PLANNING MALARIA CONTROL 
291 
What is the limit of local bond issuance 
and the present outstanding indebtedness? 
Likewise, malaria control must vie with 
other health improvements for its support. 
What is the importance of malaria relative 
to other health problems in terms of mor¬ 
tality, morbidity and dollars and cents? 
How much proprietary and ethical anti- 
malarial medication is consumed and what 
does it cost? Is there reason for believing 
that malaria affects or is affected by other 
local, chronic disabilities such as mainour-, 
ishment, undernourishment, hookworm dis¬ 
ease, etc.? Is the health officer keenly in¬ 
terested in malaria or is he preoccupied 
with other health problems ? These consid¬ 
erations may be important in determining 
the immediate scope, the continuity rate 
and the final success or failure of the 
malaria control project. 
Malaria is usually a rural disease and is, 
therefore, frequently associated with popu¬ 
lations dependent upon agricultural pur¬ 
suits for their livelihood. Is the local econ¬ 
omy based upon products whose market is 
fluctuating, whose prices are speculative? 
Are agricultural practices up-to-date? Is 
any attempt being made to apply new 
methods of planting, cultivation and har¬ 
vesting, to introduce new crops or farming 
activities, to develop new markets? These 
considerations may seem remote from the 
general subject of malaria prevalence and 
control, yet in planning the initial scale 
and ultimate extent of the program, they 
are determinants of primary importance. 
Fourth Consideration: Selection of 
Malaria Control Measures 
The survey report will undoubtedly in¬ 
clude recommendations for control and a 
supporting budget. These should be pre¬ 
pared on a somewhat idealized basis to re¬ 
flect clearly the relative malaria impor¬ 
tance of each area and the preferred meth¬ 
ods—and anticipated costs—of dealing 
with each of them. 
Desirable malaria-control practice calls 
for permanent, preventive measures wher¬ 
ever possible. Essentially, those involve 
the complete removal of man or the trans¬ 
mitting species of Anopheles. Depopula¬ 
tion is rarely feasible on a large scale 
because of the expense involved and the 
reluctance of people to leave their home¬ 
steads. It does have minor application, 
however, in sub-marginal lands and in the 
relocation of workers’ quarters on planta¬ 
tions. In the vicinity of wildlife refuges 
and reservations where drainage and larvi- 
cidal measures are not sanctioned, popula¬ 
tion removal is the ideal method of protec¬ 
tion to be recommended. 
The filling of anopheline breeding-places 
has the unique advantage of being imme¬ 
diately and permanently effective without 
requiring further expenditure. Its capital 
cost is so great, however, that its use is vir¬ 
tually restricted to small ponds, pools and 
pits in or near cities. 
All things considered, drainage is prob¬ 
ably the most satisfactory control method 
now used. It should be recommended 
wherever the dewatering of breeding places 
can be accomplished without violating 
vested, recreational or wildlife interests 
whose values are believed to transcend those 
of health improvement in the area. The 
construction costs of drainage are high, 
and are largely dependent upon the type 
of soil moved and the method used. Hand- 
labor excavation costs from 40 to 50 cents 
per cubic yard. Machine (dragline) dig¬ 
ging costs run from 15 to 20 cents per cubic 
yard but require a huge yardage to justify 
the purchase or rental of the equipment. 
In swampy places where a heavy dragline 
cannot be readily moved or where large 
stumps must be dislodged from the ditch 
line, dynamite excavation may be employed 
to advantage though its cost is a little above 
that of dragline operation. 
If drainage is the . method of election, an 
index of ponds should be included in the 
report, showing precisely the malariogenic 
status of each and the type of drainage 
construction proposed. It will then be pos¬ 
sible to devise a desirable sequence of drain¬ 
age operations by hand labor, or, if justi¬ 
fied, by machine. 
The greatest defect in planning for 
drainage control is failure to provide for 
