Trends of Malaria, Diagnostic Challenge and the Effects of Artemether–Lumefantrine with Single-Dose Primaquine on Plasmodium falciparum Gametocyte Clearance and Mosquito Infectivity in Northwest Ethiopia

Malaria remains a major public health challenge in Ethiopia. Control efforts are hindered by complex epidemiology, inconsistent diagnostic performance across health facilities, and emerging insecticide and drug resistance. The artemether–lumefantrine (AL), the first-line therapy for uncomplicated Plasmodium falciparum malaria, effectively clears asexual parasites. However, it has limited activity against mature gametocytes that sustain transmission.This study aimed to assess ten-year trends of malaria, diagnostic challenge, and the effect of AL combined with single low-dose primaquine (SLD-PQ) on gametocyte clearance and Anopheles arabiensis infectivity post treatment.