the community based growth monitoring program illustrates that it is possible to improve indicators, especially the adequate coverage, while following the principles of quality assurance and minimizing the need for additional financial resources. The use of data collection and analysis to sensitize politicians and policy makers in the fight against malnutrition, as well as the implementation of quality assurance activities, has been shown to improve the management of community based growth monitoring. It is important to continue to explore new opportunities to improve the impact of community based growth monitoring. The expansion of community based growth monitoring into a positive deviance framework, integration of quality assurance policies at all levels, financial incentives for community performance, and household utilization of mutual health insurance, are all prospects in the improvement of nutrition and health for children

This study considers the ontological value of metaphor as a site of ceaseless interaction among multiple (gendered) subjects, drawing on the theoretical work of Max Black, Victor Turner, Jacques Derrida, Paul Ricœur, George Lakoff, and Mark Johnson. Its focus is on the particular function of metaphor, locally and internationally, in three of the “new wars” of the twentieth century. The first chapter examines how the bridge metaphor, undergirded by cultural discourses on Mostar’s Old Bridge and Ivo Andrić’s The Bridge on the Drina, shaped knowledge of gendered experiences in the Bosnian War. The second chapter historicizes the cockroach metaphor, which features in many representations of the Rwandan Genocide, and identifies how “the cockroach” is gendered by metaleptic reference to ubuhake, or pastoral clientship—which gained metaphoric significance through populist movements in the 1950s, when Saverio Naigiziki published The Optimist. The third chapter explores depictions of female civilians, combatants, and suicide-bombers as “prisoners,” considering this metaphor’s gendered variations from Aleksandr Pushkin’s “Prisoner of the Caucasus” to discourses on the Chechen Wars. These three metaphors are of central importance to the production of knowledge about how and in what ways post-cold-war conflicts are gendered. Frequently, the international community objectifies “distant conflicts” through the same metaphors that, for local agents, articulate political self-identifications and enact gendered violence. Locally-initiated metaphors, thusly circulating among multiple discourses, produce interactive sites of semantic investment and imaginary exchange. Global and regional representations in metaphor of the Bosnian War, the Rwandan Genocide, and the Chechen Wars enter into common if asymmetrical networks of geopolitical and temporal interactions structured in part by human rights norms in the 1990s. By tracing the historical, cultural, and modal transformations of bridge, cockroach, and prisoner metaphors, this study investigates how fiction, poetry, journalism, memoir, testimony, film, and performance gender knowledge of the Bosnian War, the Rwandan Genocide, and the Chechen Wars.

<p>Corruption is a serious problem which has many negative impacts on sustainable economic development globally. The clandestine nature of corruption makes it difficult to detect. Hence, efforts to combat corruption successfully demand comprehensive anti-corruption legislation, strong powers, as well as special investigative techniques and strategies. An effective anti-corruption regime requires a comprehensive anti-corruption legal framework which not only punishes all forms of corruption but also capacitates anti-corruption institutions. A strong anti-corruption agency is a&nbsp / crucial requirement and a necessary part of a country&rsquo / s anti-corruption strategy. The failure or the success of an anti-corruption agency depends on a variety of factors, such as powers and means to detect, investigate and prosecute corruption and related offences. The lack of trained staff, as well as the lack of adequate material resources, also affects the effectiveness of an anti-corruption agency. The anti-corruption agencies covered by this research are not empowered or resourced sufficiently, which may result in their ineffectiveness. This paper provides a set of recommendations in respect of the powers and strategies needed for a successful anti-corruption agency.</p>

This study considers the ontological value of metaphor as a site of ceaseless interaction among multiple (gendered) subjects, drawing on the theoretical work of Max Black, Victor Turner, Jacques Derrida, Paul Ricœur, George Lakoff, and Mark Johnson. Its focus is on the particular function of metaphor, locally and internationally, in three of the “new wars” of the twentieth century. The first chapter examines how the bridge metaphor, undergirded by cultural discourses on Mostar’s Old Bridge and Ivo Andrić’s The Bridge on the Drina, shaped knowledge of gendered experiences in the Bosnian War. The second chapter historicizes the cockroach metaphor, which features in many representations of the Rwandan Genocide, and identifies how “the cockroach” is gendered by metaleptic reference to ubuhake, or pastoral clientship—which gained metaphoric significance through populist movements in the 1950s, when Saverio Naigiziki published The Optimist. The third chapter explores depictions of female civilians, combatants, and suicide-bombers as “prisoners,” considering this metaphor’s gendered variations from Aleksandr Pushkin’s “Prisoner of the Caucasus” to discourses on the Chechen Wars. These three metaphors are of central importance to the production of knowledge about how and in what ways post-cold-war conflicts are gendered. Frequently, the international community objectifies “distant conflicts” through the same metaphors that, for local agents, articulate political self-identifications and enact gendered violence. Locally-initiated metaphors, thusly circulating among multiple discourses, produce interactive sites of semantic investment and imaginary exchange. Global and regional representations in metaphor of the Bosnian War, the Rwandan Genocide, and the Chechen Wars enter into common if asymmetrical networks of geopolitical and temporal interactions structured in part by human rights norms in the 1990s. By tracing the historical, cultural, and modal transformations of bridge, cockroach, and prisoner metaphors, this study investigates how fiction, poetry, journalism, memoir, testimony, film, and performance gender knowledge of the Bosnian War, the Rwandan Genocide, and the Chechen Wars.

