Plasmodium falciparum; artemisinin resistance; drug resistance markers; treatment outcome; Antimalarials; Protozoan Proteins; Humans; Protozoan Proteins/genetics; Prevalence; Global Health; Plasmodium falciparum/drug effects; Plasmodium falciparum/genetics; Drug Resistance/genetics; Malaria, Falciparum/drug therapy; Malaria, Falciparum/parasitology; Malaria, Falciparum/epidemiology; Antimalarials/pharmacology; Antimalarials/therapeutic use; Immunology and Allergy; Molecular Biology; Immunology and Microbiology (all); Microbiology (medical); Infectious Diseases
Abstract :
[en] Malaria remains a global health threat, with Plasmodium falciparum causing most deaths, especially in sub-Saharan Africa. Although artemisinin-based therapies reduce the burden, drug-resistant parasites threaten control efforts. Mapping the distribution and evolution of molecular resistance markers is vital for evidence-based strategies. This systematic review mapped the global distribution, pooled prevalence, and temporal trends of key P. falciparum antimalarial resistance markers. Following the PRISMA methodology (PROSPERO: CRD4202511098991), databases (PubMed, Web of Science, Scopus, and Google Scholar) and gray sources were searched (July 2005-July 2025). Data were extracted in Rayyan, assessed via the JBI prevalence tool, and analyzed using Python v3.13 for WHO regional distribution, temporal trends, and treatment outcome trends. Of the 1972 records, 261 studies from 64 countries qualified for inclusion in this review. The pooled prevalence was highest for pfdhfr (85.7%), followed by pfcrt (78.0%), pfdhps (73.7%), pfmdr1 (60.5%), and pfk13 (45.0%). High heterogeneity (I2 > 95%) and rising pfk13 since 2012 highlight emerging artemisinin resistance, while persistent pfdhfr/pfdhps mutations show that ongoing sulfadoxine-pyrimethamine (SP) pressure on P. falciparum drug resistance, decreased parasite clearance, and treatment failure remain widespread and evolving in Africa. Integrating molecular surveillance into national malaria programs is essential to guide treatment modalities and support progress toward malaria elimination.
Disciplines :
Genetics & genetic processes
Author, co-author :
Habarugira, Felix ; Department of Biomedical Laboratory Sciences, School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali P.O. Box 3286, Rwanda ; Pathology Department, Research Directorate, University Teaching Hospital of Butare, Huye P.O. Box 254, Rwanda
Dieng, Mame ; Université de Liège - ULiège > TERRA Research Centre ; Program in Biology, Division of Sciences and Mathematics, New York University Abu Dhabi, Abu Dhabi P.O. Box 129188, United Arab Emirates
Idaghdour, Youssef ; Program in Biology, Division of Sciences and Mathematics, New York University Abu Dhabi, Abu Dhabi P.O. Box 129188, United Arab Emirates
Mutesa, Leon ; Department of Medical Biochemistry, Molecular Biology and Genetics, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Huye P.O. Box 3286, Rwanda ; Centre for Human Genetics, University of Rwanda, Kigali P.O. Box 4285, Rwanda
Language :
English
Title :
The Global Landscape of Plasmodium falciparum Drug Resistance Markers, 2005-2025: A Systematic Review and Meta-Analysis.
Publication date :
06 February 2026
Journal title :
Pathogens
eISSN :
2076-0817
Publisher :
Multidisciplinary Digital Publishing Institute (MDPI), Switzerland
This research was funded by the University of Rwanda, European Union-Team Europe Initiative-MAV+, and Access to Quality Vaccines, Medicines and Health Technologies in Rwanda\u2014Kwigira Project (Grant number: RWA2100111).
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