l l HHHIHWIHH I Ill/HIHHIWIWUNIWIWIHUHHIH ' 113 872 , THSF RSITY LIBRARIES a. 10.53am "rillllllllglfllljlllljll n "ll 56 2565 LIBRARY Michigan State University This is to certify that the thesis entitled DISEASE AND DEVELOPMENT: A SOCIOLOGICAL ANALYSIS OF THE PROBLEM OF SCHISTOSOMIASIS IN AFRICA presented by And emar iam Kidanemar iam has been accepted towards fulfillment of the requirements for M t f . ' as er 0 Arts degree 1n Scalology WM Damrg‘finfiey March 17, 1988 Date 0-7639 MS U is an Affirmative Action/Equal Opportunity Institution MSU LIBRARIES .—c—_ RETURNING MATERIALS: Place in book drop to remove this checkout from your record. FINES will be charged if book is returned after the date stamped below. DISEASE AND DEVELOPMENT: A SOCIOLOGICAL ANALYSIS OF THE PROBLEM OF SCHISTOSOMIASIS IN AFRICA BY Andemariam Kidanemariam A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF ARTS Department of Sociology 1988 fiQfiB-céFVJ7 ABSTRACT DISEASE AND DEVELOPMENT: A SOCIOLOGICAL ANALYSIS OF THE PROBLEM OF SCHISTOSOMIASIS IN AFRICA . BY Andemariam Kidanemariam The prevalence of disease cannot be seen in isolation from the overall socio-economic processes in a society. This exploratory study examines the impact of development, irrigation development that is, in creating favorable conditions that predispose people to the risk of schistosomiasis infection in Africa" An analysis of the relationship of schistosomiasis exposure and certain macro-sociological and development variables in undertaken for 29 schistosomiasis endemic African countries. Results of a multiple regression analysis show that of the five independent variables correlated with schistosomiasis exposure, percent of land irrigated, percentage of population in absolute poverty, and population density are positively associated with the dependent variable exposure to schistosomiasis. The other two independent 'variables. - gross national product (GNP jper capita) and physical quality of life index (PQLI) are inversely correlated with the dependent variable. In general, an increase in population density, area of land coming under permanent irrigation, and conditions of poverty are likely to increase the risk of schistosomiasis. ACKNOWLEDGEMENTS I am indebted to many people who directly or indirectly have contributed to the realization of this thesis. I am, especially, grateful to my committee members, Professors Wiley, Vanderpool and Hunter for the unreserved assistance they gave me in writing my thesis. I would especially like to express my profound gratitude to my thesis and academic advisor, Professor David Wiley who has so patiently guided and encouraged me through every' stage of the thesis. I am also grateful to Professor Vanderpool, without whose insightful and friendly assistance from the very formative stage of the project, this study would never have reached its present stage. Profound thanks is also due to Professor Hunter for his critical and constructive comments which proved to be invaluable to my study. I would also like to express my gratitude to my friend Surendar Yadava for his unreserved assistance with the SPSS/PC program during the analysis of my data. Finally, I am greatly indebted to my beloved wife, Almaz whose unfailing emotional and_ psychological support sustained me during this most trying moments of my academic life. Her healing power surpasses that of the physician. I am also grateful to my two daughters, Ayda and Lidia. I Finally, I dedicate this thesis to my family. 111 Chapter I Chapter II Chapter III Chapter IV Chapter V Bibliography TABLE OF CONTENTS Introduction Statement of the Problem Data and Methods Presentation and Discussion of Findings Summary and Conclusions iv 17 21 28 32 Table Table Table Table LIST OF TABLES Page The Percentage of Population Exposed 18 to the Risk of Schistosomiasis in 29 African Countries Percentage of Population Exposed to 22 Schistosomiasis by Country, GNP, PQLI, % of Land Irrigated, % of Population in Absolute Poverty and Population Density Matrix of Correlation Coefficients of the 25 1975 Data (N = 29) Regressing Independent Variable Predictors 26 on Exposure to Schistosomiasis, 1975 Data INTRODUCTION Schistosomiasis is a major parasitic disease that afflicts millions of people in the tropics and subtropics of Africa. Over 500 million people worldwide are believed to suffer from this insidious and debilitating disease. In View of its prevalence, the morbidity it causes, and the adverse effects it imposes on the economies of endemic nations, schistosomiasis has become one of the most important public health and economic problems of tropical Africa (Andreano, 1976). It appears that the disease is endemic in almost all African countries with the possible exception of Lesotho (Kloos and. Thompson, 1979), whose high attitude apparently retards the growth of the snail intermediate hosts of the disease (Rosenfield, 1979). It is generally claimed that schistosomiasis like many other diseases, is often closely associated with conditions of poverty and underdevelopment in places where it is widely prevalent. In the words of Davis (1976, p. 228): "In developing countries schistosomiasis is generally an infection of rural or agricultural areas with a low socio economic status, poor housing, lack of water supplies