G6PD Deficiency and Malaria in Sudan: Advancing Precision Public Health Through Novel Diagnostic Technologies and Implementation Strategies

The coexistence of malaria and Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency presents a critical therapeutic challenge in Sudan. This review systematically assesses G6PD enzyme activity among Sudanese malaria patients, focusing on prevalence, genetic epidemiology, and implications for 8-aminoquinoline-based therapies. We conducted a systematic literature review of multiple databases and institutional reports from 2000 to 2025. Our synthesis reveals a high and heterogeneous prevalence of G6PD deficiency (10-20% across different states), dominated by Mediterranean and A- variants. Recent 2025 evidence clarifies that this protective effect against P. falciparum is significant specifically in populations with high (>13%) G6PD deficiency prevalence, explaining the evolutionary persistence of this trait in Sudan. A critical finding is the inadequacy of current qualitative rapid diagnostic tests for detecting intermediate deficiencies, particularly in heterozygous females. Crucially, 2025 meta-analyses identify the STANDARD G6PD Test as a superior quantitative point-of-care solution, while Sudanese implementation studies demonstrate that AI-driven clinical decision support can increase protocol adherence to 96.8%. We conclude with an evidence-based, phased implementation framework for integrating quantitative G6PD testing into national programs. Urgent investment in these advanced diagnostics, coupled with further safety research and digital support tools, is paramount for optimizing patient safety, ensuring equitable treatment access, and achieving malaria elimination goals in Sudan.