The creation of water reservoirs in regions of unstable malaria transmission often results in intensified malaria. Our work investigated the dynamics of this relationship around the Koka reservoir in Ethiopia. We first identified the degree to which malaria transmission is greater near the reservoir. We then determined that i) the greater malaria transmission resulted from greater mosquito abundance and ii) the most important mosquito larvae breeding site was the reservoir shoreline. Finally, we determined a relationship between rates of water level change and success of larval development, with subsequent consequences for malaria case-rates. These findings have important implications for dam operation. The potential exists to modify the operation of the dam to greatly improve public health in the region, although inevitably there are trade-offs with other reservoir objectives.
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