This review examines the global distribution and population at risk of malaria from the 20th century, using geographic information systems and historical maps to quantify the impact of human activities on malaria distribution. It highlights that despite a reduction in the area supporting malaria by half, the global population at risk increased by 2 billion due to demographic changes. The study shows that nearly 1 billion people are exposed to hypoendemic and mesoendemic malaria in Southeast Asia. It also notes that estimates of malaria burden in Africa may be distorted due to different methods of calculation. Population projections indicate that by 2010, around 400 million births will occur within the current malaria distribution, challenging the Roll Back Malaria initiative to halve the global malaria burden. The paper discusses the historical spread of malaria, with evidence suggesting that Plasmodium falciparum expanded in Africa around 10,000 years ago, coinciding with human population growth and agricultural development. Malaria control efforts in the 20th century significantly reduced the area of malaria risk, with the global distribution of malaria shrinking from 53% to 27% of the Earth's land surface. However, the most significant reductions were in areas of lower endemicity, while hyperendemic and holoendemic areas saw minimal changes. The global human population grew from 1 to 6 billion during the 20th century, with the percentage of the global population at risk of malaria decreasing from 77% to 46% by 1994. By 2002, this percentage had increased slightly to 48% due to population growth. The number of people at risk increased consistently from 0.9 to 3 billion. The study also highlights regional differences in malaria risk, with significant growth in populations at risk in Africa and Southeast Asia. The paper discusses the challenges of malaria control in areas of high transmission, emphasizing the need for effective drug management and vector control. It also addresses the issue of drug resistance, noting that areas of low malaria transmission may contribute to the development of antimalarial drug resistance. The study concludes that while international priorities focus on Africa, there is a need to define the global extent of malaria risk to enable effective and equitable prioritization of investment and strategic direction. The global burden of malaria is still dominated by African countries, which are least able to raise financial resources to tackle their high rates of malaria death and disability.This review examines the global distribution and population at risk of malaria from the 20th century, using geographic information systems and historical maps to quantify the impact of human activities on malaria distribution. It highlights that despite a reduction in the area supporting malaria by half, the global population at risk increased by 2 billion due to demographic changes. The study shows that nearly 1 billion people are exposed to hypoendemic and mesoendemic malaria in Southeast Asia. It also notes that estimates of malaria burden in Africa may be distorted due to different methods of calculation. Population projections indicate that by 2010, around 400 million births will occur within the current malaria distribution, challenging the Roll Back Malaria initiative to halve the global malaria burden. The paper discusses the historical spread of malaria, with evidence suggesting that Plasmodium falciparum expanded in Africa around 10,000 years ago, coinciding with human population growth and agricultural development. Malaria control efforts in the 20th century significantly reduced the area of malaria risk, with the global distribution of malaria shrinking from 53% to 27% of the Earth's land surface. However, the most significant reductions were in areas of lower endemicity, while hyperendemic and holoendemic areas saw minimal changes. The global human population grew from 1 to 6 billion during the 20th century, with the percentage of the global population at risk of malaria decreasing from 77% to 46% by 1994. By 2002, this percentage had increased slightly to 48% due to population growth. The number of people at risk increased consistently from 0.9 to 3 billion. The study also highlights regional differences in malaria risk, with significant growth in populations at risk in Africa and Southeast Asia. The paper discusses the challenges of malaria control in areas of high transmission, emphasizing the need for effective drug management and vector control. It also addresses the issue of drug resistance, noting that areas of low malaria transmission may contribute to the development of antimalarial drug resistance. The study concludes that while international priorities focus on Africa, there is a need to define the global extent of malaria risk to enable effective and equitable prioritization of investment and strategic direction. The global burden of malaria is still dominated by African countries, which are least able to raise financial resources to tackle their high rates of malaria death and disability.