Corporate Social Responsibility, Path Dependency and Cultural Influence: An Analysis of Equitable Health Insurance Schemes for Niger

Health care is essential for the wellbeing of people and the development of a country. Populations in developing countries tend to encounter challenges in accessing good healthcare which could however be improved with health insurance. This thesis investigates the reasons for the low health coverage in Niger, in the perspective of proposing equitable schemes for attaining universal coverage. The study sheds light on the low rate of health insurance coverage in the country, as at least 70 % of the population, essentially from the informal sector does not have sustainable health insurance plan. For this study, the theoretical framework of CSR, culture and path dependency of healthcare policies informed about the role of these three concepts in the development of health insurance in Niger. Critical ethnography used as the theoretical methodology enabled a close look at the explaining factors for the low coverage. Moreover, the triangulation of data collection including interviews, focus groups and questionnaires generated in depth results useful to address the research question. The analysis of the data involved a triangulation with thematic, discourse and comparison analysis for the qualitative data; while some of the quantitative data involved statistical analysis. Three prominent themes emerged from the analysis of focus groups and interviews. The theme structure of health insurance concerned the different institutions providing health insurance and their level of financial contributions to health expenditure. The theme consumption of health insurance referred to the different groups of the population and their consumption of health insurance. Results confirmed the literature as the informal sector is the largest uninsured segment in Niger. The study made a distinctive contribution by showing the impact of CSR, culture and path dependency of policies in the development of health insurance. Through praxis by combining literature and the research findings, recommendations have been made for an equitable health coverage. A mix of mechanisms for financing health insurance seems necessary to address the lack of financial resources. Then, it is important to develop health coverage for the informal sector by addressing the barriers of culture and education. Private insurance, which only covers 3% of the population, would need to extend its market through corporate social responsibility. The extension of public insurance would require a reform of policies, which would favour the development of health insurance for the informal sector. The proposed mechanisms of basket fund raising and exchange of services in particular are likely to increase the number of uninsured people from the poor segments

Awareness of Dental Team towards HIV Positive Patients in Sudan

Background: The deficit of awareness about the mode of transmission and the use of safety equipment may explain the stigma HIV positive patients faced in health care services worldwide, in particular in Sudan. The paper intends to examine the knowledge and the use of standard precaution measures by oral health professionals.Methods: A descriptive cross-sectional study was conducted in Ribat University Teaching Hospital, Sudan. A, convenient sample of 105 oral health professionals was interviewed. A self-administrated questionnaire developed in English and translated in Arabic by the author was handled to the participants. The research instrument comprised sociodemographic information, HIV knowledge, awareness towards the mode of transmission and the use of safety equipment and measures. Data were entered in Epi InfoTM 7.1.5.0 and analyzed with SPSS 21 for MS Windows (SPSS, Chicago, IL, USA). A reliability analysis of the scale of measurement based on Cronbach’s alpha method was performed to assess the quality of the answers of the participants.Results: Of the 97 participants, 50.5% had poor knowledge of HIV oral signs.  Concerning the use of safety equipment (n=105), only 29.5% were “Fully aware”. Of the 105 participants, ways of prevention of transmission were reported to be known by 94.3%. The study revealed that 59.6% of the participants (n=105) were “Fully aware” and 40.4% were “Not aware” about the appropriate measures to be taken.Conclusions: The results of the study suggested that oral health professionals lack knowledge about HIV signs and use of safety standards, these weakened their awareness. These findings had implications for continuing education for all oral health professions to incorporate evidence-based on HIV transmission and prevention

Prevalence and Clinical Presentations of Dilated Cardiomyopathy in Sudanese patients with Heart Failure.

