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: Malaria is a significant public health challenge in the Democratic Republic of the Congo. In conflict-affected areas, access to quality-assured ACTs is restricted by chronic stockouts and circulation of substandard and falsified antimalarials. This study investigates perceptions and social acceptability of Artemisia annua herbal tea in the Kalima Health Zone. Methods: Distinct from the prior provider-arm cross-sectional survey of the same program in the Kalima Health Zone which sampled only biomedical healthcare workers (n = 337), this exploratory qualitative study adopted a socio-anthropological design across three stakeholder strata (community users, biomedical providers, opinion leaders). Maximum-variation purposive sampling recruited 30 informants across five health areas (11 end-users, 11 providers, 8 opinion leaders). Sample-size adequacy was assessed against Malterud’s information power framework; data collection continued until operational thematic saturation. Hybrid inductive–deductive thematic content analysis followed COREQ reporting. Results: End-users demonstrated high willingness, driven by accessibility, perceived three-day recovery, and avoidance of unreliable ACTs. Biomedical providers voiced intense posological anxieties over uncalibrated raw biomass and sub-therapeutic dosing. Behavioral patterns were shaped by socio-religious norms and digitally mediated religious discourse. A unanimous demand for industrial galenic transformation of raw biomass into calibrated tablets emerged across all groups. Conclusions: This study does not validate the clinical efficacy, safety, posological adequacy, or resistance-attenuation potential of Artemisia annua herbal tea. It documents a transversal household-level consensus, across the three strata and five health areas, that Artemisia annua herbal tea adoption responds to documented double ACT supply chain failure. A unanimous demand for industrial galenic transformation emerged across all stakeholder groups.

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.