other than natural sources, substandard hygienic conditions; and few, if any, sanitary facilities. Domestic, recreational, occupational, hygienic...activities bring the population into contact with water and transmission begins." While it is believed that schistosomiasis existed in Egypt (humorously described as the cradle of schistosomiasis in Africa) under these conditions as far back as the times of the Pharaos (Farooq, 1973), it is unlikely that the disease was very widespread at the time because of a lack of perennial irrigation and the consequent lack of suitable sites for transmission (Sandbach, 1976). Then is the problem of schistosomiasis one of underdevelopment or development? or both? A growing preoccupation among the works addressing this problem today is the role of economic development in expanding the prevalence of schistosomiasis to an unprecedented. magnitude. .As a result schistosomiasis has become almost synonymous with irrigation development. Although the literature on schistosomiasis is replete with many studies that demonstrate the role of development in triggering the widespread prevalence of schistosomiasis, little or no systematic analyses have been undertaken that show the impact of the former on the latter. An analysis of the relationship between development indicators and the prevalence of schistosomiasis can illuminate our understanding of how development aggravates the prevalence of the disease, but it has not been part of the tradition of the studies that address this problem. Much of the problem of increased schistosomiasis prevalence is attributed to either the careless 3 application of technology and/or the lack of ecological foresight in the planning as well as the execution of water resources development programs. In the present study, an analysis will be made of the relationship between some measure of development and demography with schistosomiasis, also, the ways in which economic development aggravates the prevalence of schistosomiasis. Schistosomiasis will be examined within a theoretical framework that views disease as an integral aspect of the socio-economic processes of a society. The analysis of the impact of economic development on the rapidly increasing prevalence of schistosomiasis in Africa will be undertaken utilizing data on population exposed to schistomiasis and relevant socio-economic development indicators. for' 29 schistosomiasis endemic .African countries. At this point it should be noted that this is an exploratory study of a macro-sociological nature. As such, huge error terms are expected in the equations because of the nature of the variables. While all the independent variables, namely gross national product per capta (GNP), physical quality of life index (PQLI), percent of population in absolute poverty, percent of land irrigated, and population density are aggregate national indicators, the dependent variable, schistosomiasis is not an aggreageate indicator. The data relating to schistosomiasis are drawn from particular segments of the population of the country and not the entire population of that country. 4 We, therefore, note that the ecological analysis pursued in the present study might make the findings amenable to the danger of ecological fallacy - a fallacy that results from an analysis of aggregate data which make inferences based on the behavior or properties of individuals (Dugan and Rokkan, 1969; Nachmias and Nachmias, 1981). The rest of the thesis is organized in the following manner: chapter two is the statement of the problem, the relevant literature review, theoretical framework, and the formulation of the hypotheses. Chapter three describes the method of data I collection and the analysis employed in this study. Chapter four presents the findings of the study. Chapter five concludes with a summa y of the study. Chapter II STATEMENT OF THE PROBLEM The general problem that is being addressed here is that of the impact of development on the. prevalence of schistosomiasis. It is believed that the disease was widely prevalent in Africa long before large—scale water resources develoment projects came into existence. Even today schistosomiasis occurs widely in natural settings such as lakes, rivers, streams, swamps, etc. throughout 'tropical Africa. However, its association with development- economic development that is, has caused a great deal of concern. The rapid expansion of irrigation schemes and the construction of dams for agricultural and industrial development have greatly expanded the incidence of the disease. IHowever, existing studies that have thus far attempted to address this problem greatly suffer from a narrowly focused theoretical perspective in analyzing the relationship between development and schistosomiasis. More specifically, in spite of the considerable attention given to the exacerbating effect of development on 6 schistosomiasis, little has been done to place this relationship between economic development and the problem of schistosomiasis in the context of a social science theory. The present study strives to fill these gaps in our knowledge. Attempts will be made to systematically analyze the relationship between economic development and schistosomiasis using relevant development indicators. Various hypotheses are designed