BackgroundIdiopathic dilated cardiomyopathy (DCM) is a heart muscle disease of undefined cause that commonly presents as congestive cardiac failure. The etiology of weakness of the heart muscle is often unknown, but many causal factors had been identified. The aim of this study was to determine the prevalence and clinical presentations of dilated cardiomyopathy in Sudanese patients with heart failure.MethodA prospective hospital-based observational study was undertaken during the period of January to April 2007 in two teaching hospitals namely Academy Charity Teaching Hospital and Shaab Teaching Hospital. All patients diagnosed by the physician to have heart failure were included in the study after their well informed consent and the consent of their treating physician. A standardized questionnaire developed by the researcher was used to collect data on patients socio-demographic characteristics, results of clinical, laboratory and radiography exams. All data were analyzed through the Statistical package for Social Sciences. Significance testing of difference between proportions was conducted using the Chi-square test were applicable, adjusted by Pearson's or Fisher's exact test, depending on the number of observations, with a value corresponding to p <0.05 for significance unless otherwise.ResultsOf the 72 patients in the study, 53.0% were males and 47.0% were females. The prevalence of DCM was found to be 43.1% (31 out of 72 heart failure patients). The prevalence was higher in males than females with a prevalence of respectively 47.4% and 38.2%. There was no significant difference in gender distribution of DCM (p=0.4). DCM affected older age with a mean age of 55.4 years (SEM=2.5). Palpitations, severe grade of dyspnea (grade 3 and 4), raised jugular venous pressure and cardiomegaly were the most frequent clinical presentations. The mean ejection fraction in DCM was found to be 36.7 (SEM=1.4).ConclusionContrary to common belief among clinicians in Sudan DCM is one of the commonest causes of heart failure. Its prevalence called up a best practice among clinicians, in particular those practicing in emergency units

The geographic distribution of onchocerciasis in the 20 participating countries of the African Programme for Onchocerciasis Control:(2) pre-control endemicity levels and estimated number infected

BACKGROUND: The original aim of the African Programme for Onchocerciasis Control (APOC) was to control onchocerciasis as a public health problem in 20 African countries. In order to identify all high risk areas where ivermectin treatment was needed to achieve control, APOC used Rapid Epidemiological Mapping of Onchocerciasis (REMO). REMO involved spatial sampling of villages to be surveyed, and examination of 30 to 50 adults per village for palpable onchocercal nodules. REMO has now been virtually completed and we report the results in two articles. A companion article reports the delineation of high risk areas based on expert analysis. The present article reports the results of a geostatistical analysis of the REMO data to map endemicity levels and estimate the number infected. METHODS: A model-based geostatistical analysis of the REMO data was undertaken to generate high-resolution maps of the predicted prevalence of nodules and of the probability that the true nodule prevalence exceeds the high risk threshold of 20%. The number infected was estimated by converting nodule prevalence to microfilaria prevalence, and multiplying the predicted prevalence for each location with local data on population density. The geostatistical analysis included the nodule palpation data for 14,473 surveyed villages. RESULTS: The generated map of onchocerciasis endemicity levels, as reflected in the prevalence of nodules, is a significant advance with many new endemic areas identified. The prevalence of nodules was > 20% over an area of 2.5 million km2 with an estimated population of 62 million people. The results were consistent with the delineation of high risk areas of the expert analysis except for borderline areas where the prevalence fluctuated around 20%. It is estimated that 36 million people would have been infected in the APOC countries by 2011 if there had been no ivermectin treatment. CONCLUSIONS: The map of onchocerciasis endemicity levels has proven very valuable for onchocerciasis control in the APOC countries. Following the recent shift to onchocerciasis elimination, the map continues to play an important role in planning treatment, evaluating impact and predicting treatment end dates in relation to local endemicity levels

Progress towards onchocerciasis elimination in the participating countries of the African Programme for Onchocerciasis Control: Epidemiological evaluation results

