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Kaimen Rigor review

A sustainable house design to improve child health in rural Africa: a cluster-randomized controlled trial.

Mshamu S, Mukaka M, Sanga C, Kambanga S, Rutaihwa AD, Bøjstrup TC, Meta J, Mmbando A, Pell C, Adhikari B, Olotu AI, Kapologwe N, White NJ, Dondorp AM, Day NPJ, Imwong M, Deen J, Lindsay SW, Knudsen JB, von Seidlein L

DOI: 10.1038/s41591-026-04367-w
Record issued: 2026-08-15
Engine: 7.39.0
Exported: 2026-09-22

Prepared by Alpha1. This document is confidential: it is intended for the recipient it was shared with and must not be redistributed. The live record at alpha1science.com/verify/8b3869f7-a2d1-44e8-98b5-21817e7b9000 is authoritative.

Kaimen Rigor review

Kaimen Rigor reviewed

3.75 / 5

Adequate — real issues to address

Interventional Study

Critical

High-priority

How this rating was calculated

Started at 5★ — deductions

IntegrityIntegrity concern ×2−1★
CitationsUnresolved reference−0.25★

Model-reported confidence: highReviewer agreement: highEngine: 7.39.0Source: full text

Findings by category

101ArithmeticNumerical inconsistencies 02OverreachNone found 03AuthenticityNone found 04DisclosureNone found 105AvailabilityBroken references and links 06Copyedit5 minor suggestions

This Kaimen Rigor review uses Kaimen Rigor reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

This is a well-conducted and transparently reported cluster-randomized trial. The study design is rigorous, ethical approvals are clearly documented, and reporting follows CONSORT with trial registration. Minor issues include a potential arithmetic inconsistency in Table 1 and a not-found reference, but these do not undermine the overall integrity.

Both reviewers independently scored all eight dimensions as pass, with no substantive divergence. The study type is interventional (cluster-randomized trial). The statistics verification recomputed 7 tests, all consistent, but coverage is limited to a subset; model-based estimates were not fully verifiable. The citation check flagged one reference not found in the registry.

Numerical inconsistencies

1 finding · worst low

Values that contradict each other or are impossible for the stated sample: recomputed p-values and test statistics, GRIM/GRIMMER checks on summary numbers, percentages against their own counts, totals against their parts, and estimates against their own confidence intervals.

Internal contradictions in the reported numbersAssessed

Recomputed 7 tests: 7 consistent, 0 inconsistent; 5 recomputed directly from the reported test statistics, 2 via agent-written checks.

Agent-written checks— recomputed from reported CIs / ratios by code the agent wrote

