Evaluation of factors affecting adherence to asthma controller therapy in chest clinics in a sub-Saharan African setting: a cross-sectional study

Background: Adherence to controller therapy in asthma is a major concern during the management of the disease. Objective: To determine the adherence rate and identify the predictors of low adherence to asthma controller therapy. Methods: A cross-sectional study including asthma patients was conducted from November 1, 2012 to May 31, 2013 in 4 chest clinics in Cameroon. The adherence to asthma treatment was rated using Morisky Medication Adherence Scale. A multivariate logistic regression analysis was performed for the identification of factors associated with adherence to asthma treatment. Results: Among the 201 asthma patients included, 133 (66.2%) were female. The mean age of participants was 41.2 years. Sixty-one (30.3%) of the patients did not visit the chest physician during the last year prior to the study. Asthma was well controlled in 118 patients (58.7%). The prevalence of low adherence rate to asthma controller therapy was 44.8% and the absence of any chest specialist visit within the last 12 months was the only factor associated with the low adherence rate to asthma treatment (OR 5.57 ; 95% CI 2.84–10.93). Conclusion: The adherence rate to asthma controller therapy in Cameroon is low and it could be improved if scheduled visits are respected by patients.

Polio eradication efforts in regions of geopolitical strife: the Boko Haram threat to efforts in sub-Saharan Africa.

The World Health Organization aims to eradicate wild poliovirus worldwide by the end of 2018. Cameroon and Nigeria, neighboring countries, have been affected by the terrorist and militant activities of the Islamist sect Boko Haram. Impacted regions are mainly the far North of Cameroon and Northern Nigeria. Targets of Boko Haram aggression in these zones include violence against polio workers, disruption of polio immunization campaigns, with consequent reduced access to health care and immunization. In addition to this significant problem, Northern Nigeria has historically seen rejection of polio virus vaccine initiatives. It remains to know how health systems can continue operations against polio in areas where Boko Haram operates. If appropriate measures are not urgently taken, it will be not possible to meet the 2018 goal of polio virus eradication. The response should include specialized immunization activities in conflict zones, will engagement of leaders. Countries should also explore immunization activities by soldiers and military personnel.

Review: Head and neck squamous cell carcinoma in sub-Saharan Africa

Aim Review the literature from 1990 to 2013 to determine known anatomic sites, risk factors, treatments, and outcomes of head and neck squamous cell carcinoma (HNSCC) in sub-Saharan Africa. Methods Using a systematic search strategy, literature pertaining to HNSCC in sub-Saharan Africa was reviewed and patient demographics, anatomic sites, histology, stage, treatment, and outcomes were abstracted. The contributions of human immunodeficiency virus (HIV), human papillomavirus (HPV) and behavioural risk factors to HNSCC in the region were assessed. Results Of the 342 papers identified, 46 were utilized for review, including 8611 patients. In sub-Saharan Africa, the oropharyngeal/oral cavity was found to be the most common site, with 7750 cases (90% of all cases). Few papers distinguished oropharyngeal from oral cavity, making identification of possible HPV-associated oropharyngeal squamous cell carcinoma (SCC) difficult. SCC of the nasopharynx, nasal cavity, or paranasal sinuses was identified in 410 patients (4.8% of all cases). Laryngeal SCC was found in 385 patients (4.5% of all cases), and only 66 patients (0.8% of all cases) with hypopharyngeal SCC were identified. In 862 patients with data available, 43% used tobacco and 42% used alcohol, and reported use varied widely and was more common in laryngeal SCC than that of the oropharyngeal/oral cavity. Toombak and kola nut use was reported to be higher in patients with HNSCC. Several papers reported HIV-positive patients with HNSCC, but it was not possible to determine HNSCC prevalence in HIV-positive compared to negative patients. Reports of treatment and outcomes were rare. Conclusions The oropharyngeal/oral cavity was by far the most commonly reported site of HNSCC reported in sub-Saharan Africa. The roles of risk factors in HNSCC incidence in sub-Saharan Africa were difficult to delineate from the available studies, but a majority of patients did not use tobacco and alcohol.

