Suchergebnisse

Human activity has transformed the planet at a pace and scale unprecedented in recorded history, causing irreversible damage to communities and ecosystems. Countries have focused their capacities on economic growth, with too little attention to externalities in terms of environmental quality. The world will not avoid catastrophic warming unless wealthy nations accelerate their reduction of own emissions and help poorer countries to do the same. North America and Europe have contributed 62% of carbon dioxide emissions since the industrial revolution, while Africa has contributed only 3%. However, it is in sub-Saharan Africa (SSA) that the impacts are most severe and the people most vulnerable. Developed countries, in their own interests, should focus on ways to help developing countries phase out fossil fuels and transition to renewable energy. However, there are tensions between richer and poorer nations over who should pay the costs of global warming. Rich countries have a responsibility to act more quickly than their low-income counterparts. Yet governments continue to subsidise the use of fossil fuels, and banks and companies still invest more in polluting industries than in climate solutions. The consumption habits of the richest 10% of people generate three times more pollution than those of the poorest 50%. Emerging economies such as China and India, which plan to achieve net-zero emissions by 2060 and 2070 respectively, should join the developed world in accelerating emissions reductions. It is not just the way we produce and use energy that needs to change quickly. It's the way we consume food, the way we protect nature. It's everything, everywhere, all at once. The agricultural sector is particularly vulnerable, especially in SSA countries where agriculture is central to the economy. Among the top eight countries with the highest cumulative net emissions from agriculture, forestry and other land use are two SSA countries, Nigeria and DR Congo. Most of these emissions are embodied in trade and are caused by consumption in regions such as Europe, the United States and China. The establishment of the Loss and Damage Fund agreed at COP27 will not be enough to turn the tide, nor will it necessarily translate into climate finance commitments, given the lack of progress in delivering the promised US$100 billion in annual climate finance from rich countries. African countries themselves need to reflect on their own strengths and step up their efforts in a timely and substantial way.

Objective: We examined the divergent patterns, prevalence and correlates of contraceptive use among parenting adolescents in sub-Saharan Africa using the Demographic and Health Survey datasets of 17 countries. Design: We included a weighted sample of 9488 parenting adolescent girls in our analysis. Current contraceptive use was defined as the use of any methods to delay or avoid getting pregnant at the survey time. We reported the prevalence of any contraceptive use for all countries and used multilevel binary logistic regression analysis to examine the individual and contextual factors associated with contraceptive use. Outcome measures: Contraceptive use. Results: We found an overall contraceptive prevalence of 27.12% (CI 27.23% to 28.03%) among parenting adolescent girls in sub-Saharan Africa, ranging from 70.0% (CI 61.76% to 77.16%) in South Africa to only 5.10% (CI 3.04% to 8.45%) in Chad. The prevalence of contraceptive use was lowest in West andCentral Africa, with most countries having less than 20% prevalence. Increasing age (adjusted OR (aOR)=1.46, 95% CI 1.28 to 1.65), being married (aOR=1.63, 95% CI 1.43 to 1.87), having a secondary or higher level of education (aOR=2.72, 95% CI 2.25 to 2.3.27), and media exposure (aOR=1.21, 95% CI 1.08 to 1.36), were associated with higher odds of contraceptive use in the pooled data but preference for a higher number of children (more than five children) (aOR=0.61, 95% CI 0.52 to 0.72) was related to lower likelihood of use. Significant heterogeneity was observed in the country-level disaggregated results. Conclusion: African countries differ widely when it comes to contraceptive use among parenting adolescent girls, with only three countries having a relatively high prevalence of use. The governments of countries in sub-Saharan Africa, particularly those in West and Central Africa, should invest in expanding access to contraceptives for adolescent mothers to prevent repeat pregnancy and improve the overall well-being of parenting adolescent girls.

Sub-saharan Africa (SSA) is characterized by a high population growth and a significant poverty. In addition, this area deals with a burden of disease due to both traditional infection diseases and the emerging chronic diseases. Randomised controlled trials (RCTs) taking into account the local context are needed to strength health policy and to improve the population health. However, because of constraint research capacities, RCTs performed in SSA must investigate relevant research questions, biases must be avoided in methods, and health interventions evaluated must be reported completely for easing implementation in current clinical practice. Such efforts help to avoid waste of research. Our objectives were to describe the epidemiology of SSA RCTs, and then to evaluate the methodological quality as well as the reporting of evaluated interventions. On the one hand, our works highlighted that SSA RCTs mainly focused on diseases of the highest burden in that area, although they were frequently funded by high-income countries, and most of the corresponding authors were affiliated to those countries. In the other hand, we have shown that methods at high risk of bias can be avoided through simple methodological adjustments of minor cost. Improving the methodological quality of SSA RCTs implies a large dissemination of available methods at low risk of bias and guidelines on the complete reporting of interventions. Furthermore, understanding barriers and facilitators to the uptake of those methods and guidelines is equally required. ; L'Afrique sub-saharienne (SSA) se caractérise par une croissance démographique rapide et une pauvreté notoire. Cette région du monde fait face à une charge de morbidité causée à la fois par les maladies infectieuses traditionnelles et par l'émergence des maladies chroniques. Les essais contrôlés randomisés (ECR) prenant en compte le contexte local sont nécessaires pour renforcer les politiques de santé publique et améliorer l'état de santé des populations. Toutefois à cause des capacités ...

