Appendix A
PARADIGMS
TYPES OF MALARIA
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African wet savannah
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Forest
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Irrigated agriculture
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Highland fringe
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Desert fringe and oasis
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Urban malaria
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Plains—traditional agriculture
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Coastal
DETERMINANTS
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Level of endemicity
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Highly endemic: perennial transmission
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Moderately endemic: perennial transmission
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Modestly endemic: seasonal transmission
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Highly endemic: seasonal transmission
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Low endemicity: seasonal transmission
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Epidemic transmission
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Parasite species
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Plasmodium falciparum
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P. vivax
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P. malariae
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P. ovale
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Population characteristics
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Immune status (high, low, none)
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Movement (settled, resettled, transient); if transient: organized, nomads, random
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Population density and settlement patterns
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Social, behavioral, and economic characteristics
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Housing
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Occupation
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Water utilization
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Health-seeking behavior
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Sleeping habits
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Customs and taboos
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Income and wealth
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Local understanding of malaria
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Access to health care
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5. Health infrastructure
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National health budget
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Status of governmental health care delivery system
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National malaria control program (type, budget, and efficiency)
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Importance of non-governmental services (i.e. missions, private voluntary organizations)
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Availability of private health care
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Importance of health care delivery by family, market, etc.
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Use of drugs
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Cost
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Availability
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Drug-use patterns
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Effectiveness (degree of resistance)
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Vector considerations
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Behavior (breeding, feeding, resting)
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Susceptibility to insecticides
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Cost, safety, and acceptability of effective insecticides
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Availability and cost of bed nets
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Feasibility of bed net impregnation with insecticides
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Availability and cost of repellents and fumigant coils
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Development projects
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Government development projects (dam construction, road building)
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Unofficial or illegal activities (mining, gemming)
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organized
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random
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TOOLS
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Vector control
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Personal protection
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nets or curtains with or without insecticide
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screens
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house siting (where the house is physically located)
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repellents
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smoke coils
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Environmental management
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source reduction
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flushing, sluicing
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clearing vegetation
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water management
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reforestation
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Larvicides
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chemical
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mechanical
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biological
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Adulticiding (killing the adult forms of the mosquito)
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residual spraying
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fogging
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largescale ULV (ultra low volume spraying)
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Zooprophylaxis
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Medical resources
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Diagnosis
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clinical
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microscopic
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