Background: Emergence of Plasmodium falciparum resistance to artemisinin and itsrnderivatives poses a threat to global effort in controlling malaria. Resistance has alreadyrnemerged to most antimalarial drugs in common use. While the concern on resistance in SouthrnEast Asia but with potential benefits of DHA-PQ over other ACTs, it is necessary to assess ifrnthe antimalarial treatment efficacy of this regimen in Africa has changed. The aim of thisrnreview was, therefore, to compare the efficacy and safety of dihydroartemisinin-piperaquinernand artemether-lumefantrine for treatment of uncomplicated P.falciparum malaria in Africanrnchildren.rnrnMethod: An electronic systematic search method was used to search for articles from onlinerndatabases PubMed/ MEDLINE, Embase, and Cochrane Center for Clinical Trial databasern(CENTRAL) for repossessing randomized control trials comparing efficacy and safety ofrnDHA-PQ and AL for management of uncomplicated Plasmodium falciparum malaria inrnAfrican children. The search was done from August 2020 to 30 April 2021. Using Rev-Manrnsoftware (V5.4), R-studio, and Comprehensive Meta-analysis software, the data obtainedrnfrom the included studies were assembled as risk ratio (RR), MD, and SMD with 95%rnconfidence interval (CI). The per-protocol analysis was used.rnrnResult: In this review, 25 studies which involved a total of 13,198 participants werernincluded. PCR unadjusted treatment failure in children aged between 6 months to 15 yearsrnwas significantly lower in DHA-PQ treatment arm on day 28 than that of AL (RR 0.14, 95%rnCI 0.08 to 0.26; participants = 1302; studies = 4; Irn2rn = 0%, high quality of evidence).rnConsistently, the risk of treatment failure adjusted by PCR was significantly lower withrnDHA-PQ treatment group on day 28 (RR 0.45, 95% CI 0.29 to 0.68; participants = 8508;rnstudies = 16; Irn2rn = 51%, high quality of evidence) and on day 42 (RR 0.60, 95% CI 0.47 torn0.78; participants = 5959; studies = 17; Irn2 rn= 0%, high quality of evidence). However, thernefficacy was â‰¥95% in both treatment groups on day 28. On days 28 and 42, a significantrnincrease in serum hemoglobin level from the baseline was also observed in DHA-PQrntreatment arm (SMD 0.15, 95% CI 0.05 to 0.26; participants = 2715; studies = 4; Irn= 32%,rnhigh quality of evidence) and (MD 0.35, 95% CI 0.12 to 0.59; participants = 1434; studies =rn3; Irn2rn = 35%, high quality of evidence), respectively. However, DHA-PQ was somewhatrncoupled with a higher incidence of early vomiting (RR 2.26, 95% CI 1.46 to 3.50; rnparticipants = 7796; studies = 10; Irn2rn = 0%, high quality of evidence), vomiting (RR 1.02, 95%rnCI 0.87 to 1.19; participants = 8789; studies = 13; Irn2 rn= 20%, high quality of evidence), coughrn(RR 1.06, 95% CI 1.01 to 1.11; participants = 8013; studies = 13; Irn2 rn= 0%, high quality ofevidence), and diarrhea (RR 1.16, 95% CI 1.03 to 1.31; participants = 6841; studies = 11; Irn =rn8%, high quality of evidence) were more frequent in DHA-PQ treatment arm.rnrnConclusion: From this review, it can be concluded that DHA-PQ reduces recurrent infectionrnand recrudescence with significant impact on hemoglobin recovery more than AL, and bothdrugs are well tolerated. DHA-PQ may, therefore be recommended as an alternative first linetreatment for uncomplicated falciparum malaria in Africa, while use of AL continues.