Antimalarial drug resistance markers in Southeast Asia (2000–2025) - a systematic review protocol for surveillance and spatial mapping

Abstract

Introduction and aim. Southeast Asia has historically been the epicenter of drug resistance against Plasmodium falciparum. The resistance has markedly reduced the effectiveness of key antimalarial drugs, such as chloroquine, sulfadoxine-pyrimethamine, and artemisinin-based combination therapy (ACTs). This systematic review protocol aims to characterize the spatio-temporal distribution and trends of drug resistance markers, both molecular and phenotypic, in P. falciparum malaria across Southeast Asian countries from 2000 to 2025 and to identify regional research and surveillance gaps. Material and methods. This study will follow a systematic search of literature published in English with full text from January 2000 to December 2025, including grey literature from five electronic databases. Data extraction and analysis will strictly adhere to the PRISMA-P guidelines and PECO/PICO framework. Risk of bias will be assessed independently by two reviewers using the Joanna Briggs Institute (JBI) critical appraisal tools matched to study design, including the JBI Analytical Cross-Sectional Checklist for molecular surveillance studies and the JBI Prevalence Checklist for epidemiological surveys. Expected outcomes. This systematic protocol is expected to synthesize evidence on the prevalence, geographical distribution, and temporal trends of resistance markers and treatment failure associated with drug-resistant P. falciparum in Southeast Asia.