Police Legitimacy in Sub-Saharan Africa

Is fairness in process and outcome a generalizable driver of police legitimacy? In many industrialized nations, studies have demonstrated that police legitimacy is largely a function of whether citizens perceive treatment as normatively fair and respectful. Questions remain whether this model holds in less-industrialized contexts, where corruption and security challenges favor instrumental preferences for effective crime control and prevention. Support for and against the normative model of legitimacy has been found in less-industrialized countries, yet few have simultaneously compared these models across multiple industrializing countries. Using a multilevel framework and data from respondents in 27 countries in sub-Saharan Africa (n~43,000), I find evidence for the presence of both instrumental and normative influences in shaping the perceptions of police legitimacy. More importantly, the internal consistency of legitimacy (defined as obligation to obey, moral alignment, and perceived legality of the police) varies considerably from country to country, suggesting that relationships between legality, morality, and obligation operate differently across contexts. Results are robust to a number of different modeling assumptions and alternative explanations. Overall, the results indicate that both fairness and effectiveness matter, not in all places, and in some cases contrary to theoretical expectations.

Determining conservation priority areas for Palearctic passerine migrant birds in sub-Saharan Africa

Migratory bird species breeding in the Palearctic and overwintering in sub-Saharan Africa face multiple conservation challenges. As a result, many of these species have declined in recent decades, some dramatically. We therefore used the best available database for the distribution of 68 passerine migrants in sub-Saharan Africa to determine priority regions for their conservation. After modeling each species’ distribution using BIOMOD software, we entered the resulting species distributions at a 1° × 1° grid resolution into MARXAN software. We then used several different selection procedures that varied the boundary length modifier, species penalty factor, and the inclusion of grid cells with high human footprint and with protected areas. While results differed between selection procedures, four main regions were regularly selected: (1) one centered on southern Mali; (2) one including Eritrea, central Sudan, and northern Ethiopia; (3) one encompassing southwestern Kenya and much of Tanzania and Uganda; and (4) one including much of Zimbabwe and southwestern Zambia. We recommend that these four regions become priority regions for research and conservation efforts for the bird species considered in this study.

HIV-related discrimination in Sub-Sahran Africa: Explanatory characteristics and consequences on employment and HIV-testing

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and Economics

Saharan eteläpuolisen Afrikan suoriutuminen globaalin talouskriisin aikana

Saharan eteläpuolinen Afrikka on kokenut monia talouskriisejä. Kuitenkin ne talouskriisit, jotka eivät lähde tai pääosin koske Saharan eteläpuolista Afrikkaa, voivat tarjota sille tilaisuuksia. SSA ei yleisen käsityksen mukaan osallistu täysipainoisesti maailmankauppaan, joten se ei välttämättä kykene tarttumaan kaikkiin tilaisuuksiinsa.

High prevalence of the GSTM3*A/B polymorphism in sub-Sarahan African populations

A 3-bp insertion/deletion polymorphism in intron 6 of GSTM3 (rs1799735, GSTM3*A/*B) affects the activity of the phase 2 xenobiotic metabolizing enzyme GSTM3 and has been associated with increased cancer risk. The GSTM3*B allele is rare or absent in Southeast Asians, occurs in 5-20% of Europeans but was detected in 80% of Bantu from South Africa. The wide genetic diversity among Africans led us to investigate whether the high frequency of GSTM3*B prevailed in other sub-Saharan African populations. In 168 healthy individuals from Angola, Mozambique and the São Tomé e Príncipe islands, the GSTM3*B allele was three times more frequent (0.74-0.78) than the GSTM3*A allele (0.22-0.26), with no significant differences in allele frequency across the three groups. We combined these data with previously published results to carry out a multidimensional scaling analysis, which provided a visualization of the worldwide population affinities based on the GSTM3 *A/*B polymorphism.

