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This meta-analysis focused on the genetic component of resistance, specifically evaluating mutations in the\n                      <jats:italic>kelch13<\/jats:italic>\n                      (R622I, P441L and A675V) and\n                      <jats:italic>Pfmdr1<\/jats:italic>\n                      (Y184F and D1246Y) genes within Ethiopian Plasmodium falciparum strains.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A systematic literature search was conducted across the PubMed\/MEDLINE, Scopus, Web of Science, Cochrane Library, and Google Scholar databases. Eligible studies included primary data on the prevalence of\n                      <jats:italic>kelch13<\/jats:italic>\n                      and\n                      <jats:italic>Pfmdr1<\/jats:italic>\n                      gene mutations in\n                      <jats:italic>Plasmodium falciparum<\/jats:italic>\n                      isolates from Ethiopia. Two reviewers independently conducted study selection, data extraction, and quality assessment. Heterogeneity was evaluated using the I\u00b2 statistic, and a random-effects model was utilized to pool prevalence estimates with 95% confidence intervals (CI). Subgroup and sensitivity analyses were performed to explore sources of heterogeneity. Publication bias was assessed using funnel plots and Eggers test. All analyses were carried out using STATA software version 16.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of fifteen studies were reviewed and analyzed, comprising 11,269 samples and 5,521 positive cases of\n                      <jats:italic>Plasmodium falciparum<\/jats:italic>\n                      . Pooled prevalence of\n                      <jats:italic>kelch13<\/jats:italic>\n                      gene mutations at R622I, A675V, and P441L was 11%, 1% and 0% respectively. Pooled prevalence of\n                      <jats:italic>Pfmdr1<\/jats:italic>\n                      gene mutations at D1246Y and Y184F was 6% and 77%, respectively. Subgroup analysis revealed this resistance marker has significantly increased over time, rising from 66% (2007\u20132014) to a concerning 91% (2015\u20132025).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      While most resistance markers remain rare or absent, the significant rise in the\n                      <jats:italic>Pfmdr1<\/jats:italic>\n                      Y184F mutation highlights a growing concern regarding antimalarial drug resistance in Ethiopia.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-026-13164-2","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T09:36:21Z","timestamp":1774517781000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence of kelch13 and Pfmdr1 gene mutations associated with antimalarial drug resistance in Plasmodium falciparum isolates from Ethiopia: a systematic review and meta-analysis"],"prefix":"10.1186","volume":"26","author":[{"given":"Temesgen Mitiku","family":"Yeshanew","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bokretsion Gidey","family":"Brhane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betelhem Abebe","family":"Begashew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemechis Waktole","family":"Bayisa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nega","family":"Birhane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"issue":"1","key":"13164_CR1","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1186\/s12936-022-04178-7","volume":"21","author":"A Monroe","year":"2022","unstructured":"Monroe A, Williams NA, Ogoma S, Karema C, Okumu F. 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