GENERAL CONSIDERATIONS IN PLANNING 
MALARIA CONTROL 1 
By JUSTIN ANDREWS 
DIVISION OF MALARIA AND HOOKWORM SERVICE, GEORGIA DEPARTMENT OF PUBLIC HEALTH, 
ATLANTA, GA. 
What constitutes a malaria problem is 
more than a rhetorical question. In theory, 
any place in which man, infectible mos¬ 
quito and malaria parasite are accessible to 
one another under favorable natural con¬ 
ditions may constitute a malaria problem. 
In practice, however, these situations vary 
in malaria intensity with respect to the 
quantitative and qualitative aspects of 
these factors. Since the malariologist can 
rarely serve all of them at once, it becomes 
imperative for him to develop some selec¬ 
tive policy and procedure by means of 
which his services and resources shall be¬ 
come available first in places where they 
will do the most good. This aphorism, 
then, states both the necessity for, and the 
objective of, malaria-control planning. 
As a preliminary step, therefore, the 
public health malariologist might define a 
malaria problem as a situation in which 
proved malaria morbidity, or morbidity 
and mortality, prevail at such heights as to 
stimulate concerted group activity aimed 
at suppressive efforts. This stimulation 
may be spontaneous or induced. It will 
be the former if morbidity and mortality 
are sufficiently severe, i.e., under epidemic 
or hyperendemic conditions; it may be in¬ 
duced if these effects are not impressive 
enough to alarm the public, though they 
result in demonstrable economic loss which 
may not be realized until the malariologist 
points it out. 
First Consideration: Developing the 
General Picture op Malariousness 
The first essential in planning malaria 
control is to visualize the usual intensity- 
distribution of the disease over the entire 
area of responsibility. For this purpose, 
i Contribution No. 6. 
information may be obtained from the offi¬ 
cial vital statistics pertaining to malaria, or 
from malaria reconnaissance. Neither of 
these methods is completely satisfactory. 
Theoretically the former is preferable, for 
the best measure of malaria should be the 
amount of sickness and death which it 
causes. Unfortunately these attributes are 
not reported with numerical accuracy 
under routine conditions and are, there¬ 
fore, of limited dependability. 
Deaths from malaria are generally over¬ 
reported. Many medical practitioners in 
malarious areas are prone to accept any 
antemortem sign or symptom suggestive 
of malaria as evidence of infection and, in 
the absence of some more obvious factor, to 
certify it as the cause of death. Blood 
smears, and even more rarely thick blood 
films, are made on only a fraction of cases. 
Dauer and Faust (1937) state that of the 
reported malaria deaths in Mississippi for 
the year 1935, the causes of only 34 per 
cent of the deaths of colored persons were 
confirmed by laboratory diagnosis. Me- 
leney (1937) showed that of 115 malaria 
deaths reported in Tennessee in 1935, blood 
smears had been made on only 40 per cent, 
all of which were positive. Brown (1940) 
analyzed 101 malaria deaths reported in 
Georgia in 1937 and found that blood 
smears had been made on 51 per cent of 
the eases. 
Industrial life insurance policies costing 
from 5 to 25 cents a week and requiring 
no medical examination are very popular 
in the South, especially among negroes. 
They pay death benefits of from $70 to 
$350. Many of them contain the following 
limited liability clause or its equivalent 
“. . . this Policy shall be void if the in¬ 
sured . . . has ever had before said date 
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