Ecological change increases malaria risk in the Brazilian Amazon.

Ecological change in the Brazilian Amazon is closely linked to human mobility and health. Mining, agriculture, logging, and other activities alter highly diverse ecological and demographic contexts and subsequent exposure to diseases such as malaria. Studies that have attempted to quantify the impact of deforestation on malaria in the Brazilian Amazon have produced conflicting results. However, they varied in methodology and data sources. Most importantly, all studies used annual data, neglecting the subannual seasonal dynamics of malaria. Here, we fill the knowledge gap on the subannual relationship between ecological change in the Brazilian Amazon and malaria transmission. Using the highest spatiotemporal resolution available, we estimated the effect of deforestation on malaria cases between 2003 and 2022 using a stratified Bayesian spatiotemporal hierarchical zero-inflated Poisson model fitted with the Integrated Nested Laplace Approximation. The model was also stratified by state. We found that a 1% increase in 1-mo lagged deforestation increased malaria cases in a given month and municipality by 6.3% [95% credible interval (Crl): 6.2, 6.5%]. Based on an interaction term included in the model, the effect of deforestation on malaria was even larger in areas with higher forest cover. We found that the coefficients for deforestation and mobility were highly variable when stratified by state. Our results provide detailed evidence that, on average, deforestation increases malaria transmission, but that the relationship is not spatiotemporally uniform. These results have implications for stratifying malaria control interventions based on ecological dynamics to help Brazil achieve its goal of malaria elimination by 2035.