A sustainable house design to improve child health in rural Africa: a cluster-randomized controlled trial.

Summary

In a cluster-randomized trial of 110 “Star Homes” versus 513 traditional houses over 3 years, children living in the redesigned, insect-proof, smoke-free homes experienced 44% less malaria, 30% less diarrhea, and 18% fewer acute respiratory infections. Children under five were taller for age, highlighting broad health benefits from an integrated built-environment intervention.

Key Findings

• Children in Star Homes had 44% lower malaria incidence (IRR 0.56, 95% CI 0.43–0.72), 30% less diarrhea (IRR 0.70, 95% CI 0.53–0.91), and 18% fewer ARIs (IRR 0.82, 95% CI 0.73–0.93).
• The intervention combined insect-proofing, reduced indoor smoke exposure, improved cooling, and reliable water/sanitation in a two-story design.
• Children under 5 years living in Star Homes were taller-for-age compared with those in traditional homes.
• Cluster randomization allocated 110 Star Homes versus 513 traditional houses, with outcomes measured over 3 years.

Clinical Implications

Integrating insect-proofing, clean indoor air (smoke-free cooking), and reliable water/sanitation into housing can reduce ARI incidence at the population level. Public health programs and donors should consider built-environment upgrades as core components of child respiratory health strategies.

Limitations

• Open-label nature and bundled intervention limit attribution to specific components
• Generalizability beyond study regions requires replication and cost-effectiveness analyses

Future Directions

Replicate across ecological zones, quantify indoor air quality and exposure pathways, and conduct cost-effectiveness and implementation studies to guide national scale-up.