Comportements sexuels chez les adolescents en Afrique sub-Saharienne : l’exemple du Burkina Faso, du Ghana, du Malawi et de l’Ouganda

On s’accorde à dire que les adolescents constituent l’avenir quel que soit le temps et l’espace considéré. Il est également reconnu que le développement de leur capital humain et social, nécessaire pour une vie adulte de qualité, dépend des conditions dans lesquelles ils vivent et de l’environnement dans lequel s’opérera la transition vers cette vie adulte. Plus que dans toute autre partie du monde, ce constat est encore plus d’actualité en Afrique sub-Saharienne où, à la situation socio-économique déjà précaire, s’ajoutent d’importants problèmes de santé sexuelle et reproductive auxquels font face les adolescents en particulier le VIH. Conscients de l’enjeu majeur que représente la santé des adolescents, les gouvernements en Afrique sub-Saharienne, aidés en cela par les organismes non-gouvernementaux et toute la communauté internationale, ont inscrit la promotion de stratégies efficientes en santé sexuelle et reproductive des adolescents comme haute priorité dans leurs agendas. Mais force est de constater que l’élaboration et la mise en œuvre de telles stratégies supposent la production de connaissances sans cesse actualisées ainsi que la formulation de politiques innovatrices basées sur des données probantes et éprouvées en matière de santé sexuelle et reproductive, ce qui n’est pas toujours le cas. De plus, le fait que ce segment particulier de la population ne constitue pas un groupe homogène pose un défi supplémentaire quant à l’élaboration de stratégies généralisables. Fort de ce qui précède, le présent travail, qui porte sur le Burkina Faso, le Ghana, le Malawi et l’Ouganda, fait d’abord le point sur les problèmes majeurs de santé sexuelle et reproductive auxquels fait face cette frange spécifique de la population, tout en jetant un regard critique sur les efforts déployés par les sciences sociales pour les analyser. Il apporte ensuite des réponses à des questions spécifiques de recherche que nous nous sommes posées à travers les trois articles qui constituent l’ossature de cette thèse et dont l’essentiel de l’analyse empirique peut être résumé comme suit : Dans le premier article, nous sommes partis du constat suivant : dans les quatre pays étudiés, une importante proportion des adolescents qui se déclarent non encore sexuellement actifs pensent paradoxalement que leurs chances de contracter le VIH sont très grandes. Face à un tel constat, la question que l’on est en droit de se poser est celle de savoir pourquoi sont-ils si préoccupés? Quels sont les facteurs qui déterminent cette perception du risque? Les résultats confirment ce que certaines études ont déjà démontré à savoir que les individus élaborent leur propre définition du risque qui peut ne pas se résumer nécessairement à une opposition binaire «risque/aucun risque», mais est plutôt fonction des caractéristiques individuelles mais aussi du contexte social et épidémiologique dans lesquels ils vivent. Le deuxième article de la thèse analyse le contexte dans lequel s’opère la transition vers le premier rapport sexuel chez les adolescentes des quatre pays étudiés. Il part du constat selon lequel les recherches ont très souvent abordé les comportements sexuels des adolescents sous un angle marqué par la dichotomie entre les «sexuellement actifs» et les «non encore sexuellement actifs». Or le calendrier de l’entrée en sexualité et le contexte dans lequel elle a lieu (dans l’union ou hors union) sont non seulement des marqueurs des comportements sexuels à risque vis-à-vis du VIH, mais ils conditionnent aussi et surtout la qualité de la transition vers l’entrée dans la vie adulte. Les résultats montrent ici également que le contrôle parental est significativement associé à une faible probabilité pour les adolescents d’initier la sexualité hors de l’union. Quant au troisième article, il se penche sur un cas précis de comportement à risques chez les adolescents: le multipartenariat sexuel aggravé par la non utilisation systématique du condom, pourtant le seul moyen pour l’instant (en dehors de l’abstinence) de se protéger contre les infections sexuellement transmissibles et le VIH/SIDA. Les résultats montrent entre autres que le contrôle parental est significativement associé à une faible probabilité de comportement sexuel à risque, défini ici comme étant la co-occurrence de plusieurs partenaires sexuels au cours de 12 derniers mois et la non-utilisation systématique du condom avec chacun des partenaires. Sur un plan programmatique, ce résultat est plutôt encourageant car il prouve que l’autorité parentale jadis considérée comme érodée, demeure une pierre angulaire dans les stratégies de prévention du VIH chez les adolescents.

