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Healthy houses make happy homes - outcome of a workshop

January 23, 2010 - 14:01 -- Bart G.J. Knols

The statistics say it all: 70% of the transmission of infectious diseases is focused in and around the house. Including malaria, where the key vectors in Africa are almost exclusively feeding indoors and at night. The forum on MalariaWorld that discussed this issue was very well read (more than 1000 views), and although comments were limited, it was enough to move forward with the idea...

How can we make houses less prone to mosquito invasion and reduce transmission?

To this effect, a workshop was organised by Derek Charlwood and Erling Moller Pedersen in Copenhagen last week, attended by Jakob Knudsen, Peter Williams, Steve Lindsay, Petter Brandberg, and myself. The goal was broader, by not focusing only on malaria, but health in general. Vector-borne diseases, (chronic) respiratory infections, and diarrhoeal diseases - can we design houses that reduce or even virtually eliminate these health threats?

For three days, we reviewed the historical evidence that is there, examples of where house improvement really made a difference in disease. Screening of porches in the southern USA made a huge difference in malaria transmission, concrete floors can substantially reduce diarrhoeal diseases, and improved airflow can have a massive impact on smoke-related disease and TB.

We then detailed as much as possible the issues associated with health and the housing environment (see image) and based on that designed what could be a 'disease-proof' house. A house that will be constructed in Mozambique, using locally available materials, over the next few months.

We acknowledged the fact that the complexity of this issue merits the involvement of other disciplines (like anthropology) that will be included in future endeavours. Preferably, a house that is both healthy and acceptable, desirable, and a 'wonna-have' in local communities will emerge from this. The health gains can, no doubt, be phenomenal, if this can be accomplished.

Our next step will be to draft a funding proposal to move forward with the ideas in South America, Africa, and South-East Asia. We aim to study local house designs and monitor climatic variables therein, to see why people build the houses the way they do, and how comfortable these are in terms of indoor climate (temperature, humidity, airflow). Next, we aim to study the behaviour of vectors in and around houses in much greater detail, which is the key to develop changes in house structure that can interfere with this process (e.g. turn the house into a trap). The same applies to the 'behaviour' of (airborne) pathogens. Such interventions can then be field-tested and reviewed in terms of acceptability and cost, and improved where needed.

We invite anyone interested in this subject to comment and suggest additional ideas for this project.

We acknowledge support from the Bill and Melinda Gates Foundation to organise this workshop.

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Comments

William Jobin's picture
Submitted by William Jobin on

Bart, that is beautiful.

House design, as well as water supply and waste disposal, cover most of people's ills in the tropics. I really like the mention of improved air circulation. Besides getting rid of cooking smoke, a well ventilated sleeping area disturbs the gradients of the "stinky feet" odor which anophelines used to track their targets at night. I proposed such a project in Sudan last year to Gates, which was not funded but which I would like to try again. We proposed low-level wall openings in the sleeping areas to promote night-time air circulation. Also the use of vents at ceiling level, to suck the engorged female mosquitoes up into a screened trap where they can't find their way out, a la VIP latrine stacks.

Also of course, we proposed to seal the eaves, where half of the mosq try to enter, using mud or paper as appropriate. If door and window screens are installed (the most cost-effective protection in my book) it is important to seal the jambs, and to put springs on the door to counter the effect of those small boys who always leave the door open.

I will follow your project with great interest. Please keep us informed on your prelim designs.

Bill

William Jobin Director of Blue Nile Associates

Submitted by Ricardo Ataide on

Hi Bart,

I liked the idea a lot, especially the fact that you want to include in your design studies from anthropological fields. i think its important to help the communities to get access to better homes but also homes they feel confortable living in, homes that suit their needs as individuals and as a community and also homes that can easily and affordably be repaired in case some of the improvements get destroyed (as so often it tends to happen in the presence of small kids!).

Please lets us know how it goes.

Cheers,
Ricardo

Ricardo Ataíde

Paul Emerson's picture
Submitted by Paul Emerson on

I have been a supporter of this idea for years, and have been working on improving access to household pit latrines for a number of years. From my experience houses in rural Africa tend to be remarkably similar in design by ethnicity or geographical area. That is to say most houses in rural Mopti Mali look the same, as do houses in Amhara, Ethiopia - not that all houses across rural Africa are the same. People are constrained by the availability of local building materials, but prefer to also constrain themselves by building in the 'traditional' way - whatever that tradition may be. Although there is a lot of homogeneity there are always deviants who do it slightly differently. The existing positive deviants may point the way to the design of a healthy home.

For example cement floors are desirable and are often added to traditional homes if money is available - they are easy to clean and provide some protection from rodents, but they are not attainable by everyone due to the cost. Can you identify an existing local solution that is better than earth, but not costly so that it is attainable by everyone?

Same applies to windows, eaves, roofing material. Are there existing desirable modifications that you can bring together?

You don't want to end up with a beautiful model home that people aspire to but can never reach for themselves.

Switching from an unattainable 'gold standard' of cement latrine slabs, vent pipes, and corrugated iron roofs for latrines in rural Ethiopia to an 'attainable' eucalyptus log platform with grass walls and thatch roof has been accompanied by increases in access to sanitation from 3% to 56% in some districts - that's hundreds of thousands of latrines built by the people themselves rather than a few thousands built by NGOs.