{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T17:54:55Z","timestamp":1791309295065,"version":"4.3.1"},"reference-count":66,"publisher":"American Society of Tropical Medicine and Hygiene","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,6]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Global efforts to control and eliminate malaria are threatened by antimalarial drug resistance. The WHO recommends molecular surveillance of resistance markers as a complementary approach to therapeutic efficacy studies. Here, the first regional analysis of antimalarial resistance markers across six southern African countries spanning diverse transmission intensities and geographies is reported. Dried blood spots, collected from rapid diagnostic test-positive individuals in Angola, Eswatini, Namibia, and Zambia in 2023, Mozambique in 2022, and South Africa between 2022 and 2024 using a standardized collection method, were analyzed using a\n                    <jats:italic>Plasmodium falciparum<\/jats:italic>\n                    -targeted amplicon sequencing protocol. The distribution of resistance markers was spatially heterogeneous. Validated markers of artemisinin partial resistance (ART-R) were rare. However, more than 30% of samples from eastern Namibia and Zambia\u2019s Western and Central Provinces carried the candidate\n                    <jats:italic>kelch13<\/jats:italic>\n                    P441L ART-R marker. Other ART-R markers (\n                    <jats:italic>kelch13<\/jats:italic>\n                    R515K, P553L, P574L, A675V) were detected at a prevalence rate &lt;1.3% in all countries except Mozambique, where these markers were absent. The wild-type multidrug resistance 1 N86 allele, potentially associated with reduced lumefantrine susceptibility, was near fixation (&gt;99%) across all countries, whereas the chloroquine resistance marker K76T, in the chloroquine resistance transporter (\n                    <jats:italic>crt<\/jats:italic>\n                    ) was nearly absent in most districts. The sulfadoxine\u2013pyrimethamine resistance dihydropteroate synthase (\n                    <jats:italic>dhps<\/jats:italic>\n                    )-dihydrofolate reductase quintuple mutation was approaching fixation (&gt;95%) in 35% of districts. Northern Angola was a clear outlier, with a lower\n                    <jats:italic>dhps<\/jats:italic>\n                    K540E prevalence (\u226420%) but a higher\n                    <jats:italic>crt<\/jats:italic>\n                    K76T prevalence (48% to 56%). This pronounced spatial heterogeneity underscores the need for timely high-resolution local resistance data generation and sharing to safeguard antimalarial drug efficacy and guide malaria control and elimination strategies across the region.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.26-0299","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T17:38:24Z","timestamp":1791308304000},"source":"Crossref","is-referenced-by-count":0,"title":["Geographical Variation in Antimalarial Drug Resistance Marker Prevalence across the Southern African Elimination Eight Region"],"prefix":"10.4269","author":[{"given":"Jaishree","family":"Raman","sequence":"first","affiliation":[{"name":"Laboratory for Antimalarial Resistance Monitoring and Malaria Operational Research, Centre of Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa;"},{"name":"Wits Research Institute for Malaria, University of Witwatersrand, Johannesburg, South Africa;"},{"name":"University of Pretoria Institute for Sustainable Malaria Control, University of Pretoria, Pretoria, South Africa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9s","family":"Aranda-D\u00edaz","sequence":"additional","affiliation":[{"name":"EPPIcenter Research Program, Department of Medicine, University of California, San Francisco, California, USA;"},{"name":"Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, California, USA;"},{"name":"ISGlobal, Barcelona, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxwell","family":"Mabona","sequence":"additional","affiliation":[{"name":"Laboratory for Antimalarial Resistance Monitoring and Malaria Operational Research, Centre of Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukosha","family":"Chisenga","sequence":"additional","affiliation":[{"name":"SADC Malaria Elimination Eight Secretariat, Windhoek, Namibia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Florinda","family":"Jo\u00e3o","sequence":"additional","affiliation":[{"name":"Programa Nacional do Controlo da Mal\u00e1ria, Luanda, Angola;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domingos","family":"Jandondo","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Investiga\u00e7\u00e3o em Sa\u00fade, Luanda, Angola;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro Rafael","family":"Dimbu","sequence":"additional","affiliation":[{"name":"Programa Nacional do Controlo da Mal\u00e1ria, Luanda, Angola;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nomcebo","family":"Nhlengethwa","sequence":"additional","affiliation":[{"name":"National Malaria Programme, Manzini, Eswatini;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabelo V.","family":"Dlamini","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Sciences, University of Eswatini, Mbabane, Eswatini;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia","family":"Eloff","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Microbiology, and Biotechnology, School of Science, University of Namibia, Windhoek, Namibia;"},{"name":"Malaria Operational Research Program, Multidisciplinary Research Services, University of Namibia, Windhoek, Namibia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stark","family":"Katokele","sequence":"additional","affiliation":[{"name":"Ministry of Health and Social Services, National Vector-Borne Disease Control Program, Windhoek, Namibia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davis R.","family":"Mumbengegwi","sequence":"additional","affiliation":[{"name":"Malaria Operational Research Program, Multidisciplinary Research Services, University of Namibia, Windhoek, Namibia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qedusizi","family":"Nyawo","sequence":"additional","affiliation":[{"name":"KwaZulu-Natal Provincial Malaria Control Program, Jozini, South Africa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mbavhalelo","family":"Shandukani","sequence":"additional","affiliation":[{"name":"National