Novel House Design Cuts Childhood Malaria by 44%

A radical rethink of rural housing in sub-Saharan Africa can protect children from the three deadliest diseases, according to landmark research published in Nature Medicine. The study shows that children living in specially designed two-storey 'Star Homes' have dramatically lower rates of malaria, diarrhoea, and acute respiratory infections compared with those in traditional mud-and-thatch houses.

Medical results

The study, the first household randomised controlled trial of a purpose-built healthy house, found that over three years of active surveillance across 70 villages in rural Mtwara, southern Tanzania, children under 13 years old living in 110 'Star Homes' experienced:

• 44% less malaria
• 30% less diarrhoea
• 18% fewer acute respiratory infections
• Significantly greater height-for-age growth trajectories, indicating a reversal of stunting

The 'Star Home' is a prefabricated two-storey dwelling that uses passive design strategies rather than costly technology to prevent disease, and was developed by the Royal Danish Academy in collaboration with Tanzanian and international researchers.

Key architectural features include elevated sleeping areas that protect against mosquitoes, permeable mesh walls, insect-proof windows, and self-closing doors. The design also incorporates a raised, easy-to-clean concrete ground floor, rainwater harvesting, a ventilated and fly-proof latrine, smoke-free cooking, and solar-powered lighting.

Groundbreaking study to combine architecture and medicine

'What is groundbreaking about the project is that architecture is incorporated as an active component of a randomized clinical trial and measured with the same level of rigour as medical research. Architecture can function as a health intervention on a par with medicine when it is developed and documented using scientific methods, while at the same time saving resources and reducing carbon emissions, ' says Jakob Brandtberg Knudsen, researcher and Dean of Architecture at the Royal Danish Academy. 

A 'Star Home' is at the same time 24% cheaper in materials than a traditional single-storey cement block house, requires 73% less concrete, and generates 57% lower embodied CO₂ emissions.

'Malaria, diarrhoea, and respiratory infections have been killing children in sub‑Saharan Africa for generations. Our results show that thoughtful house design — insect‑proof, smoke‑free, cooler, and with clean water — can protect children from all three at once. The Star Home may not be the final word, but it proves the concept and we hope it will inspire architects, builders, and governments to think differently about rural housing,' says Lorenz von Seidlin, professor ved Mahidol‑Oxford Tropical Medicine Research Unit. 

Partners behind the Star Homes Project

The Star Homes project was carried out in collaboration with the following institutions and research organisations:

• Royal Danish Academy - Architecture, Design, Conservation (Denmark)
• CSK Research Solutions (Tanzania)
• Mahidol‑Oxford Tropical Medicine Research Unit (MORU), University of Oxford (UK)
• Ifakara Health Institute (Tanzania)
• Durham University (UK)
• Amsterdam UMC (Holland)
• University of the Philippines, Manila
• East, Central and Southern Africa Health Community.