African wet savannah

Forest

Irrigated agriculture

Highland fringe

Desert fringe and oasis

Urban malaria

Plains—traditional agriculture

Coastal

Level of endemicity

• * Highly endemic: perennial transmission
• * Moderately endemic: perennial transmission
• * Modestly endemic: seasonal transmission
• * Highly endemic: seasonal transmission
• * Low endemicity: seasonal transmission
• * Epidemic transmission

Parasite species

• * Plasmodium falciparum
• * P. vivax
• * P. malariae
• * P. ovale

Population characteristics

• * Immune status (high, low, none)
• * Movement (settled, resettled, transient); if transient: organized, nomads, random
• * Population density and settlement patterns

Social, behavioral, and economic characteristics

• * Housing
• * Occupation
• * Water utilization
• * Health-seeking behavior
• * Sleeping habits
• * Customs and taboos
• * Income and wealth
• * Local understanding of malaria
• * Access to health care

Health infrastructure

• * National health budget
• * Status of governmental health care delivery system
• * National malaria control program (type, budget, and efficiency)
• * Importance of non-governmental services (i.e. missions, private voluntary organizations)
• * Availability of private health care
• * Importance of health care delivery by family, market, etc.

Use of drugs

• * Cost
• * Availability
• * Drug-use patterns
• * Effectiveness (degree of resistance)

Vector considerations

• * Behavior (breeding, feeding, resting)
• * Susceptibility to insecticides
• * Cost, safety, and acceptability of effective insecticides
• * Availability and cost of bed nets
• * Feasibility of bed net impregnation with insecticides
• * Availability and cost of repellents and fumigant coils

Development projects

• * Government development projects (dam construction, road building)
• * Unofficial or illegal activities (mining, gemming)
  • - organized
  • - random

Vector control

• * Personal protection
  • - nets or curtains with or without insecticide
  • - screens
  • - house siting (where the house is physically located)
  • - repellents
  • - smoke coils
• * Environmental management
  • - source reduction
  • - flushing, sluicing
  • - clearing vegetation
  • - water management
  • - reforestation
• * Larvicides
  • - chemical
  • - mechanical
  • - biological
• * Adulticiding (killing the adult forms of the mosquito)
  • - residual spraying
  • - fogging
  • - large-scale ULV (ultra low volume spraying)
• * Zooprophylaxis

Medical resources

• * Diagnosis
  • - clinical
  • - microscopic
• * Treatment facilities
  • - inpatient
  • - outpatient
  • - market
• * Prophylaxis
• * Mass chloroquine-primaquine administration for epidemics

Information, education, and communication

• * Public
  • - individuals, households, and communities
  • - school curricula
  • - radio
  • - newspapers
  • - television
  • - local media (songs, theater, etc.)
• * Health care providers

Surveillance

• * Diagnosis and treatment
  • - morbidity
  • - incidence of severe malaria
  • - mortality
  • - prevalence of parasitemia
• * Epidemic early warning
• * Vector information
  • - insecticide resistance
  • - behavioral changes
• * Antimalarial drug resistance