A Longitudinal Study of Housing Improvement Interventions and Paediatric Pneumonia Incidence in Low-Income Urban Households in Malawi

This longitudinal study protocol addresses the critical public health burden of paediatric pneumonia in low-income urban settings in sub-Saharan Africa, where indoor air pollution from household biomass fuels is a well-established risk factor. It outlines a randomised controlled trial to investigate whether structural housing interventions can reduce pneumonia incidence in children under five in Blantyre, Malawi. A cohort of 1,200 children from 800 households in informal settlements will be recruited. Households will be randomised into either an intervention group, receiving improved cookstoves and window installations to enhance ventilation, or a control group receiving no modifications. The primary outcome is the incidence of caregiver-reported pneumonia episodes, clinically verified by community health workers at six-month intervals over a five-year follow-up period concluding in 2026. Secondary outcomes include measured indoor particulate matter (PM2.5) levels. Analysis will employ generalised estimating equations to account for repeated measures and potential confounding. The study is designed to provide robust, locally generated evidence on the efficacy of low-cost housing improvements as a preventive measure against childhood pneumonia. Its findings aim to inform Malawian and regional public health policy, advocating for the integration of ventilation and air quality standards into broader child health strategies.