Helmut Kloos - The Ecology Of Health And Disease In Ethiopia

To the memory of Dr. Admassu Teferra, Mrs. Innes Marshall, and Dr. Shamebo Desta, who contributed significantly to a better understanding of health problems in Ethiopia

This is a revision and expansion of The Ecology of Health and Disease in Ethiopia by Zein Ahmed Zein and Helmut Kloos, which was written in the mid-1980s mainly from an epidemiological perspective for health practitioners and planners in Ethiopia. The present book examines more comprehensively prevailing human health problems in their political, socioeconomic, cultural, and physical/biotic settings. A second objective is to demonstrate the value of detailed field knowledge of individual health problems to achieve such a perspective. The contributors to this volume are Ethiopian experts in their respective fields of study and foreigners with extensive field experience in Ethiopia. In spite of the diverse background of the contributors and scarcity of information, all have tried to keep the ecological perspective in mind. The chapters are offered here not as proven models but as a benchmark and prelude for further work.

This volume helps to bridge the gap which has so often separated scholars working in Ethiopia from those in Western countries, and the intellectual gap between the biomedical and social sciences. The papers in this collection will be of use to specialists who wish to continue research on the ecology, epidemiology, and control of the various health problems under discussion. Equally important, they will also be of value to nonspecialists who need a comprehensive introduction to the diseases and health resources of Ethiopia.

The plan of this book is as follows: Part 1 discusses physical and socioeconomic environment, food/nutritional information, and disasters. Part 2 evaluates modern and traditional health resources and examines the occurrence of nonvectored communicable diseases. Part 3 includes chapters on the major vectored diseases, and Part 4 on noncommunicable diseases, injuries, and mental illness.

analyzes the devastating and far-reaching health effects of the civil war in northern Ethiopia.

Part 2 begins with chapters on the modern health services and on traditional medicine; they show the persisting reliance on the latter and progress as well as constraints in the development and utilization of the former, particularly in rural areas. The development of the EPLF (Eritrean Peoples Liberation Front) and TPLF (Tigray Peoples Liberation Front) health services as efficient and equitable primary health care (PHC) programs and the health impacts of the civil war are described in .

The eight chapters in Part 3 examine the ecologies of the most important vector-borne diseases in Ethiopia. Their geographic distribution, epidemiology, and control reflect the complexity of the Ethiopian physicobiotic environment and the influence of socioeconomic factors. Their occurrence was also affected by the war, famine, and population movements. also provides new information on the Jarisch-Herxheimer reaction in relapsing fever.

Many diseases discussed in Part 4 have until recently received little attention from the health services in Ethiopia, partly because of lack of diagnostic facilities and trained health workers. The increasing occurrence of cardiovascular diseases, diabetes, gastritis, and several other chronic noninfectious diseases of adults is indicated in evaluates prospects for health development in the future and identifies research needs.

Helmut Kloos
Zein Ahmed Zein

This book is a joint effort of forty-seven medical and social scientists and public health officials in collaboration with government, university, and private institutions. Much gratitude is due to numerous colleagues of the medical and social science faculties of Addis Ababa University for their advice, information, and encouragement, especially Dr. Redda Tekle Haimanot, Dr. Dominique Frommel, Dr. Richard M. Hodes, and Dr. Daniel Gamachu. Mr. Degefe Gebre Tsadek, Mr. Tadesse Woudineh, and Mr. Tadesse Kalbessa of the libraries of the Institute of Ethiopian Studies, the Institute of Development Research, and the medical faculty, all at Addis Ababa University, as well as Mrs. Nancy Crossfield of the medical library of the Veterans Administration Hospital in Fresno, assisted with data searches. We are also thankful to Professor M. E. Duncan, Professor Frederick L. Dunn, Dr. Eyassu Habte-Gabr, Professor Oscar Gish, Mr. Paul B. Henze, Dr. Charles P. Larson, and Professor Allan Young for reviewing different chapters and forwarding their constructive comments and criticisms. Mrs. Phyllis Martens and Mrs. Mary Steinhauer edited the text expertly at short notice, and Mrs. Frieda Kasdorf typed and prepared the camera-ready manuscript with much dedication, efficiency, and cheerfulness during long working days. Mr. Bill Slusser of California State University, Fresno assisted with the drafting of several maps. The financial support of the McGill-Ethiopia Community Health Project and SIDA, SAREC, and WHO (through the Ethiopian Ministry of Health Project HSR-5) is also much appreciated.