House modifications for preventing malaria

Abstract

Background Malaria remains an important public health problem. Research in 1900 suggested house modifications may reduce malaria transmission. A previous version of this review concluded that house screening may be effective in reducing malaria. This update includes data from five new studies. Objectives To assess the effects of house modifications that aim to reduce exposure to mosquitoes on malaria disease and transmission. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register; Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE (PubMed); Embase (OVID); Centre for Agriculture and Bioscience International (CAB) Abstracts (Web of Science); and the Latin American and Caribbean Health Science Information database (LILACS) up to 25 May 2022. We also searched the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, and the ISRCTN registry to identify ongoing trials up to 25 May 2022. Selection criteria Randomized controlled trials, including cluster‐randomized controlled trials (cRCTs), cross‐over studies, and stepped‐wedge designs were eligible, as were quasi‐experimental trials, including controlled before‐and‐after studies, controlled interrupted time series, and non‐randomized cross‐over studies. We sought studies investigating primary construction and house modifications to existing homes reporting epidemiological outcomes (malaria case incidence, malaria infection incidence or parasite prevalence). We extracted any entomological outcomes that were also reported in these studies. Data collection and analysis Two review authors independently selected eligible studies, extracted data, and assessed the risk of bias. We used risk ratios (RR) to compare the effect of the intervention with the control for dichotomous data. For continuous data, we presented the mean difference; and for count and rate data, we used rate ratios. We presented all results with 95% confidence intervals (CIs). We assessed the certainty of evidence using the GRADE approach. Main results One RCT and six cRCTs met our inclusion criteria, with an additional six ongoing RCTs. We did not identify any eligible non‐randomized studies. All included trials were conducted in sub‐Saharan Africa since 2009; two randomized by household and four at the block or village level. All trials assessed screening of windows, doors, eaves, ceilings, or any combination of these; this was either alone, or in combination with roof modification or eave tube installation (an insecticidal "lure and kill" device that reduces mosquito entry whilst maintaining some airflow). In one trial, the screening material was treated with 2% permethrin insecticide. In five trials, the researchers implemented the interventions. A community‐based approach was adopted in the other tri...

The Uganda Housing Modification Study – Association between housing characteristics and malaria burden in a moderate to high transmission setting in Uganda

“…[8,16] Recent studies have documented higher odds of malaria infection and disease in residents of traditional houses compared to modern houses. [10][11][12] In this study we show that: 1) traditional houses are the predominant type of housing in the study area; 2) the prevalence of microscopic parasitemia and prevalence of anemia was ~ 20% lower in children living in modern houses compared to children living in traditional houses; and 3) the RDT test positivity rates were 10% lower in febrile children living in modern houses. These observations were maintained even after controlling for wealth, age, and bednet use and the ndings add to the body of evidence on the bene ts of improved housing on malaria control.…”

“…[10] A more recent Cochrane review on the effects of house modi cations on malaria disease and transmission showed that screening of windows, doors, eaves, ceilings or any combination of these interventions reduced the risk of clinical malaria incidence, anemia, malaria parasitemia, and the entomological inoculation rate (EIR). [12] Additionally, a few studies that have evaluated the costs of the intervention have shown that the strategy is cost-effective especially in the longer term. [13,14] Despite these bene ts, housing modi cation for malaria prevention remains underutilized in most malaria endemic settings.…”

LLIN Evaluation in Uganda Project (LLINEUP2) – Association between housing and malaria burden in 32 districts

“…Higher temperatures in houses with metal roofs may also increase mosquito mortality 10 , and the odds of malaria infection in residents of houses with metal roofs was lower than in residents of mud-roofed houses 21 . In the latest Cochrane systematic review of housing modi cations to prevent malaria, trials conducted in sub-Saharan Africa between 2009 and 2022 evaluated house screening (of windows, doors, eaves, and ceilings -alone, or in combination), roof modi cations, and installation of eave tubes 14 . House improvements were found to protect against anaemia and may reduce prevalence of malaria parasitaemia.…”

Coproduction of a mixed-method framework for the deprioritization of communities during insecticide-treated bed net mass campaigns in Kwara Nigeria

“…Leveraging their extensive experience in Nigeria, the LUC team had previously compiled various geospatial datasets from multiple collaborators. These datasets, which could be consolidated at the ward level, included factors associated with malaria transmission such as types of residential settlements, monthly Enhanced Vegetation Index (EVI) readings, and proximity to water bodies 12,13,16,17 This information, combined with NMEP data on test positivity rates among children under ve (U5), was used to calculate malaria risk scores for each ward utilizing R software version 4.3.2. The goal was to integrate variables re ecting aspects of malaria risk, including receptivity, anthropogenic landscapes, and active transmission.…”

“…Previous research has shown that housing improvements are associated with a reduced likelihood of malaria infections 8 . This association is attributed to features such as closed eaves, fully covered ooring, window and door screens, and nished walls, which act as barriers preventing the female Anopheles mosquitoes from resting and feeding indoors 12 . Anthropogenic factors contributing to vector biting at the neighbourhood level include the proximity to dumpsites 7,13 and standing water 10 .…”