A systematic comprehensive search was conducted according to the scoping review protocol. The search was conducted across multiple databases, including PubMed, Scopus, African Index Medicus, Embase, Web of Science and Cumulative Index to Nursing and Allied Health Literature (CINAHL) to identify eligible studies. The search strategy was guided by the inclusion and exclusion criteria. A combination of keywords and Medical Subject Headings (MeSH) terms was employed to ensure the inclusion of relevant studies focusing on the relationship between climate change and malaria in Africa. The full search strategy for each database is provided in Online Appendix 2.

Additional studies were sourced through reference mining of the identified literature. The search encompassed literature published between January 2010 and December 2024. While the search was conducted in English, no language restrictions were applied to the identified literature.

Institutional and community-based studies were included if they reported malaria and climate change data in the African region and explicitly reported the observed or modelled effects of historical or future climate change on outcomes related to the distribution, dynamics or transmission of malaria, malaria cases in humans, the Plasmodium parasite or the mosquito vector. Papers were excluded if they were purely methodological or consisted of conference proceedings, preprints, abstracts without full text, literature reviews or case series.

After searching the literature and removing duplicates, the studies were further filtered by reviewing their titles. Titles and abstracts of each study were independently screened by two postgraduate-level research assistants, with any disagreements resolved by the principal investigator. Subsequently, abstracts were reviewed in detail, and studies that did not meet the inclusion criteria were excluded. Full-text articles of the remaining eligible studies were then retrieved.

A data extraction tool (Online Appendix 1) was used to record key study details, including design, setting, sample sizes, climate variables, malaria trends, bibliographic information, methodologies, quantitative and qualitative findings and limitations. The selected studies were organised by author and publication date, full journal reference, research aims or questions, study population, age groups, geographic setting, study design, methodological approach to data analysis and reported outcomes. The included reports comprised quantitative, qualitative, mixed-methods and prospective studies.

The quality of the selected studies was systematically evaluated using the Mixed Methods Appraisal Tool (MMAT),²⁴ a validated framework designed for the critical appraisal of studies employing qualitative, quantitative or mixed methods. The MMAT evaluates various dimensions of study quality, such as clarity of research questions, appropriateness of methodology, relevance of the data collection methods and robustness of the analysis. Each study was scored according to the MMAT criteria, allowing for a standardised assessment of methodological rigour. This process ensured the inclusion of studies that met minimum quality thresholds, thereby enhancing the reliability and validity of the synthesis. Studies with significant methodological limitations were flagged for cautious interpretation during analysis.

This study aimed to evaluate the impacts of climate change on the malaria transmission cycle by examining key outcomes such as malaria incidence, prevalence and frequency of outbreaks. It also assessed changes in mosquito breeding patterns, including shifts in vector populations, geographic range and the length of transmission seasons. The study further explored how variations in temperature, rainfall and humidity, alongside adverse weather events such as El Niño, cyclones and prolonged droughts, influenced the lifecycle of malaria-carrying mosquitoes and the development of Plasmodium parasites. These factors collectively contribute to the changing dynamics of malaria transmission.

A thematic content analysis was employed to synthesise the findings from the included studies. This approach allowed for the identification of recurring patterns, significant concepts and emerging themes related to the effects of climate change on malaria transmission dynamics. The synthesis categorised findings into thematic areas, such as climate variables (e.g. temperature, rainfall), vector behaviours, parasite prevalence and human–environment interactions.

Ethical clearance to conduct this study was obtained from the Medical Research Council of Zimbabwe (No. MRCZ/A/3168).

Of the 90 studies reviewed, 45% met all five quality criteria applicable to their respective designs, indicating a high level of methodological rigour (Online Appendix 1). Common strengths included clearly stated research questions, appropriate methodological approaches and the use of relevant data sources. However, some studies exhibited limitations, particularly in areas such as addressing potential sources of bias, clearly describing the sampling strategy and accounting for confounding factors. For some secondary data-based studies, they did not report the source of their dataset, while a few reported but did not outline data extraction processes clearly.

Overall, the quality of the included studies was deemed adequate to support a meaningful synthesis of the evidence on the links between climate change and malaria in Africa. The quality assessment results were used to inform the interpretation of findings, but no studies were excluded on the basis of quality alone.

