Lilia Sebouai Global Health Security Reporter

Architecture may hold the secret to slashing malaria rates in children by nearly half, researchers have found.

In a study published in the journal Nature, researchers redesigned rural homes in Tanzania to try and block the transmission routes of three deadly childhood illnesses: malaria, diarrhoea and respiratory infections.

They found children living in the new houses, known as ‘Star Homes’, had fewer bouts of sickness than those in traditional mud-walled, thatched-roof huts. Physical growth in children under five also improved.

“If children are healthier in the first five years of life, it changes their entire future,” said Prof Lorenz von Seidlein, a professor at Oxford University’s Centre for Tropical Medicine and Global Health, and the study’s principal investigator.

In a randomised controlled trial over three years, the researchers compared the health outcomes of children living in 110 purpose-built, two-storey houses and those in 513 traditional homes.

Even with high bed net use in both groups, the redesigned homes delivered striking improvements. Malaria cases fell by 44 per cent, while the incidence of diarrhoea dropped by 30 per cent and acute respiratory infections by 18 per cent.

Researchers said the results highlight the often overlooked role of housing design in disease prevention, and said structural improvements could complement existing interventions such as bed nets and vaccines.

But perhaps the most significant finding wasn’t just that children survived – they also thrived.

“If you can reduce malaria, diarrhoea, and respiratory infections, children spend less time being sick, and overall the effect is less stunting,” Prof von Seidlein told the Telegraph. “Children who are less stunted have much better chances of higher income throughout their lifetime.”

A condition caused by chronic childhood illness and malnutrition, stunting is closely tied to impaired cognitive development and reduced future earning potential. A recent study in Uganda also found that severe malaria is doing lasting damage to children’s brains.

By preventing these diseases during the critical first five years, the researchers argue that improved housing also has long-term economic benefits.

Researchers not involved in the study described the trial as “important and ambitious”.

Dr Jackie Cook, a professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine, said the difference in malaria case incidence between the two groups in the trial was “considerable, particularly as it is measured in populations that are already using bed nets.”

Speaking to The Telegraph, she said that the findings highlight the need for funding from donors or governments, as well as “the collaboration across the health and housing sectors to improve living conditions for communities”.

The ‘Star Homes’ – which cost around $8,800 (£6,519), or $118 per m², to build – use a two-storey design that looks nothing like the traditional homes they replace. Spanning 80 square metres, they accommodate a typical household of five (two parents and three children under 13).

The buildings were aligned east to west and shaded by trees to minimise sun exposure and improve temperature control. They also featured a durable corrugated iron roof and large windows screened with shade netting to allow air to flow through the building.

“One of the most common reasons people don’t use bed nets is because it feels too hot,” said Prof von Seidlein. “If there is good airflow, even with a bed net, people remain comfortable and are much more likely to use it.”

Durable materials were used throughout the building, including a ground floor made of concrete. This is far easier to clean than the earth floors found in traditional housing, helping to curb the spread of deadly diarrhoeal diseases, linked to poor sanitation. The house also includes a ventilated pit latrine with a fly-proof design.

Other design features included a smokeless cooking stove connected to a chimney. In traditional homes indoor cooking – especially during the rainy season – fills living areas with toxic smoke, a major trigger for respiratory infections in young children.

When the researchers first launched the project, they faced scepticism from the Maconde people in the Mtwara region of southern Tanzania, where there are deep-rooted traditional beliefs and a history of isolation.

“At the beginning, people thought there must be a catch – nobody gives you a house for nothing,” Prof von Seidlein said. Rumours circulated that the researchers had “supernatural powers” or that “something bad” would happen to the children.

To build trust, the research team, many of whom were older than the local youth, formed a football team.

“We usually lost because the village boys were so much faster and better than us,” said Prof von Seidlein. “It was very convincing. It showed we weren’t supernatural people. It gave us the opportunity to explain what we were doing as equals.”

Next, the researchers have a new group to persuade: policymakers.

The hope is that the design principles learned will be incorporated into future building designs. While the $8,800 cost per home is expensive for the region, the researchers argued it makes economic sense given traditional homes have to be re-built every five years. Local craftsmen are working to replicate designs for less.

“The biggest fear is that people will say nobody can afford $8,000 for a house,” said Prof von Seidlein.

“But if you take some of the principles and integrate them, you can still have a healthier home. If you take certain elements of the design and apply them to your next house, your children will be better off.”

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