Ippolito Matthew M, Searle Kelly M, Hamapumbu Harry, Shields Timothy M, Stevenson Jennifer C, Thuma Philip E, Moss William J
Divisions of Infectious Diseases and Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Am J Trop Med Hyg. 2017 Nov;97(5):1561-1567. doi: 10.4269/ajtmh.17-0299. Epub 2017 Aug 18.
House structure may influence the risk of malaria by affecting mosquito entry and indoor resting. Identification of construction features associated with protective benefits could inform vector control approaches, even in low-transmission settings. We examined the association between house structure and malaria prevalence in a cross-sectional analysis of 2,788 children and adults residing in 866 houses in a low-transmission area of Southern Province, Zambia, over the period 2008-2012. Houses were categorized according to wall (brick/cement block or mud/grass) and roof (metal or grass) material. Malaria was assessed by point-of-care rapid diagnostic test (RDT) for . We identified 52 RDT-positive individuals residing in 41 houses, indicating an overall prevalence in the sample of 1.9%, ranging from 1.4% to 8.8% among the different house types. Occupants of higher quality houses had reduced odds of malaria compared with those in the lowest quality houses after controlling for bed net use, indoor insecticide spraying, clustering by house, cohabitation with another RDT-positive individual, transmission season, ecologic risk defined as nearest distance to a Strahler-classified third-order stream, education, age, and gender (adjusted odds ratio [OR]: 0.26, 95% confidence interval [CI]: 0.09-0.73, = 0.01 for houses with brick/cement block walls and metal roof; OR: 0.22, 95% CI: 0.09-0.52, < 0.01 for houses with brick/cement block walls and grass roof). Housing improvements offer a promising approach to vector control in low-transmission settings that circumvents the threat posed by insecticide resistance, and may confer a protective benefit of similar magnitude to current vector control strategies.
房屋结构可能通过影响蚊子进入和室内栖息来影响疟疾风险。识别与防护效益相关的建筑特征可为病媒控制方法提供依据，即使在低传播环境中也是如此。在2008 - 2012年期间，我们对赞比亚南部省份一个低传播地区居住在866所房屋中的2788名儿童和成人进行了横断面分析，研究房屋结构与疟疾流行率之间的关联。房屋根据墙壁（砖/水泥块或泥/草）和屋顶（金属或草）材料进行分类。通过即时快速诊断检测（RDT）评估疟疾情况。我们在41所房屋中识别出52名RDT阳性个体，样本总体流行率为1.9%，不同房屋类型的流行率在1.4%至8.8%之间。在控制了蚊帐使用、室内杀虫剂喷洒、房屋聚类、与另一名RDT阳性个体同居、传播季节、定义为到斯特拉勒分类的三级溪流的最近距离的生态风险、教育程度、年龄和性别后，与居住在质量最低房屋中的人相比，居住在质量较高房屋中的人患疟疾的几率降低（调整后的优势比[OR]：0.26，95%置信区间[CI]：0.09 - 0.73，对于有砖/水泥块墙壁和金属屋顶的房屋，P = 0.01；OR：0.22，95% CI：0.09 - 0.52，对于有砖/水泥块墙壁和草屋顶的房屋，P < 0.01）。房屋改善为低传播环境中的病媒控制提供一种有前景的方法，该方法规避了杀虫剂抗性带来的威胁，并且可能带来与当前病媒控制策略类似程度的防护效益。