CONSISTENTreported p = .007 · recomputed p = .010
Recomputed IRR 0.70 (95% CI 0.53–0.91), reported p=0.0070
“IRR: 0.70 (95% CI: 0.53−0.91), P = 0.0070”
Find in source
Taken as given: 0.53–0.91 is a two-sided 95% confidence interval for the IRR of 0.70, not a range, an IQR, or a different interval level; the IRR is a RATIO measure, so the interval is symmetric on the log scale; p=0.0070 is the p for THIS estimate, not for another comparison in the same sentence
Method: back the two-tailed p out of the log-scale CI width and compare it against the printed p
How we recomputed it: pCI(0.7, 0.53, 0.91, 1)
CONSISTENTreported p = .001 · recomputed p = .001
Recomputed IRR 0.82 (95% CI 0.73–0.93), reported p=0.0010
“IRR: 0.82 (95% CI: 0.73−0.93), P = 0.0010”
Find in source
Taken as given: 0.73–0.93 is a two-sided 95% confidence interval for the IRR of 0.82, not a range, an IQR, or a different interval level; the IRR is a RATIO measure, so the interval is symmetric on the log scale; p=0.0010 is the p for THIS estimate, not for another comparison in the same sentence
Method: back the two-tailed p out of the log-scale CI width and compare it against the printed p
How we recomputed it: pCI(0.82, 0.73, 0.93, 1)
CONSISTENTreported p < .001 · recomputed p = <.001
Recomputed IRR 0.56 (95% CI 0.43–0.72), reported p=0.0000054
“IRR = 0.56 (95% CI: 0.43−0.72), P = 0.0000054”
Find in source
Taken as given: 0.43–0.72 is a two-sided 95% confidence interval for the IRR of 0.56, not a range, an IQR, or a different interval level; the IRR is a RATIO measure, so the interval is symmetric on the log scale; p=0.0000054 is the p for THIS estimate, not for another comparison in the same sentence
Method: back the two-tailed p out of the log-scale CI width and compare it against the printed p
How we recomputed it: pCI(0.56, 0.43, 0.72, 1)
CONSISTENTreported p = .041 · recomputed p = .040
Recomputed IRR 0.65 (95% CI 0.43–0.98), reported p=0.041
“IRR = 0.65 (95% CI: 0.43−0.98), P = 0.041”
Find in source
Taken as given: 0.43–0.98 is a two-sided 95% confidence interval for the IRR of 0.65, not a range, an IQR, or a different interval level; the IRR is a RATIO measure, so the interval is symmetric on the log scale; p=0.041 is the p for THIS estimate, not for another comparison in the same sentence
Method: back the two-tailed p out of the log-scale CI width and compare it against the printed p
How we recomputed it: pCI(0.65, 0.43, 0.98, 1)
CONSISTENTreported p = .002 · recomputed p = .002
Recomputed IRR 0.75 (95% CI 0.63–0.90), reported p=0.0020
“IRR = 0.75 (95% CI: 0.63−0.90), P = 0.0020”
Find in source
Taken as given: 0.63–0.90 is a two-sided 95% confidence interval for the IRR of 0.75, not a range, an IQR, or a different interval level; the IRR is a RATIO measure, so the interval is symmetric on the log scale; p=0.0020 is the p for THIS estimate, not for another comparison in the same sentence
Method: back the two-tailed p out of the log-scale CI width and compare it against the printed p
How we recomputed it: pCI(0.75, 0.63, 0.9, 1)
CONSISTENTreported p < .001 · recomputed p = <.001Reviewers 1, 2
Check p-value for malaria IRR (ACD) from CI
“IRR: 0.56 (95% confidence interval (CI): 0.43−0.72), P < 0.0001”
Find in source
Taken as given: The IRR is a ratio estimate with a 95% CI.; The p-value is two-sided.
Method: Compute p-value from estimate and CI using normal approximation on log scale.
How we recomputed it: pCI(0.56, 0.43, 0.72, 1)
CONSISTENTreported p = .007 · recomputed p = .010Reviewers 1, 2
Check p-value for diarrhea IRR (ACD) from CI
“IRR: 0.70 (95% CI: 0.53−0.91), P = 0.0070”
Find in source
Taken as given: The IRR is a ratio estimate with a 95% CI.; The p-value is two-sided.
Method: Compute p-value from estimate and CI using normal approximation on log scale.
How we recomputed it: pCI(0.70, 0.53, 0.91, 1)

lowinternal contradiction
The number of children in the anthropometric cohort at baseline (369) differs from the sum of Star Homes (73) and traditional homes (296) which equals 369, but the text says 73 (19.8%) and 296 (80.2%) which sum to 369, consistent.
“369 (31.2%) were under 5 years of age and participated in a nested, dynamic, anthropometric cohort, with 73 (19.8%) children in Star Homes and 296 (80.2%) children in traditional homes”
ResultsFind in source
lowinternal contradiction
In Table 1, the percentage of mRDT positive in Star Homes is reported as 36.6%, but 101 out of 247 is 40.9%. This may be a typographical error or a different denominator.
“mRDT positive | 101 (36.6) | 423 (38.2) | 524 (37.9)”
Table 1Find in source

Overstated conclusions

None found

Conclusions that reach past what the paper's own results support — including a significance claim that no longer holds when the statistic is recomputed, and efficacy resting on an unvalidated surrogate endpoint.

Checked — nothing surfaced.

