have the international visibility needed to supplement diminishing public financial support. Responsibility may also shift to the government of the host country, which may already be hard pressed to provide adequate services to its own citizens. Additionally, high-cost interventions may be introduced by comparatively well-funded international agencies that the inheriting local nongovernmental organization or government might have a difficult time sustaining. Examples include the first-line use of relatively expensive antimalarial drugs or rapid diagnostic (“dipstick”) methods that are not a normal part of the host country’s national formulary or practices.

Factors Affecting Overall Risk of Malaria: Key Points

  • Large, unplanned movements can increase both the risk of acquiring malaria and the risk of epidemics.

  • Factors influencing the overall risk of malaria include poor or no housing, movement into unused areas, deliberate movement to areas near water, overcrowding, low socioeconomic status, proximity of livestock, mobility, immune status, and under- and malnutrition.

  • Political and infrastructural factors that affect the provision of health care services include destruction or overburdening of existing infrastructure, limited availability of health care services, insufficient or poorly trained staff, insufficient coordination among agencies, and donor fatigue.

  • Most of the above factors operate simultaneously in a complex emergency and must be considered when planning realistic malaria control strategies.

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