{
  "abstract": "Global efforts to control and eliminate malaria are threatened by antimalarial drug resistance. The WHO recommends molecular surveillance of resistance markers as a complementary approach to therapeutic efficacy studies. Here, the first regional analysis of antimalarial resistance markers across six southern African countries spanning diverse transmission intensities and geographies is reported. Dried blood spots, collected from rapid diagnostic test-positive individuals in Angola, Eswatini, Namibia, and Zambia in 2023, Mozambique in 2022, and South Africa between 2022 and 2024 using a standardized collection method, were analyzed using a Plasmodium falciparum-targeted amplicon sequencing protocol. The distribution of resistance markers was spatially heterogeneous. Validated markers of artemisinin partial resistance (ART-R) were rare. However, more than 30% of samples from eastern Namibia and Zambia's Western and Central Provinces carried the candidate kelch13 P441L ART-R marker. Other ART-R markers (kelch13 R515K, P553L, P574L, A675V) were detected at a prevalence rate <1.3% in all countries except Mozambique, where these markers were absent. The wild-type multidrug resistance 1 N86 allele, potentially associated with reduced lumefantrine susceptibility, was near fixation (>99%) across all countries, whereas the chloroquine resistance marker K76T, in the chloroquine resistance transporter (crt) was nearly absent in most districts. The sulfadoxine-pyrimethamine resistance dihydropteroate synthase (dhps)-dihydrofolate reductase quintuple mutation was approaching fixation (>95%) in 35% of districts. Northern Angola was a clear outlier, with a lower dhps K540E prevalence (≤20%) but a higher crt K76T prevalence (48% to 56%). This pronounced spatial heterogeneity underscores the need for timely high-resolution local resistance data generation and sharing to safeguard antimalarial drug efficacy and guide malaria control and elimination strategies across the region.",
  "abstract_shown": true,
  "affiliations": [
    "Laboratory for Antimalarial Resistance Monitoring and Malaria Operational Research, Centre of Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa.",
    "Wits Research Institute for Malaria, University of Witwatersrand, Johannesburg, South Africa.",
    "University of Pretoria Institute for Sustainable Malaria Control, University of Pretoria, Pretoria, South Africa.",
    "EPPIcenter Research Program, Department of Medicine, University of California, San Francisco, California, USA.",
    "Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, California, USA.",
    "ISGlobal, Barcelona, Spain.",
    "SADC Malaria Elimination Eight Secretariat, Windhoek, Namibia.",
    "Programa Nacional do Controlo da Malária, Luanda, Angola.",
    "Instituto Nacional de Investigação em Saúde, Luanda, Angola.",
    "National Malaria Programme, Manzini, Eswatini.",
    "Department of Environmental Health Sciences, University of Eswatini, Mbabane, Eswatini.",
    "Department of Biochemistry, Microbiology, and Biotechnology, School of Science, University of Namibia, Windhoek, Namibia.",
    "Malaria Operational Research Program, Multidisciplinary Research Services, University of Namibia, Windhoek, Namibia.",
    "Ministry of Health and Social Services, National Vector-Borne Disease Control Program, Windhoek, Namibia.",
    "KwaZulu-Natal Provincial Malaria Control Program, Jozini, South Africa.",
    "National Department of Health, Pretoria, South Africa.",
    "National Health Research and Training Institute, Ndola, Zambia.",
    "National Malaria Elimination Centre, Ministry of Health, Lusaka, Zambia.",
    "Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique.",
    "Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.",
    "Programa Nacional do Controlo da Malária, Maputo, Mozambique.",
    "Sequencing Core Facility, National Institute for Communicable Diseases, Johannesburg, South Africa.",
    "Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique.",
    "Spanish Consortium for Research in Epidemiology and Public Health, Madrid, Spain.",
    "Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.",
    "Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 44,
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        0,
        1,
        2
      ],
      "name": "Jaishree Raman"
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        3,
        4,
        5
      ],
      "name": "Andrés Aranda-Díaz"
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    {
      "affs": [
        0
      ],
      "name": "Maxwell Mabona"
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        6
      ],
      "name": "Mukosha Chisenga"
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        7
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      "name": "Maria Florinda João"
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        8
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      "name": "Domingos Jandondo"
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    {
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        7
      ],
      "name": "Pedro Rafael Dimbu"
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    {