Department of Health, Pretoria, South Africa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sydney","family":"Mwanza","sequence":"additional","affiliation":[{"name":"National Health Research and Training Institute, Ndola, Zambia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moonga","family":"Hawela","sequence":"additional","affiliation":[{"name":"National Malaria Elimination Centre, Ministry of Health, Lusaka, Zambia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Boene","sequence":"additional","affiliation":[{"name":"ISGlobal, Barcelona, Spain;"},{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a, Manhi\u00e7a, Mozambique;"},{"name":"Facultat de Medicina i Ci\u00e8ncies de la Salut, Universitat de Barcelona, Barcelona, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arlindo","family":"Chidimatembue","sequence":"additional","affiliation":[{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a, Manhi\u00e7a, Mozambique;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardete","family":"Rafael","sequence":"additional","affiliation":[{"name":"Programa Nacional do Controlo da Mal\u00e1ria, Maputo, Mozambique;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduard","family":"Rovira-Vallbona","sequence":"additional","affiliation":[{"name":"ISGlobal, Barcelona, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brighton","family":"Mangena","sequence":"additional","affiliation":[{"name":"SADC Malaria Elimination Eight Secretariat, Windhoek, Namibia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja B.","family":"Lauterbach","sequence":"additional","affiliation":[{"name":"Laboratory for Antimalarial Resistance Monitoring and Malaria Operational Research, Centre of Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takalani I.","family":"Makhanthisa","sequence":"additional","affiliation":[{"name":"Laboratory for Antimalarial Resistance Monitoring and Malaria Operational Research, Centre of Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazel","family":"Gwarinda","sequence":"additional","affiliation":[{"name":"Laboratory for Antimalarial Resistance Monitoring and Malaria Operational Research, Centre of Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bla\u017eenka D.","family":"Letini\u0107","sequence":"additional","affiliation":[{"name":"Laboratory for Antimalarial Resistance Monitoring and Malaria Operational Research, Centre of Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faith","family":"De Amaral","sequence":"additional","affiliation":[{"name":"EPPIcenter Research Program, Department of Medicine, University of California, San Francisco, California, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isobel","family":"Routledge","sequence":"additional","affiliation":[{"name":"Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, California, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"Arregui-Gallego","sequence":"additional","affiliation":[{"name":"ISGlobal, Barcelona, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mishalan","family":"Moodley","sequence":"additional","affiliation":[{"name":"Sequencing Core Facility, National Institute for Communicable Diseases, Johannesburg, South Africa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Featherston","sequence":"additional","affiliation":[{"name":"Sequencing Core Facility, National Institute for Communicable Diseases, Johannesburg, South Africa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Power B.","family":"Tshikae","sequence":"additional","affiliation":[{"name":"KwaZulu-Natal Provincial Malaria Control Program, Jozini, South Africa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arshad","family":"Ismail","sequence":"additional","affiliation":[{"name":"Sequencing Core Facility, National Institute for Communicable Diseases, Johannesburg, South Africa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Franco","family":"Martins","sequence":"additional","affiliation":[{"name":"Programa Nacional do Controlo da Mal\u00e1ria, Luanda, Angola;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quinton","family":"Dlamini","sequence":"additional","affiliation":[{"name":"National Malaria Programme, Manzini, Eswatini;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baltazar","family":"Candrinho","sequence":"additional","affiliation":[{"name":"Programa Nacional do Controlo da Mal\u00e1ria, Maputo, Mozambique;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petrina","family":"Uusiku","sequence":"additional","affiliation":[{"name":"Ministry of Health and Social Services, National Vector-Borne Disease Control Program, Windhoek, Namibia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ednah","family":"Baloyi","sequence":"additional","affiliation":[{"name":"National Department of Health, Pretoria, South Africa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Busiku","family":"Hamainza","sequence":"additional","affiliation":[{"name":"National Malaria Elimination Centre, Ministry of Health, Lusaka, Zambia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo","family":"Mayor","sequence":"additional","affiliation":[{"name":"ISGlobal, Barcelona, Spain;"},{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a, Manhi\u00e7a, Mozambique;"},{"name":"Facultat de Medicina i Ci\u00e8ncies de la Salut, Universitat de Barcelona, Barcelona, Spain;"},{"name":"Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique;"},{"name":"Spanish Consortium for Research in Epidemiology and Public Health, Madrid, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"Greenhouse","sequence":"additional","affiliation":[{"name":"EPPIcenter Research Program, Department of Medicine, University of California, San Francisco, California, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Wesolowski","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chadwick","family":"Sikaala","sequence":"additional","affiliation":[{"name":"SADC Malaria Elimination Eight Secretariat, Windhoek, Namibia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Chimumbwa","sequence":"additional","affiliation":[{"name":"SADC Malaria Elimination Eight Secretariat, Windhoek, Namibia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Smith","sequence":"additional","affiliation":[{"name":"Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, California, USA;"},{"name":"Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"issue":"1","key":"b1","series-title":"Trop Med Infect 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