Background: The increasing popularity of Artemisia annua tea in Africa as an antimalarial remedy has raised concerns about its potential role in the development of artemisinin resistance in Plasmodium falciparum, which could undermine global malaria control efforts. Methods : This literature review analyzed publications sourced from PubMed, Web of Science, Google Scholar, and other databases. Studies included clinical trials, laboratory investigations, and surveillance reports focused on Artemisia annua tea consumption and resistance patterns. Results: Data indicate a significant rise in herbal tea use in malaria-endemic regions, particularly where access to standard therapies is limited. Some studies suggest a possible link between non-standardized use of Artemisia annua tea and early markers of artemisinin resistance, though direct causality remains unconfirmed and findings are inconsistent. Conclusions: The uncontrolled consumption of Artemisia annua tea could contribute to artemisinin resistance emergence in Africa, highlighting the need for regulated use, further research, and continuous surveillance to protect the effectiveness of antimalarial treatments.

Background: The Democratic Republic of the Congo accounts for approximately 12–13% of the global malaria burden. While international guidelines oppose the use of Artemisia annua infusions due to risks of sub-therapeutic dosing and resistance selection, the plant remains widely used in resource-limited regions. This study evaluates the clinical acceptability and perceptions of healthcare providers regarding the integration of Artemisia annua tea into formal malaria control in the Maniema province. Methods: A cross-sectional survey was conducted among 337 healthcare professionals in the Kalima health district using the KoboCollect digital platform. Multivariate logistic regression was employed to identify the primary socio-professional determinants of clinical acceptability. Results: The overall clinical acceptability of Artemisia annua integration was 81.0%, with 82.8% of providers perceiving the preparation as effective. Rural residency was the strongest predictor of adherence (AOR = 6.847; p = 0.003), reflecting a pragmatic response to frequent ACT stockouts and high treatment costs. Despite high acceptability, 49.0% of providers identified the lack of clinical evidence as a major barrier, and 91.4% demanded formal training on standardized dosage and biological mechanisms. Conclusions: A significant “policy–practice gap” exists between international guidelines and field realities in the DRC. Healthcare providers demonstrate high readiness for integration but emphasize the absolute necessity of galenic standardization to mitigate resistance risks. To address these concerns, a complementary genomic investigation is currently underway in the same study area, comparing PfKelch13 mutation prevalence among Artemisia tea users versus ACT-treated patients. This molecular surveillance will provide essential evidence to define safety parameters for future phytopharmaceutical integration.

Background: Artemisinin-based combination therapies remain the mainstay of malaria control strategies; nevertheless, the advent of genetic markers linked to partial artemisinin resistance in Plasmodium falciparum has elicited substantial concern across African settings. To assess the prevalence, geographic distribution, and clinical associations of these molecular markers, we undertook a systematic review and meta-analysis of observational cohort studies. Methods: We conducted a search of cohort studies published between January 2015 and June 2025, following PRISMA 2020 guidelines. We queried databases including PubMed/MEDLINE, Scopus, Web of Science, and CINAHL. Eligibility required prospective enrollment of patients, longitudinal monitoring (therapeutic efficacy studies), and pfkelch13 propeller domain genotyping. Results: A meta-analytical synthesis of 888 isolates from six core prospective cohorts revealed a pooled prevalence of 6% (95% CI: 2.1%–11.8%) for validated pfkelch13 mutations. A profound geographic dichotomy was identified: while West and Central African cohorts maintained a 0% prevalence, East African hotspots showed significant expansion, with prevalence reaching 12.8% in Rwanda and up to 25.5% in Northern Uganda; high statistical heterogeneity ( I ² = 96.3 %, p < 0.001 ) reflects this biological divergence. Conclusions: These findings highlight the established and expanding presence of artemisinin partial resistance in East Africa. Standardized surveillance is essential to adapt malaria control policies across the continent.

