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.