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House Structure Is Associated with Malaria among Febrile Patients in a High-Transmission Region of Zambia
Jay Sikalima
Jay Sikalima
Tropical Diseases Research Centre, Ndola, Zambia;
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Jessica L. Schue
Jessica L. Schue
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
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Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
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Sarah E. Hill
Sarah E. Hill
Johns Hopkins University School of Medicine, Baltimore, Maryland;
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Modest Mulenga
Modest Mulenga
Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, Kitwe, Zambia
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Ray Handema
Ray Handema
Tropical Diseases Research Centre, Ndola, Zambia;
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Victor Daka
Victor Daka
Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, Kitwe, Zambia
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Justin Chileshe
Justin Chileshe
Tropical Diseases Research Centre, Ndola, Zambia;
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Webster Kasongo
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Tropical Diseases Research Centre, Ndola, Zambia;
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Mike Chaponda
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Tropical Diseases Research Centre, Ndola, Zambia;
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Jean-Bertin Bukasa Kabuya
Jean-Bertin Bukasa Kabuya
Tropical Diseases Research Centre, Ndola, Zambia;
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William J. Moss
William J. Moss
Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
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Matthew M. Ippolito
Matthew M. Ippolito
Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
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for the Southern and Central Africa International Centers of Excellence for Malaria Research
for the Southern and Central Africa International Centers of Excellence for Malaria Research
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Abstract.
Since the late nineteenth century, the importance of house structure as a determinant of malaria risk has been recognized. Few studies to date have examined the association of housing and malaria in clinical populations. We conducted a cross-sectional study of febrile patients (n = 282) at two rural health clinics in a high malaria-transmission area of northern Zambia. Participants underwent testing for Plasmodium falciparum infection by PCR. Demographic and other risk factors including house structure, indoor residual spraying (IRS), bed net use, education level, and household income were collected. Data were fitted to logistic regression models for relational and mediation analyses. Residing in a house with a thatch roof was associated with higher odds of malaria than residing in a house with corrugated metal (odds ratio: 2.6; 95% CI: 1.0–6.3, P = 0.04). Lower income and educational attainment were also associated with greater odds of malaria. Living under a thatch roof accounted for 24% (95% CI: 14–82) of the effect of household income on malaria risk, and income accounted for 11% (95% CI: 8–19) of the effect of education. Neither IRS nor bed net use was associated with malaria risk despite large, local investments in these vector control interventions. The findings testify to malaria as a disease of rural poverty and contribute further evidence to the utility of housing improvements in vector control programs.
Author Notes
Disclosure: Data can be made available by the authors upon reasonable request. Verbal consent was obtained for photography.
Financial support: The parent study was funded by Meridian Bioscience (USA) and Sep Sci (Zambia). J. S., M. M., W. J. M., and M. M. I. were supported by the National Institutes of Health (U19AI089680). J. L. S. and M. M. I. were supported by the Johns Hopkins Malaria Research Institute and Bloomberg Philanthropies. M. M. I. was supported by the National Institutes of Health (K23AI139343), the Sherrilyn and Ken Fisher Center for Environmental Infectious Disease at Johns Hopkins University, and the Burroughs Wellcome Fund-American Society of Tropical Medicine and Hygiene Postdoctoral Fellowship in Tropical Infectious Diseases. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of the Fisher Center or Johns Hopkins University School of Medicine.
Authors’ addresses: Jay Sikalima, Laboratory Tropical Medicine, Tropical Diseases Research Centre (TDRC), Ndola, Zambia, E-mail: jsikalima@gmail.com. Jessica L. Schue, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, E-mail: jlschue@jhu.edu. Sarah E. Hill, Johns Hopkins University School of Medicine, Baltimore, MD, E-mail: shill49@jhu.edu. Modest Mulenga and Victor Daka, Department of Public Health, Copperbelt University, Ndola, Zambia, E-mails: m.mulenga@hotmail.com and dakavictorm@gmail.com. Ray Handema and Webster Kasongo, Department of Clinical Research, TDRC, Ndola, Zambia, E-mails: handemar@tdrc.org.zm and websterkasongo@tdrc.org.zm. Justin Chileshe, Department of Parasitology, Tropical Diseases Research Centre, Ndola, Zambia, E-mail: jbchile@yahoo.com. Mike Chaponda, Department of Health, Tropical Diseases Research Centre, Mansa, Zambia, E-mail: mikechaponda@yahoo.com. Jean-Bertin Bukasa Kabuya, Department of Health, Tropical Diseases Research Centre, Ndola, Zambia, E-mail: jeanbertinkabuya@gmail.com. William J. Moss, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, E-mail: wmoss1@jhu.edu. Matthew M. Ippolito, Department of Medicine, Johns Hopkins University, Baltimore, MD, E-mail: mippolito@jhu.edu.
Deceased.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Lane C, 1931. Housing and Malaria: A Critical Summary of the Literature Dealing with This Subject. Geneva, Switzerland: League of Nations, Health Organisation.
-
2.
Celli A, 1900. The new prophylaxis against malaria in Lazio. Lancet 156: 1603–1606.
-
3.
Tusting LS, Ippolito MM, Willey BA, Kleinschmidt I, Dorsey G, Gosling RD, Lindsay SW, 2015. The evidence for improving housing to reduce malaria: a systematic review and meta-analysis. Malar J 14: 209.