Background: The African Programme for Onchocerciasis Control (APOC) was created in 1995 to establish community-directed treatment with ivermectin (CDTi) in order to control onchocerciasis as a public health problem in 20 African countries that had 80 % of the global disease burden. When research showed that CDTi may ultimately eliminate onchocerciasis infection, APOC was given in 2008 the additional objective to determine when and where treatment can be safely stopped. We report the results of epidemiological evaluations undertaken from 2008 to 2014 to assess progress towards elimination in CDTi areas with ≥6 years treatment. Methods: Skin snip surveys were undertaken in samples of first-line villages to determine the prevalence of O. volvulus microfilariae. There were two evaluation phases. The decline in prevalence was evaluated in phase 1A. Observed and model-predicted prevalences were compared after correcting for endemicity level and treatment coverage. Bayesian statistics and Monte Carlo simulation were used to classify the decline in prevalence as faster than predicted, on track or delayed. Where the prevalence approached elimination levels, phase 1B was launched to determine if treatment could be safely stopped. Village sampling was extended to the whole CDTi area. Survey data were analysed within a Bayesian framework to determine if stopping criteria (overall prevalence <1.4 % and maximum stratum prevalence <5 %) were met. Results: In phase 1A 127 665 people from 639 villages in 54 areas were examined. The prevalence had fallen dramatically. The decline in prevalence was faster than predicted in 23 areas, on track in another 23 and delayed in eight areas. In phase 1B 108 636 people in 392 villages were examined in 22 areas of which 13 met the epidemiological criteria for stopping treatment. Overall, 32 areas (25.4 million people) had reached or were close to elimination, 18 areas (17.4 million) were on track but required more years treatment, and in eight areas (10.4 million) progress was unsatisfactory. Conclusions: Onchocerciasis has been largely controlled as a public health problem. Great progress has been made towards elimination which already appears to have been achieved for millions of people. For most APOC countries, nationwide onchocerciasis elimination is within reach

African Program for Onchocerciasis Control 1995–2010: Impact of Annual Ivermectin Mass Treatment on Off-Target Infectious Diseases

Since its initiation in 1995, the African Program for Onchocerciasis Control (APOC) has had a substantial impact on the prevalence and burden of onchocerciasis through annual ivermectin mass treatment. Ivermectin is a broad-spectrum anti-parasitic agent that also has an impact on other co-endemic parasitic infections. In this study, we roughly assessed the additional impact of APOC activities on the burden of the most important off-target infections: soil-transmitted helminthiases (STH; ascariasis, trichuriasis, hookworm, and strongyloidiasis), lymphatic filariasis (LF), and scabies. Based on a literature review, we formulated assumptions about the impact of ivermectin treatment on the disease burden of these off-target infections. Using data on the number of ivermectin treatments in APOC regions and the latest estimates of the burden of disease, we then calculated the impact of APOC activities on off-target infections in terms of disability-adjusted life years (DALYs) averted. We conservatively estimated that between 1995 and 2010, annual ivermectin mass treatment has cumulatively averted about 500 thousand DALYs from co-endemic STH infections, LF, and scabies. This impact comprised approximately an additional 5.5% relative to the total burden averted from onchocerciasis (8.9 million DALYs) and indicates that the overall cost-effectiveness of APOC is even higher than previously reported

Impact of long-term treatment of onchocerciasis with ivermectin in Kaduna State, Nigeria: first evidence of the potential for elimination in the operational area of the African Programme for Onchocerciasis Control.

BACKGROUND: Onchocerciasis can be effectively controlled as a public health problem by annual mass drug administration of ivermectin, but it was not known if ivermectin treatment in the long term would be able to achieve elimination of onchocerciasis infection and interruption of transmission in endemic areas in Africa. A recent study in Mali and Senegal has provided the first evidence of elimination after 15-17 years of treatment. Following this finding, the African Programme for Onchocerciasis Control (APOC) has started a systematic evaluation of the long-term impact of ivermectin treatment projects and the feasibility of elimination in APOC supported countries. This paper reports the first results for two onchocerciasis foci in Kaduna, Nigeria. METHODS: In 2008, an epidemiological evaluation using skin snip parasitological diagnostic method was carried out in two onchocerciasis foci, in Birnin Gwari Local Government Area (LGA), and in the Kauru and Lere LGAs of Kaduna State, Nigeria. The survey was undertaken in 26 villages and examined 3,703 people above the age of one year. The result was compared with the baseline survey undertaken in 1987. RESULTS: The communities had received 15 to 17 years of ivermectin treatment with more than 75% reported coverage. For each surveyed community, comparable baseline data were available. Before treatment, the community prevalence of O. volvulus microfilaria in the skin ranged from 23.1% to 84.9%, with a median prevalence of 52.0%. After 15 to 17 years of treatment, the prevalence had fallen to 0% in all communities and all 3,703 examined individuals were skin snip negative. CONCLUSIONS: The results of the surveys confirm the finding in Senegal and Mali that ivermectin treatment alone can eliminate onchocerciasis infection and probably disease transmission in endemic foci in Africa. It is the first of such evidence for the APOC operational area

