The Housing Modification study (HMS)

The Housing Modification study (HMS)

Study period:Ongoing.

Background
Evidence of the impact of house construction on malaria risk is growing house design which is a promising target for future interventions (Kirby 2009, Tustin 2015, Wanzirah 2015, Tustin 2016, Rek 2018). Few studies have evaluated the impact of housing modifications on epidemiological or health outcomes The Gambia trial (Kirby et al 2009) Intervention → covering doors and windows with netting; screening ceilings and blocking eaves found that housing modifications reduced anaemia in children by 48%. The Cote d’Ivoire trial (Sternberg et al 2018, Farenhorst et al. 2019) Intervention → eave tubes plus screening found a reduction of 38% for malaria incidence, 44% for malaria prevalence, 30% for anemia, as well as community protection. Improving housing is a promising new strategy. Further research is needed to explore the potential role and impact of interventions to improve housing and the built environment.
Research question: Can housing modifications (combined with PBO LLINs) reduce the malaria burden in Uganda?

Objectives:

Primary objective

• • To evaluate the effect of housing modifications plus PBO LLINs, compared to PBO LLINs alone, on the incidence of clinical malaria in Ugandan children under-five.

Secondary objectives

• To assess the effect on parasite prevalence & anaemia.
• To assess the effect on vector density, EIR & other entomologic outcomes.
• To assess the cost-effectiveness of housing modifications.
• To evaluate the sustainability of the modifications.
• To assess the acceptability of the modifications.

Study sites: Jinja, Kayunga, Kamuli, Kaliro, Iganga, Mayuge, Namayingo & Busia.
Outcomes
Primary outcomes

1. 1. Incidence of clinical malaria in children aged < 60 months as measured in the cohort study.

Secondary outcomes

1. Entomologic surveys: vector density, sporozoite rate, EIR, human biting rate, prevalence of phenotypic resistance and single nucleotide polymorphisms associated with insecticide resistance.
2. Housing modifications: acceptability, durability, feasibility; implementation of the interventions (fidelity, reach, dose delivered, dose received, effectiveness, recruitment, contextual factors).
3. Economic evaluation: cost per incident case of malaria averted (provider & societal perspective).