Changes in house design reduce exposure to malaria mosquitoes.

House design may affect an individual's exposure to malaria parasites, and hence to disease. We conducted a randomized-controlled study using experimental huts in rural Gambia, to determine whether installing a ceiling or closing the eaves could protect people from malaria mosquitoes. Five treatments were tested against a control hut: plywood ceiling; synthetic-netting ceiling; insecticide-treated synthetic-netting ceiling (deltamethrin 12.5 mg/m2); plastic insect-screen ceiling; or the eaves closed with mud. The acceptability of such interventions was investigated by discussions with local communities. House entry by Anopheles gambiae, the principal African malaria vector, was reduced by the presence of a ceiling: plywood (59% reduction), synthetic-netting (79%), insecticide-treated synthetic-netting (78%), plastic insect-screen (80%, P < 0.001 in all cases) and closed eaves (37%, ns). Similar reductions were also seen with Mansonia spp., vectors of lymphatic filariasis and numerous arboviruses. Netting and insect-screen ceilings probably work as decoy traps attracting mosquitoes into the roof space, but not the room. Ceilings are likely to be well accepted and may be of greatest benefit in areas of low to moderate transmission and when used in combination with other malaria control strategies