to test the proposition that development induces or provokes the rapid occurence of schistosomiasis. This will be done within a theoretical framework that views disease as an integral aspect of the overall socioeconomic: development. of 'the countries under consideration. The disease consequences associated with social change patterns in Africa, variously known as socio- economic-improvement, modernization, development, etc. are well documented. In Central ‘and Eastern Africa, for instance, events in the nineteenth and twentieth centuries connected with ill-conceived efforts by European colonial administrators to alter traditional patterns of herding and cultivation illustrate the unexpected side effects that sometimes arise from agricultural expansion into new regions. These efforts precipitated veritable epidemics of sleeping sickness in parts of Uganda, Congo, Tanzania, Zimbabwe (then Rhodesia), and Nigeria. As colonial regimes came to an end, the end result was a land more thickly infested with death-dealing testes flies than before 7 government policy set out to utilize more effectively what appeared to be good agricultural land. Similarily, in western Africa, when agriculture began to spread into rainforest environments, slash-and burn methods of cultivation clearly put new strains on older ecological balances. An unexpected result was the spread of malaria. The clearings created conducive breeding conditions for the vector mosquitos (McNeill, 1976). Since the agricultural penetration of the rainforest in this part of Africa is still in process, the contemporary distribution of malaria permits a plausible reconstruction of the unusually drastic consequences that alteration of ecological patterns entail and continue to entail in that environment (McNeill, 1976). The post independence era saw a growing preoccupation among African countries with rapid socio-economic development that would lead to self-reliance and self- sufficiency. This meant increased agricultural productivity, especially in ‘the face: of rapidly' growing population. As a result large-scale-water resource development projects became the key to agricultural and industrial development in much of Africa. Where cash crops are involved, which is mostly the case, the contribution of agriculture to the general economy may be substantial and indispensible as in the case of the Gezira Scheme in the 8 Sudan which provided nearly one-third of the total revenue of the country (Hughes and Hunter, 1970). The fishing industries and hydroelectric projects associated with man-made lakes such as the Volta Lake (Ghana), the Aswan High Dam (Egypt), Kainji (Nigeria), etc., have had immense benefits for the economies of these countries. ‘Yet for all their inherent. benefits, water resource development schemes carry with them a hidden cost- the problem of disease. This is the price that must be paid for development. The adverse effects of these projects on the health of the human. populations they are intended to Ibenefit are second in importance only to the good intentions of these projects (Dennis, 1983). Of the numerous diseases associated with irrigation development in Africa, schistosomiasis tends to be the most notorious of all in public health and economic impact. We will briefly review the relevant studies that have attempted to address the relationship of schistosomiasis to economic development. This relationship was perhaps for the first time highly popularized in a publication entitled "The Careless Technology" (Farvar & Milton, 1972). Though the book comprises a highly useful compilation of descriptive evidence, the way the question is posed nevertheless narrows the complexity of issues into a technologically determinist framework. It tends to engender the false notion that the. 9 problem lies in the careless application of a technology which is somehow fixed and devoid of institutional content in its development and application. In other words, the impression is created that technology is the "cause" rather than the "symptom" of a more fundamental malaise (James, 1981). The possibility that the economic, political, and institutional arrangements themselves influence the nature of the technology developed and its application is entirely missing in the Careless Technology approach (Reddy, 1977; Steward, 1977; James, 1981). Hughes and Hunter ('1970) in their work Disease Ed Degglgpmggt in Africa poignantly demonstrated how the type of economic or agricultural development occurring in Africa today has been aggravating the rapid spread of schistosomiasis. Heavy emphasis is placed on the role of development in changing the pre-existing relationship between man and his environment and the consequent prevalence of schistosomiasis. They demonstrate extensively that development is not inert from the point of view of ecology, since it changes patterns of water flow and uses, human habitat relationships, increases in population movement and mixing, and changes in the vegetation cover and the micro-environmental conditions, all of which have potentially far-reaching consequences for the spread of schistosomiasis. This purely ecological focus, however, 10 sidesteps the problem. of socio-economic reality' and. the form that this kind of development under consideration