Affordable house designs to improve health in rural Africa: a field study from northeastern Tanzania

Abstract

Background: The population of sub-Saharan Africa is currently estimated to be 1245 million and is expected to quadruple by the end of the century, necessitating the building of millions of homes. Malaria remains a substantial problem in this region and efforts to minimise transmission should be considered in future house planning. We studied how building elements, which have been successfully employed in southeast Asia to prevent mosquitos from entering and cooling the house, could be integrated in a more sustainable house design in rural northeastern Tanzania, Africa, to decrease mosquito density and regulate indoor climate. Methods: In this field study, six prototype houses of southeast Asian design were built in in the village of Magoda in Muheza District, Tanga Region, Tanzania, and compared with modified and unmodified, traditional, sub-Saharan African houses. Prototype houses were built with walls made of lightweight permeable materials (bamboo, shade net, or timber) with bedrooms elevated from the ground and with screened windows. Modified and unmodified traditional African houses, wattle-daub or mud-block constructions, built on the ground with poor ventilation served as controls. In the modified houses, major structural problems such as leaking roofs were repaired, windows screened, open eaves blocked with bricks and mortar, cement floors repaired or constructed, and rain gutters and a tank for water storage added. Prototype houses were randomly allocated to village households through a free, fair, and transparent lottery. The lottery tickets were deposited in a bucket made of transparent plastic. Each participant could draw one ticket. Hourly measurements of indoor temperature and humidity were recorded in all study houses with data loggers and mosquitoes were collected indoors and outdoors using Furvela tent traps and were identified with standard taxonomic keys. Mosquitoes of the Anopheles gambiae complex were identified to species using PCR. Attitudes towards the new house design were assessed 6–9 months after the residents moved into their new or modified homes through 15 in-depth interviews with household heads of the new houses and five focus group discussions including neighbours of each group of prototype housing. Findings: Between July, 2014, and July, 2015, six prototype houses were constructed; one single and one double storey building with each of the following claddings: bamboo, shade net, and timber. The overall reduction of all mosquitoes caught was highest in the double-storey buildings (96%; 95% CI 92–98) followed closely by the reduction found in single-storey buildings (77%; 72–82) and lowest in the modified reference houses (43%; 36–50) and unmodified reference houses (23%; 18–29). The indoor temperature in the new design houses was 2·3°C (95% CI 2·2–2·4) cooler than in the reference houses. While both single and two-storey buildings provided a cooler indoor climate than did traditional housing, two-story buildings provided the biggest reduction in mosquito densities (96%, 95% CI 89–100). Seven people who moved into the prototype houses and seven of their neighbours (three of whom had their houses modified) participated in in-depth interviews. After living in their new prototype houses for 6–9 months, residents expressed satisfaction with the new design, especially the second-storey sleeping area because of the privacy and security of upstairs bedrooms. Interpretation: The new design houses had fewer mosquitoes and were cooler than modified and unmodified traditional homes. New house designs are an underused intervention and hold promise to reduce malaria transmission in sub-Saharan Africa and keep areas malaria-free after elimination. Funding: Ruth W Jensens Foundation, Copenhagen and Hanako Foundation, Singapore.