Emergence of resistance to antimalarial drugs is a major challenge to malaria control and elimination strategies, and has crucial implications for global public health. Artesunate-pyronaridine (AS-PY) is among the most recently recommended artemisinin-based combination therapies (ACTs) endorsed by the world health organization (WHO) in 2022, and represents an additional promising tool in the global malaria control arsenal for the treatment of uncomplicated Plasmodium falciparum. Regular monitoring of the efficacy of antimalarial drugs are recommended to assess the development of antimicrobial resistance. This study aims to determine the pooled therapeutic efficacy of AS-PY for the treatment of uncomplicated Plasmodium falciparum malaria comprehensively. This systematic review and meta-analysis was conducted to evaluate the therapeutic efficacy of AS-PY for the treatments of uncomplicated Plasmodium falciparum malaria. The study was conducted adhering to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline. Relevant published articles retrieved from different databases, PubMed, Google Scholar, African Journals Library (AJOL), and Clinical Trials.gov until April 2026. Two independent reviewers performed screening of studies, data extractions, and assessed methodological quality. For studies conducted in multi center sites, result from all study site were aggregated to generate a single study-level effect estimate before conducting meta-analysis we pooled the effect estimate using a random-effects model. Heterogeneity quantified with I2. Key results reported with 95
Recurrent parasitemia following artemisinin-based combination therapy (ACT) remains a major challenge in high-transmission settings, where distinguishing true drug failure from reinfection is difficult. While ACTs demonstrate high efficacy under controlled conditions, real-world effectiveness is influenced by adherence, ongoing transmission, and socio-environmental factors. This study aimed to identify behavioral, environmental, and treatment-related determinants of recurrent parasitemia following ACT in a rural high-transmission setting in Zambia. A prospective cohort study was conducted among 272 patients aged 6 months and above with microscopy-confirmed uncomplicated Plasmodium falciparum malaria at Chavuma Mission Hospital, Zambia. All participants received standard artemether–lumefantrine therapy. The primary outcome was recurrent parasitemia within 28 days, defined as the presence of parasitemia with or without symptoms after treatment initiation. Molecular genotyping was not performed; therefore, recrudescence and reinfection were not distinguished. Data on adherence, preventive practices, and household characteristics were collected using structured interviews and direct observation. Multivariable logistic regression was used to identify factors associated with recurrent parasitemia. Recurrent occurred in 25.7
Progress toward malaria elimination has slowed, and the asymptomatic parasite reservoir is one important factor that sustains residual transmission. Mass Drug Administration (MDA) is a key strategy to clear this reservoir, but its effectiveness depends on high community participation. Understanding the complex socio-cultural factors that influence participation is critical for programmatic success. This systematic review synthesises qualitative evidence to identify barriers and facilitators to community engagement in malaria MDA. We systematically searched four databases (PubMed, Scopus, Web of Science, and CINAHL) for qualitative or mixed-methods studies from inception to 1 June 2026 exploring community perceptions of malaria MDA. Included studies were appraised using the CASP (Critical Appraisal Skills Programme) Qualitative Checklist, and findings were analysed through thematic synthesis. The search yielded 25 studies for synthesis, drawn primarily from sub-Saharan Africa (n = 14) and the Greater Mekong Sub-Region (n = 10), with one study from South Asia (n = 1). Four themes emerged: perceptual and cognitive factors; individual and household factors; social and community-level dynamics; and health-system and programmatic factors, with the facilitating and impeding form of each factor presented together. Key facilitators included high perceived risk of malaria, strong community leadership, and trust in the health system, which was built through effective engagement, local health workers, and ancillary care. Key barriers included fear of adverse events (side effects) and their economic impact, logistical conflicts with livelihood activities, widespread rumours, and a poor understanding of asymptomatic malaria. Community engagement is a central determinant of MDA success. The decision to participate is a social calculation of perceived risk versus intervention risk, mediated by trust. Malaria elimination programmes must move beyond top-down sensitisation to invest in continuous, responsive engagement, built on partnership with local leaders and a clear demonstration of community benefit. Trial registration: CRD420251182194.
Malaria persists in Peru, with transmission concentrated in the Amazon and Plasmodium vivax predominating. Integrating disease burden, geographic heterogeneity, and productivity losses may inform elimination efforts. To characterize malaria burden, demographic and spatiotemporal dynamics, and productivity losses. We conducted a retrospective, ecological, longitudinal, multisource study using surveillance data for 2000–2024, confirmed episodes for 2009–2023, district-level risk for 2019–2023, and ENAHO microdata. Negative binomial, generalized additive, segmented, and Bayesian spatiotemporal models characterized notified transmission. Productivity losses were estimated using the human capital approach and Monte Carlo simulation. GBD 2023 estimates for 1990–2023 provided a secondary comparative layer; modeled burden, notified episodes, and economic losses were analyzed as separate estimands. We identified 41 persistent P. vivax and 17 persistent P. falciparum hotspots. P. vivax predominated, and notified rates were higher at younger ages and, for P. vivax, among males. During 2017–2021, annual rates decreased by 22.7
Despite large-scale distribution of insecticide-treated nets (ITNs) in Tanzania, disparities in utilization persist. Understanding socioeconomic and geographic inequalities in ITN use is critical for advancing equitable malaria control. This study assesses determinants of ITN utilization and quantifies wealth-related inequality using nationally representative survey data. Data were drawn from the Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS) 2015–2016. A weighted sample of 37,169 households was analyzed. Survey-adjusted multilevel logistic regression was used to account for clustering at enumeration area level. An empty model estimated the intraclass correlation coefficient (ICC), followed by adjusted models including household-level covariates. Socioeconomic inequality in ITN utilization was quantified using the concentration index and concentration curves. An interaction term between poverty and residence was introduced to examine compounded disadvantage. The weighted prevalence of ITN utilization was 55.1