assumes. A few more systematic studies on the relationship between economic or agricultural development and the prevalence of disease have been carried out in other parts of the developing world that could better illuminate our understanding of the role of development in provoking disease. In a study of morbidity in two Mexican villages, Laurell et al. (1977) found a significant morbidity differential between subsistence agricultural workers and waged agricultural workers. It was found that morbidity was significantly higher in the more "developed" village-- characterized by cash-crop-commercial agriculture than in the one characterized by a predominantly subsistence economy. Analyzing mortality in the Philippines, Smith (1978) found that its increase was closely related to the change from subsistence to commercial agriculture. Gross and Underwood (1971) analyzed the effects of the introduction of sisal as the dominant crop in what. had been areas of subsistence in Northeastern Brazil. Although in economic and technological terms the sisal fiber meant an advance, the social changes that it provoked left the great majority of the population in worse conditions. A large part of the 11 turned into wage-laborers with an extremely low wage level. In evaluating the health effects of a development project in Mexico which consisted of an irrigation plan and the introduction of commercial exportation crops, Hernandez et al. (1974) found that after 13 years of its initiation, there had been a substantial decrease in mortality as a result of water' and. malaria control. Nonetheless, ‘the benefits of economic growth were concentrated in the hands of a small group, and the large population had experienced virtually no positive change. It had actually suffered some deterioration in its diet, and malnutrition was as common among them as before the transition. Social marginalism, together with its undernourished children were found to be still present as before. It is argued that the fundamental reason for this was that the benefit did not seep down sufficiently to reach the poorest of the population (Hernandez, et. al., 1974). Low socio-economic status and conditions of poverty are often strongly and positively correlated with high prevalence of disease both within advanced and Third WOrld countries (Weisbrod et. al., 1973). Generally, such conditions negatively affect the environmental sanitation, housing conditions, access to safe andi adequate water supplies, nutrition status, waste disposal systems, and many other related conditions of life, which in turn influence the disease process. By the same token, improved socio- 12 economic conditions (economic development) especially when the benefits of economic development are fairly equitably distributed, lead to an increased improvement in the dietary status, housing conditions, provision of safe water supplies, sanitary conditions, and a number of other social amenities and services, which in turn lead to a reasonably rapid decline in the prevalence of disease. The experience of the now-developed nations of Western Europe and North America is a case in point. In these countries the decline in morbidity and mortality from various diseases started long before the true nature of communicable diseases was understood (Davey et. al., 1971). Barnett (1977) makes the following observation of the life in the Gezira scheme: In as much as the financial position of any tenants is tenous, their social organization and their social relations are characterized by strong elements of divisiveness. They feel relatively deprived and experience poverty, both as individuals and as members of households. This is the kind of development which can be described as "increased growth associated with increased poverty"-- growth with substantial increase in the Gross National Product (GNP) but accompanied by greater maldistribution of income (Feder, 1983). This is a situation of poverty in growth. An increasing GNP perpetuating and exacerbating a state of poverty through income inequalities and the maldistribution of the benefits of economic development. The benefits of economic development fail to seep down to 13 the people (development laborers and tenants) who have tremendous amount of inputs toward the realization of development goals. It is not intended here to establish that this kind of economic development is a direct causal factor, but that the form it assumes, as we have been trying to explain, exacerbates and perpetuates conditions of poverty and squalor and the concomitant and/or consequent deterioration in the living conditions--such as housing, water supplies, sanitary conditions, and the nutrition conditions, all provoking and aggravating the prevalence of schistosomiasis. The theoretical premise of this study can thus be stated as follows: The form that water resources development strategies assume, and not the technological/ecological phenomena themselves, determine or provoke the circumstances that create conditions that expose people to the risk of schistosomiasis, and exacerbate the prevalence of the disease through the perpetuation and aggravation of conditions of poverty and income inequalities. Within this conceptual framework the following hypotheses are formulated: 1. The mean GNP per capita will be positively related to the mean percentage of population exposed to schistosomiasis. 