Climate changes are altering patterns of temperature and precipitation, potentially affecting regions of malaria transmission. We show that areas of the Amazon Basin with few wetlands show a variable relationship between precipitation and malaria, while areas with extensive wetlands show a negative relationship with malaria incidence. G lobal models of malaria can be used to forecast the impact of climate change on malaria, a highly climatesensitive disease that causes >1 million deaths worldwide each year, mostly in children. However, a limitation of these models is the application of a uniform malaria-precipitation relationship to geographically diverse regions (1-3). Moreover, the Millennium Ecosystem Assessment has recognized a lack of knowledge about climate-sensitive diseases such as malaria and has called for a "more systematic inventory, by region and country, of current and likely population health impacts of ecosystem change" (4). Understanding malaria-precipitation relationships at regional levels will enhance predictability of ecosystem or climate change impact on population health.Precipitation and surface hydrology are key factors in determining the abundance of Anopheles mosquito vectors for malaria. Mosquitoes require pools of water to complete their life cycle, and malaria models have estimated changing transmission by setting minimum levels of precipitation below which mosquito populations are (theoretically) suppressed. However, using a uniform hydrologic threshold for malaria does not capture critical characteristics of landscape, soil, and rainfall (i.e., intensity, frequency), all known contributors to the abundance, persistence, and spatial distribution of mosquito habitats.In the Amazon Basin, the predominant malaria vector is Anopheles darlingi. Short longitudinal studies show that human-landing catches of An. darlingi, which breeds along the edges and in debris of clear, partially sunlit pools, are closely associated with local malaria rates (5,6). These observations establish that biting rates are elevated in regions of elevated malaria risk. Likewise, biting rates correlate with abundance of larvae and larval habitats and proximity of humans to larval habitats (7,8).Local observations demonstrate the existence of different seasonal patterns for malaria. In a 3-year study in Roraima, 8 municipalities showed increased risk for malaria during the middle of the dry season or shortly after the wet season (9). Other literature on seasonal patterns is limited to local and short (<3 years) longitudinal studies that lack statistical analysis. Although different seasonal patterns emerge in graphs, the collage of different data sources makes formulating a cohesive picture of these patterns in the Amazon region diffi cult.At the regional level, interannual climatologic cycles provide insight into low-frequency malaria patterns. In Columbia, El Niño events (caused by warming sea surface temperatures in the central tropical Pacifi c) are associated with warmer temperatures, higher dew points, and l...