The recent reduction in malaria has been largely achieved by a massive scale-up of vector control, with long-lasting insecticidal nets and indoor residual spraying. The future success of these interventions, however, is threatened by the growing problem of insecticide-resistant mosquitoes, especially in West Africa and also elsewhere. There is thus an urgent need to develop more interventions that do not rely on insecticides.
There are descriptive studies that report a decrease in malaria associated with better housing but no randomised controlled studies, which are the gold standard of medical research. During the past 30 years, a revolution in house design has been taking place across Africa, and The Gambia is no exception. Traditional thatched-roofed houses are being replaced steadily by houses with metal-roofs as the continent develops. The current project intends to ride this wave of cultural change and further improve the design of houses to make them healthier to live in, potentially improving the lives of millions of people across sub-Saharan Africa.
In March 2015, traditional houses were randomised to the intervention or control arm of the RCS and informed consent was sought from house owners and residents. All 800 who consented to join the study will receive the intervention (metal roof, closed eaves, screened doors and windows), but those in the intervention arm received it at baseline and those in the control arm will receive it at the end of the study (2018). Needless to say, getting the intervention of this study in place was more difficult than for many medical interventions, but we were successful in so that the medical work could begin in June 2016.
The implementation of the intervention was a success thanks to the collaborative effort from a team of carpenters, village masons, Basse metal work and carpentry workshops, MRCG field staff, as well as the Transport and Purchasing Departments at MRCG. We are now following a cohort of children resident in the houses for malaria for the 2016 and 2017 malaria seasons.
In 2014, the study was supported by Joint Global Health Trial scheme funded by MRC-DfID-Wellcome Trust, as a collaboration between MRCG, Durham University, the School of Architecture Design and Conservation, Denmark and the Gambian National Malaria Control Programme. As a randomised controlled study (RCS), measuring the impact improved housing can have on malaria it has the code name “RooPfs”. The first task was to identify traditional houses (thatch roof, open eaves and no screening), all houses in over 100 villages in the Upper River Region (URR) were surveyed.