Vivax malaria radical cure implementation, challenges, and the way forward in the case of South Ethiopia

Malaria, a life-threatening febrile illness, is endemic in tropical regions, with 3.3 billion people at risk globally. In 2022, there were 249
million malaria cases in 85 endemic countries, with the WHO African Region bearing the brunt, accounting for 94% of cases and 95% of
deaths (580,000). In Ethiopia, 75% of the land is malaria-endemic, putting 60% of the population at risk. Plasmodium vivax (P. vivax)
prevalence varies, with Southeast Asia having the highest risk, followed by the Western Pacific, Africa, and the Eastern Mediterranean.
In Ethiopia, historically, Plasmodium falciparum (P. falciparum) caused most malaria cases (70%), but recent trends show P. vivax increasing
to 40%. The coexistence of P. falciparum and P. vivax complicates malaria control, making it a public health priority. P. vivax can relapse
due to dormant liver-stage parasites, requiring treatment of both blood (schizontocidal) and liver forms (hypnozoiticidal) for a radical cure.
Primaquine (PQ) is the only available drug in Ethiopia for P. vivax hypnozoites, but its use is limited by the risk of haemolysis in G6PDdeficient
patients, healthcare provider hesitancy to prescribe and poor adherence to the 14-day regimen.
The study aims to create a safe and effective environment for delivering radical cure to reduce P. vivax malaria. Methodologies include
quantifying the vivax burden, examining prescribing habits, and assessing the feasibility of adding reporting variables to existing
documentation using retrospective and prospective data. An individual patient data analysis will assess PQ doses on recurrence risk and
safety. Additionally, a multicenter open-label randomized trial will compare short-course, high-dose PQ and single-dose tafenoquine (TQ)
against the standard low-dose PQ regimen.
This research will quantify the malaria burden, identify gaps in current treatment, evaluate the effectiveness and safety of new regimens,
and provide evidence-based recommendations to improve P. vivax control in Ethiopia.