Nachhaltige Energie für ländliche Entwicklung in dem Sub-Sahara Afrika: interdisziplinäre Herangehensweise und organisatorische Herausforderung

Angesichts der Geschichte der Entwicklungspolitik, ist diese Arbeit darauf ausgerichtet, einige Beobachtungen in Bezug auf die so genannte Entwicklung hervorzuheben; insbesondere auf die andauernde prekäre Situation und Armut in ländlichen afrikanischen Gebieten. Armut ist nach Amartya SEN – weiter präzisiert von J.L. Dubois – die Deprivation von „Fähigkeiten“, die Individuen und lokale Gemeinschaften zu ausgeschlossenen und vergessenen Akteuren des Systems machen. Das nennt Paulo Freire, das Menschen zu „Objekten“ gemacht werden. Es rechtfertigt die starke Annahme, die in dieser Studie getroffen wird, dass vielmehr die Menschen als „Subjekte“ ihrer Veränderung und Entwicklung im Mittelpunkt stehen. Die Arbeit zeigt und erklärt in historischer Chronologie, wie die Entwicklungspolitiken und unterschiedliche Beteiligte auf allen Ebenen diese Situation verursachen. Trotz alledem bleiben die Individuen und lokalen Gemeinschaften, die in Symbiose mit ihrer natürlichen Umwelt leben, die reich an verschiedenen Ressourcen und Potentialen ist, als Reaktion darauf und gleichzeitig als Überlebensstrategie zutiefst verbunden mit dem, was sie vor Ort haben, womit sie eine tiefere und intensive Beziehung besitzen, wenn man von ihrer Geschichte, ihrer Kultur und der Handlungslogik ausgeht. Für externe Akteure, die sie über das vorhandene System dominieren und beeinflussen bleiben sie „Objekte“, aber in der Vielzahl ihrer endogenen Initiativen, zeigen sie die Fähigkeit und Substanz, die beweisen, dass sie auf ihrer Ebene das eigentliche Subjekt sind, die dynamischen Akteure. Aber isolierte Initiativen auf spezifische reale Bedürfnisse bei gleichzeitiger Dominierung durch das System mit seiner Marktlogik, führt dies langfristig nur zu dem Zirkulus Vitiosus der Armut. Daher ist eine ganzheitliche Sicht entscheidend für nachhaltige Entwicklung und für die notwendige Veränderung. Es geht nicht nur um die Veränderung des Systems und die Wahl politischer Maßnahmen, sondern genau genommen um das Verhalten der Akteure auf allen Ebenen und die Art der Beziehungen zwischen ihnen allen. Es ist eine Frage des erneuten Überdenkens des Entwicklungspfades, der andere Logik, Visionen, Interessen und Strategien aller Beteiligten, unserer so genannten Akteure einschließt. Ob dies von endogenen Initiativen oder neuen gemeinsamen Projekten ausgeht: man wird in einen Prozess kollektiven Lernens eintreten, den Paul Singer und Clarita Müller-Plantenberg erläutern und entwickeln in dem Konzept der Inkubation und Solidarischen Ökonomie, die Eigeninitiative, Selbstbestimmung und Selbstverwaltung von lokalen Gemeinschaften und die Öffnung für eine Neu-Konzeptualisierung und Institutionalisierung einschließt. So ein Prozess ist nur mit einem interdisziplinären Rahmen möglich. Dieser Rahmen soll auf einer zusätzlicher Kommunikation zwischen den Akteuren und Sozialwissenschaften beruhen und mit jenen, die auf dem Feld der Technologie arbeiten. So können dann technische „Experten“ angesichts eines technischen Projektfehlers, der aufgrund von bestimmten sozialen und kulturellen Realitäten zustande kam sagen, „es ist kein Scheitern ; es war ein Schritt innerhalb eines Lernprozesse der in die technischen Projekte und