This study was conducted in Kisii County, Kenya in the year 2021, during the months of February to June. The county has nine sub-counties. The county is located approximately 306 kms from the capital city, Nairobi. It lies at latitude: (0.41°) South, longitude: (34.46°) East. According to the 2019 Kenya population and housing census, the county population size is 1,266,660 persons [16 ]. The main economic activity is agriculture. The county is characterized by hilly topography interspersed with ridges and valleys. The county is characterized by seasonal and permanent rivers which flow into Lake Victoria. The county exhibits a highland equatorial climate with an average rainfall of 1500 mm/year. The average temperature range is between 21 and 30 °C. Most of the population lives in rural areas, residing in local houses. The county health system consists of government and private-based health facilities. The government sector has one teaching and referral hospital (KTRH), which serves as a regional reference hospital and a teaching hospital for Kisii University Medical School. This county contains 14 sub-county hospitals. The county also contains 84 dispensaries, 28 health centres and 32 community health units, which serve as centres for minor health cases [17 ]. The county records three rain seasons namely; April–May, August–September and November–December. The main killer disease is malaria. The main malaria intervention approaches used to combat malaria in this region include proper case management with anti-malarial drugs, such as artemisinin-based combinations, intermittent prophylaxis during pregnancy (IPTp) and the use of mosquito nets. The current drug of choice for treating uncomplicated malaria is artemether-lumefantrine. Diagnosis and treatment services of malaria are available in all government health facilities and a few private facilities. The current study was conducted in hospitals selected from 4 sub-counties (Kenyenya, Marani, Bonchari,Nyamache) of Kisii County (Fig. 1). A molecular study was conducted at the Molecular Biology and Immunology Laboratory, School of Health Sciences, Makerere University, Kampala, Uganda.

A map showing the study area. A Shows the country Kenya where Kisii County is located. B Shows Nyanza region where Kisii County is located and C shows different sub-counties of Kisii County where sampling was conducted (Map drawn by author)

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