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        9
      ],
      "name": "Nomcebo Nhlengethwa"
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    {
      "affs": [
        10
      ],
      "name": "Sabelo V Dlamini"
    },
    {
      "affs": [
        11,
        12
      ],
      "name": "Lydia Eloff"
    },
    {
      "affs": [
        13
      ],
      "name": "Stark Katokele"
    },
    {
      "affs": [
        12
      ],
      "name": "Davis R Mumbengegwi"
    },
    {
      "affs": [
        14
      ],
      "name": "Qedusizi Nyawo"
    },
    {
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        15
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      "name": "Mbavhalelo Shandukani"
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        16
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      "name": "Sydney Mwanza"
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        17
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      "name": "Moonga Hawela"
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    {
      "affs": [
        5,
        18,
        19
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      "name": "Simone Boene"
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    {
      "affs": [
        18
      ],
      "name": "Arlindo Chidimatembue"
    },
    {
      "affs": [
        20
      ],
      "name": "Bernardete Rafael"
    },
    {
      "affs": [
        5
      ],
      "name": "Eduard Rovira-Vallbona"
    },
    {
      "affs": [
        6
      ],
      "name": "Brighton Mangena"
    },
    {
      "affs": [
        0
      ],
      "name": "Sonja B Lauterbach"
    },
    {
      "affs": [
        0
      ],
      "name": "Takalani I Makhanthisa"
    },
    {
      "affs": [
        0
      ],
      "name": "Hazel Gwarinda"
    },
    {
      "affs": [
        0
      ],
      "name": "Blaženka D Letinić"
    },
    {
      "affs": [
        3
      ],
      "name": "Faith De Amaral"
    },
    {
      "affs": [
        4
      ],
      "name": "Isobel Routledge"
    },
    {
      "affs": [
        5
      ],
      "name": "Beatriz Arregui-Gallego"
    },
    {
      "affs": [
        21
      ],
      "name": "Mishalan Moodley"
    },
    {
      "affs": [
        21
      ],
      "name": "Jonathan Featherston"
    },
    {
      "affs": [
        14
      ],
      "name": "Power B Tshikae"
    },
    {
      "affs": [
        21
      ],
      "name": "Arshad Ismail"
    },
    {
      "affs": [
        7
      ],
      "name": "Jose Franco Martins"
    },
    {
      "affs": [
        9
      ],
      "name": "Quinton Dlamini"
    },
    {
      "affs": [
        20
      ],
      "name": "Baltazar Candrinho"
    },
    {
      "affs": [
        13
      ],
      "name": "Petrina Uusiku"
    },
    {
      "affs": [
        15
      ],
      "name": "Ednah Baloyi"
    },
    {
      "affs": [
        17
      ],
      "name": "Busiku Hamainza"
    },
    {
      "affs": [
        5,
        18,
        19,
        22,
        23
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      "name": "Alfredo Mayor"
    },
    {
      "affs": [
        3
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      "name": "Bryan Greenhouse"
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    {
      "affs": [
        24
      ],
      "name": "Amy Wesolowski"
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    {
      "affs": [
        6
      ],
      "name": "Chadwick Sikaala"
    },
    {
      "affs": [
        6
      ],
      "name": "John Chimumbwa"
    },
    {
      "affs": [
        4,
        25
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      "name": "Jennifer L Smith"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/73khrqqbr610b.bib",
  "cited_by": 0,
  "doi": "10.4269/ajtmh.26-0299",
  "fulltext_url": "https://europepmc.org/articles/PMC13675676",
  "id": "73khrqqbr610b",
  "issns": [
    "0002-9637",
    "1476-1645"
  ],
  "landing_url": "https://europepmc.org/article/MED/42838037",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2739|Malaria Research and Control"
    ]
  ],
  "openalex": "W7220686137",
  "pdf_url": "https://europepmc.org/articles/PMC13675676?pdf=render",
  "pmcid": "PMC13675676",
  "pmid": "42838037",
  "published": "2026-10-06",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/73khrqqbr610b.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:10Z",
      "native_id": "MED:42838037",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42838037"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2739|Malaria Research and Control",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Geographical Variation in Antimalarial Drug Resistance Marker Prevalence across the Southern African Elimination Eight Region.",
  "title_text": "Geographical Variation in Antimalarial Drug Resistance Marker Prevalence across the Southern African Elimination Eight Region.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:18:10Z",
  "url": "https://research.draconitic.com/paper/73khrqqbr610b",
  "venue": "The American journal of tropical medicine and hygiene",
  "versions": []
}