Table 1.

A systemic view of malaria: Factors, control strategies, and challenges

Elements	Factors	Control strategies	Challenges
Vector	Species; feeding, resting, biting, host, and breeding preference; flight range; life span; vectorial capacity; reproduction rate; resistance	Insecticide-treated nets; indoor residual spraying; larval source management; fogging or area spraying	Mosquito behavior change; insecticide resistance; novel vector control (traps, engineered mosquitoes); genetic differences
Parasite	Type and strain; resistance to antimalarials; duration of infection	Case management; malaria seasonal chemoprevention; intermittent presumptive treatment; mass drug administration	New diagnostic tools; sub-microscopic parasitemia; asymptomatic infections; gametocyte cycle; genetic diversity; hypnozoites; drug resistance; vaccines
Human	Genetic/acquired immunity; knowledge (transmission, prevention, treatment); age; migratory pattern; occupation; education; cultural beliefs; behavior; access to care; population density; political context (public health interventions, support and infrastructure, construction of major development projects, implementation of foreign assistance, political stability, and governance); globalization (market pressures, choice of crops, exploitation of natural resources); environmental change	Personal protection (repellents, protective clothing); behavior change communication	Community participation; adherence to control; risk perception; behavior change; human mobility; forced mobility (climate, conflicts); malaria in pregnancy Scale-up; sustainability of recent achievements; funding (donor fatigue); political commitment; intersectoral collaboration; strong health system; surveillance; counterfeit drugs; affordable drugs; supply chain management
Environment	Natural: temperature, rainfall, humidity; elevation/slope; soil quality; vegetation; hydrology; presence of natural enemies of mosquitoes and larvae; natural disasters Human-made: urbanization; land change/use; housing type; deforestation; infrastructure (water, waste collection, sanitation); development projects (dams, roads, oil pipelines, mining, railways, irrigation, resettlement); disasters facilitated by human change	Environmental management; house improvement	Infrastructure projects; environmental change; extreme climatic events