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Does the introduction explain the objective of the research presented in the preprint?

Yes

The introduction clearly explains the importance of artemisinin resistance and points out a gap in current understanding of its population-level consequences. The research objective is to examine whether increasing Kelch13 mutation prevalence is associated with malaria incidence across 16 Ugandan districts.

Are the methods well-suited for this research?

Somewhat appropriate

The longitudinal ecological design and negative binomial regression are well-suited for examining population-level associations. The authors also included several climatic, malaria-control, and resistance-related factors. However, the use of forward variable selection raises questions about model robustness. It would be helpful to find out whether the findings remain consistent under alternative model specifications and clarify how temporal correlation between monthly observations was handled.

Are the conclusions supported by the data?

Somewhat supported

The results support a positive association between Kelch13 mutation prevalence and malaria incidence after adjustment (aIRR = 1.131, 95% CI: 1.090–1.174). However, the ecological study design can't establish causation and the association may be bidirectional.

Are the data presentations, including visualizations, well-suited to represent the data?

Somewhat appropriate and clear

The tables and figures are well-organized. Figure 2 shows district-specific trends in mutation prevalence and malaria incidence, while figure 3 provides a clear visualization of the adjusted association. However, the apparent decline in predicted incidence at very high Kelch13 prevalence is not quite sure because there were only two observations above 60%.

How clearly do the authors discuss, explain, and interpret their findings and potential next steps for the research?

Somewhat clearly

The discussion provides biological explanations for the observed associations and acknowledges some important limitations, including possible reverse causation, residual confounding, and differences in the time scales of the data. However, the model-selection uncertainty and specific sensitivity analyses are not mentioned.

Is the preprint likely to advance academic knowledge?

Somewhat likely

This preprint adds useful evidence about the relationship between antimalarial resistance markers and population-level malaria incidence. It contributes to the integration of molecular surveillance with epidemiological, climatic, and malaria-control data in a high-burden setting.

Would it benefit from language editing?

No

This preprint is clear. Some statements could be more precise. For example, the authors sometimes use "malaria transmission" when the measured outcome is reported malaria incidence.

Would you recommend this preprint to others?

Yes, but it needs to be improved

I would recommend this preprint to researchers interested in malaria epidemiology, antimalarial resistance, and molecular surveillance. The study shows an important public health question and provides useful population-level evidence.

Is it ready for attention from an editor, publisher or broader audience?

Yes, after minor changes

I think this preprint is worth editorial consideration because it addresses an important research question and provides useful findings. However, before publication, I would recommend additional clarification of the statistical model, sensitivity analyses for variable selection.

Competing interests

The author declares that they have no competing interests.

Use of Artificial Intelligence (AI)

The author declares that they did not use generative AI to come up with new ideas for their review.