Can improved housing provide additional protection against clinical malaria over current best practice? A household-randomised controlled trial

疟疾仍然是对全球公共卫生的最大威胁之一，2012年发生了2.07亿恶性疟疾病例和62.7万人死亡，其中80%以上的死亡发生在非洲。超过80%的疟疾是在夜间在室内传播的，所以进入一所房子的疟疾蚊子的数量对感染这种疾病至关重要--住在漏水的房子里的人风险最大。我们已经证明，关闭屋檐(墙顶和屋顶之间的缝隙)并对房屋进行筛选可以显著减少进入房屋的疟疾媒介的数量。在这里，我们建议通过改装一半的自习室，使它们(1)有金属屋顶，(2)封闭的屋檐，(3)屏蔽的门窗和(4)屏蔽的空气砖，让温暖的空气从房子里冒出来，但不让蚊子进入室内，从而防止儿童感染疟疾。其他的书屋将保留茅草屋顶和敞开的屋檐，这些房子里的孩子将作为对照组。在过去的三十年里，一场无声的住宅设计革命正在整个非洲发生。随着非洲大陆的发展，传统的茅草屋顶房屋正在被金属屋顶房屋稳步取代。我们希望乘着这股文化变革的浪潮，进一步改进房屋的设计，让它们更适合居住。改善住房有可能改善撒哈拉以南非洲数百万人的生活。

Malaria remains one of the greatest threats to global public health, with 207 million cases of falciparum malaria and 627,000 deaths occurring in 2012, with over 80% of deaths occurring in Africa. More than 80% of malaria is transmitted indoors at night, so the number of malaria mosquitoes which enter a house is critical for getting the disease - with people living in 'leaky' houses being at most risk. We have shown that closing the eaves (the gap between the top of the wall and the roof) and screening a house can reduce dramatically the number of malaria vectors entering a house. Here we propose to find out whether we can protect children against malaria by modifying half the study houses so that they (1) have a metal roof, (2) closed eaves, (3) screened doors and windows and (4) screened-air bricks which allow the warm air to rise out of the house, but not let any mosquitoes indoors. The other study houses will be left with thatched roofs and open eaves and the children in these houses will serve as a comparison group. Over the past thirty years a silent revolution in house design has been happening across Africa. The traditional thatched-roofed houses are being replaced steadily by metal-roofed houses as the continent develops. We hope to ride this wave of cultural change and further improve the design of houses to make them healthier to live in. Improved housing has the potential to improve the lives of millions of people across sub-Saharan Africa.