Studien einbezogen werden muss“. Wir haben das Energiethema gewählt; und insbesondere, Energie für eine nachhaltige ländliche Entwicklung in Subsahara-Afrika, um den Weg von der Theorie in die Praxis zu illustrieren und experimentell auszuprobieren, den Weg von den Beobachtungen zu der Veränderung, wobei Fragen, Annahmen, Strategien und konkrete Aktionen für den Wandel behandelt werden. Wir nennen unseren experimentellen Weg: DRIEE, das heißt auf Deutsch Ländliche Entwicklung und Inkubation von Energieunternehmen. Dabei gehen wir davon aus, dass: - Energie im Allgemeinen auf der internationalen Ebene fast gleichbedeutend mit Elektrizität ist. Heute bestehen die wichtigsten Bedürfnisse nach Energie dort wo die agro-pastorale Produktion, das Kochen, die Nahrungsmittelkonservierung und Verarbeitung …etc. stattfindet. - Diese ländliche Bevölkerung zu etwa 80% der nationalen Wirtschaft ausmacht. Dass sie gleichzeitig aber nur zu weniger als 5% der Energieproduktion Zugang hat, was oft auf Licht reduziert ist und nicht einmal ihrer Produktion zugute kommen kann. - Die Projekte für Energie und Elektrizität vor allem auf die Technologischen Fragen konzentriert sind und weniger auf die Bedürfnisse. Fast die Gesamtheit der Fonds für Energie wird in Bezug auf die Investitionen Infrastruktur der Produktion und Verteilung durch die konventionellen zentralisierten Netze geplant. Angesichts dieser Analysen gehen die in dieser Arbeit vorgenommenen Studien in Gambia und Kamerun von Bestandsaufnahmen und / oder beschreibenden regionalen Analysen aus: - von Bedürfnissen, von Praktiken und lokalen Initiativen von Fragen der Energie, für einzelne Professionen, Haushalte, Gruppen, spezifische Gruppen, wie Frauen, ländliche Gemeinden mit ihren spezifischen Charakteristika. - Von Potentialen: natürliche lokale Energieressourcen, soziokulturelle Ressourcen – so z.B. die empirisch feststellbaren menschliche Ressourcen wie endogenes Wissen und praktische organisatorische Fähigkeiten gegenüber den Problemen der Energie. Dieser experimentelle Schritt von Handlungsforschung (DRIEE) in Kamerun führte zu der Gründung einer Organisation, über die und mit der wir die Logik der Inkubation und Solidarischen Ökonomie einführen. Das ist FERDEDSI, das heißt auf Deutsch „Forum für Erneuerbare Energie – Nachhaltige Entwicklung und Internationale Solidarität“. Zunächst war dies eine Energiegenossenschaft und dann (im Prozess) wurde es zu einer institutionellen Nische von mehreren Mikro Initiativen in ländlichen Gebieten. FERDEDSI ist ein Prozess der Inkubation und ein Inkubator ist also gleichzeitig ein inkubiertes Energieunternehmen aber auch ein Inkubator für lokale Organisationen. Die ersten Aktionen finden in den Departments von Noun und Ménoua in der westlichen Provinz von Kamerun statt. Während der Forschungsperiode findet akademische Austausch statt (Nord-Süd und Süd-Süd), diese ist dabei zu formalen Partnerschaften zu werden, nicht nur zwischen Universitäten sondern genauer lokale Organisationen und Universitäten. Dieser letzte Typ von Partnerschaften, die die solidarische Ökonomie ausmachen ist auch eine Innovation des Prozesses für die afrikanischen Fälle, die dem Beispiel dessen, was in Lateinamerika geschieht, folgen. So kommt es zu gegenseitiger sinnvoller Ausbildung in den internationalen Arbeitsgruppen und Seminaren der Universität.