1.1 14 The mean PQLI will be negatively related to the mean percentage of population exposed to schistosomiasis. The mean percentage of population in absolute poverty will be positively related to the mean percentage of population exposed to schistosomiasis. The mean percentage of land irrigated will be positively related to the mean percentage of population exposed to the risk of schistosomiasis. The mean population density will be positively related to the mean percentage of population exposed to schistosomiasis. Exposure to schistosomiasis is taken here to mean the percent or number of population at the risk of contracting the disease. GNP per capita is used here as an indicator of past economic growth. This measure has been widely accepted as the best single indicator of development for a long period; however, its limitations and weaknesses as a good yardstick of development should be remembered. GNP per capita can be useful for purposes of international comparisons, (i. e., comparing economic growth among nations) but not in measuring gross disparities between urban and rural areas, poor and rich, income inequalities, etc. 15 The Physical Quality of Life Index (PQLI) is a concept developed by the Overseas Development Council. It is a composite number calculated by averaging three indices- life expectancy, infant mortality, and literacy - giving equal weight to each of the three indices. Each is rated on a scale from 1 to 100. The PQLI is believed to be free of many of the biases and distortions that affect other measures of human progress. However, since what is being measured in this study is the morbidity and _not the mortality from schistosomiasis, the limitation of the PQLI with respect to this should be kept in mind. Percentage of land irrigated (area of land expressed as percentage of total arable land in thousands of hectares) is expected to be a good measure in predicting the impact of irrigation on schistosomiasis. In line with our theoretical argument that development induced poverty is one of the underlying factors in aggravating schistosomiasis, percentage of population in absolute poverty is taken as an indicator of poverty in testing the relationship between the latter and schistosomiasis. As is often stated, the concept of poverty is difficult to define. Here, following the FAO (1986), absolute poverty is taken to mean the absolute deprivation of certain basic necessities of life. Population density, expressed as the number of persons per square kilometer in agricultural areas, is a variable to 16 reflect partially the impact of irrigation agriculture on schistosomiasis and. the accompanying problems. of over crowding, sanitation, and contamination. The sources of the data on GNP, PQLI, land irrigated, pOpulation in absolute poverty, and population density are: GNP per capita: World Bank Wezld Development 8222::- Washington, D.C., 1978, pp. 80-81. Population Density: Kurian, G.T. The Bee; ,e; flegle Wee. New York: New American Library, 1979, pp. 61-63. Land irrigated: £59 Ezeducgiog Xea; 5993. Vol. 31, 1977, p. 57. PQLI: Overseas Development Council Phyeieel Qgelity e; Life Index. Washington, D.C. 1977, pp. 286-287. Population in absolute poverty: Overseas Development Council Qiepezigy Redection getes i3 fieeiel Igdicatozs. Washington, D.C. 1978, pp. 86-87. Chapter Three DATA AND METHODS The data for the present study are derived from secondary sources. Owing to the unavailability of estimates of national schistosomiasis prevalence for most schistosomiasis endemic countries in Africa, national estimates of population exposed to the risk of schistosomiasis are used in lieu of prevalence. Data on population exposed. to schistosomiasis (dependent variable) come from results of’ a WHO questionnaire survey of 45 African schistosomiasis endemic countries, compiled by Iarotski and Davis (1981). The data compiled by Iarotski and Davis are based on information on schistosomiasis control programs provided by 103 countries in reply to a questionnaire circulated by the World Health Organization in 1976. According to the data either given in these replies, published, or provided in internal reports to WHO, schistosomiasis is one of the most widespread parasitic infections of man. However, of the 103 countries that provided information, data for only 73 countries in Africa, Asia and South America and the Caribbean are published. Of the 73 countries, 45. are in Africa. 17 Table 1. The percentage of population exposed to the risk of schistosomiasis in 29 African countries Population Persons exposed to the disease Country Date Total Number 2 of Population (thousands) Sudan 1977 16.953 15.000.000 89.0 Madagascar 1970 6.750 5.783.503 86.0 Chad 1977 4.197 3.600.000 86.0 Togo 1977 2.348 1.953.778 83.0 Gambia 1977 553 400.000 72.0 Cent. Afr. Rep. 1970 2.370 1.500.000 63.0 Mali 1976 6.035 3.571.292 59.0 Swaziland 1976 499 270.000 54.0 Gabon 1970 500 263.000 53.0 Ghana 1976 10.309 5.000.000 49.0 Senegal _ 1976 5.115 2,500,000 49.0 Cameroon 1976 7.663 3.700.000 48.0 Liberia 1974 1.503 700.000 47.0 Egypt 1977 38.741 18.000.000 46.0 Kenya 1977 14.337 6.000.000 42.0 Guinea 1967 3.702 1.500.000 41.0 Zaire 1977 26.376 10.000.000 38.0 Somalia 1972 2.941 1.000.000 34.0 Ethiopia 1977 28.981 9.000.000 31.0 Botswana 1977 710 200.000 28.0 Mauritania 1976 1,481 375,000 25.0 Mauritius 1977 909 200.000 22.0 Nigeria 1977 78.660 15.000.000 19.0 Tanzania 1977 16.073 3.000.000 19.0 Guinea Bissau 1972 482 72.500 15.0 Uganda 1977 12.353 1.000.000 8.0 Libya 1975 2.444 183.285 8 0 Burundi 1975 3.763 250.000 7 0 Tunisia 1977 6.065 169.515 3 O Source: Iarotski, L.S. and A. Davis. "The Schistosomiasis Problem in the World: Results of a WHO Questionnaire Survey." WHO Bulletin. 