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Housing and child health in sub-Saharan Africa: A cross-sectional analysis

Tusting, Lucy S.; Gething, Peter W.; Gibson, Harry S.; Greenwood, Brian; Knudsen, Jakob; Lindsay, Steve W.; Bhatt, Samir

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Lucy S. Tusting

Peter W. Gething

Harry S. Gibson

Brian Greenwood

Jakob Knudsen

Samir Bhatt


Background: Housing is essential to human well-being but neglected in global health. Today, housing in Africa is rapidly improving alongside economic development, creating an urgent need to understand how these changes can benefit health. We hypothesised that improved housing is associated with better health in children living in sub-Saharan Africa (SSA). We conducted a cross-sectional analysis of housing conditions relative to a range of child health outcomes in SSA. Methods and findings: Cross-sectional data were analysed for 824,694 children surveyed in 54 Demographic and Health Surveys, 21 Malaria Indicator Surveys, and two AIDS Indicator Surveys conducted in 33 countries between 2001 and 2017 that measured malaria infection by microscopy or rapid diagnostic test (RDT), diarrhoea, acute respiratory infections (ARIs), stunting, wasting, underweight, or anaemia in children aged 0–5 years. The mean age of children was 2.5 years, and 49.7% were female. Housing was categorised into a binary variable based on a United Nations definition comparing improved housing (with improved drinking water, improved sanitation, sufficient living area, and finished building materials) versus unimproved housing (all other houses). Associations between house type and child health outcomes were determined using conditional logistic regression within surveys, adjusting for prespecified covariables including age, sex, household wealth, insecticide-treated bed net use, and vaccination status. Individual survey odds ratios (ORs) were pooled using random-effects meta-analysis. Across surveys, improved housing was associated with 8%–18% lower odds of all outcomes except ARI (malaria infection by microscopy: adjusted OR [aOR] 0.88, 95% confidence intervals [CIs] 0.80–0.97, p = 0.01; malaria infection by RDT: aOR 0.82, 95% CI 0.77–0.88, p < 0.001; diarrhoea: aOR 0.92, 95% CI 0.88–0.97, p = 0.001; ARI: aOR 0.96, 95% CI 0.87–1.07, p = 0.49; stunting: aOR 0.83, 95% CI 0.77–0.88, p < 0.001; wasting: aOR 0.90, 95% CI 0.83–0.99, p = 0.03; underweight: aOR 0.85, 95% CI 0.80–0.90, p < 0.001; any anaemia: aOR 0.87, 95% CI 0.82–0.92, p < 0.001; severe anaemia: aOR 0.89, 95% CI 0.84–0.95, p < 0.001). In comparison, insecticide-treated net use was associated with 16%–17% lower odds of malaria infection (microscopy: aOR 0.83, 95% CI 0.78–0.88, p < 0.001; RDT: aOR 0.84, 95% CI 0.79–0.88, p < 0.001). Drinking water source and sanitation facility alone were not associated with diarrhoea. The main study limitations are the use of self-reported diarrhoea and ARI, as well as potential residual confounding by socioeconomic position, despite adjustments for household wealth and education. Conclusions: In this study, we observed that poor housing, which includes inadequate drinking water and sanitation facility, is associated with health outcomes known to increase child mortality in SSA. Improvements to housing may be protective against a number of important childhood infectious diseases as well as poor growth outcomes, with major potential to improve children’s health and survival across SSA.


Tusting, L. S., Gething, P. W., Gibson, H. S., Greenwood, B., Knudsen, J., Lindsay, S. W., & Bhatt, S. (2020). Housing and child health in sub-Saharan Africa: A cross-sectional analysis. PLoS Medicine, 17(3), Article e1003055.

Journal Article Type Article
Acceptance Date Feb 19, 2020
Online Publication Date Mar 23, 2020
Publication Date 2020
Deposit Date Apr 1, 2020
Publicly Available Date Apr 2, 2020
Journal PLoS Medicine
Print ISSN 1549-1277
Electronic ISSN 1549-1676
Publisher Public Library of Science
Peer Reviewed Peer Reviewed
Volume 17
Issue 3
Article Number e1003055


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Copyright Statement
Copyright: © 2020 Tusting et al. This is an open<br /> access article distributed under the terms of the<br /> Creative Commons Attribution License, which<br /> permits unrestricted use, distribution, and<br /> reproduction in any medium, provided the original<br /> author and source are credited.

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