# Why Was This Study Done?
- Insecticide-treated bednets and house spraying have been highly effective in reducing malaria illness and deaths in Africa since 2000, but supplementary approaches are needed for long-term, sustainable intervention.
- Since most malaria mosquitoes bite indoors at nighttime, simple house improvements that prevent mosquitoes from entering homes (e.g., closing eave gaps) can help protect people against malaria infection and disease.
- Although housing improvements show promise as a malaria intervention, few studies with human participants have rigorously evaluated their effect on malaria, nor compared their effectiveness with established malaria interventions.
- We assessed whether modern, improved housing, compared with unimproved housing, was associated with a lower risk of malaria infection in children across Africa.
# What Did the Researchers Do and Find?
- We performed a cross-sectional analysis using data from 21 African countries collected in 15 Demographic and Health Surveys and 14 Malaria Indicator Surveys between 2008 and 2015.
- We analysed data from 139,318 total children aged 0–5 y, living in 84,153 households, who were tested for malaria infection using a blood smear or rapid test.
- In individual surveys, the proportion of children with malaria infection in their blood detectable by microscopy ranged from 0.4% to 45.5% among children living in modern houses and from 0.4% to 70.6% among children living in traditional houses.
- Children living in modern, improved housing (e.g., with metal roofs and brick or concrete walls) were less likely (9%–14% lower odds) to be infected with malaria than children living in traditional, unimproved housing, after accounting for differences in levels of urbanisation, wealth, and use of malaria interventions.
- As a comparison, children sleeping under insecticide-treated bednets were less likely (15%–16% lower odds) to be infected with malaria compared to children not sleeping under bednets.
# What Do These Findings Mean?
- Improving the quality of housing in Africa may help to reduce the burden of malaria and is a promising intervention for sustainable malaria control.
- Improved housing may have an effect on malaria similar to that of insecticide-treated bednets.
- Community-level experimental studies are needed to confirm our findings in different African settings.