Infectious Diseases Research Collaboration, Kampala, Uganda.
Department of Internal Medicine, Makerere University College of Health Science, Kampala, Uganda.
Malar J. 2024 Jul 30;23(1):223. doi: 10.1186/s12936-024-05051-5.
Scale up of proven malaria control interventions has not been sufficient to control malaria in Uganda, emphasizing the need to explore innovative new approaches. Improved housing is one such promising strategy. This paper describes housing characteristics and their association with malaria burden in a moderate to high transmission setting in Uganda.
Between October and November 2021, a household survey was conducted in 1500 randomly selected households in Jinja and Luuka districts. Information on demographics, housing characteristics, use of malaria prevention measures, and proxy indicators of wealth were collected for each household. A finger-prick blood sample was obtained for thick blood smears for malaria from all children aged 6 months to 14 years in the surveyed households. Febrile children had a malaria rapid diagnostics test (RDT) done; positive cases were managed according to national treatment guidelines. Haemoglobin was assessed in children aged < 5 years. Households were stratified as having modern houses (defined as having finished materials for roofs, walls, and floors and closed eaves) or traditional houses (those not meeting the definition of modern house). Associations between malaria burden and house type were estimated using mixed effects models and adjusted for age, wealth, and bed net use.
Most (65.5%) of the households surveyed lived in traditional houses. Most of the houses had closed eaves (85.5%), however, the use of other protective features like window/vent screens and installed ceilings was limited (0.4% had screened windows, 2.8% had screened air vents, and 5.2% had ceiling). Overall, 3,443 children were included in the clinical survey, of which 31.4% had a positive smear. RDT test positivity rate was 56.6% among children with fever. Participants living in modern houses had a significantly lower parasite prevalence by microscopy (adjusted prevalence ratio [aPR = 0.80]; 95% confidence interval [CI] 0.71 - 0.90), RDT test positivity rate (aPR = 0.90, 95%CI 0.81 - 0.99), and anaemia (aPR = 0.80, 95%CI 0.65 - 0.97) compared to those in traditional houses.
The study found that even after adjusting for wealth, higher quality housing had a moderate protective effect against malaria, on top of the protection already afforded by recently distributed nets.
在乌干达，已证实的疟疾控制干预措施的推广力度仍不足以控制疟疾，这凸显出有必要探索创新的新方法。改善住房就是这样一种很有前景的策略。本文描述了在乌干达中高疟疾传播地区的住房特征及其与疟疾负担的关系。
2021 年 10 月至 11 月，在 Jinja 和 Luuka 区随机选择了 1500 户家庭进行了一项家庭调查。为每户家庭收集了人口统计学、住房特征、疟疾预防措施的使用情况以及财富的替代指标信息。从调查家庭中所有 6 个月至 14 岁的儿童中采集了手指刺破的血样，用于制作厚血涂片进行疟疾检查。发热儿童进行了疟疾快速诊断检测（RDT）；阳性病例根据国家治疗指南进行管理。对 <5 岁的儿童进行了血红蛋白评估。根据屋顶、墙壁和地板的完成材料以及封闭的屋檐，将家庭分为现代房屋（定义为）和传统房屋（不符合现代房屋定义的房屋）。使用混合效应模型估计疟疾负担与房屋类型之间的关联，并根据年龄、财富和蚊帐使用情况进行调整。
接受调查的家庭中，大多数（65.5%）居住在传统房屋中。大多数房屋都有封闭的屋檐（85.5%），但是，其他保护措施（如窗户/通风口纱窗和安装的天花板）的使用很有限（纱窗的使用率为 0.4%，通风口纱窗的使用率为 2.8%，天花板的使用率为 5.2%）。总的来说，共有 3443 名儿童参加了临床调查，其中 31.4%的儿童有阳性涂片。发热儿童的 RDT 检测阳性率为 56.6%。与居住在传统房屋的儿童相比，居住在现代房屋的儿童的寄生虫镜检患病率明显较低（调整后的患病率比 [aPR] = 0.80；95%置信区间 [CI] 0.71-0.90），RDT 检测阳性率（aPR = 0.90，95%CI 0.81-0.99）和贫血（aPR = 0.80，95%CI 0.65-0.97）。
研究发现，即使在调整了财富因素后，高质量的住房对疟疾也有一定的保护作用，这在最近分发的蚊帐提供的保护之外又增加了一层保护。