5 major claims checked against the paper's own evidence: all adequately supported.

supportedReviewers 1, 2
Children living in Star Homes had 44% less malaria compared to traditional homes.
The claim is directly supported by the primary outcome IRR of 0.56 (95% CI 0.43-0.72).
Evidence: IRR = 0.56 (95% CI: 0.43−0.72), P < 0.0001
“children living in Star Homes had 44% less malaria (incidence rate ratio (IRR): 0.56 (95% confidence interval (CI): 0.43−0.72), P < 0.0001)”
AbstractFind in source
supportedReviewers 1, 2
Children in Star Homes had 30% less diarrhea.
The claim is supported by the secondary outcome IRR of 0.70 (95% CI 0.53-0.91).
Evidence: IRR = 0.70 (95% CI: 0.53−0.91), P = 0.0070
“Children in Star Homes had 30% less diarrhea (IRR: 0.70 (95% CI: 0.53−0.91), P = 0.0070)”
AbstractFind in source
supportedReviewers 1, 2
Children in Star Homes had 18% less ARIs.
The claim is supported by the secondary outcome IRR of 0.82 (95% CI 0.73-0.93).
Evidence: IRR = 0.82 (95% CI: 0.73−0.93), P = 0.0010
Children in Star Homes had 18% less ARIs (IRR: 0.82 (95% CI: 0.73−0.93), P = 0.0010)
Abstractreviewer’s wording
supportedReviewers 1, 2
Children under 5 years of age living in Star Homes were taller for their age than those in traditional homes.
The claim is supported by the significantly steeper HAZ slope in Star Homes.
Evidence: HAZ slope 0.095 (95% CI: 0.052−0.137), P < 0.0001 vs 0.019 (95% CI: −0.001 to 0.040), P = 0.062
“The HAZ of children living in Star Homes had a significantly steeper slope (0.095 (95% CI: 0.052−0.137), P < 0.0001) compared to children living in traditional homes (0.019 (95% CI: −0.001 to 0.040), P = 0.062)”
ResultsFind in source
supportedReviewers 1, 2
The Star Home design is intended to inspire innovative designs for healthier homes.
This is a forward-looking statement, not a scientific claim, and is supported by the study's findings.
Evidence: The study demonstrates health benefits of the Star Home design.
“Our house design is intended to inspire those working in the building sector and with local communities to develop innovative designs for healthier homes.”
AbstractFind in source

Efficacy claim is anchored to an adequate endpoint and a meaningful effect.

ADEQUATESurrogate endpoint
The primary outcome is malaria incidence, a clinical disease event, not a surrogate. Secondary outcomes include diarrhea and ARI incidence, also clinical events. The growth outcome (HAZ) is a validated anthropometric measure. The paper reports target engagement via entomological surveillance (51% fewer Anopheles gambiae entering Star Homes) and cites prior evidence linking improved housing to reduced malaria. Thus, the efficacy claim is based on hard clinical outcomes, not surrogates.
“The primary outcome of the trial was malaria cases over 3 yearsʼ follow-up. The IRR of malaria cases detected by active case detection (ACD) was 0.56 (95% CI: 0.43−0.72, P < 0.0001), indicating a 44% reduction in the malaria incidence for children in Star Homes compared to those in traditional homes.”
Find in source
ADEQUATEEffect size
The reported effect sizes are substantial: 44% reduction in malaria, 30% reduction in diarrhea, 18% reduction in ARIs, and a significant improvement in height-for-age z-score. These are clinically meaningful reductions in disease incidence, and the paper anchors them to public health impact. The effect sizes are statistically significant and presented as material benefits.
“children living in Star Homes had 44% less malaria (incidence rate ratio (IRR): 0.56 (95% confidence interval (CI): 0.43−0.72), P < 0.0001) compared to children living in traditional homes. Children in Star Homes had 30% less diarrhea (IRR: 0.70 (95% CI: 0.53−0.91), P = 0.0070) and 18% less ARIs (IRR: 0.82 (95% CI: 0.73−0.93), P = 0.0010) than children living in traditional homes.”
Find in source

Data authenticity concerns

None found

An adversarial read for patterns associated with data that may not be genuine: results that look too clean, implausibly large effects, duplicated data or images, and methods that do not match the results reported.

Checked — nothing surfaced.

Reporting gaps

None found

Required detail the manuscript never states — study design, biological variables, ethics approval and consent, key resources, statistical reporting, data and code availability, and overall transparency.

Checked — nothing surfaced.

Eight Dimensions8 pass

The introduction cites numerous studies on housing and disease, including a pilot study and experimental work in The Gambia, and acknowledges limitations of prior observational studies. The hypothesis follows logically from the cited evidence.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The paper establishes a strong scientific premise with extensive prior work and a clear rationale linking housing to disease transmission.

