House structure is associated with malaria among febrile patients in a high-transmission region of zambia

Jay Sikalima, Jessica L. Schue, Sarah E. Hill, Modest Mulenga, Ray Handema, Victor Daka, Justin Chileshe, Webster Kasongo, Mike Chaponda, Jean Bertin Bukasa Kabuya, William J. Moss, Matthew M. Ippolito

Research output: Contribution to journalArticlepeer-review


Since the late nineteenth century, the importance of house structure as a determinant of malaria risk has been recognized. Few studies to date have examined the association of housing and malaria in clinical populations. We conducted a cross-sectional study of febrile patients (n = 282) at two rural health clinics in a high malaria-transmission area of northern Zambia. Participants underwent testing for Plasmodium falciparum infection by PCR. Demographic and other risk factors including house structure, indoor residual spraying (IRS), bed net use, education level, and household income were collected. Data were fitted to logistic regression models for relational and mediation analyses. Residing in a house with a thatch roof was associated with higher odds of malaria than residing in a house with corrugated metal (odds ratio: 2.6; 95% CI: 1.0-6.3, P = 0.04). Lower income and educational attainment were also associated with greater odds of malaria. Living under a thatch roof accounted for 24% (95% CI: 14-82) of the effect of household income on malaria risk, and income accounted for11%(95% CI: 8-19) of the effect of education. Neither IRS nor bed net use was associated with malaria risk despite large, local investments in these vector control interventions. The findings testify to malaria as a disease of rural poverty and contribute further evidence to the utility of housing improvements in vector control programs.

Original languageEnglish (US)
Pages (from-to)2131-2138
Number of pages8
JournalAmerican Journal of Tropical Medicine and Hygiene
Issue number6
StatePublished - Jun 2021

ASJC Scopus subject areas

  • Parasitology
  • Virology
  • Infectious Diseases


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