Of the 90 included studies, 31 were multinational. Of these, 15 assessed climate change and malaria across multiple regions of the African continent, three focused on various countries within SSA, six were specific to West Africa, six to East Africa and one to Southern Africa. Among individual countries, Ethiopia had the highest number of studies (n = 13), followed by Kenya (n = 8), Uganda (n = 6), South Africa (n = 4), Burundi (n = 4), Ghana (n = 4), Senegal (n = 3), Tanzania (n = 3), Malawi (n = 3), the Democratic Republic of Congo (n = 2) and one study each in the Gambia (n = 1), Niger (n = 1), Zambia (n = 1) and Eswatini (n = 1) Most of the studies (n = 37) used nationally representative datasets. This was followed by studies focusing on highland regions within selected countries (n = 7), while five studies (n = 5) used health facility-based datasets from specific districts or facilities. The remaining studies examined a single district, region or zone within individual or multiple countries (Table 1).

Most studies (n = 81) used historical datasets or laboratory experimental data for malaria and climate outcomes, describing or analysing changes in either indicator. The remaining studies (n = 10) utilised historical data to estimate the potential effects of climate on malaria, either regionally or within individual countries. A significant proportion of studies (n = 66) employed modelling techniques to analyse the datasets, using various approaches such as Bayesian modelling, spatial modelling, time-series analysis and regression models. Other common modelling methods included machine learning techniques, agent-based modelling and dynamical systems modelling, which were used to simulate malaria transmission under different climate scenarios. Eight studies described various analytic study designs, including cohort studies (n = 2), cross-sectional studies (n = 2) and case-control studies (n = 4). These studies predominantly used secondary datasets or collected historical information during data collection. The remaining eight studies were experimental, with five conducted in laboratory settings and three using quasi-experimental designs. The laboratory studies were mainly related to manipulating the environment in which mosquitoes lived to see how climatic changes’ effect on climate change simulated real-world scenarios.

Nearly three-quarters (n = 67) of the studies examined the effect of climate on malaria in humans, with a similar proportion also considering the impact of climate on the female Anopheles mosquito (n = 74) or the Plasmodium parasite (n = 71). Among the studies focusing on malaria in humans, 26 analysed the effect of climate on malaria transmission, 11 investigated malaria incidence, 11 examined malaria immunity, eight explored malaria epidemics, six studied malaria cases, three focused on malaria in children and one addressed malaria in women and children. For studies examining the effect of climate on the mosquito vector, a majority (n = 41) did not specify the species. Among those identifying specific species, 17 considered A. gambiae, ten focused on Anopheles arabiensis, nine on A. funestus and two on Anopheles stephensi. One study investigated multiple species, including Anopheles christyi, Anopheles demeilloni, Anopheles pharoensis, Anopheles cinereus and A. arabiensis, while another study examined the climate’s effect on Anopheles larvae. Regarding the studies investigating the impact of climate on the malaria parasite, 27 did not specify the species, whereas 40 considered P. falciparum, seven focused on P. vivax, one on Plasmodium chabaudi and one on Plasmodium malariae (Table 1).

Mosquito vector survival is limited at temperatures below 18 °C and above 32 °C, with most mosquitoes dying at temperatures exceeding 40 °C. The optimal temperature for P. falciparum incubation within mosquitoes is around 30 °C, while the most suitable temperature for mosquito vector development is approximately 22 °C.

A modelling study in Burundi found that a rise in minimum temperatures during the preceding month was strongly associated with increased malaria incidence, highlighting the strong relationship between temperature and malaria transmission.⁷⁹ Similarly, a modelling study in Ghana demonstrated that temperature variations significantly impact malaria prevalence. Higher temperatures accelerate the development of both the parasite and mosquito vectors, increasing the risk of transmission.³² For instance, a 1 °C rise in temperature was shown to shorten the extrinsic incubation period of P. falciparum within mosquitoes, thereby enhancing transmission potential.¹⁰⁹ Even modest temperature increases can substantially alter malaria dynamics in regions with endemic conditions. One of the included studies predicted that under global warming scenarios, malaria transmission might decline in regions already experiencing high temperatures.⁴⁷

In contrast, other studies have shown that temperature increases could have significant consequences in cooler regions, particularly in the East African Highlands. A modelling study predicted that these highlands would face heightened malaria risks under 1.5 °C and 2 °C warming scenarios.⁸⁴ The study also projected that previously malaria-free highland areas would likely experience increased transmission, making them vulnerable to outbreaks. Multiple studies in the Eastern Highlands reinforce this prediction, attributing recent regional malaria epidemics to rising temperatures.^61,68 These studies argue that warming has enabled Anopheles mosquitoes to expand beyond their historical geographical range, colonising higher altitudes and increasing transmission potential in areas considered unsuitable for malaria.

