The socio-territorial construction of inequalities: territorial diagnosis as a decision aid tool – COheSIoN

The study will be based on an analysis of the urbanization process in the city of Bouaké with regard to malaria, used as a health indicator. The choice of the city is justified by its place in the urban network (second city of the country), the impact of the socio-political crisis, its environmental situation and its current dynamics.
The tools, techniques and methods of the OpenStreetMap project will be used to create the geographical data. We will use high-resolution satellite imagery to characterize the built environment, land use, road network and hydrographic network. Field data (equipment, roads, frame) collected by innovative techniques (Android OSMand and OpenDataKit applications) will complete the urban description. The use of very high resolution images (drone) will allow a detailed approach of the field, at the level of recent urbanization and the ecology of malaria.
The health state of the populations and the vector risk will be characterized by surveys that relate exposure to the disease and the environment at a given time, thus allowing a better adjustment with the metrics used (prevalence, immunity, entomological indicators, socio-environmental variables).
Qualitative surveys will complement the quantitative measurements. Interviews will be conducted with the population and stakeholders (health facilities, health departments, NGOs, civil society, municipalities, neighborhood leaders). The health interviews will be structured around questions aimed at asking people about their «good health«, their knowledge of malaria (semiology, etiology, popular nosological entities), the challenges they face in social, economic and health terms in coping with the disease (use of care and prevention, satisfaction with care, cost of the disease).

Heterogeneity of malaria transmission was demonstrated for the early rainy season, in terms of prevalence and exposure to vector bites. Vector pressure is also unequal according to neighborhoods with the identification of a species previously absent from Côte d'Ivoire whose emergence is generally associated with urbanization. The impact of land management (urban agriculture) is also highlighted. The use of insecticide-treated nets (ITNs) appeared to be lower than national figures showed, and unevenly distributed among neighborhoods. Residual transmission in response to ITN use also appeared to be occurring, raising the question of the medium-term effectiveness of these prevention tools.
The results obtained validate the hypothesis of unequal transmission of malaria and the urban typology produced with regard to this indicator, through field surveys coupled with high and very high resolution imagery analysis, which thus appear relevant to apprehend the inequality of the urbanization process.

The approach adopted in the OpenScience paradigm has enabled a renewal of research in urban geography for development in the South. The mobilization of tools and methods of the OpenStreetMap project allows for increased efficiency in the creation, sharing and communication of basic and thematic data and cartographic products. Data is currently available at ifl.francophonelibre.org/mapstore/
Faster very high resolution image processing techniques are being validated as well as the use of landscape metrics to better predict malaria risk at a very fine scale.
A collaboration with DirectMairie (France) for the development of an application dedicated to the collection of information on the city of Bouaké (illegal dumps, broken traffic lights, blocked gutters, defects on the road, etc.) is underway.

An article on the geography of the health care system will soon be available in the journal Espace Populations Sociétés. Results on the geographical data collection method were presented at 2 State Of The Map (Bordeaux 2018 and Abidjan 2019) and discussed at a workshop organized in the framework of the Understanding Risk conference (World Bank, Abidjan 2019).
Two PhD (geography and entomology) are in progress and the project has hosted 4 masters (geography, entomology, sociology).
Several trainings have been organized for the production of geographical data.
Several workshops have been held with the Bouaké City Council and the Gbeke Regional Health Department, which have allowed stakeholders to bring forward some of their needs (health map, school map).

Urbanization is one of the most striking phenomena of recent decades and affects the African continent, as more than half of its population is expected to live in cities by 2030. In the current difficult economic, the inevitable urbanization remains poorly controlled, which is not without consequence on the well-being of the populations. In fact, cities have become the cradle of inequalities of all kinds. Urban dwellers in African cities face housing, transport and work difficulties, living in places where they are exposed to risks associated with lack of sanitation, difficulties in supplying drinking water, lack of care facilities, etc.
While the link between the environment and health has long been recognized, it is also known that the ways in which the territories are organized, equipped, managed and appropriated, how actors, city dwellers, local authorities act, appropriate and transform their territories can also have an effect on health.
However, relations between the city and health are far from being formalized at the political level: urban planners take little account of the health needs of the populations, while health policies neglect the city.
Proposing a territorial diagnosis of Bouaké, the second city of Côte d'Ivoire, in the midst of changes following the socio-political crisis of the previous decade, thus appears as a means of approaching the issue of urban inequalities from the perspective of health which is known to be the cause and consequence of development.
Through a multidisciplinary approach, the project aims (1) to describe the past and present process of urbanization in Bouaké with a particular focus on health issues, (2) to research malaria risk factors and their combinations in sub-spaces illustrating urban diversity (3) to study the socio-territorial constructions of health in the same urban sub-areas to understand how they affect the dynamics of the disease.
The expectations of the project are two-fold: on the one hand, understanding the local combinations of health determinants, and on the other hand, identifying obstacles and levers that can help decision-makers and local actors to develop action plans to reduce socio-spatial inequalities.