{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T05:54:23Z","timestamp":1790920463830,"version":"4.1.0"},"posted":{"date-parts":[[2025,4,10]]},"group-title":"Epidemiology","reference-count":81,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T00:00:00Z","timestamp":1744243200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,4,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>\n                  <jats:italic>Plasmodium falciparum<\/jats:italic>\n                  malaria remains a leading cause of mortality in Angola, with emerging antimalarial resistance threatening treatment and prevention strategies. Efficacy of artemether-lumefantrine, one of the country\u2019s preferred malaria treatments, has been reported below 90% in two provinces, underscoring the need for routine resistance surveillance and efficacy monitoring to guide policy decisions.\n                <\/jats:p>\n                <jats:p>\n                  Between March and July 2023, dried blood spots and demographic data were collected from\n                  <jats:italic>P<\/jats:italic>\n                  .\n                  <jats:italic>falciparum<\/jats:italic>\n                  -positive participants at 16 health facilities across 8 provinces. Multiplexed amplicon deep sequencing was used to characterize single nucleotide polymorphisms in 12 genes linked with resistance, estimate allele frequencies, and detect co-infecting non-falciparum Plasmodium species.\n                <\/jats:p>\n                <jats:p>\n                  Sequence data from 817 samples revealed significant geographic variation in resistance markers. In the southeast, artemisinin partial resistance markers (\n                  <jats:italic>k13<\/jats:italic>\n                  P574L, P441L), were detected at very low prevalence (&lt;0.1%), while the quintuple\n                  <jats:italic>dhps<\/jats:italic>\n                  \/\n                  <jats:italic>dhfr<\/jats:italic>\n                  haplotype, linked to sulfadoxine-pyrimethamine (SP) resistance, was very prevalent (&gt;40% of samples). In the northwest, the sextuple\n                  <jats:italic>dhps<\/jats:italic>\n                  \/\n                  <jats:italic>dhfr<\/jats:italic>\n                  haplotype, a marker of higher SP resistance, was most prevalent in Zaire (14.2%). The\n                  <jats:italic>crt<\/jats:italic>\n                  CVIET haplotype, associated with chloroquine resistance, had a national prevalence of 15.9%, detected in over 48% of samples from Zaire and U\u00edge. The\n                  <jats:italic>mdr1<\/jats:italic>\n                  N86 genotype, linked to reduced lumefantrine susceptibility, was widespread, detected in 99.3% of samples. Co-infections of\n                  <jats:italic>P<\/jats:italic>\n                  .\n                  <jats:italic>falciparum<\/jats:italic>\n                  and non-falciparum species were rare with no clear geographic distribution. No\n                  <jats:italic>P<\/jats:italic>\n                  .\n                  <jats:italic>vivax<\/jats:italic>\n                  co-infections were detected.\n                <\/jats:p>\n                <jats:p>These findings highlight the need for continued monitoring to safeguard treatment efficacy, reinforcing the importance of molecular surveillance in malaria control strategies.<\/jats:p>","DOI":"10.1101\/2025.04.08.25325242","type":"posted-content","created":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T17:15:12Z","timestamp":1744305312000},"source":"Crossref","is-referenced-by-count":5,"title":["Geographical Heterogeneity in Antimalarial Resistance Markers Revealed by Genomic Surveillance in Angola, 2023"],"prefix":"10.64898","author":[{"given":"Maria Florinda","family":"Jo\u00e3o","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0566-4901","authenticated-orcid":false,"given":"Andr\u00e9s","family":"Aranda-D\u00edaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faith De","family":"Amaral","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6044-3669","authenticated-orcid":false,"given":"Takalani I.","family":"Makhanthisa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4941-9972","authenticated-orcid":false,"given":"Sonja B.","family":"Lauterbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukosha","family":"Chisenga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brighton","family":"Mangena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo","family":"Maquina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0354-4076","authenticated-orcid":false,"given":"Isobel","family":"Routledge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chadwick","family":"Sikaala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Chimumbwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domingos","family":"Jandondo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Franco","family":"Martins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0728-3093","authenticated-orcid":false,"given":"Jaishree","family":"Raman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro Rafael","family":"Dimbu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2025112409300476000_2025.04.08.25325242v1.1","unstructured":"World Health Organization., 2024. 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