Evidence

paraphrase[Introduction, paragraphs 3-4]

“In 2017, we conducted a pilot study in Magoda, Tanga region, Tanzania, to evaluate the benefits of innovative housing components... Further experimental studies in The Gambia showed that elevating a bedroom and having large, screened windows in the bedroom can reduce indoor mosquito entry.”

“We hypothesized that a reduction of vectors, provision of safe water, improved sanitation and better air exchange with reduced smoke would result in a reduction of the three childhood diseases: malaria, ARIs and diarrheal diseases.”

Introduction ¶5Find in source

paraphrase[Discussion, paragraph 2]

“Our results are consistent with earlier observational studies in sub-Saharan Africa that found a 47% reduced likelihood of malaria associated with improved housing.”

PASSReviewer 2· 90% conf

The paper establishes a strong scientific premise with extensive prior work and a clear rationale linking housing to disease transmission.

Evidence

paraphrase[Introduction, paragraphs 3-4]

Introduction ¶5Find in source

paraphrase[Discussion, paragraph 2]

“Randomized controlled trials to evaluate specific house modifications reported a similar trend with smaller effect sizes in malaria reduction.”

Randomization used a lottery-based allocation with public drawing, and the unit of randomization was the household. A power analysis was conducted with assumptions on malaria incidence and ICC. Inclusion/exclusion criteria were pre-specified. Blinding was not feasible and is acknowledged as a limitation. Outlier handling is addressed through exclusion of baseline-positive cases and censoring.

Sub-criteria

controlsN/A

power analysisADEQUATE

blinding levelsADEQUATE

outlier handlingADEQUATE

randomization unitADEQUATE

inclusion exclusionADEQUATE

randomization methodADEQUATE

replicate distinctionN/A

independent replicationN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The trial design is rigorous with clear randomization, sample size calculation, and pre-specified outcomes, though blinding was not possible (open-label).

Evidence

“Participants were randomly assigned to study groups using a lottery-based allocation procedure over two rounds.”

MethodsFind in source

paraphrase[Methods, Sample size (truncated section)]

“First, it was not possible to blind the study participants or research assistants to the study group.”

LimitationsFind in source

PASSReviewer 2· 90% conf

The trial design is rigorous with clear randomization, sample size calculation, and pre-specified outcomes, though blinding was not possible (open-label).

Evidence

“Participants were randomly assigned to study groups using a lottery-based allocation procedure over two rounds. In each village, the names of eligible heads of households were written on slips of paper, each placed in an individual envelope.”

MethodsFind in source

“we made the assumption of 10 malaria episodes per 100 children per year in the control households, with a projected 30% decrease to seven malaria episodes per 100 children per year in the Star Homes . To detect this difference with 80% statistical power and a 5% significance level, we determined that 105 households with three child-years of observation each would be required per group.”

MethodsFind in source

“First, it was not possible to blind the study participants or research assistants to the study group.”

LimitationsFind in source

Sex and age are reported in baseline characteristics. Health status is captured through baseline fever, mRDT positivity, diarrhea, and cough. Demographics are reported. Species/strain and housing conditions are not applicable for a human trial.

Sub-criteria

demographicsADEQUATE

sex reportedADEQUATE

sex justifiedN/A

age weight healthADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Biological variables are well reported for a human trial, including sex, age, and health status.

Evidence

“Female | 118 (48) | 441 (47) | 559 (47)”

Table 1Find in source

“Fever ≥37.5 °C | 3 (1.2) | 1 (0.1) | 4 (0.3)”

Table 1Find in source

PASSReviewer 2· 85% conf

Biological variables are well reported for a human trial, including sex, age, and health status; demographics are detailed.

Evidence

“Female | 118 (48) | 441 (47) | 559 (47)”

Table 1Find in source

“Fever ≥37.5 °C | 3 (1.2) | 1 (0.1) | 4 (0.3)”

Table 1Find in source

“Family living in the same house | 240 (97) | 862 (92) | 1,102 (93)”

Table 1Find in source

The trial protocol was approved by the Tanzanian National Institute for Medical Research and the Oxford Tropical Research Ethics Committee, with protocol numbers. Written informed consent was obtained from parents/legal guardians. Regulatory compliance is implied through adherence to CONSORT guidelines.