Extreme weather events related to climate change include flooding and droughts that can affect the reproductive cycle of malaria vectors. Excessive rain can potentially wash away mosquito larvae and destroy breeding sites, leading to a temporary reduction in transmission. This was observed in several flood-prone areas of Eastern African countries such as Kenya, where surges in rainfall disrupted mosquito population growth.³³ On the other hand, drought conditions, particularly in regions of East Africa, have been found to create unexpected breeding opportunities. During droughts, water scarcity often leads to the formation of isolated stagnant water bodies, such as puddles and shallow pools, which serve as ideal habitats for mosquito breeding. These habitats are less likely to be disturbed and can sustain mosquito populations, increasing the risk of malaria transmission.³³ Moreover, the variability of rainfall patterns, exacerbated by climate change, adds another layer of complexity to malaria control efforts. Unpredictable shifts in rainfall intensity and distribution can lead to simultaneous flooding and drought risks within the same region, making it more challenging to anticipate and mitigate malaria outbreaks.

Four of the studies (n = 4) assessed the effect of extreme weather events on malaria transmission. Cyclones, tropical storms, flooding, heat waves and El Niño significantly influence malaria transmission dynamics, often creating conditions conducive to malaria transmission. This can be through disrupting ecosystems, destroying human settlements or increasing vulnerabilities.

Cyclones and tropical storms, characterised by heavy rainfall and flooding, create extensive breeding grounds for Anopheles mosquitoes. Floodwaters often lead to stagnant pools, ideal for mosquito larval development. At the same time, the displacement of communities during such events disrupts access to healthcare and preventive measures, increasing the risk of transmission. A study in Mozambique highlighted a surge in malaria cases following Cyclone Idai in 2019, with disrupted healthcare systems further compounding the burden. Similarly, tropical storms have been linked to malaria outbreaks in previously stable transmission areas in Madagascar.

On the other hand, heat waves can affect malaria transmission depending on local temperature thresholds. Extremely high temperatures may hinder Plasmodium development within the mosquito, reducing transmission in some regions. However, heat waves can accelerate transmission by shortening the extrinsic incubation period in areas where temperatures remain within the optimal range for both the parasite and mosquito vectors. In regions with limited cooling infrastructure, heat waves may also increase human exposure to mosquito bites during night-time outdoor activities.

El Niño events alter global weather patterns and have been associated with malaria epidemics, particularly in Africa. These events typically lead to increased rainfall in some regions and prolonged droughts in others, which can drive malaria transmission. For example, studies from East Africa have linked El Niño-induced rainfall with significant malaria outbreaks because of expanded mosquito breeding habitats. Conversely, drought conditions can create isolated water bodies, providing stable breeding sites that persist over time, as observed in semi-arid regions of Ethiopia.

Socio-economic vulnerabilities, such as inadequate infrastructure, displacement of communities and limited access to healthcare, compound the impact of these adverse weather events. Understanding the interaction between adverse weather events and malaria is essential for developing early warning systems and targeted interventions, particularly in regions prone to extreme weather.

Moreover, climate variability and extreme weather events such as El Niño and drought have been implicated in the recent re-emergence of malaria in regions like the East African Highlands. Studies suggest that the increased climate extremes since the late 1980s, including a higher frequency of El Niño events, have contributed to heightened malaria risk in these areas.²⁵ Such extreme events not only influence malaria transmission by altering environmental conditions but also exacerbate socio-economic vulnerabilities, further complicating malaria control efforts.

The relationship between climate, socio-economic factors, the environment and malaria transmission is complex and context specific. A study in Gambia found that communities living in metal-roof houses were better protected from mosquitoes, with a higher proportion of mosquitoes being eradicated in households with metal roofs than those with thatched roofs.⁶³

Climate change’s impact on agriculture, food security and animal rearing also creates a cascade of effects on malaria transmission. Many African communities rely on subsistence farming, and in efforts to mitigate climate impacts such as drought and flooding that threaten crops, land-use activities like deforestation and land degradation have been employed. Additionally, creating irrigation systems can increase mosquito breeding sites, heightening malaria risk. Deforestation in the African highlands and wetland conversion have allowed A. gambiae larvae to survive outside traditionally endemic areas. Deforestation has indirectly influenced climate change in Zambia, thus fostering conditions that promote malaria transmission.¹¹²

