Background:Nepal is preparing to eliminate malaria by 2026. To evaluate the progress of vector control and prioritize areas for targeted intervention, understanding the recent changing distribution of high and moderate malaria risk areas is vital.Methods:Patterns of designated high and moderate malaria risk wards in Nepal between 2018 and 2021 were analyzed to identify stable and newly generated high- and moderate-risk (HaMR) wards, using the Spatial Temporal Analysis of Moving Polygons (STAMP) method.Results and Conclusions:High-risk and moderate-risk wards decreased by about 55% and the number of districts containing these wards also decreased from 20 to 14. However, several stable and new HaMR wards, mostly in the northwest and the southwest of the country, are apparent, despite intervention efforts. Public health officials should prioritize those wards for malaria surveillance and vector control, and future studies should explore the underlying reasons for persistent risk wards.