Role of Economics, Health, And Social And Political Stability In Determining Health Outcomes.

PHP289 A SyStemAtic Review of tHe imPAct of imPRoved HouSing inteRventionS on HeAltH in low And middle income tRoPicAl SettingS Butt T1, Von Seidlein L2 1University College London, London, UK, 2Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand Objectives: Housing has a major impact on human health and wellbeing in the developing world directly (e.g. through household accidents) and indirectly (e.g. through mediating contact between occupants and disease vectors). The objective of this review was to investigate the impact of improved housing on health in tropical zones of low and middle income countries. MethOds: A systematic review of major health and architecture databases was conducted in order to identify records reporting the impact of housing features on the health of people living in tropical regions. Information was extracted and reported using a standardised form. Results were classified by study characteristics and qualitative trends explored. Results: We identified 120 studies that met the inclusion criteria. Studies covered vector-borne, gastrointestinal and respiratory diseases and household injuries. 76 were observational, 27 were trials (including 11 randomised controlled trials), 9 were models and 7 were studies considering economic aspects of housing interventions. Of the economic studies identified, 3 were cost benefit analysis, 3 were cost per disability-adjusted life year (DALY), while 1 measured burden of disease in DALYs. Outcomes were classified as economic (7) such as DALYs, direct health (57) such as incidence of diarrhoea, indirect health such as questionnaires (16) or surrogate (39) such as mosquito counts in a house. cOnclusiOns: There have been a considerable number of studies investigating the impact of housing features on health in tropical regions. Most focused on the impact of one or more housing feature on one or more health outcome. A smaller number of studies looked at whole house interventions and there have been few economic evaluations of improved housing interventions. A holistic approach to assessing health in the context of housing and consideration of issues of economics and implementation would be valuable topics for future research.