59(1):115-127 (1981). 18 19 Of the 45 endemic African countries included in the work of Iarotski and Davis, complete information on the number and percentage of population exposed to schistosomiasis is available only for 29 countries (Table 1). The dates (years) for which information on schistosomiasis was reported by the 29 countries vary from 1970 to 1977. However, most of these data were reported for 1977 (48%), followed by 1976 (21%). The rest (about 30%) are distributed over 1970, 1972, 1974, and 1975. Both for reporting convenience and for the purpose of matching the dates of the dependent variable (schistosomiasis) and the independent variables, 1975 is taken as the mid-year between 1970 and 1977. The data are gathered for.a total of 29 schistosomiasis endemic African countries. The number of countries considered in this study is determined by the availability of data in the work of Iarotski and Davis (1981). The term 'exposed to' (as it relates to population exposed to schistosomiasis) is taken here to mean number (and/or percent) of population at the risk of contracting schistosomiasis. As already mentioned in the introduction, the «distribution. of the disease in 'the countries under consideration is uneven, and the data for schistosomiasis reflect this. Thus, bearing in mind that the data are neither for the entire population nor representative samples of these populations, any generalization of the findings can 20 be made only to the segment of the populations on which the schistosomiasis data are based. The method of analysis utilize multiple regression, in which the dependent variable, percentage of population exposed to schistosomiasis, is regressed on the independent variables - GNP per capita, PQLI, percentages of population in absolute poverty, percentage of land irrigated, and population density. Chapter Four PRESENTATION AND DISCUSSION OF FINDINGS A brief glance at Table 2 shows that the percentage of population. exposed. to schistosmiasis greatly' varies from country to country - ranging from as high as 89.0% in the Sudan to as low as 3.0% in Tunisia. Fourteen (48.0%) of the 29 countries have percentage of population exposed to the risk of the disease well above the mean (42.0%) percentage of population exposed to schistosomiasis. Sudan, Madagascar, Chad, Togo, Gambia and Central African Republic are among the countries with the highest percentage of population exposed to the disease, far above the mean (42.0%). At the same time these countries have GNP per capita far below the mean GNP ($660.0). In contrast to these, countries like Somalia, Ethiopia, Burundi, Nigeria, Zaire, Tanzania, Guinea Bissau, among others, have relatively lower percentage of population exposed. to the risk of schistosomiasis (far below the mean), although they have comparable or even lower’ GNP jper capita than the countries with the highest percentage of population exposed to schistosomiasis. Egypt, Sudan, Madagascar, Somalia, Swaziland, and Mauritius head the list in terms of the 21 Table 2. Percentage of Population Exposed to Schistosomiasis by Country, GNP, PQLI, Z of Land Irrigated, Z of Inland Water Bodies. Z of Population in Absolute Poverty, and Population Density Country Z of Pop. GNP PQLI z of Land Population 2 of Pop. Exposed to Irrigated Density in Absolute Schistosomiasis Poverty Sudan 89 290 33 20.1 62 43 Madagascar 86 200 44 16.7 24 52 Chad 86 120 20 0.0 10 75 Togo 83 260 28 0.1 162 43 Gambia 72 180 22 9.6 105 45 C. Afr. Rep. 63 230 18 13.0 40 52 Mali 59 100 15 0.9 21 7S Swaziland 54 470 36 15.3 40 17 Gabon 53 2590 21 2.0 13 7 Ghana 49 580 31 1.9 90 25 Senegal 49 390 22 5.3 157 36 Cameroon 48 290 28 0.1 55 33 Liberia 47 450 26 1.6 315 22 Egypt 46 280 46 105.0* 1533 36 Kenya 42 240 40 2.3 273 43 Guinea 41 150 20 0.1 72 70 Zaire 38 140 28 0.1 97 60 Somalia . 34 110 19 15.7 13 75 Ethiopia 31 100 16 0.4 43 75 Botswana 28 410 38 0.1 2 31 Mauritania 25 340 15 0.3 4 34 Mauritius 22 680 75 15.0 829 19 Nigeria 19 380 25 0.1 178 30 Tanzania 19 180 28 1.1 38 54 G. Bissau 15 140 10 6.0 52 30 Uganda 8 240 33 0.1 132 64 Libya 8 8640 42 5.6 33 1 Burundi 7 120 23 0.5 245 75 Tunisia 3 840 44 4.0 87 10 Mean. - 42 $660 29 8.0 163 42 *This shows that 105% of Egypt's arable land is irrigated. 22 23 highest percent of land irrigated. Interestingly, Egypt and Mauritius are also the most densely populated countries (1533 and 829 persons per sq. Kilometer respectively), followed by Liberia (315 persons per sq. Kilometer) and Kenya (273 persons per sq. Kilometer). Ethiopia, Somalia and Chad which rank among the countries with the lowest GNP per capita ($100, $110 and $120 respectively), have also the highest percentage of population in absolute poverty (75% each). Thus far we have simply tried to make a cursory look at the relationships of some of the significant variables, but this does not. provide a om ousaomn< ca coAumasaom mo owmucmoumm mammfisomOumfinow ou pomomxm coaumascom we owmucoouom Ho>aa Loo. 6:6 um osmoauaawam I «I Ha>m5 so. «so um oamuaoaawam +i%$ u « oooo.