Because malaria is responsible for so many deaths in the developing world, its prevention is important. A new study shows that housing and architecture can reduce the impact of malaria.
25th April 2010 marks World Malaria day. Malaria is one of the leading causes of sickness and death in the developing world. Despite modern day scientific and technological advancements, a child dies of malaria every 30 seconds, even though malaria is preventable and curable About 40% of the world’s population are at risk of malaria and there are 300 to 500 million clinical cases of malaria each year resulting in 1.5 to 2.7 million deaths[i].
Architecture: A new way to prevent malaria?
Presently malaria prevention prioritizes two main interventions; use of long lasting insecticide treated bed-nets, and indoor residual spraying (IRS). In addition, malaria drugs are used for prophylaxis, especially for the vulnerable groups in highly endemic areas, such as pregnant women. But what is the relationship between malaria, and architecture – particularly that of housing design? The increased number of inadequate housing has been seen to significantly contribute to the malaria burden. In 1994, slums settlements contributed to approximately 25% of the total malaria in Dindigul town in India.[ii]
Is it effective?
But are simple changes in house designs effective in malaria reduction? Mosquito-proofed houses have the potential for protecting people against malaria. A study by Steve Lindsay[iii] from the London School of Hygiene and Tropical Medicine highlights historic findings and urges us not to forget or ignore valuable lessons. Lindsay shows that since the 19th century, it was demonstrated that people could be protected from malaria by screening their homes against mosquitoes. In fact, there was a 96% reduction in cases of malaria among residents with mosquito-proof houses! In 1921, Mark Boyd found that better quality housing was associated with protection against malaria in Missouri, USA. The British army also mosquito-proofed their houses in Lahore, Pakistan, in 1925, and this reduced the incidence of malaria by 68%.
How do these architectural changes work?
The issue about the vector behavioural differences may be raised at this point. The African mosquito Anopheles gambiae, which is one of the world’s most efficient, and dangerous vectors, is adapted for entering houses at night and feeding on people. When this mosquito reaches a wall when trying to enter a house, it flies upwards, and identifies openings or cracks to fly in, unlike other species that fly off sideways when encountered with a wall. Steve Lindsay noted that preventing this mosquito from entering a house either by installing ceilings or closing eaves should reduce malaria transmission, infection and disease. Also, because most mosquitoes searching for blood fly close to the ground, one of the simplest ways of avoiding mosquito bites is by building homes of the ground.
Yazoume Ye [iv] also suggested that house characteristics should be taken into account when designing health interventions against malaria infection. He carried out a study in Burkina Faso which compared the prevalence of malaria infection between children living in mud roofed houses, and iron sheet roofed houses, and found that, after controlling for potential confounders, children living in iron-sheet houses had a two times less risk of malaria infection compared to those living in houses with mud roofs.
Help us raise awareness!
The above listed studies highlight the importance of simple architectural designs as a means of vector control. If mosquito-proofed housing is used in conjunction with existing methods of vector control, the reduction in malaria infection incidence could be substantial. It is ARCHIVE’s ultimate goal, that we will be able to raise awareness and stimulate debate about the use of architecture as a means of mitigating malaria transmission. As World Malaria day comes approaches, please join the discussion on Facebook: www.facebook.com/archiveinstitute or visit us at www.archiveinstitute.org
[ii] A Srivastava, BN Nagpal, R Saxena, A Eapen, GIS based malaria information management system for urban malaria scheme in India, Computer Methods and Programs in Biomedicine, Volume 71, Issue 1, pp 63
[iii] Lindsay, S.W, Emerson, P.M, Charlwood, J.D, Reducing Malaria by mosquito-proofing houses, Trends in Parasitology Vol 18 No 11, 2002.
[iv] Ye, Y., Hoshen, M, Louis V, Seraphin, s, Traore, I, Sauerborn, R, Housing Conditions and Plasmodium falciparum infection: protective effect of iron-sheet roofed houses, Malaria Journal, 2006, 5:8
Diana Inegbenebor is a Research Coordinator with the ARCHIVE Institute, UK. She trained as a physician, and has worked in Nigeria as a clinician. She has an MSc in Tropical Medicine and International Health, and a Diploma in Tropical Medicine and Hygiene, from the London School of Hygiene and Tropical Medicine. The ARCHIVE (Architecture for Health In Vulnerable Environments) Institute uses housing design as a means for improving health among the world's poor.