The role of ligneous vegetation for livestock nutrition in the sub-Sahelian and Sudanian zones of West Africa: Potential effects of climate change

Climate change and variability in sub-Saharan West Africa is expected to have negative consequences for crop and livestock farming due to the strong dependence of these sectors on rainfall and natural resources, and the low adaptive capacity of crops farmers, agro-pastoralist and pastoralists in the region. The objective of this PhD research was to investigate the anticipated impacts of expected future climate change and variability on nutrition and grazing management of livestock in the prevailing extensive agro-pastoral and pastoral systems of the Sahelian and Sudanian zones of Burkina Faso. To achieve this, three studies were undertaken in selected village territories (100 km² each) in the southern Sahelian (Taffogo), northern Sudanian (Nobere, Safane) and southern Sudanian (Sokouraba) zone of the country during 2009 and 2010. The choice of two villages in the northern Sudanian zone was guided by the dichotomy between intense agricultural land use and high population density near Safane, and lower agricultural land use in the tampon zone between the village of Nobere and the National Park Kaboré Tambi of Pô. Using global positioning and geographical information systems tools, the spatio-temporal variation in the use of grazing areas by cattle, sheep and goats, and in their foraging behaviour in the four villages was assessed by monitoring three herds each per species during a one-year cycle (Chapter 2). Maximum itinerary lengths (km/d) were observed in the hot dry season (March-May); they were longer for sheep (18.8) and cattle (17.4) than for goats (10.5, p<0.05). Daily total grazing time spent on pasture ranged from 6 - 11 h with cattle staying longer on pasture than small ruminants (p<0.05). Feeding time accounted for 52% - 72% of daily time on pasture, irrespective of species. Herds spent longer time on pasture and walked farther distances in the southern Sahelian than the two Sudanian zones (p<0.01), while daily feeding time was longer in the southern Sudanian than in the other two zones (p>0.05). Proportional time spent resting decreased from the rainy (June - October) to the cool (November - February) and hot dry season (p<0.05), while in parallel the proportion of walking time increased. Feeding time of all species was to a significantly high proportion spent on wooded land (tree crown cover 5-10%, or shrub cover >10%) in the southern Sahelian zone, and on forest land (tree crown cover >10%) in the two Sudanian zones, irrespective of season. It is concluded that with the expansion of cropland in the whole region, remaining islands of wooded land, including also fields fallowed for three or more years with their considerable shrub cover, are particularly valuable pasturing areas for ruminant stock. Measures must be taken that counteract the shrinking of wooded land and forests across the whole region, including also active protection and (re)establishment of drought-tolerant fodder trees. Observation of the selection behaviour of the above herds of cattle and small ruminant as far as browse species were concerned, and interviews with 75 of Fulani livestock keepers on use of browse as feed by their ruminant stock and as remedies for animal disease treatment was undertaken (Chapter 3) in order to evaluate the consequence of climate change for the contribution of browse to livestock nutrition and animal health in the extensive grazing-based livestock systems. The results indicated that grazing cattle and small ruminants do make considerable use of browse species on pasture across the studied agro-ecological zones. Goats spent more time (p<0.01) feeding on browse species than sheep and cattle, which spent a low to moderate proportion of their feeding time on browsing in any of the study sites. As far as the agro-ecological zones were concerned, the contribution of browse species to livestock nutrition was more important in the southern Sahelian and northern Sudanian zone than the southern Sudanian zone, and this contribution is higher during the cold and hot dry season than during the rainy season. A total of 75 browse species were selected on pasture year around, whereby cattle strongly preferred Afzelia africana, Pterocarpus erinaceus and Piliostigma sp., while sheep and goats primarily fed on Balanites aegyptiaca, Ziziphus mauritiana and Acacia sp. Crude protein concentration (in DM) of pods or fruits of the most important browse species selected by goats, sheep and cattle ranged from 7% to 13% for pods, and from 10% to 18% for foliage. The concentration of digestible organic matter of preferred browse species mostly ranged from 40% to 60%, and the concentrations of total phenols, condensed tannins and acid detergent lignin were low. Linear regression analyses showed that browse preference on pasture is strongly related to its contents (% of DM) of CP, ADF, NDF and OM digestibility. Interviewed livestock keepers reported that browse species are increasingly use by their grazing animals, while for animal health care use of tree- and shrub-based remedies decreased over the last two decades. It is concluded that due to climate change with expected negative impact on the productivity of the herbaceous layer of communal pastures browse fodder will gain in importance for animal nutrition. Therefore re-establishment and dissemination of locally adapted browse species preferred by ruminants is needed to increase the nutritional situation of ruminant stock in the region and contribute to species diversity and soil fertility restoration in degraded pasture areas. In Chapter 4 a combination of household surveys and participatory research approaches was used in the four villages, and additionally in the village of Zogoré (southern Sahelian zone) and of Karangasso Vigué (northern Sudanian zone) to investigate pastoralists’ (n= 76) and agro-pastoralists’ (n= 83) perception of climate change, and their adaptation strategies in crop and livestock production at farm level. Across the three agro-ecological zones, the majority of the interviewees perceived an increase in maximum day temperatures and decrease of total annual rainfall over the last two decades. Perceptions of change in climate patterns were in line with meteorological data for increased temperatures while for total rainfall farmers’ views contrasted the rainfall records which showed a slight increase of precipitation. According to all interviewees climate change and variability have negative impacts on their crop and animal husbandry, and most of them already adopted some coping and adaptation strategies at farm level to secure their livelihoods and reduce negative impacts on their farming system. Although these strategies are valuable and can help crop and livestock farmers to cope with the recurrent droughts and climate variability, they are not effective against expected extreme climate events. Governmental and non-governmental organisations should develop effective policies and strategies at local, regional and national level to support farmers in their endeavours to cope with climate change phenomena; measures should be site-specific and take into account farmers’ experiences and strategies already in place.

