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Rapid improvements to rural Ugandan housing and their association with malaria from intense to reduced transmission:: a cohort study

Rapid improvements to rural Ugandan housing and their association with malaria from intense to reduced transmission:: a cohort study
Rapid improvements to rural Ugandan housing and their association with malaria from intense to reduced transmission:: a cohort study
Background: rapid population growth in Africa requires an urgent expansion and improvement of housing options. Improving housing presents a promising opportunity for malaria control by reducing indoor exposure to mosquitoes. We measured recent changes in house design in rural Uganda and evaluated their association with malaria in relation to a mass scale-up of control efforts.Methods: this analysis was part of a cohort study designed to compare temporal changes in malaria incidence from a cohort of children and adults with temporal changes in malaria test positivity rate from health facility surveillance. All children aged 6 months to 10 years (n=384) living in 107 households in Nagongera sub-country, Tororo, Uganda, were given long-lasting insecticide-treated nets and followed between Aug 19, 2011, and June 30, 2017. Repeat rounds of indoor residual spraying of insecticide were initiated on Dec 5, 2014. Socioeconomic data were collected at two timepoints (Sept 25–Oct 9, 2013 and June 21–July 11, 2016) and houses were classified as modern (cement, wood, or metal walls, tiled or metal roof, and closed eaves) or traditional (all other homes). Associations between house design and three outcomes were evaluated before and after the introduction of indoor residual spraying: human biting rate estimated monthly in each household using US Centers for Disease Control and Prevention light traps; parasite prevalence measured routinely by microscopy every 3 months before indoor residual spraying and monthly after indoor residual spraying; and malaria incidence measured by passive surveillance.Findings: the implementation of indoor residual spraying was associated with significant declines in human biting rate (33·5 vs 2·7 Anopheles per house per night after indoor residual spraying, p<0·0001), parasite prevalence (32·0% vs 14·0%, p<0·0001), and malaria incidence (3·0 vs 0·5 episodes per person-year at risk, p<0·0001). The prevalence of modern housing increased from 23·4% in 2013 to 45·4% in 2016 (p=0·001). Compared with traditional houses, modern houses were associated with a 48% reduction in human biting rate before indoor residual spraying (adjusted incidence rate ratio [aIRR] 0·52, 95% CI 0·36–0·73, p=0·0002), and a 73% reduction after indoor residual spraying (aIRR 0·27, 0·17–0·42, p<0·0001). Before indoor residual spraying, there was no association between house type and parasite prevalence, but after indoor residual spraying there was a 57% reduction in the odds of parasitaemia in modern houses compared with traditional houses, controlling for age, sex, and socioeconomic position (adjusted odds ratio 0·43, 95% CI 0·24–0·77, p=0·004). House type was not associated with malaria incidence before or after indoor residual spraying.Interpretation: house design improved rapidly in rural Uganda and was associated with additional reductions in mosquito density and parasite prevalence following the introduction of indoor residual spraying. Changes to house design in endemic Africa, including closing eaves and the replacement of traditional building materials, might help further the gains achieved with more widely accepted malaria control interventions.
2542-5196
e83-e94
Rek, John C.
d16205aa-104b-42d4-b246-230da59ed07d
Alegana, Victor
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Arinaitwe, Emmanuel
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Cameron, Ewan
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Kamya, Moses R.
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Katureebe, Agaba
73250fb1-1d1a-4701-99db-05caad1b1de4
Lindsay, Steve W.
5438bb36-9fb0-427b-94e5-66da0d8102ce
Rek, John C.
d16205aa-104b-42d4-b246-230da59ed07d
Alegana, Victor
f5bd6ab7-459e-4122-984f-2bdb5f906d82
Arinaitwe, Emmanuel
010b00f1-a151-4041-91b1-4d7b7fe5caad
Cameron, Ewan
0f6addb8-15d6-47bb-b0ca-8b6108f5d6a0
Kamya, Moses R.
80271fd7-15a0-4339-8bd1-507e3f08c815
Katureebe, Agaba
73250fb1-1d1a-4701-99db-05caad1b1de4
Lindsay, Steve W.
5438bb36-9fb0-427b-94e5-66da0d8102ce

Rek, John C., Alegana, Victor, Arinaitwe, Emmanuel, Cameron, Ewan, Kamya, Moses R., Katureebe, Agaba and Lindsay, Steve W. (2018) Rapid improvements to rural Ugandan housing and their association with malaria from intense to reduced transmission:: a cohort study. The Lancet Planetary Health, 2 (2), e83-e94. (doi:10.1016/S2542-5196(18)30010-X).

