Socioeconomic Determinants of Malaria and Dengue Risk Following Extreme Weather Events: A Systematic Review with Narrative Synthesis
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Background: Extreme-weather events influence malaria and dengue transmission, but disease burden varies substantially between populations exposed to similar climatic hazards. Structural socioeconomic conditions may modify this relationship through housing, basic services, displacement, preventive-resource access, and healthcare availability. Objective: To systematically evaluate how socioeconomic vulnerability influences malaria and dengue risk under extreme-weather and climate-sensitive conditions and to characterize the pathways supported by observational evidence. Methods: A systematic review with narrative synthesis was structured according to PRISMA 2020 and PRISMA-S principles. PubMed/MEDLINE, Scopus, Web of Science, Embase, and Cochrane Library were searched using terms for extreme weather, socioeconomic vulnerability, malaria, and dengue. Observational human studies examining relevant structural determinants were eligible. Study characteristics, associations, and methodological limitations were synthesized without meta-analysis because of substantial heterogeneity. Results: Of 1,482 records identified, 312 duplicates were removed, 1,170 records were screened, 56 full texts were assessed, and eight studies contributed to the narrative evidence set. Housing and basic-service deficiencies consistently increased vector-related vulnerability. Post-flood malaria risk was associated with displacement and reduced access to insecticide-treated nets, while socioeconomic conditions modified temperature-associated dengue risk. Healthcare-system vulnerability represented a plausible additional pathway, although direct event-specific evidence was limited. Conclusion: Socioeconomic vulnerability appears to amplify climate-sensitive malaria and dengue risk through interacting structural and healthcare pathways. Climate-resilient disease control should integrate vector surveillance with housing, water, preventive-resource, displacement, and healthcare interventions
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