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Background  While there is growing recognition of the malaria impacts of large dams in sub-Saharan Africa, the cumulative malaria impact of reservoirs associated with current and future dam developments has not been quantified. The objective of this study was to estimate the current and predict the future impact of large dams on malaria in different eco-epidemiological settings across sub-Saharan Africa.    Methods  The locations of 1268 existing and 78 planned large dams in sub-Saharan Africa were mapped against the malaria stability index (stable, unstable and no malaria). The  Plasmodium falciparum  infection rate (PfIR) was determined for populations at different distances (<1, 1–2, 2–5, 5–9 km) from the associated reservoirs using the Malaria Atlas Project (MAP) and WorldPop databases. Results derived from MAP were verified by comparison with the results of detailed epidemiological studies conducted at 11 dams.    Results  Of the 1268 existing dams, 723 are located in malarious areas. Currently, about 15 million people live in close proximity (<5 km) to the reservoirs associated with these dams. A total of 1.1 million malaria cases annually are associated with them: 919,000 cases due to the presence of 416 dams in areas of unstable transmission and 204,000 cases due to the presence of 307 dams in areas of stable transmission. Of the 78 planned dams, 60 will be located in malarious areas and these will create an additional 56,000 cases annually. The variation in annual PfIR in communities as a function of distance from reservoirs was statistically significant in areas of unstable transmission but not in areas of stable transmission.    Conclusion  In sub-Saharan Africa, dams contribute significantly to malaria risk particularly in areas of unstable transmission. Additional malaria control measures are thus required to reduce the impact of dams on malaria.

Malaria impact of large dams in sub-Saharan Africa: maps, estimates and predictions