Comparative Efficacy of Dihydroartemisinin-Piperaquine versus Artemether-Lumefantrine in Treating Pediatric Malaria in Western Kenya

Malaria remains a leading cause of morbidity and mortality among children under five in sub-Saharan Africa, with Western Kenya bearing a particularly high burden. This review evaluated the comparative efficacy, safety, and operational feasibility of two widely used artemisinin-based combination therapies (ACTs) artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DHA-PPQ) in treating pediatric malaria in this region. DHA-PPQ, characterized by once-daily dosing and extended post-treatment prophylaxis, may offer advantages over AL, which requires twice-daily administration and has a shorter protective window. The article was developed through a narrative synthesis of peer-reviewed clinical trials, pharmacokinetic analyses, observational studies, and implementation research focused on pediatric malaria treatment in high-transmission settings. Evidence suggested that while both therapies are effective in parasite clearance, DHA-PPQ demonstrates superior protection against reinfection and improved adherence due to its simplified dosing. Concerns about QT interval prolongation with DHA-PPQ exist but remain clinically manageable. Given the operational challenges associated with AL and the epidemiological context of frequent reinfections in Western Kenya, DHA-PPQ emerges as a promising alternative, especially for pediatric use. Adoption of DHA-PPQ into national treatment protocols should be informed by robust pharmacovigilance, resistance monitoring, and health systems readiness to optimize outcomes and support sustained malaria control efforts among vulnerable children. Keywords: Pediatric malaria, Dihydroartemisinin-piperaquine (DHA-PPQ), Artemether-lumefantrine (AL), Antimalarial efficacy, Western Kenya.