Le 6 avril 1994 débutait le génocide le plus rapide de l'histoire de l'humanité: dans les cent jours qui suivirent, plus de 800000 Tutsis et Hutus modérés furent massacrés à coups de machettes et de gourdins selon un plan méticuleusement préparé et exécuté par une clique extrémiste ne voulant pas perdre son pouvoir et ses privilèges. Devant ces atrocités, la communauté internationale demeura passive et ce n'est que le 21 juin qu'une grande puissance décida d'intervenir, en l'occurrence la France avec l'Opération Turquoise, opération sanctionnée par les Nations Unies, pour mettre fin aux massacres. Plusieurs experts considèrent que ce triste événement est le cas le plus patent de génocide depuis l'Holocauste de la Deuxième Guerre mondiale. Presque dix ans plus tard, un autre événement faisait les manchettes pour des raisons similaires. En février 2003, la région occidentale du Soudan, le Darfour, s'embrasa à son tour à la suite du soulèvement de groupes rebelles et de la répression gouvernementale qui s'en suivit. Lors des célébrations entourant le dixième anniversaire du génocide au Rwanda, plusieurs personnalités publiques mirent en garde la communauté internationale que le « Plus jamais! », véritable slogan politique scandé sur toutes les tribunes après le Rwanda, perdrait toute sa signification si rien n'était fait pour mettre un terme aux violences. Quoique la nature et la définition des violences fassent encore l'objet d'un débat constant au sein de la communauté internationale, il est clair que la situation demeure extrêmement problématique et que la population civile du Darfour fait les frais de ces affrontements entre rebelles et forces gouvernementales. En 1994, l'administration Clinton fut complètement silencieuse durant le génocide, ne voulant même pas reconnaître publiquement que c'était un génocide. En comparaison, l'administration de George W. Bush a été très bruyante à propos du Darfour, décrivant la situation comme étant un génocide, émettant des sanctions sévères et poursuivant des résolutions contraignantes au Conseil de sécurité de l'ONU. Par contre, il y a des similarités frappantes entre les politiques étrangères de ces deux administrations alors qu'aucune d'entre elles n'a été en mesure de mettre un terme aux violences. L'objectif de ce mémoire est donc de répondre à la question suivante: qu'est-ce qui peut expliquer les différences et les ressemblances entre la politique étrangère de l'administration Clinton et celle de George W. Bush? Un des principaux arguments afin d'expliquer l'inaction américaine en 1994 est que la société civile et le Congrès furent totalement silencieux et ne mirent pas de pression sur le gouvernement américain pour que ce dernier change sa politique. Cette leçon semble avoir été retenue dans le cas du Darfour, car rarement a-t-on vu autant de groupes différents se mobiliser pour un enjeu de politique étrangère. C'est une des raisons qui explique, à notre avis, les différences entre les deux politiques étrangères. Pour expliquer les ressemblances, plus frappantes que les différences, nous aurons recours aux variables perceptuelles, c'est-à-dire l'influence de la perception de l'environnement extérieur de la part des dirigeants, et bureaucratiques, c'est-à-dire l'influence des différentes entités bureaucratiques qui composent le gouvernement américain. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : Rwanda, Darfour, États-Unis, Génocide, Politique étrangère.

Humanitarian intervention becomes a focal point of international debate because it seems to be morally right but legally wrong. It challenges the principle of non-intervention and non-use of force encompassed in the Charter of the United Nations (UN), which was established in 1945 to prevent aggressions that led to the two world wars. However, since the 1990s, state practices of military intervention to protect human rights increased dramatically, many of which were even endorsed by the UN or in close cooperation with it. In other words, the UN is the most important, or insofar the only acceptable, body to authorize and legitimize any military operations with humanitarian rationale. This research aims at investigating the limitations of the UN in coordinating its responsibilities of maintaining peace and security and of protecting human rights. Two cases, Rwanda in 1994 and Sudan from 2003 on, are chosen as examples to probe into the practice of the UN and try to determine what has changed and what remains steadfast of the UN practice in humanitarian intervention in these ten years. By focusing on the cases of Rwanda and Sudan, this thesis is intended to address the following questions: (1) In the past decade, has the UN system become more comfortable with humanitarian intervention? (2) What are the limitations of the UN in conducting “humanitarian intervention”? What causes these limitations? And why? (3) What can be done to improve the incompetence of the UN in terms of humanitarian intervention? How to harmonize the UN’s conflicting responsibilities of upholding human rights and defending the principle of non-intervention? This research concludes that the new approach of the “responsibility to protect” that was created in recent years shows that a normative change is on the way. Besides, from Rwanda to Sudan, the UN has made progress in addressing grave humanitarian issues. However, all the efforts still have to depend on the political will of the member states of the UN. Since this issue is still more a political one than a legal one, in the years to come, the UN will still face the difficulty of fulfilling its responsibility.