Housing Improvements and Malaria Risk in Sub-Saharan Africa: A Multi-Country Analysis of Survey Data

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.

Related Publications

URLDOITusting LS., Bottomley C., Gibson H., Kleinschmidt I., Tatem AJ., Lindsay SW., Gething PW.,

Housing improvements and malaria risk in sub-Saharan Africa: a multi-country analysis of survey data

PLoS Medicine. February 2017 14(2): e1002234.