Global trends in the burden of malaria: mapping the prevalence, incidence and mortality of Plasmodium falciparum and Plasmodium vivax in the era of climate change and emerging drug resistance

Introduction Malaria remains a major global health challenge, with Plasmodium falciparum and P. vivax showing marked geographical and biological differences. Climate variability and change, antimalarial drug resistance, insecticide resistance and vector adaptation increasingly complicate malaria control and elimination.Materials and methods We systematically reviewed evidence on the global epidemiology of P. falciparum and P. vivax, focusing on prevalence, incidence, mortality, geographical distribution, climate-related transmission, antimalarial drug resistance, insecticide resistance and vector adaptation. Searches of major bibliographic databases were complemented by authoritative malaria surveillance and modelling sources. Evidence was synthesised according to species, geographical region, epidemiological outcome, environmental determinants and resistance characteristics.Results Malaria burden showed substantial geographical heterogeneity, with P. falciparum predominating in sub-Saharan Africa and P. vivax contributing substantially outside this region. Temperature, precipitation and humidity influenced vector and parasite biology and transmission suitability, although projected climate-related changes remained subject to substantial uncertainty. Artemisinin and partner-drug resistance in P. falciparum, chloroquine resistance and radical-cure challenges in P. vivax, and insecticide resistance and behavioural adaptation in vectors emerged as major threats.Discussion Sustainable malaria elimination requires integrated, species-specific, resistance-informed and climate-sensitive strategies combining surveillance, effective treatment, adaptive vector control and resilient health systems.