Stabilité d’un film viscoplastique sur un plan incliné

This thesis studies the instability of a viscoplastic film flowing down an inclined plane. The viscoplastic fluids need to exceed a minimal stress τ_y to flow. Understanding this problem makes it possible to better explain the physical mechanisms involved in the destructive power of roll-waves in mud and lava flows. Unlike for Newtonian fluids, this has not yet been accurately measured for viscoplastic flows. We cannot then compare the existing theoretical models. So, we have designed a model experimental setup. The experimental setup is a channel with a variable slope angle, in which a permanent flow of a Herschel-Bulkley fluid is established. Controlled frequency and amplitude pertubations are imposed at the entrance of the channel to generate roll waves. The spatial evolution of these waves is followed with a laser sensor at the entrance of the channel, which measures the local fluid thickness. Growth rates and cutoff frequencies are obtained after processing the thickness signal. So, we can deduce the experimental critical Reynolds and Bingham numbers. The experimental results show that the model of ordre 0 in ε of Balmforth and Liu (2004) well describes the stability threshold. However, this does not work for dispersion effects. Highers orders in ε seems necessary. An extension has been carried out up to order 1 in ε . This study shows that the Balmforth's model tends to overestimate the stability thresholds. This effect is more important for higth power indices n . Finally, an exploratory study on the nonlinear regime of a visco-plastic film shows results similar to those of Newtonian fluids, notably amplitude saturation, wave front stiffening and coalescenceCette thèse s'intéresse à la stabilité de l'écoulement d'un film viscoplastique sur un plan incliné. Ce type de fluides présente la particularité de ne pouvoir s'écouler que lorsqu'on applique une contrainte supérieure à une contrainte seuil τ_y. L'étude de ce problème permet notamment de mieux appréhender les phénomènes physiques liés à l'apparition d'ondes de surfaces que nous rencontrons par exemple lors des coulées de boue, pouvant entrainer des effets encore plus ravageurs. Contrairement aux fluides newtoniens, les conditions de stabilité des films viscoplastique n'ont pas été étudiées précisément sur le plan expérimental ce qui ne permet pas de confronter les théories. Pour pallier ce manque, nous avons mis en œuvre un dispositif expérimental. Il s'agit d'un canal d'angle variable, dans lequel un écoulement permanent de fluide de Herschel-Bulkley est établi. Des perturbations avec des fréquences et des amplitudes contrôlées sont imposées à l'entrée du canal pour générer des ondes de surface. L'évolution spatiale des ondes est suivie avec un télémètre laser, pour mesurer l'épaisseur locale du film. Les taux de croissance et les fréquences neutres sont obtenus après traitement du signal donnant l'épaisseur du film le long du canal. Il est alors possible de déduire des nombres de Reynolds et de Bingham critiques. Nos expériences montrent que le modèle de Balmforth et Liu (2004), d'ordre 0 en ε (le rapport d'aspect entre l'épaisseur du film et sa longueur caractéristique) décrit bien les seuils de stabilité. Cependant, il est insuffisant pour décrire les effets de dispersion pour lesquels des ordres supérieurs en ε sont nécessaires. Un prolongement du développement de Balmforth et Liu (2004) a été réalisé à l'ordre 1 en ε. Ce développement montre que le modèle de Balmforth et Liu (2004) surestime légèrement les seuils de stabilité et que la correction augmente avec l'indice rhéologique n. Ce modèle permet également d'obtenir des résultats numériques concernant les effets de dispersion systématiquement plus proches des expériences, même si ces derniers s'avèrent encore insuffisants pour décrire le comportement expérimental. Enfin, une étude exploratoire sur le régime non-linéaire montre des comportements similaires à ceux de fluides newtoniens, à savoir une saturation de l'amplitude, un raidissement du front des ondes et une transition supercritique vers le régime non-linéaire