Background Over the years, sanitation programs over the world have focused more on household sanitation, with limited attention towards the disposal of children's stools. This lack of attention could be due to the misconception that children's stools are harmless. The current study examined the individual and contextual predictors of safe disposal of children's faeces among women in sub-Saharan Africa (SSA). Methods The study used secondary data involving 128,096 mother-child pairs of under-five children from the current Demographic and Health Surveys (DHS) in 15 sub-Saharan African countries from 2015 to 2018. Multilevel logistic analysis was used to assess the individual and contextual factors associated with the practice of safe disposal of children's faeces. We presented the results as adjusted odds ratios (aOR) at a statistical significance of p< 0.05. Results The results show that 58.73% (57.79-59.68) of childbearing women in the 15 countries in SSA included in our study safely disposed off their children's stools. This varied from as high as 85.90% (84.57-87.14) in Rwanda to as low as 26.38% (24.01-28.91) in Chad. At the individual level, the practice of safe disposal of children's stools was more likely to occur among children aged 1, compared to those aged 0 [aOR = 1.74; 95% CI: 1.68-1.80] and those with diarrhoea compared to those without diarrhoea [aOR = 1.17, 95% CI: 1.13-1.21]. Mothers with primary level of education [aOR = 1.42, 95% CI: 1.30-1.5], those aged 35-39 [aOR = 1.20, 95% CI: 1.12-1.28], and those exposed to radio [aOR = 1.23, 95% CI: 1.20-1.27] were more likely to practice safe disposal of children's stools. Conversely, the odds of safe disposal of children's stool were lower among mothers who were married [aOR = 0.74, 95% CI: 0.69-0.80] and those who belonged to the Traditional African Religion [aOR = 0.64, 95% CI: 0.51-0.80]. With the contextual factors, women with improved water [aOR = 1.13, 95% CI: 1.10-1.16] and improved toilet facility [aOR = 5.75 95% CI: 5.55-5.95] had higher odds of safe disposal of children's stool. On the other hand, mothers who lived in households with 5 or more children [aOR = 0.89, 95% CI: 0.86-0.93], those in rural areas [aOR = 0.86, 95% CI: 0.82-0.89], and those who lived in Central Africa [aOR = 0.19, 95% CI: 0.18-0.21] were less likely to practice safe disposal of children's stools. Conclusion The findings indicate that between- and within-country contextual variations and commonalities need to be acknowledged in designing interventions to enhance safe disposal of children's faeces. Audio-visual education on safe faecal disposal among rural women and large households can help enhance safe disposal. In light of the strong association between safe stool disposal and improved latrine use in SSA, governments need to develop feasible and cost-effective strategies to increase the number of households with access to improved toilet facilities.

Despite numerous investments that have been made to increase access to education in sub-Saharan Africa, a noteworthy share of children drop out of school prior to completing primary education. To address this issue, this thesis examines the factors that drive education decisions in a rural risky environment. The first chapter focuses on one of the core determinant of education investment that has been under-explored, the opportunity costs of education. To identify these costs that can significantly hinder education, we determine children's productivity on the farm and provide an estimate range of the value of one day of child labor. In order to better understand education decisions in rural sub-Saharan Africa, the second chapter assesses the different benefits of education in rural Tanzania, where family farm is the dominant structure in agriculture and where the technology level is low. Finally, the third chapter investigates whether productivity shocks are detrimental to educational achievement and children's cognitive skills by considering two particular aspects, the age at which shocks occur, and the length of shocks. This subject is all the more relevant today when the number of productivity shocks is growing. Throughout these three chapters which focus on rural Tanzania, this thesis provides some insight into the role of public policies in protecting and promoting education. ; Si de nombreux efforts ont été déployés pour améliorer l'accès à l'éducation en Afrique subsaharienne, la proportion d'enfants qui interrompent leur scolarité avant la fin du cycle primaire reste encore très élevée. Pour tenter de répondre à ce défi majeur, cette thèse se propose d'examiner les déterminants de la demande d'éducation dans un environnement rural exposé à de nombreux risques. Le premier chapitre s'intéresse à la place essentielle, et pourtant peu étudiée, que tiennent les coûts d'opportunité du temps des enfants dans les choix éducatifs. Il s'avère dans ce cas nécessaire d'estimer la productivité du travail des enfants afin d'identifier les coûts susceptibles de compromettre leur scolarisation. Afin de mieux appréhender les choix en matière d'éducation, le deuxième chapitre dresse quant à lui une estimation des bénéfices de l'éducation dans un contexte agricole qui se distingue à la fois par un accès limité aux nouvelles technologies et par la prédominance d'exploitations familiales de petites tailles. Enfin, le troisième chapitre interroge les effets des chocs de productivité sur les décisions de scolarisation et sur les performances scolaires des enfants. Deux critères retiennent notre attention, l'âge auquel les enfants sont confrontés à ces chocs et leur intensité. Ce sujet nous semble d'autant plus pertinent que la fréquence de ces chocs ne cesse aujourd'hui d'augmenter. À travers ces trois chapitres centrés sur la Tanzanie rurale, cette thèse offre ainsi un aperçu du rôle des politiques publiques dans la protection et le développement de l'éducation.