-
4.
Furnival-Adams J, Olanga EA, Napier M, Garner P, 2020. House modifications for preventing malaria. Cochrane Database Syst Rev 10: CD013398.
-
5.
Mukonka VM et al. 2014. High burden of malaria following scale-up of control interventions in Nchelenge district, Luapula province, Zambia. Malar J 13: 153.
-
6.
Eisele TP et al. 2016. Short-term impact of mass drug administration with dihydroartemisinin plus piperaquine on malaria in southern province Zambia: a cluster-randomized controlled trial. J Infect Dis 214: 1831–1839.
-
7.
Moss WJ et al. 2015. Malaria epidemiology and control within the international centers of excellence for malaria research. Am J Trop Med Hyg 93 (Suppl 3): 5–15.
-
8.
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-
9.
Chizema-Kawesha E, Miller JM, Steketee RW, Mukonka VM, Mukuka C, Mohamed AD, Miti SK, Campbell CC, 2010. Scaling up malaria control in Zambia: progress and impact 2005–2008. Am J Trop Med Hyg 83: 480–488.
-
10.
Kent RJ, Thuma PE, Mharakurwa S, Norris DE, 2007. Seasonality, blood feeding behavior, and transmission of Plasmodium falciparum by Anopheles arabiensis after an extended drought in southern Zambia. Am J Trop Med Hyg 76: 267–274.
-
11.
Ippolito MM, Searle KM, Hamapumbu H, Shields TM, Stevenson JC, Thuma PE, Moss WJ; For The Southern Africa International Center Of Excellence For Malaria Research, 2017. House structure is associated with Plasmodium falciparum infection in a low-transmission setting in southern Zambia. Am J Trop Med Hyg 97: 1561–1567.
-
12.
Paaijmans KP, Thomas MB, 2011. The influence of mosquito resting behaviour and associated microclimate for malaria risk. Malar J 10: 183.
-
13.
Kirby MJ, West P, Green C, Jasseh M, Lindsay SW, 2008. Risk factors for house-entry by culicine mosquitoes in a rural town and satellite villages in the Gambia. Parasit Vectors 1: 41.
-
14.
Lindsay SW, Snow RW, 1988. The trouble with eaves; house entry by vectors of malaria. Trans R Soc Trop Med Hyg 82: 645–646.
-
15.
Njie M, Dilger E, Lindsay SW, Kirby MJ, 2009. Importance of eaves to house entry by anopheline, but not culicine, mosquitoes. J Med Entomol 46: 505–510.
-
16.
Lindsay SW et al. 2019. Reduced mosquito survival in metal-roof houses may contribute to a decline in malaria transmission in sub-Saharan Africa. Sci Rep 9: 7770.
-
17.
Jatta E, Jawara M, Bradley J, Jeffries D, Kandeh B, Knudsen JB, Wilson AL, Pinder M, D'Alessandro U, Lindsay SW, 2018. How house design affects malaria mosquito density, temperature, and relative humidity: an experimental study in rural Gambia. Lancet Planet Health 2: e498–e508.
-
18.
Lahondere C, Lazzari CR, 2012. Mosquitoes cool down during blood feeding to avoid overheating. Curr Biol 22: 40–45.
-
19.
Iwashita H, Dida G, Futami K, Kaneko S, Horio M, Kawada H, Maekawa Y, Aoki Y, Minakawa N, 2010. Sleeping arrangement and house structure affect bed net use in villages along Lake Victoria. Malar J 9: 176.
-
20.
Correa A, Galardo AKR, Lima LA, Câmara DCP, Müller JN, Barroso JFS, Lapouble OMM, Rodovalho CM, Ribeiro KAN, Lima JBP, 2019. Efficacy of insecticides used in indoor residual spraying for malaria control: an experimental trial on various surfaces in a “test house”. Malar J 18: 345.
-
21.
Desalegn Z, Wegayehu T, Massebo F, 2018. Wall-type and indoor residual spraying application quality affect the residual efficacy of indoor residual spray against wild malaria vector in southwest Ethiopia. Malar J 17: 300.
-
22.
Tusting LS, Willey B, Lucas H, Thompson J, Kafy HT, Smith R, Lindsay SW, 2013. Socioeconomic development as an intervention against malaria: a systematic review and meta-analysis. Lancet 382: 963–972.
-
23.
Worrall E, Basu S, Hanson K, 2005. Is malaria a disease of poverty? A review of the literature. Trop Med Int Health 10: 1047–1059.
-
24.
Griliches Z, Mason WM, 1972. Education, income, and ability. J Political Economy 80: S74–S103.
-
25.
Ahmed SM, Haque R, Haque U, Hossain A, 2009. Knowledge on the transmission, prevention and treatment of malaria among two endemic populations of Bangladesh and their health-seeking behaviour. Malar J 8: 173.
-
26.
Gingrich CD, Hanson K, Marchant T, Mulligan JA, Mponda H, 2011. Price subsidies and the market for mosquito nets in developing countries: a study of Tanzania’s discount voucher scheme. Soc Sci Med 73: 160–168.
-
27.
Hanson K, Worrall E, 2002. Social Marketing of Insecticide Treated Nets – Phase 2 (SMITN2), Tanzania: End of Project Household Survey Analysis. London, United Kingdom: Malaria Consortium, 43.
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