Ethiopia has experienced a substantial resurgence in malaria in recent years, with increasing case numbers and a growing contribution of Plasmodium vivax in several regions. At the same time, new evidence supporting improved radical cure strategies, including high-dose primaquine and single-dose tafenoquine, alongside advances in molecular tools, offers opportunities to address persistent transmission and relapse. Against a backdrop of constrained funding and health system challenges, a stakeholder meeting was convened in Addis Ababa in November 2025 to review emerging evidence and discuss implications for malaria control and elimination in Ethiopia. The two-day meeting brought together 38 representatives from the National Malaria Control Programme, research institutions, regional health bureaus, and implementation partners. Key themes emerging from the meeting included: (i) systemic challenges shaping malaria control, including funding constraints, operational disruptions, and climate-related pressures; (ii) uncertainty around the contribution of relapse to overall P. vivax burden and the potential role of molecular tools to address this gap; (iii) important health system considerations for the introduction of G6PD-guided radical cure, particularly regarding service delivery levels and equity; (iv) the central role of economic evidence, with substantial uncertainty around drug pricing and implementation costs; and (v) the need for strengthened collaboration between researchers and policymakers to support evidence-informed decision-making. The meeting highlighted that, while more effective tools for P. vivax radical cure are available, their adoption in Ethiopia will depend on addressing key evidence gaps, particularly around relapse burden, feasibility, and cost-effectiveness. Given the current challenges, there is a pressing need for context specific research and continued dialogue between stakeholders, which will be critical to inform policy decisions and support progress towards malaria elimination.

Artemether-lumefantrine is the most widely used antimalarial treatment for uncomplicated Plasmodium falciparum malaria. Malaria predominantly affects populations in rural areas of tropical and subtropical regions. Drug resistance is a growing concern, and monitoring antimalarial efficacy remains crucial for detecting changes in treatment performance and tracking potential resistance trends. In this study, we present an efficient method for collecting blood samples in resource-limited settings, using dried blood spots on pre-treated filter paper, which enhances the stability of lumefantrine. This approach builds on previous methods by incorporating rapid sample processing through semi-automated punching robots for 96-well plate formats, quick sample cleanup via filtration through a phospholipid removal plate, and expedited analysis using liquid chromatography-tandem mass spectrometry (LC-MS/MS) with a turnaround time of just 2 min per sample. The method also achieves a significantly improved the lower limit of quantification of 15 ng of lumefantrine per ml of blood (i.e. LLOQ of 15 ng/ml). A Phenomenex Luna-CN 50 × 2 mm, 3 µm LC column was used, with a flow rate of 400 µl/min and a mobile phase consisting of acetonitrile and ammonium formate buffer (10 mM, 0.5% formic acid) in a 67:33 (v/v) ratio. The linear range for quantification spanned from 15 to 15,000 ng/ml, based on three 3.2 mm punched discs from a 50 µl blood spot. Accuracy was within ± 15% of the validation criteria, and precision was demonstrated by intra-assay variability of less than 7.2% and inter-assay variability of less than 12% across all concentration levels. The stability of lumefantrine in dried blood spots on pre-treated filter paper was demonstrated using a sample set obtained from another research group, which had been stored in the dark under low-humidity conditions for up to 16 years. The method showed no endogenous interference or interference from the concomitant drug artemether and is suitable for use in clinical trials.