{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:40:47Z","timestamp":1785426047657,"version":"3.56.0"},"posted":{"date-parts":[[2026,5,22]]},"group-title":"Epidemiology","reference-count":55,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Gates Foundation","award":["INV-024346"],"award-info":[{"award-number":["INV-024346"]}]},{"name":"Gates Foundation","award":["INV-019032"],"award-info":[{"award-number":["INV-019032"]}]},{"name":"Gates Foundation","award":["INV-067310"],"award-info":[{"award-number":["INV-067310"]}]},{"name":"Gates Foundation","award":["INV 031512"],"award-info":[{"award-number":["INV 031512"]}]},{"DOI":"10.13039\/100004417","name":"Global Fund to Fight AIDS, Tuberculosis and Malaria","doi-asserted-by":"crossref","award":["QPA-M-E8S"],"award-info":[{"award-number":["QPA-M-E8S"]}],"id":[{"id":"10.13039\/100004417","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Departament de Recerca i Universitats","award":["2021 SGR 01517"],"award-info":[{"award-number":["2021 SGR 01517"]}]},{"name":"Departament de Recerca i Universitats","award":["2022 FI_B 00148"],"award-info":[{"award-number":["2022 FI_B 00148"]}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"crossref","award":["5K01AI153555"],"award-info":[{"award-number":["5K01AI153555"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/00r6akf90","id-type":"ROR","asserted-by":"publisher"}]},{"id":[{"id":"https:\/\/ror.org\/04ra91131","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002809","name":"Generalitat de Catalunya","doi-asserted-by":"crossref","award":["CERCA"],"award-info":[{"award-number":["CERCA"]}],"id":[{"id":"10.13039\/501100002809","id-type":"DOI","asserted-by":"crossref"}]},{"award":["CEX2023-0001290-S"],"award-info":[{"award-number":["CEX2023-0001290-S"]}],"id":[{"id":"https:\/\/ror.org\/05r0vyz12","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,5,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>\n                  Global efforts to control and eliminate malaria are threatened by the emergence and spread of antimalarial drug resistance. The World Health Organization recommends surveillance of molecular markers of resistance as a complementary approach to therapeutic efficacy studies. Here, we report the first regional analysis of malaria drug resistance markers from genomic surveillance across six southern African countries spanning diverse transmission intensities and geographies. 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.\n                <\/jats:p>\n                <jats:p>\n                  The distribution of resistance markers was spatially heterogeneous. Markers of artemisinin partial resistance (ART-R) were rare, never detected in &gt;1.3% of samples from any country. However, over 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 low frequencies in all countries except Mozambique. The wild type\n                  <jats:italic>mdr1<\/jats:italic>\n                  N86 allele, potentially associated with reduced lumefantrine susceptibility, was near fixation across all countries. The sulfadoxine-pyrimethamine (SP) resistance\n                  <jats:italic>dhps<\/jats:italic>\n                  -\n                  <jats:italic>dhfr<\/jats:italic>\n                  quintuple mutation was approaching fixation in most districts, except northern Angola, where\n                  <jats:italic>dhps<\/jats:italic>\n                  K540E prevalence was lower and the\n                  <jats:italic>crt<\/jats:italic>\n                  K76T chloroquine resistance marker more frequently detected. 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":"10.64898\/2026.05.20.26353165","type":"posted-content","created":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T01:30:25Z","timestamp":1779499825000},"source":"Crossref","is-referenced-by-count":0,"title":["Geographical Variation in Antimalarial Drug Resistance Marker Prevalence Across the Southern African Elimination Eight Region"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0728-3093","authenticated-orcid":false,"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"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0566-4901","authenticated-orcid":false,"given":"Andr\u00e9s","family":"Aranda-D\u00edaz","sequence":"additional","affiliation":[{"name":"EPPIcenter Research Program, Department of Medicine, University of California, San Francisco, United States of America"},{"name":"Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, United States of America"},{"name":"ISGlobal, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0701-589X","authenticated-orcid":false,"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, 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