Abundance of impacted forest patches less than 5 km 2 is a key driver of the incidence of malaria in Amazonian Brazil.

The precise role that deforestation for agricultural settlements and commercial forest products plays in promoting or inhibiting malaria incidence in Amazonian Brazil is controversial. Using publically available databases, we analyzed temporal malaria incidence (2009-2015) in municipalities of nine Amazonian states in relation to ecologically defined variables: (i) deforestation (rate of forest clearing over time); (ii) degraded forest (degree of human disturbance and openness of forest canopy for logging) and (iii) impacted forest (sum of deforested and degraded forest patches). We found that areas affected by one kilometer square of deforestation produced 27 new malaria cases (r² = 0.78; F1,10 = 35.81; P < 0.001). Unexpectedly, we found both a highly significant positive correlation between number of impacted forest patches less than 5 km2 and malaria cases, and that these patch sizes accounted for greater than ~95% of all patches in the study area. There was a significantly negative correlation between extraction forestry economic indices and malaria cases. Our results emphasize not only that deforestation promotes malaria incidence, but also that it directly or indirectly results in a low Human Development Index, and favors environmental conditions that promote malaria vector proliferation.