Record type: Article

Abstract

Background: rapid population growth in Africa requires an urgent expansion and improvement of housing options. Improving housing presents a promising opportunity for malaria control by reducing indoor exposure to mosquitoes. We measured recent changes in house design in rural Uganda and evaluated their association with malaria in relation to a mass scale-up of control efforts.Methods: this analysis was part of a cohort study designed to compare temporal changes in malaria incidence from a cohort of children and adults with temporal changes in malaria test positivity rate from health facility surveillance. All children aged 6 months to 10 years (n=384) living in 107 households in Nagongera sub-country, Tororo, Uganda, were given long-lasting insecticide-treated nets and followed between Aug 19, 2011, and June 30, 2017. Repeat rounds of indoor residual spraying of insecticide were initiated on Dec 5, 2014. Socioeconomic data were collected at two timepoints (Sept 25–Oct 9, 2013 and June 21–July 11, 2016) and houses were classified as modern (cement, wood, or metal walls, tiled or metal roof, and closed eaves) or traditional (all other homes). Associations between house design and three outcomes were evaluated before and after the introduction of indoor residual spraying: human biting rate estimated monthly in each household using US Centers for Disease Control and Prevention light traps; parasite prevalence measured routinely by microscopy every 3 months before indoor residual spraying and monthly after indoor residual spraying; and malaria incidence measured by passive surveillance.Findings: the implementation of indoor residual spraying was associated with significant declines in human biting rate (33·5 vs 2·7 Anopheles per house per night after indoor residual spraying, p<0·0001), parasite prevalence (32·0% vs 14·0%, p<0·0001), and malaria incidence (3·0 vs 0·5 episodes per person-year at risk, p<0·0001). The prevalence of modern housing increased from 23·4% in 2013 to 45·4% in 2016 (p=0·001). Compared with traditional houses, modern houses were associated with a 48% reduction in human biting rate before indoor residual spraying (adjusted incidence rate ratio [aIRR] 0·52, 95% CI 0·36–0·73, p=0·0002), and a 73% reduction after indoor residual spraying (aIRR 0·27, 0·17–0·42, p<0·0001). Before indoor residual spraying, there was no association between house type and parasite prevalence, but after indoor residual spraying there was a 57% reduction in the odds of parasitaemia in modern houses compared with traditional houses, controlling for age, sex, and socioeconomic position (adjusted odds ratio 0·43, 95% CI 0·24–0·77, p=0·004). House type was not associated with malaria incidence before or after indoor residual spraying.Interpretation: house design improved rapidly in rural Uganda and was associated with additional reductions in mosquito density and parasite prevalence following the introduction of indoor residual spraying. Changes to house design in endemic Africa, including closing eaves and the replacement of traditional building materials, might help further the gains achieved with more widely accepted malaria control interventions.

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Accepted/In Press date: 21 January 2018
Published date: 12 February 2018

Identifiers

Local EPrints ID: 417887
URI: https://eprints.soton.ac.uk/id/eprint/417887
ISSN: 2542-5196
PURE UUID: a127b805-6917-4fd1-8582-4ed8cf39bb68
ORCID for Victor Alegana: ORCID iD orcid.org/0000-0001-5177-9227

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Date deposited: 16 Feb 2018 17:30
Last modified: 14 Mar 2019 01:33

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Contributors

Author: John C. Rek
Author: Victor Alegana ORCID iD
Author: Emmanuel Arinaitwe
Author: Ewan Cameron
Author: Moses R. Kamya
Author: Agaba Katureebe
Author: Steve W. Lindsay

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