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OCR for page 279
MALARIA: Obstacles and Opportunities Appendix A PARADIGMS TYPES OF MALARIA African wet savannah Forest Irrigated agriculture Highland fringe Desert fringe and oasis Urban malaria Plains—traditional agriculture Coastal DETERMINANTS 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
OCR for page 280
MALARIA: Obstacles and Opportunities 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 5. 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)
OCR for page 281
MALARIA: Obstacles and Opportunities 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 TOOLS 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 largescale ULV (ultra low volume spraying) Zooprophylaxis Medical resources Diagnosis clinical microscopic
OCR for page 282
MALARIA: Obstacles and Opportunities Treatment facilities inpatient outpatient market Prophylaxis Mass chloroquineprimaquine 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
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