Construire la Prévention du Paludisme | Building Malaria Prevention | Cameroon

Minkoaméyos Map

In Cameroon, malaria is responsible for 50% of deaths among children under five. In the capital, Yaoundé, 85% of settlements are considered informal. ARCHIVE links this high mortality rate and the state of housing among the urban poor to reduce malarial mosquito exposure through housing innovations.

Vast evidence confirms that adequate housing is more effective in reducing malaria incidence than other preventative measures. Data from 2004 showed that only 11% of children under five in Cameroon slept under mosquito nets and only 1% slept under insecticide treated nets. In a Gambian study, however, when netting could be incorporated into ceiling design, exposure to mosquitoes plummeted by 85%.

Despite growing effort by the National Malaria Control Program in Cameroon, malaria continues to be one of the top three causes of morbidity and mortality in the country. Two major contributors to this burden are the development of drug resistance to medication and insecticide and the cost of treatment, which is out of reach for a majority of households.

How can we decrease the number of mosquitoes infiltrating the home and infecting the community? We’re directly combating malaria through housing design in Cameroon’s poorest communities, using screened doors, windows and eaves, and adequate ventilation, sewage and draining solutions. Such solutions can halt vector mosquitoes and reduce the incidence of malaria.

The project was funded through a generous grant from the UBS Optimus Foundation which will cover its budget of CHF 377,195 over 3 years. The project also received US$12,000 from the Selavip Foundation to cover materials and labor of housing improvements for the first 24 houses.

The project consists of 3 main phases:

Phase 1 – Baseline Survey and Open Innovation Competition (completed)
A baseline survey was initially carried out to assess the environmental, health and housing conditions of the intervention site, Minkoaméyos. Our survey found that up to 80% of the children in Minkoaméyos tested positive for Malaria.The information gathered on the site was used to inform potential designs, develop framework for the open innovation and act as a point of reference for the project evaluation process. Multi-disciplinary teams from across the globe from health and design professions were later invited to submit housing designs according to the design brief. A panel selected the winners according to the criteria established in the design brief. The winning designs were shown to the local community during an exhibition based in Yaoundé.
Phase 2 – Implementation and Program Delivery (in progress)
a. Research Design and Pilot (in progress):
A list of households eligible for housing improvements in Minkoameyos were selected according to the following criteria:

  • At least one child under five in household
  • More than two adults living in a room
  • One-story house

The enrolled households were then split into two groups: control and intervention groups.

In the control group, also composed of 24 households, the usual malaria prevention strategy will remain unaffected, and no improvements will be made to the houses.

b. Main Construction (in progress – to be completed by end of 2015):

Housing improvements will be carried out over an additional 240 houses. Local labor will be used and household members will be encouraged to participate in the works.

c. Awareness and Capacity Building Activities (in progress):

Training workshops will be held in Minkoameyos, each attended by approximately 20 people. The aim is to raise awareness of how housing can contribute to malaria prevention and to provide the skills necessary to implement the adequate home improvements. The sessions will also highlight the link between the living environment and malaria. Participants will understand how to recognize signs of malaria infections, its origins, what treatments are available and how to prevent malaria by using ITNs, IPT, IRS and maintaining a home environment that reduces exposure to mosquitoes.

d. Radio Broadcasts (ongoing):
ARCHIVE and its local partners in Cameroon will make appearances on radio broadcasts to raise awareness of how the living environment affects malaria, and talk about the health workshops.

Phase 3 – Evaluation (To be completed by early 2016)

a. Risk of Malaria Exposure Data Collection:

It is anticipated that housing improvements will decrease the risk of exposure to malaria carrying mosquitoes by at least 50%. To measure the effect of housing improvements on the risk of exposure to a malaria infected mosquito, data will be collected:

  • Entomological Inoculation rate (EIR) will be carried out in one of the wet seasons March-June or September-November when mosquito densities are highest.
  • Once the construction work is over, health data collectors will conduct weekly visits to improved (intervention) and unimproved (control) households to gather the following information:
    • Number of mosquitoes trapped in each household of the study group
    • Proportion of those mosquitoes that are carrying malaria parasites

b. Risk of Malaria Exposure Data Analysis:

Data will be analyzed using General Linear Mixed Effects Regression with an appropriate error structure to measure difference in mosquito density and infection in improved and unimproved houses controlling for spatial and temporal bias as well as household occupancy and use of additional mosquito control methods such as bed nets that might affect mosquito densities. Data will be presented as relative risks (RR) to demonstrate and change in household risk of exposure to infected mosquitoes between improved and unimproved housing within the same area.

impact chart

Working in partnership with local partners, ARCHIVE aims to create awareness regarding the important role of housing in the effective elimination of malaria in Cameroon and to involve both global and local actors in all stages of the project. The main objectives of the project include: training 4000 people in home improvements for disease prevention; improving living conditions for 264 households; improving awareness of malaria prevention among 200,000 people by the end of Year 3; reducing malaria incidences by 20% among 264 intervention households by Year 3; and developing best practice guidelines for malaria control through housing design.