Socio-Behavioral and Clinical Predictors of Suspected Artemisinin Resistance in Plasmodium falciparum in Dutse Northern Nigeria

Abstract

Background: Artemisinin-based combination therapies (ACTs) remain the cornerstone of treatment for Plasmodium falciparum malaria. However, the emergence of artemisinin resistance threatens malaria control efforts, particularly in sub-Saharan Africa. While molecular markers of resistance have been widely studied, limited evidence exists on the socio-behavioral and clinical factors contributing to suspected resistance in Nigeria. A cross-sectional study was conducted among 384 patients presenting with suspected malaria in Dutse, northern Nigeria. Among these, 145 patients with microscopy-confirmed Plasmodium falciparum infection were included in the socio-behavioral and clinical analysis. Data were collected using structured interviewer-administered questionnaires and clinical records. Logistic regression analysis was used to identify predictors of resistance-related infections based on clinical and treatment outcome indicators.Treatment difficulty requiring multiple treatment courses was the strongest predictor of resistance-related infections (OR = 4.050; 95% CI: 2.1–7.8; p < 0.001). Completion of the full ACT treatment course was associated with significantly lower odds of resistance-related infections (OR = 0.158; 95% CI: 0.07–0.35; p < 0.001). Regular use of malaria preventive measures also showed a protective effect (OR = 0.283; 95% CI: 0.12–0.65; p = 0.002). Repeated malaria episodes were associated with increased likelihood of resistance-related infections, suggesting that frequent infections and repeated treatment exposure may contribute to resistance development. Self-medication and suspected use of substandard antimalarial drugs showed positive associations but were not statistically significant.The findings suggest that socio-behavioral and clinical factors play an important role in the emergence and spread of suspected artemisinin resistance in northern Nigeria. Treatment difficulty and repeated malaria episodes were major predictors, while treatment adherence and preventive measures were protective. Malaria control strategies should therefore integrate treatment adherence programs, drug quality regulation, preventive interventions, and resistance surveillance to sustain ACT effectiveness.