Seventy years of malaria in Pakistan: trends in vector distribution, disease dynamics, and control measures (1947–2019)

Abstract Malaria and its associated complications continue to affect a significant proportion of the population in Pakistan. This review aims to provide a comprehensive overview of malaria in Pakistan, addressing parasite specific distribution, therapeutic challenges, vector control measures and challenges, along with socioeconomic factors influencing burden of disease. Main malaria vectors in Pakistan are An. culicifacies and An. stephensi . Pakistan is home to multiple malaria parasite species and Plasmodium vivax are most predominant. Antimalarial drug resistance is a pressing concern, with molecular studies revealing chloroquine resistance in both P. falciparum and P. vivax . Artesunate and sulfadoxine-pyrimethamine remain effective, cautious prescription practices are vital. The distinct CQ-resistance mechanisms involve the pfcrt gene in P. falciparum , contrasting with homologues in P. vivax . Vector control depended on neurotoxic insecticides mainly organochlorine and organophosphates, is compromised by environmental safety and development of insecticides resistance. Control measures face additional challenges due to continuous political instability and regional conflicts. Sustained efforts and comprehensive strategies are essential for effective malaria control nationwide.