Malaria control project was first initiated in Nepal in 1954 with the support from USAID (then USOM). The objective of the project was to study malaria mainly in Terai belt of central Nepal. In 1958, national malaria eradication program, was launched with the objective of eradicating malaria from the country within a stipulated time period. Due to various reasons the eradication concept was reverted to control program in 1978. Following the call of WHO to revamp the malaria control programs in 1998, Roll Back Malaria (RBM) initiative was launched to address the perennial problem of malaria in hard-core forestes, foot hills, inner Terai and valley areas of the hills, where more than 70 percent of the total malaria cases of the country prevail. The high risk of acquiring the disease is attributed to the abundance of vector mosquitoes, mobile and vulnerable population, relative inaccessibility of the area, suitable temperature, environmental and socio-economic factors.
Currently Nepal has headed into elimination in 2025 with activities rolled out across all the 77 districts of the country including the high, moderate, low and no risk districts. Since 2016, the program has been updating the microstratification every year and has classified risks at a ward level. Based on the most recent malaria microstratification, 2019: a total of 2,686 wards out of total 6,743 wards in 77 districts were found to be at - risk of malaria transmission. Out of these, 47 wards (0.7% of total wards) in 28 municipalities (G.P and N.P.) of 15 districts were found to be at high risk. In addition, 151 wards (2.2% of total wards) across 60 municipalities of 18 districts were categorized as moderate risk. There were 2,488 wards (37% of total wards) categorized as low risk whereas the remaining 4,057 wards (60.1% of total wards) came under no risk categories. High and moderate malaria - at risk areas were identified in 198 wards scattered over 20 districts. Similarly, 2,488 low risk wards were identified in additional 47 districts.
A total of 1,97,084 people (0.7%) live in high-risk wards. Similarly, 9,34,931 people (3.2%) live in moderate risk wards, 1,10,92,688 people (37.9%) live in low risk wards and 1,70,24,477 (58.2 %) live under no risk wards.
At a provincial level, 30 high risk wards (approx. 64%) are in Sudurpashchim Province, 7 wards are in Karnali Province, 3 wards in Province 5, 1 ward in Bagmati Province and 6 wards in Province 2. High risk ward wasn’t identified in Province 1 and Gandaki Province.