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L’hémodialyse (HD) Longue Nocturne (HDLN) intermittente permet de combiner dialyse et sommeil. Ses avantages cliniques sont une vitesse d’ultrafiltration réduite, un meilleur contrôle de la volémie avec amélioration de la tolérance des séances et des performances cardiaques, une phosphatémie et des moyennes molécules mieux épurées et une meilleure survie dans les études de cohortes. La qualité de vie n’est pas altérée par la longueur des séances et elle s’améliore quand elle n’est pas optimale lors du transfert de l’HD standard vers l’HDLN. La qualité du sommeil n’est parfois perturbée mais elle n’est pas une cause importante de sortie du programme. La pérennité d’un programme d’HDLN passe par les volontés conjointes médicales et managériales, la sélection des patients stables, le respect des horaires et de la durée de séances, indispensable à la dialyse de sommeil. Les autorités de santé doivent jouer un rôle pour permettre cette modalité dans des conditions financières acceptables. L’information au patient de l’existence de l’HDLN avant le stade de la dialyse est essentielle, aidée par le témoignage des pairs. Les sociétés savantes doivent soutenir la recherche et l’information aux néphrologues. Enfin les conditions architecturales favorisant l’intimité et le sommeil sont une clé de réussite du programme.

Abstract: Between 2015 and 2017 there was a 40% increase in daily hemodialysis, according to the REIN database. This increase concerns 1% of patients and the private sector remains under-represented. Our retrospective study aims to describe the clinical features, the organizational and medico-economic specificities of this technique in a private hemodialysis center. Methods: We included 12 dialyzed patients trained on Nx Stage® machine from February 2020 to April 2021. Data were retrospectively obtained through review of our electronic medical records (EUCLID®). Results: Of the 12 patients trained, 11 dialyzed from home, with an average follow-up of 9 months (1-14). The average age was 45 with a sex ratio of 4/8 (M/W), and a median Charlson score of 3 (2-4). The average residual urinary output was 700 mL/24h, and 50% of patients were anuric. 100% of patients had an arteriovenous fistula and were cannulated using the buttonhole technique. 9 patients are on a transplant list. One patient needed anticoagulants. The mean training time was 35 days (28-35). 83% of patients were dialyzed 6 days a week with an average duration of 210 minutes (130-150) per session. The average volume of dialysate was 24.85 liters. One patient developed an allergy to the PUREMA® membrane. Pre-dialytic hemoglobin, serum creatinine, urea, phosphoremia and B2-microglobuline are stable at 9 months with improvement in metabolic acidosis. Conclusion: DHHD allowed a better socio-professional integration. One patient received a transplant and 3 patients resumed professional activity.

The study reviews the land policy in Zimbabwe and investigates the extent to which the policy provides incentives for investment and technology adoption to increase labour productivity in the agricultural sector. The research is based on a desk study of relevant literature and land policies implemented by the Zimbabwe government since 1980. This is complemented by empirical data drawn from various organisations that have been tracking the progress of the land reform programme. Findings from the study show that land policies delivered well on the equity but much less on land use efficiency as technology adoption and investment by reform beneficiaries remained low. Low public investment in infrastructure and services has constrained trade and agrarian transformation. Land policies that promote technology adoption and investments are needed and scope exists towards this through proper attention to land policy.

Zimbabwe has been experiencing a rapid rate of urbanization amidst a failure by conventional approaches of urban land management to cope with the demand for housing. In view of these challenges, this paper investigates the feasibility and nature of land readjustment for urban land management in Zimbabwe. Using case study research methodology and a desk review of evidence from developed and developing countries the potential use of land readjustment in Zimbabwe is examined. Findings from Zimbabwe show the existence of opportunities for use of land readjustment in rationalizing urban land use. However, the study revealed constraints concerning the legal framework, limited public participation in planning, and the complexity of the land readjustment process. Overall, it is the authors’ conclusion that evident opportunities for land readjustment would require legal and institutional reforms providing for the concept in law and the adoption of more inclusive planning methods by urban authorities.

The political dysfunction that had come to characterize an imploding Zimbabwean economy is beyond dispute. This paper explores how a government that had become weakened in the face of a formidable opposition in urban areas turned to use land as a reward for supporters and as a means of luring new members to join the ruling party. It argues that land patronage has been used as a means for legitimating fledgling state rule while undermining the tenure security of the poor. Any policy to support the poor in post–crisis Zimbabwe will need to prioritize the idea of land as a social and economic asset rather than a political instrument of the state.

Zimbabwe has been experiencing a rapid rate of urbanization amidst a failure by conventional approaches of urban land management to cope with the demand for housing. In view of these challenges, this paper investigates the feasibility and nature of land readjustment for urban land management in Zimbabwe. Using case study research methodology and a desk review of evidence from developed and developing countries the potential use of land readjustment in Zimbabwe is examined. Findings from Zimbabwe show the existence of opportunities for use of land readjustment in rationalizing urban land use. However, the study revealed constraints concerning the legal framework, limited public participation in planning, and the complexity of the land readjustment process. Overall, it is the authors’ conclusion that evident opportunities for land readjustment would require legal and institutional reforms providing for the concept in law and the adoption of more inclusive planning methods by urban authorities.

The political dysfunction that had come to characterize an imploding Zimbabwean economy is beyond dispute. This paper explores how a government that had become weakened in the face of a formidable opposition in urban areas turned to use land as a reward for supporters and as a means of luring new members to join the ruling party. It argues that land patronage has been used as a means for legitimating fledgling state rule while undermining the tenure security of the poor. Any policy to support the poor in post–crisis Zimbabwe will need to prioritize the idea of land as a social and economic asset rather than a political instrument of the state.