~ «*qmmw. oomo.l wm¢~.I «mmmm. memo. Swanson .aom +++++ I oooo.~ m¢m0.I wNmO.I mfiem. ammfi. poumwwuuH pang +++ I I oooo.~ «m-m.| NNHN. q~m~.I mzw I I I oooo.H *qwmq. mmwfi. zuuo>om musaomn< ++ I I I I oooo.a mews. I Haas I I I I I oooo.~ .oumfinom Cu ousmoaxm .+ zufimcoo pmumwfiuuH muum>om .Oumfisom .dom puma mzu ousaomn< qum on whamOme Aam I zv moan mean man do moaaaoauuaoo coaumfiouuoo do xauomz .m «Heme 25 Table 4. Regressing Independent Variable Predictors on Exposure to Schistosomiasis, 1975 Data. Beta 33 I Sig. T PQLI -.0055 .0156 .483 .6338 GNP -.2653 .0663 -1.343 .1923 Z of Population .0496 .0344 .172 .8652 in Poverty Z of Land Irrigated .7252 .0189 2.110 .0459* Population Density .0775 .0060 1.952 .0633** Mult. R 1L2. F(ean) Sig. F .4767 .2273 1.353 .278 NOTE: * 8 Significant at the .045 level. ** 8 Significant at the .063 level. 26 27 independent variables combined explain 23% of the variance in schistosomiasis exposure (Table 4). In other words, 23% in schistosomiasis exposure can be predicted by a combination of all the independent variables. Chapter Five SUMMARY AND CONCLUS ION One of the major objectives of this exploratory study has been to systematically examine the influence of water resources or irrigation development on the continued aggravation of the problem of schistosomiasis in Africa within the context of a macro-sociological approach. Using economic development indicators and macro-sociological variables relevant to the understanding of the relationships between irrigation-related economic development and the percentage of population exposed to the risk of schistosomiasis, a multiple regression analysis was performed on the 1975 data (Table 2). The results of the analysis show that of the five independent variables correlated with percentage of population exposed to schistosomiasis, percent of land irrigated, population density, percentage of population in absolute poverty, and PQLI, are all related to the dependent variable in a way consistent with the hypothesized expectations. On the other hand, GNP per capita is correlated with percentage of population exposed to schistosomiasis in a direction opposite to what is hypothesized. Percent of land irrigated, population density, percentage of population in 28 29 absolute poverty, and PQLI provide strong support for most of the hypotheses formulated in support of the theoretical model of the study. Thus in conformity with the theoretical argument pursued in the present study, increased and intensive agricultural land coming under irrigation for the purpose of economic growth (with the consequences of creating favorable conditions for the attraction of labor force to develooment projects and snail breeding sites), the concomitant-increasing of population density, and the increase in absolute. poverty’ have all shown. a positive association with population exposed to the risk of schistosomiasis. In general on the basis of the present findings, percent of land irriagated, population density, percentage of population in absolute poverty, and PQLI can be said to be good predictors of the pattern of population exposure to and prevalence of schistosomiasis. In spite of a considerable limitation in the availability of as many relevant data as would have been desired, the present study has nevertheless, yielded positive results consistent with the theoretical argument advanced. The selection of the variables might have been arbitrary to some extent owing to the limitation in the availability of data as pointed out earlier. It is also unlikely that all relevant variables have been identified and. measured, again for reasons of inadequacy and even 30 unavailability of such variables. Some relevant variables thus might have been excluded, while others that were included may not be very important determinants of the variation in the prevalence of schistosomiasis. This is not unusual; one frequently must try to build a model from available data, as voluminous or scanty as the data may be. It should be pointed out that future research endeavors in this area could highly benefit from field research in connection with identifying and measuring variables and collecting adequate data that are not readily available for a researcher from secondary sources. The present study has strived to place the analysis of economic development vis-a- vis the problem of schistosomiasis within the focus of a sociological perspective. It is not claimed that this study is a thoroughgoing and finished product. On the contrary, it is strongly felt that it represents one potentially useful strategy for opening a serious consideration of a topic (research problem) that has been to date been largely neglected by sociological studies or approaches. Over the course of the past several decades the study of schistosomiasis. has been. predominantly biomedical in focus. The study of schistosomiasis within the context of socio-economic development in tropical Africa today remains a virgin research area in which the application of medical sociological