title: Mind the gap: house structure and the risk of malaria in Uganda.
abstract: BACKGROUND
  Good house construction may reduce the risk of malaria by limiting the entry of mosquito vectors. We assessed how house design may affect mosquito house entry and malaria risk in Uganda.
  
  
  METHODS
  100 households were enrolled in each of three sub-counties: Walukuba, Jinja district; Kihihi, Kanungu district; and Nagongera, Tororo district. CDC light trap collections of mosquitoes were done monthly in all homes. All children aged six months to ten years (n = 878) were followed prospectively for a total of 24 months to measure parasite prevalence every three months and malaria incidence. Homes were classified as modern (cement, wood or metal walls; and tiled or metal roof; and closed eaves) or traditional (all other homes).
  
  
  RESULTS
  A total of 113,618 female Anopheles were collected over 6,765 nights. 6,816 routine blood smears were taken of which 1,061 (15.6%) were malaria parasite positive. 2,582 episodes of uncomplicated malaria were diagnosed after 1,569 person years of follow-up, giving an overall incidence of 1.6 episodes per person year at risk. The human biting rate was lower in modern homes than in traditional homes (adjusted incidence rate ratio (IRR) 0.48, 95% confidence interval (CI) 0.37-0.64, p<0.001). The odds of malaria infection were lower in modern homes across all the sub-counties (adjusted odds ratio 0.44, 95%CI 0.30-0.65, p<0.001), while malaria incidence was lower in modern homes in Kihihi (adjusted IRR 0.61, 95%CI 0.40-0.91, p = 0.02) but not in Walukuba or Nagongera.
  
  
  CONCLUSIONS
  House design is likely to explain some of the heterogeneity of malaria transmission in Uganda and represents a promising target for future interventions, even in highly endemic areas.
authors: Infectious Disease Research Collaboration, Mulago Hospital Complex, Kampala, Uganda.
authors: Humphrey
authors: H
authors: Wanzirah
authors: Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors: Lucy S
authors: LS
authors: Tusting
authors: Infectious Disease Research Collaboration, Mulago Hospital Complex, Kampala, Uganda.
authors: Emmanuel
authors: E
authors: Arinaitwe
authors: Infectious Disease Research Collaboration, Mulago Hospital Complex, Kampala, Uganda.
authors: Agaba
authors: A
authors: Katureebe
authors: Infectious Disease Research Collaboration, Mulago Hospital Complex, Kampala, Uganda.
authors: Kilama
authors: K
authors: Maxwell
authors: Infectious Disease Research Collaboration, Mulago Hospital Complex, Kampala, Uganda.
authors: John
authors: J
authors: Rek
authors: Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors: Christian
authors: C
authors: Bottomley
authors: Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors: Sarah G
authors: SG
authors: Staedke
authors: Department of Medicine, Makerere University College of Health Science, Kampala, Uganda.
authors: Moses
authors: M
authors: Kamya
authors: Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.
authors: Grant
authors: G
authors: Dorsey
authors: Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom.
authors: Steve W
authors: SW
authors: Lindsay
mesh_terms: D000818:Animals; D000852:Anopheles; D002648:Child; D005191:Family Characteristics; D005260:Female; D006798:Housing; D006801:Humans; D015994:Incidence; D007299:Insect Bites and Stings; D008288:Malaria / Q000453:epidemiology* / Q000469:parasitology; D008297:Male; D010963:Plasmodium falciparum / Q000502:physiology; D012307:Risk Factors; D014454:Uganda / Q000453:epidemiology
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