Sub-criteria

iacuc statementN/A

informed consentADEQUATE

irb ethics statementADEQUATE

regulatory complianceADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 95% conf

Ethical approvals are clearly documented with named ethics committees and informed consent.

Evidence

“The trial protocol was approved by the Tanzanian National Institute for Medical Research (NIMR/HQ/R.8a/Vol.IX/3695) and the Oxford Tropical Research Ethics Committee (OxTREC 533-20).”

EthicsFind in source

“Written informed consent was obtained from the parents or legal guardians of all participating children.”

EthicsFind in source

PASSReviewer 2· 95% conf

Ethical approvals are clearly documented with named ethics committees and informed consent.

Evidence

“The trial protocol was approved by the Tanzanian National Institute for Medical Research (NIMR/HQ/R.8a/Vol.IX/3695) and the Oxford Tropical Research Ethics Committee (OxTREC 533-20).”

EthicsFind in source

“Written informed consent was obtained from the parents or legal guardians of all participating children.”

EthicsFind in source

paraphrase[Methods, Ethics approval]

“This report follows the CONSORT 2025 extended guidelines.”

The Star Home is described in detail with construction materials and manufacturer. Diagnostic tests (mRDT brands) are named. Software (Stata, Archicad) is identified with versions. Antibodies, cell lines, and mycoplasma testing are not applicable.

Sub-criteria

mycoplasma testingN/A

reagents identifiedADEQUATE

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Key resources are adequately identified, including the investigational product (Star Home), diagnostic tests, and software.

Evidence

“using Paracheck (Orchid Biomedical Systems), ParaHIT (ARKRAY Healthcare Pvt. Ltd.) or Bioline Malaria Ag P.f/Pan”

MethodsFind in source

“Analyses were performed in Stata software (version 18).”

Statistical analysisFind in source

PASSReviewer 2· 85% conf

Key resources are adequately identified, including the investigational product (Star Home), diagnostic tests, and software.

Evidence

“a positive malaria rapid diagnostic test (mRDT) using Paracheck (Orchid Biomedical Systems), ParaHIT (ARKRAY Healthcare Pvt. Ltd.) or Bioline Malaria Ag P.f/Pan”

MethodsFind in source

“Analyses were performed in Stata software (version 18).”

Statistical analysisFind in source

“The houses were constructed in 3 d BIM software, Archicad version 28.1.1 (Graphisoft, Budapest, Hungary).”

MethodsFind in source

The primary analysis used GEE Poisson models, which are appropriate for clustered count data. Tests are named, and effect sizes are reported with 95% CIs. Exact p-values are provided. Software is identified. Data presentation includes Kaplan-Meier curves and per-group n. Mathematical plausibility checks were not possible for most outcomes due to model-based estimates, but no inconsistencies were found.

Sub-criteria

tests namedADEQUATE

exact p valuesADEQUATE

effect sizes ciADEQUATE

data presentationADEQUATE

software identifiedADEQUATE

assumptions verifiedADEQUATE

mathematical plausibilityN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Statistical methods are appropriate and well-described, with exact p-values and effect sizes with confidence intervals.

Evidence

paraphrase[Methods, Statistical analysis]

“Malaria incidence data... were analyzed using generalized estimating equation (GEE) Poisson models”

paraphrase[Abstract]

“P < 0.0001”

paraphrase[Abstract]

“IRR: 0.56 (95% confidence interval (CI): 0.43−0.72)”

PASSReviewer 2· 85% conf

Statistical methods are appropriate and well-described, with exact p-values and confidence intervals reported.

Evidence

“Two-sided z -tests from the GEE Poisson model were performed.”

Table 2Find in source

paraphrase[Abstract]

“P < 0.0001”

paraphrase[Abstract]

“IRR: 0.56 (95% CI: 0.43−0.72)”

The data availability statement describes a concrete route via the MORU Data Access Committee with conditions and timeframe. Repository deposit and accession numbers are not applicable for identifiable patient data. Code sharing is not applicable as no bespoke code is mentioned.

Sub-criteria

code sharingN/A

accession numbersN/A

repository depositN/A

data availability statementADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Data availability is well-documented with a clear managed-access procedure, though no code is shared.

Evidence

“All data requests are reviewed by the MORU Data Access Committee in accordance with the MORU Tropical Network Policy on Sharing Data and Other Outputs.”

