Recommendations for building out mosquito-transmitted diseases in sub-Saharan Africa: the DELIVER mnemonic

Abstract

In sub-Saharan Africa, most transmission of mosquito-transmitted diseases, such as malaria or dengue, occurs within or around houses. Preventing mosquito house entry and reducing mosquito production around the home would help reduce the transmission of these diseases. Based on recent research, we make key recommendations for reducing the threat of mosquito-transmitted diseases through changes to the built environment. The mnemonic, DELIVER, recommends the following best practices: (i) Doors should be screened, self-closing and without surrounding gaps; (ii) Eaves, the space between the wall and roof, should be closed or screened; (iii) houses should be Lifted above the ground; (iv) Insecticide-treated nets should be used when sleeping in houses at night; (v) houses should be Ventilated, with at least two large-screened windows to facilitate airflow; (vi) Environmental management should be conducted regularly inside and around the home; and (vii) Roofs should be solid, rather than thatch. DELIVER is a package of interventions to be used in combination for maximum impact. Simple changes to the built environment will reduce exposure to mosquito-transmitted diseases and help keep regions free from these diseases after elimination. This article is part of the theme issue 'Novel control strategies for mosquito-borne diseases'.

Keywords: built environment; dengue; housing; malaria; sub-Saharan Africa.

Figure 1.

Models of carbon dioxide (yellow) dispersion from a sleeping person (orange) in: (a) a metal-roofed mud walled house with open eaves and (b) a similarly constructed house, but with closed eaves and two windows to improve ventilation. Simulations produced using Ansys Fluent v19 (https://www.ansys.com).

Figure 2.

DELIVER at a glance. The mnemonic, DELIVER, recommends the following best practices: (a) Doors should be screened, self-closing and without surrounding gaps; (b) Eaves, the space between the wall and roof, should be closed or screened; (c) houses should be Lifted above the ground; (d) Insecticide-treated nets should be used when sleeping in houses at night; (e) houses should be Ventilated, with at least two large-screened windows to facilitate airflow; (f) Environmental management should be conducted regularly inside and around the home; and (g) Roofs should be solid, rather than thatch.

Figure 3.

Importance of windows on opposite walls to encourage airflow through the building.

Figure 4.

Framework for inter-sectoral action. An example of those bodies that could be brought together to make towns and cities resilient against the threat of mosquito-transmitted diseases.

Figure 5.

How the United Nations' Sustainable Development Goals (SDGs) stimulate UN organizations to produce international guidelines on health, the built environment and resilience. Our plea is for integration across these three organizations to reduce the threat from mosquito-transmitted diseases. Note that only the principal SDGs are shown.