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However, concerns remain that its expanded use may select for artemisinin-resistant\n                      <jats:italic>Plasmodium falciparum<\/jats:italic>\n                      strains. This baseline study assessed the presence of molecular markers of resistance to artemisinin and partner drugs and investigated factors associated with\n                      <jats:italic>Plasmodium falciparum<\/jats:italic>\n                      infection prior to RAS implementation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A community-based cross-sectional survey was conducted in remote areas of the Kapolowe health district, Democratic Republic of the Congo, in March\u2013April 2024. Dried blood spot samples were collected from asymptomatic children aged 6\u201359\u00a0months. Molecular markers of antimalarial drug resistance in\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      were analyzed using targeted next-generation sequencing, focusing on the\n                      <jats:italic>Pfkelch13, Pfcoronin, Pfubp1, Pfmdr1, and Pfcrt<\/jats:italic>\n                      genes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1242 children screened in 906 households, 656 (53%, 95% CI: 50\u201355%) were\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      malaria rapid diagnostic test-positive, of which 646 samples were available for analyses. Factors associated with reduced odds of asymptomatic\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      infection included higher household socio-economic status and non-agricultural sources of income, whereas children from households where malaria was perceived as treatable had increased odds of infection. No validated\n                      <jats:italic>Pfkelch13<\/jats:italic>\n                      mutations associated with artemisinin partial resistance were detected. Several non-synonymous\n                      <jats:italic>Pfkelch13<\/jats:italic>\n                      mutations were observed more than once, including A578S (7\/395, 1.8%). Two\n                      <jats:italic>Pfubp1<\/jats:italic>\n                      mutations associated with reduced dihydroartemisinin susceptibility, D1525E (88\/354, 24.9%) and E1528D (62\/354, 17.5%) were observed. No resistance-associated\n                      <jats:italic>Pfcoronin<\/jats:italic>\n                      mutations were detected. The wild-type\n                      <jats:italic>Pfcrt<\/jats:italic>\n                      CVMNK haplotype predominated, while the\n                      <jats:italic>Pfmdr1<\/jats:italic>\n                      NFSND haplotype (57\/379, 15.0%) associated with reduced lumefantrine susceptibility was identified.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      The absence of\n                      <jats:italic>Pfkelch13<\/jats:italic>\n                      mutations and a full reversal to wild-type\n                      <jats:italic>Pfcrt<\/jats:italic>\n                      are reassuring for directly guiding the implementation strategies of RAS and continued effectiveness of current ACTs. However, the detection of the\n                      <jats:italic>Pfmdr1<\/jats:italic>\n                      single mutant N\n                      <jats:bold>F<\/jats:bold>\n                      SND haplotype highlights the need for continued monitoring of lumefantrine susceptibility.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12936-026-06016-6","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T15:34:16Z","timestamp":1782747256000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence of antimalarial drug resistance markers and factors associated with Plasmodium falciparum infection in asymptomatic children prior to rectal artesunate implementation in Kapolowe Health District, Democratic Republic of the Congo"],"prefix":"10.1186","volume":"25","author":[{"given":"Flory","family":"Luzolo Khote","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madalena","family":"Raposo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tafadzwa","family":"Maseko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Kanyamukenge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Hachizovu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geofrey","family":"Makenga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Mukomena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aim\u00e9","family":"Kakudji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augustin","family":"Mutombo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghislain","family":"Kikunda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00e9mie","family":"Sombola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivi","family":"Maketa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Nambozi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Duparc","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Rietveld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Alifrangis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helle","family":"Hansson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Wellmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Ouare","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Manyando","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JP","family":"Van Geertruyden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vito","family":"Baraka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hypolite","family":"Muhindo Mavoko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"6016_CR1","unstructured":"World malaria report 2025. 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