Data availabilityFind in source

PASSReviewer 2· 90% conf

Data availability is well-documented with a clear managed-access procedure via the MORU Data Access Committee.

Evidence

“All data requests are reviewed by the MORU Data Access Committee in accordance with the MORU Tropical Network Policy on Sharing Data and Other Outputs.”

Data availabilityFind in source

“Decisions regarding approval or rejection of requests will normally be communicated within 4–6 weeks.”

Data availabilityFind in source

The trial is registered with ClinicalTrials.gov (NCT04529434). The paper follows CONSORT 2025 guidelines. All pre-specified outcomes are reported, including null results. Limitations are extensively discussed. Conclusions are proportional to the evidence. Funding and competing interests are declared.

Sub-criteria

funding coiADEQUATE

trial registrationADEQUATE

reporting guidelineADEQUATE

methods completenessADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Reporting is transparent with trial registration, CONSORT adherence, and thorough discussion of limitations.

Evidence

“ClinicalTrials.gov: NCT04529434”

AbstractFind in source

paraphrase[Methods, Ethics approval]

“This report follows the CONSORT 2025 extended guidelines.”

“Our study had limitations. First, it was not possible to blind the study participants or research assistants to the study group.”

LimitationsFind in source

PASSReviewer 2· 90% conf

Reporting is transparent with trial registration, CONSORT adherence, and thorough discussion of limitations.

Evidence

“ClinicalTrials.gov: NCT04529434”

AbstractFind in source

paraphrase[Methods, Ethics approval]

“This report follows the CONSORT 2025 extended guidelines.”

“Our study had limitations. First, it was not possible to blind the study participants or research assistants to the study group.”

LimitationsFind in source

Registered (1 ID: ClinicalTrials.gov). Reporting guideline cited: CONSORT.

ClinicalTrials.gov

NCT04529434

Reporting guidelines: CONSORT

Broken references and links

1 finding · worst low

References checked against Crossref, OpenAlex and Retraction Watch for retractions and resolvability, plus declared data and code links probed for whether they resolve to content matching the paper.

References not resolvable to a published paperRecomputed

Checked 41 references by DOI: 7 verified — 1 DOI unresolved, 33 no DOI (shown, not verified).

UNRESOLVED10.1016/s2352-4642(21
World malaria report 2025
Cited DOI does not resolve to any Crossref record.
NO DOI
Global, regional, and national causes of under-5 mortality in 2000−19: an updated systematic analysis with implications for the Sustainable Development Goals
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
National, regional, and global causes of mortality in 5−19-year-olds from 2000 to 2019: a systematic analysis
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Prevalence and determinants of acute lower respiratory infections among children under-five years in sub-Saharan Africa: evidence from demographic and health surveys
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Housing and health outcomes: evidence on child morbidities from six Sub-Saharan African countries
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
The impact of poor housing and indoor air quality on respiratory health in children
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Crowding has consequences: prevention and management of COVID-19 in informal urban settlements
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Effect of in-house crowding on childhood hospital admissions for acute respiratory infection: a matched case−control study in Bangladesh
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Safer water, better health: costs, benefits and sustainability of interventions to protect and promote health
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Indoor fuel exposure and the lung in both developing and developed countries: an update
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Affordable house designs to improve health in rural Africa: a field study from northeastern Tanzania
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
The relationship between house height and mosquito house entry: an experimental study in rural Gambia
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Impact of increased ventilation on indoor temperature and malaria mosquito density: an experimental study in The Gambia
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Effect of a novel house design (star home) on indoor malaria mosquito abundance in rural Tanzania: secondary outcomes of an open-label, household, randomised controlled trial
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
The evidence for improving housing to reduce malaria: a systematic review and meta-analysis
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Community responses to a novel house design: a qualitative study of ‘Star Homes’ in Mtwara, southeastern Tanzania
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Bias due to misclassification in the estimation of relative risk
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Global patterns of submicroscopic Plasmodium falciparum malaria infection: insights from a systematic review and meta-analysis of population surveys
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Interventions to improve sanitation for preventing diarrhoea
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Effect of a novel house (Star home) and toilet design on domestic fly densities in rural Tanzania
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Home environmental interventions for prevention of respiratory tract infections: a systematic review and meta-analysis
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Use of growth charts for assessing and monitoring growth in Canadian infants and children: executive summary
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
World Population Prospects 2024
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Understanding reticence to occupy free, novel-design homes: a qualitative study in Mtwara, Southeast Tanzania
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Studying the health benefits of improved housing in rural Tanzania: challenges and progress
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
High-throughput ultrasensitive molecular techniques for quantifying low-density malaria parasitemias
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
The value of a statistical life-year in sub-Saharan Africa: evidence from a large population-based survey in Tanzania
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Out-of-pocket costs and other determinants of access to healthcare for children with febrile illnesses: a case-control study in rural Tanzania
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
The economic rationale for investing in stunting reduction
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
The Global Health Observatory
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Integrated Labour Force Survey 2024
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Tanzania
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Cluster Randomised Trials
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Characterisation of between-cluster heterogeneity in malaria cluster randomised trials to inform future sample size calculations
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).