Santé et mortalité en Afrique sub-saharienne francophone : introduction à l’édition spéciale

This introduction underlies the specificities of the health transition that is underway in Francophone Africa to place the special issue in context. It also presents the different contributions collected in this issue and outlines new research directions suggested by these papers.

Infertility Care And The Introduction Of New Reproductive Technologies In Poor Resource Settings.

The overall prevalence of infertility was estimated to be 3.5-16.7% in developing countries and 6.9-9.3% in developed countries. Furthermore, according to reports from some regions of sub-Saharan Africa, the prevalence rate is 30-40%. The consequences of infertility and how it affects the lives of women in poor-resource settings, particularly in developing countries, has become an important issue to be discussed in reproductive health. In some societies, the inability to fulfill the desire to have children makes life difficult for the infertile couple. In many regions, infertility is considered a tragedy that affects not only the infertile couple or woman, but the entire family. This is a position paper which encompasses a review of the needs of low-income infertile couples, mainly those living in developing countries, regarding access to infertility care, including ART and initiatives to provide ART at low or affordable cost. Information was gathered from the databases MEDLINE, CENTRAL, POPLINE, EMBASE, LILACS, and ICTRP with the key words: infertility, low income, assisted reproductive technologies, affordable cost, low cost. There are few initiatives geared toward implementing ART procedures at low cost or at least at affordable cost in low-income populations. Nevertheless, from recent studies, possibilities have emerged for new low-cost initiatives that can help millions of couples to achieve the desire of having a biological child. It is necessary for healthcare professionals and policymakers to take into account these new initiatives in order to implement ART in resource-constrained settings.

Factors associated with sexual initiation and condom use among adolescents on Santiago Island, Cape Verde, West Africa

Foram analisados fatores associados ao início da vida sexual de adolescentes na Ilha de Santiago, Cabo Verde, segundo sexo. Estudo realizado com amostra probabilística e representativa de 768 adolescentes, age 13-17 anos, de escolas secundárias públicas da Ilha de Santiago em 2007. A associação foi testada pelo teste de proporção, qui-quadrado de Pearson ou Fisher e regressão logística. Nos rapazes, os fatores associados ao início da vida sexual foram: idade maior que 14 anos, ser católico e consumo de bebidas alcoólicas. Para meninas: escolaridade maior que nove anos e ter parceiro afetivo-sexual. Ao contrário de outros contextos da África Subsaariana, foram constatadas taxas elevadas de uso de preservativo por adolescentes no início da vida sexual. Os adolescentes podem iniciar a vida sexual de maneira mais segura se tiverem informação, educação sexual e acesso a métodos de prevenção à gravidez e às DST. Este artigo oferece elementos para a reflexão sobre o delineamento de políticas de redução da vulnerabilidade dos jovens às DST/AIDS e sobre os limites e desafios da promoção do uso do preservativo e educação sexual, focando as relações desiguais de gênero