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Background <p>While <i>Artemisia annua</i> 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.</p> Methods <p>Following PRISMA 2020 guidelines, a systematic review was conducted on 24 studies investigating <i>A. annua</i> 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.</p> Findings <p>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&#xa0;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 <i>pfkelch13</i> mutant alleles, such as R561H and A675V, which are already emerging in East African hotspots.</p> Conclusion <p>The non-standardized use of <i>Artemisia annua</i> 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.</p>

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Artemisia annua tea for malaria treatment in Africa: a systematic review of efficacy, safety and resistance concerns

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月24日

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  • Jérôme Munyangi Wa Nkola,
  • Alioune Camara

摘要

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.