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PLoS One. 2015 Jan 30;10(1):e0117396. doi: 10.1371/journal.pone.0117396. eCollection 2015.

Mind the gap: house structure and the risk of malaria in Uganda.

Author information

1
Infectious Disease Research Collaboration, Mulago Hospital Complex, Kampala, Uganda.
2
Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
3
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
4
Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
5
Department of Medicine, Makerere University College of Health Science, Kampala, Uganda.
6
Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.
7
Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom.

Abstract

BACKGROUND:

Good house construction may reduce the risk of malaria by limiting the entry of mosquito vectors. We assessed how house design may affect mosquito house entry and malaria risk in Uganda.

METHODS:

100 households were enrolled in each of three sub-counties: Walukuba, Jinja district; Kihihi, Kanungu district; and Nagongera, Tororo district. CDC light trap collections of mosquitoes were done monthly in all homes. All children aged six months to ten years (n = 878) were followed prospectively for a total of 24 months to measure parasite prevalence every three months and malaria incidence. Homes were classified as modern (cement, wood or metal walls; and tiled or metal roof; and closed eaves) or traditional (all other homes).

RESULTS:

A total of 113,618 female Anopheles were collected over 6,765 nights. 6,816 routine blood smears were taken of which 1,061 (15.6%) were malaria parasite positive. 2,582 episodes of uncomplicated malaria were diagnosed after 1,569 person years of follow-up, giving an overall incidence of 1.6 episodes per person year at risk. The human biting rate was lower in modern homes than in traditional homes (adjusted incidence rate ratio (IRR) 0.48, 95% confidence interval (CI) 0.37-0.64, p<0.001). The odds of malaria infection were lower in modern homes across all the sub-counties (adjusted odds ratio 0.44, 95%CI 0.30-0.65, p<0.001), while malaria incidence was lower in modern homes in Kihihi (adjusted IRR 0.61, 95%CI 0.40-0.91, p = 0.02) but not in Walukuba or Nagongera.

CONCLUSIONS:

House design is likely to explain some of the heterogeneity of malaria transmission in Uganda and represents a promising target for future interventions, even in highly endemic areas.

PMID:
25635688
PMCID:
PMC4311957
DOI:
10.1371/journal.pone.0117396
[Indexed for MEDLINE]
Free PMC Article

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