A study in Djibouti also found that rapid urbanisation, largely driven by climate change and globalisation, has facilitated the spread of A. stephensi, a mosquito species common and known to thrive mostly in urban environments.¹¹³ Similarly, in areas that were previously non-endemic, malaria outbreaks have often been associated with higher incidence and mortality rates, largely because of limited knowledge of malaria prevention.⁹⁷

While this review provides valuable insights into the relationship between climate change and malaria in Africa, several limitations should be acknowledged. Notably, the review did not explore certain potentially influential factors such as urbanisation, land use changes and socio-economic determinants in detail. These factors are intricately linked to climate variability and malaria transmission patterns, and their exclusion may limit the depth and contextual relevance of the findings. This omission partly reflects the scope and focus of the included studies, many of which did not explicitly examine these broader environmental and social determinants.

Variations in malaria testing algorithms such as rapid diagnostic tests versus microscopy complicate study comparisons. Climate data quality remains a concern, with significant data gaps reported. Other challenges include difficulty establishing causal mechanisms between climatological and epidemiological factors and needing to account for confounding variables like household spraying programmes, malaria prophylaxis and socio-demographic influences on malaria risk.

A notable gap in the reviewed studies was the lack of data on the impact of climate change on malaria-associated morbidity and mortality and the environmental effects of malaria prevention programmes. Future research should address these areas to inform environmentally responsible malaria strategies and enhance the effectiveness of interventions in the context of climate change. Increased preparedness requires resource allocation, ecosystem-based solutions and enhanced monitoring efforts. To develop comprehensive and adaptive solutions, stakeholders must prioritise integrating climate, ecological and social science research into malaria control initiatives.

The lack of reliable long-term environmental and temperature data in SSA hinders robust analysis of climate’s impact on malaria. Disparate methodologies and obsolete research techniques further exacerbate these challenges. Advanced data analysis, improved climate modelling and interdisciplinary approaches are urgently needed.

Finally, the review highlights a critical disconnect between malaria control efforts and climate change mitigation policies. The absence of integrated frameworks prevents holistic responses to the increasing malaria incidence in new regions. Transdisciplinary research and policy integration are essential to bridge these gaps and address the multifaceted challenges climate change poses to malaria dynamics.

It is essential to adopt a multifaceted approach to address the challenges climate change poses to malaria transmission effectively. A key priority is the establishment of standardised frameworks for collecting and analysing climate and health data. Integrating these datasets can improve outbreak prediction and inform targeted interventions. Existing models, such as the WHO’s Climate Services for Health framework and the Integrated Disease Surveillance and Response (IDSR) strategy, offer practical entry points for aligning health systems with meteorological services through shared indicators and joint early warning systems. Enhanced surveillance systems that combine environmental and epidemiological data can significantly improve malaria control efforts by providing actionable insights. Tailored solutions that account for regional variations in climate and malaria dynamics are equally important. To ensure their effectiveness, interventions must be adapted to local conditions, such as temperature and rainfall patterns. For example, cooler highland regions experiencing warming may require proactive measures to prevent the spread of malaria into previously unaffected areas. At the same time, arid zones may benefit from strategies to manage breeding sites formed during droughts.

Innovative vector control methods also hold promise in mitigating the impact of climate change on malaria. Context-specific measures, such as eco-friendly housing designs that reduce mosquito entry and targeted management of mosquito breeding sites, can be highly effective. These approaches address current transmission patterns and build resilience against future climate variability. Furthermore, transdisciplinary research is critical to understanding the complex interactions between climate and malaria. Expanding the scope of studies to include underexplored factors such as wind speed, air pollution and socio-economic changes can refine predictive models and intervention strategies. Collaborative efforts across disciplines, such as public health, environmental science and urban planning, are necessary to develop comprehensive solutions. Finally, integrating malaria control efforts with broader climate adaptation and mitigation strategies is essential for long-term sustainability. Aligning policies across health, environmental and economic sectors will ensure that interventions are both practical and sustainable. By embedding malaria control within the broader context of climate change responses, governments and stakeholders can build more resilient systems to protect vulnerable populations and achieve lasting progress in malaria eradication.

Future research should prioritise study designs and analytical approaches that better elucidate causal mechanisms between climate variables and malaria transmission. Longitudinal studies, natural experiments and modelling approaches that account for temporal and spatial variability may be particularly useful in strengthening causal inference.