290 
MALARIA 
sideration of available resources as by 
known degrees of endemicity. Even where 
means are at hand, a vigorous promotional 
and educational campaign may be neces¬ 
sary to secure their utilization. 
The size of area to be selected deserves 
mention. Every effort should be made to 
avoid units so small that nullification of all 
malaria hazards within them will not ap¬ 
preciably affect malaria rates. On the other 
hand, it is difficult to maintain malaria- 
control interest in an area so large that the 
effectiveness of control can be appreciated 
by only a minor fraction of its inhabitants. 
Generally speaking, it is advisable to ad¬ 
here to existing political subdivisions, be¬ 
cause vital statistics, public expenditure, 
local health agencies and other participat¬ 
ing organizations are usually related to 
them. Occasionally a major situation, such 
as the head-watershed or impoundment of 
a large river system, may make it necessary 
to involve several subdivisions. Again, ma¬ 
laria prevalence may be intense but so lim¬ 
ited in extent within a county that the 
county population is unwilling to endorse 
public expenditures for its control. Under 
such circumstances, the project must be 
developed and studied on less than a county 
basis. 
Third Consideration : Malaria Surveys 
Assuming that these choices have been 
made, the third step in malaria-control 
planning is to assemble detailed malario- 
logical information about each area. Such 
a study is called a malaria survey. It dif¬ 
fers from a reconnaissance in that its scope 
is intensive rather than extensive. Whereas 
the reconnaissance is only a preliminary 
investigation aimed at defining areas of 
malaria importance within a region, the 
object of the survey is to show how and at 
what levels malaria is being transmitted 
and what can be done to reduce that level 
in areas where malaria control is proposed. 
Thus it involves not only measurements of 
malaria in man, but studies of local anophe- 
lines and of the specific environmental con¬ 
ditions which influence the development 
and transfer of parasites from man to in¬ 
sect and vice-versa. Essentially, it will try 
to distinguish between primary focaliza- 
tions and secondary extensions of endemic¬ 
ity and to determine the specific location 
and nature of the breeding places from 
which the anophelines responsible for trans¬ 
mission in each primary focus are derived. 
Inasmuch as Dr. Elmendorf’s contribu¬ 
tion treats of the techniques, analysis, and 
interpretations of malaria surveys, no men¬ 
tion is made of these phases of the subject 
in this presentation, noting only that the 
comprehensive survey report will contain, 
in addition to particularized malariologic 
information, some account of the social and 
economic conditions prevailing locally. Is 
the population composed of family units, 
including children, or of adult, male 
laborers employed on some remote construc¬ 
tion project? Is it their custom to sit out- 
of-doors or to travel about in the evening? 
Are they housed adequately in buildings 
that, at a reasonable cost, might be made 
mosquito-proof? What is the per capita 
or per family income and how is it spent? 
Do property-owners, renters, wage-hands, 
or share-croppers predominate in number? 
How many of them pay taxes ? How much 
of the land is owned by absentee landlords ? 
Are the intellectual capacity and experience 
of the people such that they can accept 
responsibility for the proper use of screens, 
bed-nets, or antimalarial drugs provided 
with prophylactic intent? Are they sub¬ 
ject to any sort of discipline, direct or indi¬ 
rect, or must all cooperation be voluntary? 
In obtaining public funds, health depart¬ 
ments must compete with other public ser¬ 
vices. An expanded program of road¬ 
building, of schoolhouse construction, of 
providing old-age pensions, etc., may seri¬ 
ously jeoparidize public interest in and 
maintenance of major malaria-control un¬ 
dertakings. Can the present health allot¬ 
ment be expanded to defray the costs of 
malaria control? If not, what special fiscal 
provisions can be made for this purpose? 
What is the total assessed value of private 
property and public utilities? Would a 
special malaria tax be constitutional or 
would it require enabling legislation ? 
