Can better housing help prevent malaria?

An architectural blog article referenced in MalariaWorld provides further support for the linkage of occurrence of malaria to the quality of housing to which I have frequently made reference. ‘Can better housing help prevent malaria? The Star Homes Project in Sub-Saharan Africa’ by Lonati in designwanted.com describes a custom-built housing project in Mtwara region of Tanzania.

The project started in 2015 when the team noted that traditional rural houses in hot, humid Africa are often built in ways that inadvertently worsen health outcomes: thick walls trap heat, making it uncomfortable to sleep, and ground-level bedrooms and poor ventilation create ideal conditions for disease transmission. They observed that the typology of rural housing in hot-humid Asia differs significantly, despite being in the same climate zone. Houses are often light, air-permeable structures frequently made of bamboo, often on stilts. African houses have earth floor, wattle and daub walls, and thatched, or corrugated iron roofs.

They designed six house types clad in shadenet, timber and bamboo and chose a two-storey shadenet design (picture) which proved the most effective at reducing indoor heat and mosquito entry. However, not insignificantly it had additional features such as rainwater collection tanks, ventilated pit latrines, and washable surfaces to improve hygiene and reduce exposure to disease.

They constructed 110 units of the new Star homes in Mtwara and compared with 440 traditional houses in a study with households of three children to track malaria, respiratory diseases and diarrhoea for three years from 2021. The final report has not yet been published, and preliminary results suggest a 30–40% reduction in malaria among children living in the Star Homes, children under five have shown improved growth, and indoor mosquito abundance has decreased by 50%.

Naturally, much emphasis is placed on excluding mosquitos. The reduction was 50%. There is no doubt that it is more comfortable to sleep if not at risk of mosquito bites. But is the benefit the result of better sleep or less vector borne disease?

And perhaps the health benefit was the result of the other improvements – rainwater collection tanks, ventilated pit latrines, and washable surfaces. Many studies have shown that children who live in better houses are less affected by malaria.