Plasmodium vivax Malaria in Afghanistan: A Scoping Review of Epidemiology, Relapse, Treatment and Elimination Challenges

BACKGROUND: Plasmodium vivax predominates in Afghanistan. Recurrent disease and the safety requirements of anti-relapse treatment complicate elimination, while routine case counts provide limited information about completed radical cure. OBJECTIVE: To synthesize Afghanistan-specific evidence on P. vivax epidemiology, recurrence, treatment, G6PD safety, diagnosis, resistance and elimination, and translate it into measurable service priorities. METHODS: This JBI- and PRISMA-ScR-guided nested scoping review reassessed 287 publications and 45 reports from a parent evidence map using a vivax-focused population-concept-context framework. The core search ended on 12 August 2026; 40 publications and 10 institutional reports were included. Two reviewers independently assessed eligibility and charted data, with third-reviewer verification. RESULTS: WHO reported 247,100 P. vivax cases among 257,524 confirmed malaria cases in 2024 (96.0%). An independent national series recorded 887,227 vivax episodes in 2018-2023, peaking in September. In a 593-patient Afghan trial, chloroquine plus 14-day primaquine reduced 1-year recurrence compared with chloroquine alone (hazard ratio: 0.37, 95% CI: 0.25-0.54). Paired primaquine comparisons support an important relapse contribution, but their attribution estimate is assumption-dependent and is not a national relapse rate. Historical treatment studies, G6PD surveys, and molecular findings support continued efficacy and safety surveillance. Evidence is geographically uneven, and supported refugee-camp treatment outcomes do not establish feasibility in contemporary routine services. CONCLUSIONS: The priority is to link case characterization to a measurable radical-cure cascade: diagnosis, G6PD assessment, regimen selection, initiation, completion, safety monitoring and recurrence investigation. Phased delivery should combine district- and season-specific targeting with clinical efficacy monitoring and documented cross-border referral.