1 data/code link checked; 1 live.

datahttps://www.tropmedres.ac/units/moru-bangkok/bioethics-engagement/data-sharing/moru-tropical-network-policy-on-sharing-data-and-other-outputsLIVEHTTP 200
Resolves, but the content could not be matched to the paper.

Copyediting

5 minor

Wording, consistency and formatting errors that need correcting before submission.

No major wording or formatting errors. 5 minor suggestions below.

5 copyedit issues flagged: mostly consistency, clarity, typo.

MINORtypoAbstract
“Mshamu Salum Mukaka Mavuto Sanga Casiana Kambanga Stanslous Rutaihwa Aneth Deogratias Bøjstrup Thomas Chevalier Meta Judith Mmbando Arnold Pell Christopher Adhikari Bipin Olotu Ally Ibrahim Kapologwe Ntuli White Nicholas J Dondorp Arjen Day Nicholas P J Imwong Mallika Deen Jacqueline Lindsay Steven W Knudsen Jakob Brandtberg von Seidlein Lorenz”
→ Format author names correctly (e.g., 'Salum Mshamu, Mavuto Mukaka, ...')
Author list appears as a single string without proper formatting.
MINORconsistencyResults, Table 1
“mRDT positive | 101 (36.6) | 423 (38.2) | 524 (37.9)”
→ Check that percentages are consistent with the reported n values.
The percentage for Star Homes (36.6%) does not match the n=101 out of 247 (40.9%). This may be a typo or a different denominator.
MINORclarityMethods, Statistical analysis
“The statistical analysis plan is available upon reasonable request.”
→ Consider providing a link or repository for the SAP.
Availability upon request is less transparent than a public link.
MINORconsistencyResults, Table 1
“mRDT positive | 101 (36.6) | 423 (38.2) | 524 (37.9)”
→ Check if the percentages are consistent with the counts (e.g., 101/247 = 40.9%, not 36.6%).
Potential arithmetic inconsistency in baseline table.
MINORclarityMethods, Statistical analysis
“The statistical analysis plan is available upon reasonable request.”
→ Consider providing a link or more specific access instructions.
Vague statement about the analysis plan availability.

Kaimen Rigor Action ItemsFinal pass before journal submission

The published work is robust and well-reported. An informed reader should weigh the minor Table 1 percentage inconsistency and the unresolved reference as low-severity issues that do not affect the main conclusions. No erratum is strictly required, but correcting the Table 1 typo and verifying the reference would strengthen the record.