Stability of a visco-plastic film down an inclined plane

Cette thèse s'intéresse à la stabilité de l'écoulement d'un film viscoplastique sur un plan incliné. Ce type de fluides présente la particularité de ne pouvoir s'écouler que lorsqu'on applique une contrainte supérieure à une contrainte seuil τ_y. L'étude de ce problème permet notamment de mieux appréhender les phénomènes physiques liés à l'apparition d'ondes de surfaces que nous rencontrons par exemple lors des coulées de boue, pouvant entrainer des effets encore plus ravageurs. Contrairement aux fluides newtoniens, les conditions de stabilité des films viscoplastique n'ont pas été étudiées précisément sur le plan expérimental ce qui ne permet pas de confronter les théories. Pour pallier ce manque, nous avons mis en œuvre un dispositif expérimental. Il s'agit d'un canal d'angle variable, dans lequel un écoulement permanent de fluide de Herschel-Bulkley est établi. Des perturbations avec des fréquences et des amplitudes contrôlées sont imposées à l'entrée du canal pour générer des ondes de surface. L'évolution spatiale des ondes est suivie avec un télémètre laser, pour mesurer l'épaisseur locale du film. Les taux de croissance et les fréquences neutres sont obtenus après traitement du signal donnant l'épaisseur du film le long du canal. Il est alors possible de déduire des nombres de Reynolds et de Bingham critiques. Nos expériences montrent que le modèle de Balmforth et Liu (2004), d'ordre 0 en ε (le rapport d'aspect entre l'épaisseur du film et sa longueur caractéristique) décrit bien les seuils de stabilité. Cependant, il est insuffisant pour décrire les effets de dispersion pour lesquels des ordres supérieurs en ε sont nécessaires. Un prolongement du développement de Balmforth et Liu (2004) a été réalisé à l'ordre 1 en ε. Ce développement montre que le modèle de Balmforth et Liu (2004) surestime légèrement les seuils de stabilité et que la correction augmente avec l'indice rhéologique n. Ce modèle permet également d'obtenir des résultats numériques concernant les effets de dispersion systématiquement plus proches des expériences, même si ces derniers s'avèrent encore insuffisants pour décrire le comportement expérimental. Enfin, une étude exploratoire sur le régime non-linéaire montre des comportements similaires à ceux de fluides newtoniens, à savoir une saturation de l'amplitude, un raidissement du front des ondes et une transition supercritique vers le régime non-linéaire.This thesis studies the instability of a viscoplastic film flowing down an inclined plane. The viscoplastic fluids need to exceed a minimal stress τ_y to flow. Understanding this problem makes it possible to better explain the physical mechanisms involved in the destructive power of roll-waves in mud and lava flows. Unlike for Newtonian fluids, this has not yet been accurately measured for viscoplastic flows. We cannot then compare the existing theoretical models. So, we have designed a model experimental setup. The experimental setup is a channel with a variable slope angle, in which a permanent flow of a Herschel-Bulkley fluid is established. Controlled frequency and amplitude pertubations are imposed at the entrance of the channel to generate roll waves. The spatial evolution of these waves is followed with a laser sensor at the entrance of the channel, which measures the local fluid thickness. Growth rates and cutoff frequencies are obtained after processing the thickness signal. So, we can deduce the experimental critical Reynolds and Bingham numbers. The experimental results show that the model of ordre 0 in ε of Balmforth and Liu (2004) well describes the stability threshold. However, this does not work for dispersion effects. Highers orders in ε seems necessary. An extension has been carried out up to order 1 in ε . This study shows that the Balmforth's model tends to overestimate the stability thresholds. This effect is more important for higth power indices n . Finally, an exploratory study on the nonlinear regime of a visco-plastic film shows results similar to those of Newtonian fluids, notably amplitude saturation, wave front stiffening and coalescenc