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The evidence for improving housing to reduce malaria: a systematic review and meta-analysis
Open accessAbstract
BACKGROUND: The global malaria burden has fallen since 2000, sometimes before large-scale vector control programmes were initiated. While long-lasting insecticide-treated nets and indoor residual spraying are highly effective interventions, this study tests the hypothesis that improved housing can reduce malaria by decreasing house entry by malaria mosquitoes. METHODS: A systematic review and meta-analysis was conducted to assess whether modern housing is associated with a lower risk of malaria than traditional housing, across all age groups and malaria-endemic settings. Six electronic databases were searched to identify intervention and observational studies published from 1 January, 1900 to 13 December, 2013, measuring the association between house design and malaria. The primary outcome measures were parasite prevalence and incidence of clinical malaria. Crude and adjusted effects were combined in fixed- and random-effects meta-analyses, with sub-group analyses for: overall house type (traditional versus modern housing); screening; main wall, roof and floor materials; eave type; ceilings and elevation. RESULTS: Of 15,526 studies screened, 90 were included in a qualitative synthesis and 53 reported epidemiological outcomes, included in a meta-analysis. Of these, 39 (74%) showed trends towards a lower risk of epidemiological outcomes associated with improved house features. Of studies assessing the relationship between modern housing and malaria infection (n=11) and clinical malaria (n=5), all were observational, with very low to low quality evidence. Residents of modern houses had 47% lower odds of malaria infection compared to traditional houses (adjusted odds ratio (OR) 0°53, 95% confidence intervals (CI) 0°42-0°67, p< 0°001, five studies) and a 45-65% lower odds of clinical malaria (case-control studies: adjusted OR 0°35, 95 % CI 0°20-0°62, p<0°001, one study; cohort studies: adjusted rate ratio 0°55, 95% CI 0°36-0°84, p=0°005, three studies). Evidence of a high risk of bias was found within studies. CONCLUSIONS: Despite low quality evidence, the direction and consistency of effects indicate that housing is an important risk factor for malaria. Future research should evaluate the protective effect of specific house features and incremental housing improvements associated with socio-economic development.
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![Fig. 1 Changes in housing in sub-Saharan Africa, 1975–2012. Despite limited data, there is evidence that the quality of both urban and rural housing is improving in parts of SSA, including Bioko, Kenya, Ethiopia and Tanzania. a. Trends in housing in Bioko, Equatorial Guinea, 2009–2012 [18]. b. Proportion of homes with thatch and iron roofs in Kenya, 1993–2009 [33]. c. Proportion of homes with thatch and iron roofs in Ethiopia, 2000–2011 [33]. d. Estimated proportion of homes with concrete walls and iron roofs in Korogwe, Tanzania, 1975–2008 [34]. e. Percent reduction in the proportion of households with natural or rudimentary flooring in SSA (comparing earliest and latest available Demographic and Health Surveys (DHS); dates are shown for each country) [35]](/paper-figures/04aaf120a3fe458d88fabb24647fd514/the-evidence-for-improving-housing-to-reduce-malaria-a-systematic-review-and-figure-1.jpg)
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“in many contemporary houses (e.g., houses comprising brick walls and metal roofs), the eaves are often closed [6].”
From Semi-field evaluation of the cumulative effects of a "Lethal House Lure" on malaria mosquito mortality (2019) · cites this paper as [6]
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“This sort of house improvement has been proposed as an important route to reducing disease burden [6–8].”
From Semi-field evaluation of the cumulative effects of a "Lethal House Lure" on malaria mosquito mortality (2019) · cites this paper as [6]
In the citing paper
“and that closed eaves, together with modern housing elements, such as metal roofs, window screening, and improved doors, are associated with reduced malaria burdens.10, 11, 12, 13”
From Impact and cost-effectiveness of a lethal house lure against malaria transmission in central Côte d'Ivoire: a two-arm, cluster-randomised controlled trial (2021) · cites this paper as [10]
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Metadata
- Authors
- Tusting, L. S., Ippolito, M. M., Willey, B. A., Kleinschmidt, I., Dorsey, G., Gosling, R. D., & Lindsay, S. W.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- Johns Hopkins University (US)
- University of California, San Francisco (US)
- Durham University (GB)
- Corresponding author
- Tusting, Lucy S
- ORCID
- Venue
- Malaria Journal
- Published
- 2015-06-09
- Volume
- 14
- Issue
- 1
- Pages
- 209-209
- ISSN
- 1475-2875 (ISSN-L)
- PMC
- PMC4460721
- OpenAlex
- W1542774706
- Cited by
- 355
- References
- 36
- Citations by year
- 2026: 12 · 2025: 36 · 2024: 31 · 2023: 38 · 2022: 35 · 2021: 60 · 2020: 39 · 2019: 21 · 2018: 25 · 2017: 26 · 2016: 24 · 2015: 8
- FWCI
- 4.01
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Malaria Journal (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Durham Research Online (Durham University) (acceptedVersion, other-oa)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Durham Research Online (Durham University) (submittedVersion, cc-by)
- Funders
- U.S. Department of Homeland Security
- Bill and Melinda Gates Foundation (OPP1053338)
- Novartis Foundation for Sustainable Development
- Novartis Foundation
- Leverhulme Trust
- Department for International Development
- National Institutes of Health
- Science and Technology Directorate
- Medical Research Council (MR/K012126/1)
- National Institute of Allergy and Infectious Diseases (U19AI089674)
- Fogarty International Center
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Mosquito-borne diseases and control
- Social Sciences › Urban Studies › Urban and Rural Development Challenges
- Keywords
- malaria, housing design, modern housing, traditional dwellings, house screening, malaria risk factors, parasite prevalence, clinical malaria incidence, eaves, socio-economic development
- MeSH terms
- Housing, Humans, Malaria, Mosquito Control, Incidence, Prevalence
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