1.
HIGHcopyedit
In Table 1, correct the percentage for mRDT positive in Star Homes: 101/247 is 40.9%, not 36.6%.
The reported percentage is arithmetically inconsistent with the count and denominator, which could mislead readers.
2.
HIGHreporting
Verify the reference 'World malaria report 2025' (DOI 10.1016/s2352-4642(21) — appears truncated) and correct or replace it, as it was not found in the registry.
An unresolved reference may be a fabrication signal and undermines citation integrity.
3.
MEDIUMreporting
In the Methods, Statistical analysis section, provide a public link or repository for the statistical analysis plan instead of 'available upon reasonable request'.
A public SAP enhances transparency and reproducibility.
4.
MEDIUMreporting
Report the observed intracluster correlation coefficients (ICCs) for the primary outcomes.
ICCs were assumed for sample size calculation; reporting observed values informs future trials.
5.
MEDIUMreporting
Clarify the handling of missing data in the anthropometric cohort, as the number of participants varies across years.
Transparent missing-data handling is essential for interpreting growth outcomes.
6.
MEDIUMreporting
Add a statement in the Methods about the inability to blind and its potential impact, even though it is in the Limitations.
Blinding limitations are relevant to the design and should be noted upfront.
7.
MEDIUMreporting
Provide a CONSORT flow diagram in the main text to improve clarity of participant flow.
A flow diagram is a key CONSORT element and aids reader comprehension.
8.
MEDIUMreporting
Report the number of participants with missing data for each outcome and how missing data were handled.
Missing data can bias results; transparency is needed.
9.
MEDIUMreporting
Discuss the generalizability of the findings to other settings with different housing and disease transmission patterns.
The trial was conducted in a specific context (Mtwara, Tanzania); generalizability should be addressed.
10.
LOWreporting
Provide a more detailed breakdown of the economic analysis, including sensitivity analyses.
Economic evaluations benefit from sensitivity analyses to assess robustness.
11.
LOWreporting
Report exact p-values for the HAZ slope difference, as only P < 0.0001 is given.
Exact p-values are more informative than threshold-only values.
12.
LOWreporting
Clarify the definition of 'household' used for randomization and analysis, as it may affect clustering.
A clear definition of the unit of randomization is important for interpretation.
13.
LOWcopyedit
Format the author names in the Abstract correctly (e.g., 'Salum Mshamu, Mavuto Mukaka, ...').
The current single-string format is a typographical error that should be corrected.

Full text (78,917 chars · analyzed ~95%, head + tail)Analyzed: Aug 15, 2026

RigorReviewer 1

RigorReviewer 2

RigorPre-Submission Reviewer

CopyeditAgent Scribe

CitationsCitation Integrity

StatisticsStatistics Consistency

ReproducibilityLink verification (liveness + content)· no model (rule-based)

PreregistrationDeterministic check· no model (rule-based)

The star rating is the report’s one-glance summary. Every paper starts at 5★ and loses stars for the concrete problems the review finds — so a rating is never a vague average, it’s a running total you can read line by line under “How this rating was calculated.”

How stars are deducted

Reporting — 8 dimensionseach dimension that fully fails−½★
each dimension partially met−¼★
Statistics · Integrity · Claimseach serious problem−1★
each medium problem−½★
Citationseach retracted or unverifiable reference−¼★
Copyeditonly when the manuscript needs a full edit−½★

The rating never drops below 1★, and a demonstrable critical failure (an impossible statistic, a proven ethics violation) caps it at 1★ on its own — so the stars can never look healthy when the verdict is CRITICAL.

The rating draws on a panel of agents. Three independent Kaimen Rigor reviewers grade the eight dimensions below across several independent passes (the shown verdict is their majority vote — steadier than any single run), isolate the paper’s major claims and check its own evidence backs them, and flag integrity concerns. Alongside them, a citation agent resolves every reference against Crossref, OpenAlex, and Retraction Watch; a statistics agent recomputes reported tests; and rule-based checks verify that declared data/code links actually resolve. Full text is required — an abstract-only submission is not analyzed.

The eight reporting dimensions

Scientific PremisePrior work, rationale, and how it addresses gaps.

Study Design & RigorRandomization, blinding, power, controls, replication.

Biological VariablesSex, age, species/strain, housing, demographics.

Ethical ApprovalsIRB/IACUC approval, informed consent, regulatory compliance.

Key ResourcesAntibodies, cell lines, organisms, software — identified with persistent IDs.

Statistical ReportingNamed tests, exact p-values, effect sizes, plausible summary stats.

Data & Code AvailabilityAvailability statements, repositories, accession numbers, shared code.

Reporting TransparencyMethods, registration, guidelines, outcomes, limitations, funding/COI.

Graded against NIH, MDAR, ARRIVE 2.0, CONSORT, EQUATOR, and RRID guidelines. A dimension that doesn’t apply to the study type is skipped, never penalized.

This Kaimen Rigor review is model-assisted and is not a substitute for formal expert review. It complements human evaluation by surfacing potential methodological concerns — verify each finding against the source.

A sustainable house design to improve child health in rural Africa: a cluster-randomized controlled trial.

DOI

10.1038/s41591-026-04367-w

Record issued

2026-08-15

Engine

7.39.0

Exported

2026-09-22