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This is a critical concern in Uganda, where artemisinin-based combination therapy (ACT) is the first-line treatment for uncomplicated falciparum. The objective of this study was to compare the efficacy and safety of dihydroartemisinin\u2013piperaquine (DHA\u2013PQ) and artemether\u2013lumefantrine (AL) for the treatment of uncomplicated falciparum malaria in Ugandan children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A search of PubMed and the Cochrane Central Register of Controlled Trials for retrieving randomized controlled trials comparing the efficacy and safety of DHA\u2013PQ and AL for treatment of uncomplicated falciparum malaria in Ugandan children was done. The search was performed up to 31 August 2020. The data extracted from eligible studies and pooled as risk ratio (RR) with a 95% confidence interval (CI), using Rev Man Software (5.4). The protocol was registered in PROSPERO, ID: CRD42020182354.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eleven trials were included in this review and two of them only included under safety outcome. Total 3798 participants were enrolled. The PCR unadjusted treatment failure was significantly lower with DHA\u2013PQ at day 28 (RR 0.30, 95% CI 0.19\u20130.49; participants\u2009=\u20097863; studies\u2009=\u20095; I<jats:sup>2<\/jats:sup>\u2009=\u200993%, low quality evidence) and at day 42 (RR 0.53, 95% CI 0.38\u20130.76; participants\u2009=\u20091618; studies\u2009=\u20094; I<jats:sup>2<\/jats:sup>\u2009=\u200979%, moderate quality of evidence). The PCR adjusted treatment failure at day 42 was significantly lower with DHA\u2013PQ treatment group (RR 0.45, 95% CI 0.28 to 0.72; participants\u2009=\u20091370; studies\u2009=\u20095, high quality of evidence), and it was below 5% in both arms at day 28 (moderate quality of evidence). AL showed a longer prophylactic effect on new infections which may last for up to 63\u00a0days (PCR-adjusted treatment failure: RR 2.04, 95% CI 1.13\u20133.70; participants\u2009=\u20091311; studies\u2009=\u20092, moderate quality of evidence). Compared to AL, DHA\u2013PQ was associated with a slightly higher frequency of cough (RR 1.07, 95% CI 1.01 to 1.13; 2575 participants; six studies; high quality of evidence). In both treatment groups, the risk of recurrent parasitaemia due to possible recrudescence was less than 5% at day 28. The appearance of gametocyte between 29 and 42\u00a0days was also significantly lower in DHA\u2013PQ than AL (RR 0.26, 95% CI 0.12 to 0.56; participants\u2009=\u2009623; studies\u2009=\u20092; I<jats:sup>2<\/jats:sup>\u2009=\u20090%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Compared to AL, DHA\u2013PQ appeared to reduce treatment failure and gametocyte carriage in Ugandan children. This may trigger DHA\u2013PQ to become the first-line treatment option. Both treatments were safe and well-tolerated.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12936-021-03711-4","type":"journal-article","created":{"date-parts":[[2021,4,1]],"date-time":"2021-04-01T16:03:07Z","timestamp":1617292987000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Efficacy and safety of dihydroartemisinin\u2013piperaquine versus artemether\u2013lumefantrine for treatment of uncomplicated Plasmodium falciparum malaria in Ugandan children: a systematic review and meta-analysis of randomized control trials"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9951-5762","authenticated-orcid":false,"given":"Dawit Getachew","family":"Assefa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eden Dagnachew","family":"Zeleke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delayehu","family":"Bekele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna Amanuel","family":"Tesfahunei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emnet","family":"Getachew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Joseph","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsegahun","family":"Manyazewal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,4,1]]},"reference":[{"key":"3711_CR1","unstructured":"WHO. 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