Improving housing conditions may provide a boost to malaria prevention at a time when other efforts may be losing steam, according to new research.
As Africa rapidly moves away from traditional mud-and-thatch housing, experts see a chance for architects and urban planners to join the fight against the disease.
Bed nets and indoor insecticide spraying have been extremely effective in curtailing malaria. Rates are down by about 40 percent worldwide. But these efforts are not enough. More than 400,000 people died of the disease in 2015, mostly African children, according to the World Health Organization. And mosquitoes are becoming resistant to the insecticides.
At the same time, researchers are seeing a transition across Africa. Traditional mud-walled, thatch-roofed housing is being replaced by more modern construction, with concrete walls and metal or tile roofs.
Housing is also changing as the continent experiences among the world's fastest rates of urbanization.
As these transitions take place, "We have an opportunity to tap into the changes that are ongoing in many parts of Africa in order to build healthier housing," says University of Oxford epidemiologist Lucy Tusting, lead author of the new study in the journal PLOS Medicine.
Housing as a public health tool
Most mosquitoes that carry the malaria parasite bite indoors at night. So better-quality housing, with fewer gaps in the walls and ceiling where insects can get in, should help prevent the disease.
Using housing as a public health tool against malaria is not a new idea. Screened windows and doors were the very first effective technique used to prevent the disease in the early 20th century. But there hasn't been much research on the subject.
Tusting and colleagues looked at health and demographic surveys from 21 countries. They found that children living in modern-construction homes were 9-to-14 percent less likely to have malaria than those living in traditional housing.
That's similar to the level of protection insecticide-treated bed nets provided. Children sleeping under bed nets had 15-to-16 percent lower odds of malaria infection than those who did not.
That's not to diminish the importance of bed nets, Tusting says.
As Africa's population expands rapidly, she adds, "We can leverage those changes. But to do so, it's important for health specialists to reach beyond the health sector" and work with architects, urban planners and policymakers to build malaria prevention into the habitat of the continent's growing cities.