The role of improved housing in the African malaria recession
The aim of this fellowship is to investigate the potential contribution of better housing to malaria control in Africa.
This will be achieved by addressing three questions:
- How is malaria associated with housing quality in different parts of sub-Saharan Africa?
- To what extent has housing improved in Africa, and how does this change relate to trends in malaria endemicity, 2000-2015?
- What is the potential impact of using better housing as an intervention against malaria?
In summary, this study will evaluate the potential of building better homes to impact on malaria in Africa. The outcomes of this research will provide critical information to guide research and policy decisions relating to sustainable malaria control, at a pivotal time.
Malaria is a mosquito-borne disease, mainly confined to the tropics. Today, malaria control is at a pivotal juncture. The disease remains a major source of human illness and death, killing around 600,000 people annually. Yet the past fifteen years have seen great advances in controlling malaria, with a third reduction in the annual incidence of cases. These reductions have been mainly achieved by distributing chemically-treated bed nets for people to sleep beneath and by spraying houses with chemicals that kill mosquitoes. However, mosquitoes have become resistant to the chemicals used, meaning that additional tools are urgently needed to avoid losing the progress made.
Since malaria is a 'disease of poverty', strongly influenced by its environment, there is heightened interest in using broader, non-chemical approaches for its control, by working with sectors outside health such as agriculture, water and sanitation and urban planning. This is especially pertinent as we approach the launch of the Sustainable Development Goals for international development later in 2015. The research proposed here will specifically investigate how one such approach - improving housing - can help to reduce malaria in sub-Saharan Africa.
Good housing, traditionally a key pillar of public health, remains underexploited in malaria control. Yet most bites by malaria mosquitoes in sub-Saharan Africa are received indoors at night, so the home can be a risky place. Historically, improved living conditions and house screening contributed to malaria elimination in Europe and the USA. Today, studies have shown that well-built housing can help to protect against malaria in many African settings. However, house design has been largely neglected as a potential malaria control tool, due to reliance on other interventions.
Today, unprecedented population expansion and socioeconomic development in sub-Saharan Africa presents an unrivalled opportunity to build healthy homes. The continent's population is projected to double between 2010 and 2040 to nearly two billion and may surpass three billion by 2070, with 144 million new houses needed by 2030 in rural areas alone. Housing quality is also transforming across much of the continent, as incomes increase. This economic and cultural revolution represents an exceptional opportunity for malaria control.