Towards the end game: operational research on improving rural housing in sub-Saharan Africa as a strategy to support malaria elimination

Most of malaria infection in sub-Saharan Africa occurs indoors and at night. In 2018, this region accounted for 213 million malaria cases and 380,700 malaria-related deaths. Malaria has consequences for the health status of the population, as well as in education, production, economy, and development. Despite major reductions in malaria infection achieved by the massive deployment of insecticide-treated nets (ITNs), indoor residual spraying, and prompt and effective treatment with antimalarials between 2005 and 20155, malaria control has stalled in sub-Saharan Africa. New approaches are needed to reduce malaria.

Malaria mainly affects poor people living in rural areas; many of them depending on subsistence agriculture and facing vulnerable conditions whether related to economy, access to health care, access to education, infrastructure, inequality or a combination of them. Because of malaria, people’s productivity decreases, affecting workdays and family’s financial situations. At the same time, this impacts general living standards and opportunities for a better future for children and youth, specially related to education levels.

About 80% of malaria transmission occurs indoors. The Anopheles mosquitoes that transmit malaria locate a human by detecting human odours and use it as guide to find their source of blood. This is why having a ventilated house is as important as having a screened one. A ventilated house will be cooler, increasing the chances of using bed nets and reduces human odours. A multisector approach, combining research in mosquito-transmitted diseases and the built environment, may lead to novel ways to protect people from malaria in their homes.

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