theories (and theories and methods of the sociology of development) can play a significant part in the 31 analysis of the role of macrosociological factors in influencing the prevalence of schistosomiasis. For a fuller and proper understanding of the contribution of the macrosociological factors in influencing the prevalence of schistosomiasis and the implications for the control of the disease, an important task for future studies should be to place the problem of schistosomiasis in the context of a sociological approach. within. one or' both. of’ the above- mentioned sub-fields of sociology. The results of this study point to the fact that the socio-economic development indicators and the related structural characteristics play a crucial role in explaining the circumstances leading to the aggravation of the prevalence of schistosomiasis in Africa today. It is only on the basis of such information that sound and meaningful strategies for the control of the disease are likely to be realized. BIBLIOGRAPHY .Andreano, R.L. 1976. "The Recent History of Parasitic Disease in China: The Case of Schistosomiasis, Some Public IHealth. and. Economic .Aspects." International Journal g; Health Services. 6:53-68. Barnett, Tony. 1977. The Gezira Scheme: _Ag Illusion o_f Development. London: Frank Cass and Company, Ltd. Davey, T.H. and T. Wilson. 1971. The Control pf Disease lg tge Tropics. London: H.K. Lewis and Co., Ltd. Davis, A. 1976. "Epidemiology and Control of Schistosomiasis." pp. 223-242 in Epidemiology and Community Health lg Warm Climate Counpyies. Edited by R. Cruiskshank, K.I. Standard and H.B.I. Russel, New York: Churchill Livingstone Longman. Dennis, Emmet A. 1983. "Parasitic Hazards of Irrigation Projects." Workshop gg Irrigation and Human Welfare: Igtegrated Management gfi Watep Resourees lg LDCs. New Brunswick: Rutgers University. Dogan, M. and S. Rokkan. eds. 1969. Quantitative Ecological Analysis lg the Social Sciences. Cambridge: M.I.T. Press. Farooq, M. 1973. "Review of Schistosomiasis National Control Program." pp. 388-421 in. Epidemiology and Control pf Schistosomiasis. Edited by N. Ansari Baltimore: University Park Press. Favar, M.T. and J.P. Milton. eds. 1972. The Careless Technology, Ecology and International Development. New York: Natural History Press. Feder, E. 1983. "Plundering the Poor: The Role of the World Bank." Igterngtiogal gggygel pf Health Seyyices. 13:649-660. 32 33 Food and Agricultural Organization. 1977. Production Year Book. Rome. Food and Agricultural Organization. 1986. The Dynamics _g Rural Poverty . Rome . Gross, D.R. and B.A. Underwood. 1971. "The Technological Change and Caloric Cost: Sisal Agriculture in Northeastern Brazil." Ageplcan Anphropologist 73: 725-736. Hernandez, M.; C.H. Perez; J. Ramirez and. H. Madrigal. 1974. "Effects of Economic Growth on Nutrition in a Tropical Community." Ecology g; Eood end Nutrition. 3:283-291. Hughes, C.C. and J.M. Hunter. 1970. "Disease and 'Development' in Africa." Soclal Science and Medicine. 3:443-493. Iarotski, L.S. and A. Davis. 1981. "The Schistosomiasis Problem in the World: Results of a WHO Questionnaire Survey." Bulletin p; the World Health Organization. 59:115-127. James, J. 1981. "Growth, Technology and the Environment in Less Developed Countries: A Survey." pp. 115-142, in Recent lssues lg ‘World Developmen . Edited. by P. Streeten and R. Jolly. Oxford: Pergamon Press. Kloos, IL. and IL. Thompson. 1979. "Schistosomiasis iJI Africa: An Ecological Perspective." The Journal _o_f_ Tropical Geoghpaphy. 48:31-46. Kurian, Georg T. 1979. Tge Dook o_f_ World Rankings. New York: New American Library. Laurell, A.C., 1981. "Mortality and Working Conditions in Agriculture in Underdeveloped Countries." lgteygational gournal pf Healtg Services. 11:39-54. Laurell, A.C., J.B. Gill, T. Machetto, J. Palmo, C.P. Rulfo, M.R. Chavez, M. Urbina, and N. Velazquez 1977. Disease and Development: A Sociological Analysis of Morbidity in Two Mexican Villages." Tgtepnatlonal goupnal g1; Health Sepyiges. 7:401-423. McNeill, W.H. 1976. Elagges end Peoples. New York: Garden City-Anchor Press/Doubleday. 34 Nachmias, D. and C. Nachmias. 1981. Research Methods _i_n phe Social Sciences. New York: St. Martin's Press. Overseas Development Council. 1977. ghysicalI Duality _cfi Life Index. New York: Sequoia-Elsvier Publishing Company. Overseas Development Council. 1978. Disparity Reduction Rates lg Social lndicators. New York: Sequoia Elsvier Publishing Company. Reddy, A.K.N. 1977. "The Transfer, Transformation, and Generation of Technology for Development." Labop and Society. 2:145-170. Rosenfield, P.L. 1979. The Management pg Schistosomiasis. Washington D.C.: Resources for the Future Inc. Sandbach. F.R. 1976. "The History of Schistosomiasis- Research and Policy for Its Control." Medical -HistO]_.’y. 20:259-274. ' Smith, P.L. 1978. "Crisis Mortality In the 19th Century Philippines." Journal 9; Asian Studies. 38:51-76. Stewart, F. 1977. Technology and Underdevelopment. London:MacMillan Press. Weisbrod, B.A., R. Andreano, R. Baldwin, E. Epstein and A.C. Kelly. 1973. Disease and Economic Development. Madison: The University of Wisconsin Press. World Bank. 1978. World Development gepor . New York: Oxford University Press. lllsllllllllzllllllllllllllllllllllllllllllllllzlllllllllllll