Background: Malaria remains a catastrophic public health crisis in the Democratic Republic of the Congo. In conflict-affected and isolated territories like the Maniema Province, access to Artemis-based Combination Therapies is restricted by a dual failure: chronic physical stockouts and a pervasive “lack of quality control” of substandard and falsified medications. This study investigated the social acceptability of Artemisia annua herbal tea as a strategy for a survival strategy under these systemic vulnerabilities in the Kalima Health Zone. Methods: This exploratory qualitative study used a socio-anthropological approach, structured around the Health Belief Model and the WHO Behavioral and Social Drivers framework. Purposive maximum variation sampling (N = 30) continued until thematic saturation was achieved. The cohort included healthcare providers, community end-users, and opinion leaders across five isolated health areas. Data were analyzed using thematic content analysis. Results: Findings revealed a profound epistemological friction between actors. Community end-users demonstrated high willingness to utilize the remedy, driven by its accessibility and a perceived three-day recovery timeline that bypassed the financial and quality barriers of the formal market. Conversely, healthcare providers expressed intense “posological anxieties” regarding the uncalibrated biomass used. Socio-behavioral practices were heavily mediated by socio-religious norms; while vital religious networks remain vital for validation, contemporary discourse is increasingly shaped by digital platforms that can propagate health misinformation. Consequently, a unanimous demand emerged for standardized pharmaceutical tablets to ensure clinical safety. Conclusion: This investigation does not validate clinical efficacy. It highlights that in resource-constrained conflict zones, structural barriers—including the threat of poor-quality synthetic drugs—override individual agency, transforming non-standardized phytotherapy into a tool of structural survival. Mitigating malaria mortality and resistance risks demands substantial state investment in the quality of formal supply chains and culturally grounded community engagement strategies.

Background: Malaria remains a leading cause of morbidity and mortality in the Democratic Republic of the Congo, particularly in conflict-affected regions like the Maniema province. Amidst systemic supply chain failures and the regional emergence of Plasmodium falciparum resistance mutations, households are increasingly adopting local botanical alternatives. This study investigates the socio-economic and informational determinants of the reliance on Artemisia annua infusions in the Kalima Health Zone. Methods: A cross-sectional survey was conducted among 621 household heads employing an asset-based wealth index and multivariate logistic regression models. The study adhered to STROBE and ChecKAP reporting standards to ensure methodological transparency in evaluating Knowledge, Attitudes, and Practices regarding malaria management. Results: Results reveal a significant reliance on Artemisia annua infusions, with a prevalence of 77.8%. While 95.5% of respondents recognize malaria as a lethal threat, a critical “etiological gap” persists, with only 58.5% correctly identifying mosquito bites as the primary mode of transmission. Multivariate analysis identified television ownership (Adjusted OR = 2.736, 95% CI: 1.168–6.406, p = 0.020) and prior information exposure as the strongest independent predictors of health behaviors. Economic vulnerability is a primary driver: households in the lowest wealth tertile (64.7%) and those with large families (≥16 members, 77.8%) are significantly more likely to utilize infusions. Although 88.2% of users report high community-perceived tolerance, this local confidence exists in direct tension with international concerns regarding sub-therapeutic dosing and potential selection pressure for resistance. Conclusion: The reliance on Artemisia annua in Maniema functions as a rational socio-economic coping mechanism rather than a rejection of scientific medicine. This “localized resilience” highlights critical gaps in the formal healthcare infrastructure and the supply chain for subsidized ACTs. Effective malaria control in fragile settings requires bridging the access gap for validated therapies while integrating community practices into standardized genomic and clinical surveillance systems.

Background: While Artemisia annua possesses intrinsic antimalarial activity, its increasing use as artisanal tea infusions across Africa raises critical concerns regarding the emergence of artemisinin resistance. This study evaluates the clinical efficacy, pharmacological variability, and the risk of selecting resistant strains associated with this practice. Methods: Following PRISMA 2020 guidelines, a systematic review was conducted on 24 studies investigating A. annua use in Africa. A meta-analysis was performed to quantify the Day-3 parasite positivity (D3P) rate, a key indicator of partial artemisinin resistance. Study quality was assessed using the Cochrane RoB 2 tool and the Newcastle–Ottawa Scale. Findings: The meta-analysis of studies providing extractable clinical data revealed a pooled D3P rate of 18.5% (95% CI: 14.2–23.1%). This result significantly exceeds the 10% alert threshold established by the World Health Organization for signaling partial artemisinin resistance. While initial symptom relief is common, recrudescence rates reach up to 72% at 28 days in several clinical trials. This therapeutic instability is directly linked to the extreme variability of artemisinin content in infusions, which fluctuates significantly (0.05 to 1.2%) depending on preparation methods. Such sub-therapeutic exposure creates a biological "selective window" that facilitates the survival and spread of pfkelch13 mutant alleles, such as R561H and A675V, which are already emerging in East African hotspots. Conclusion: The non-standardized use of Artemisia annua tea as monotherapy represents a significant pharmacological risk to health security in Africa. The failure of these preparations to ensure rapid and complete parasite clearance fuels selective pressure on mutant strains. Public health policies must prioritize access to standardized, quality-assured artemisinin-based combination therapies and regulate the transition toward stable pharmaceutical forms, such as whole-plant tablets, to safeguard the long-term efficacy of artemisinin on the continent.