Housing and child health in sub-Saharan Africa: A cross-sectional analysis
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BACKGROUND: Housing is essential to human well-being but neglected in global health. Today, housing in Africa is rapidly improving alongside economic development, creating an urgent need to understand how these changes can benefit health. We hypothesised that improved housing is associated with better health in children living in sub-Saharan Africa (SSA). We conducted a cross-sectional analysis of housing conditions relative to a range of child health outcomes in SSA. METHODS AND FINDINGS: Cross-sectional data were analysed for 824,694 children surveyed in 54 Demographic and Health Surveys, 21 Malaria Indicator Surveys, and two AIDS Indicator Surveys conducted in 33 countries between 2001 and 2017 that measured malaria infection by microscopy or rapid diagnostic test (RDT), diarrhoea, acute respiratory infections (ARIs), stunting, wasting, underweight, or anaemia in children aged 0-5 years. The mean age of children was 2.5 years, and 49.7% were female. Housing was categorised into a binary variable based on a United Nations definition comparing improved housing (with improved drinking water, improved sanitation, sufficient living area, and finished building materials) versus unimproved housing (all other houses). Associations between house type and child health outcomes were determined using conditional logistic regression within surveys, adjusting for prespecified covariables including age, sex, household wealth, insecticide-treated bed net use, and vaccination status. Individual survey odds ratios (ORs) were pooled using random-effects meta-analysis. Across surveys, improved housing was associated with 8%-18% lower odds of all outcomes except ARI (malaria infection by microscopy: adjusted OR [aOR] 0.88, 95% confidence intervals [CIs] 0.80-0.97, p = 0.01; malaria infection by RDT: aOR 0.82, 95% CI 0.77-0.88, p < 0.001; diarrhoea: aOR 0.92, 95% CI 0.88-0.97, p = 0.001; ARI: aOR 0.96, 95% CI 0.87-1.07, p = 0.49; stunting: aOR 0.83, 95% CI 0.77-0.88, p < 0.001; wasting: aOR 0.90, 95% CI 0.83-0.99, p = 0.03; underweight: aOR 0.85, 95% CI 0.80-0.90, p < 0.001; any anaemia: aOR 0.87, 95% CI 0.82-0.92, p < 0.001; severe anaemia: aOR 0.89, 95% CI 0.84-0.95, p < 0.001). In comparison, insecticide-treated net use was associated with 16%-17% lower odds of malaria infection (microscopy: aOR 0.83, 95% CI 0.78-0.88, p < 0.001; RDT: aOR 0.84, 95% CI 0.79-0.88, p < 0.001). Drinking water source and sanitation facility alone were not associated with diarrhoea. The main study limitations are the use of self-reported diarrhoea and ARI, as well as potential residual confounding by socioeconomic position, despite adjustments for household wealth and education. CONCLUSIONS: In this study, we observed that poor housing, which includes inadequate drinking water and sanitation facility, is associated with health outcomes known to increase child mortality in SSA. Improvements to housing may be protective against a number of important childhood infectious diseases as well as poor growth outcomes, with major potential to improve children's health and survival across SSA.
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Closed eaves, together with modern housing elements such as metal roofs, window screening, and improved doors, are associated with reduced malaria burdens.
“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 [13]
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COVID-19 & informal settlements: is Stay Home safe?Preprint
Nix, E., Paulose, J., Lakhanpaul, M., Factor-Litvak, P. R., Parikh, P., Altamirano, H., Karim, Y. B., & Manikam, L. (2021) · doi:10.14324/111.444/000038.v2
- Authors
- Tusting, L. S., Gething, P. W., Gibson, H. S., Greenwood, B., Knudsen, J., Lindsay, S. W., & Bhatt, S.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- University of Oxford (GB)
- Royal Danish Academy – Architecture, Design, Conservation (DK)
- Durham University (GB)
- Corresponding author
- Tusting, Lucy S.
- ORCID
- Venue
- PLoS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2020-03-23
- Volume
- 17
- Issue
- 3
- Pages
- e1003055
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC7089421
- OpenAlex
- W3012798392
- Cited by
- 130
- References
- 30
- Citations by year
- 2026: 21 · 2025: 16 · 2024: 17 · 2023: 16 · 2022: 24 · 2021: 33 · 2020: 3
- FWCI
- 12.01
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Architecture, Design and Conservation (Aarhus School of Architecture, Design School Kolding, The Royal Danish Academy of Fine Arts, Schools of Architecture, Design and Conservation (KADK)) (publishedVersion, other-oa)
- Durham Research Online (Durham University) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Durham Research Online (Durham University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Academy of Medical Sciences (SBF004\1080)
- European Commission (EDCTP2-programme, EDCTP2)
- Department for International Development (N011570)
- Global Challenges Research Fund
- Directorate for Biological Sciences
- Medical Research Council (MR/N011570/2, N011570, MR/R015600/1, MR/N011570/1)
- Biotechnology and Biological Sciences Research Council (BB/R00532X/1)
- European and Developing Countries Clinical Trials Partnership (EDCTP2)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Social Sciences › Urban Studies › Urban and Rural Development Challenges
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- housing conditions, child health, improved housing, malaria, diarrhea, acute respiratory infections, stunting, wasting, underweight, anemia, household wealth, sanitation, drinking water, sub-Saharan Africa, child mortality, insecticide-treated nets, vaccination status, household crowding
- MeSH terms
- Child Health, Age Factors, Anemia, Child, Preschool, Cross-Sectional Studies, Diarrhea, Female, Health Status, Health Surveys, Housing, Humans, Infant, Infant, Newborn, Malaria, Male, Prospective Studies, Risk Factors, Sanitation, Child Nutrition Disorders, Africa South of the Sahara, Risk Assessment, Insecticide-Treated Bednets, Drinking Water, Social Determinants of Health, Protective Factors
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