Avalilação PREreview Estruturada de Perceptions and Acceptability of Artemisia annua Herbal Tea for Malaria Treatment: A Qualitative Study in Kalima Health Zone, Maniema, Democratic Republic of the Congo

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

Yes

The introduction establishes the following context: Scope: It focuses on socio-behavioral patterns rather than clinical efficacy. Standard ACTs remain the primary treatment, as raw biomass carries risks of improper dosing and resistance. Context: Using the Extended Health Belief Model and WHO frameworks, the study explores how individuals choose healthcare when structural barriers—like conflict, supply chain failures, and fake drugs—leave formal medicine unavailable. Purpose: It addresses a lack of data on community reliance on herbal remedies during health system failures, drawing on insights from healthcare workers, community members, and local leaders to help shape policy.

Are the methods well-suited for this research?

Highly appropriate

The study's qualitative, socio-anthropological approach is methodologically sound given its focus on human behavior and decision-making under constraint rather than clinical trials. Design: Qualitative methods effectively capture how communities navigate healthcare fragments and fake medications—nuances hard to measure quantitatively. Framework: Pairing the Health Belief Model with the WHO BeSD framework connects individual choices (like herbal tea adoption) to structural realities like stockouts and conflict. Sampling & Rigor: Sampling across patients, biomedical staff, and community leaders brings out conflicting perspectives (such as provider dosing anxieties vs. patient access needs). Relying on thematic saturation ($n=30$) and COREQ guidelines adds clear methodological rigor.

Are the conclusions supported by the data?

Highly supported

• Scope: The paper accurately avoids making clinical claims. As a qualitative study (N=30), it measures social acceptability rather than parasite clearance or drug safety. • Motivations: Turning to herbal remedies is framed as a survival tactic driven by real-world barriers—specifically, frequent drug stockouts and widespread counterfeit medicines. • Provider vs. User Divide: There is clear tension between end-users, who value the plant's accessibility and low cost, and healthcare workers, who worry about dosing unpredictability and active compound variation. • Shared Policy Goals: Participants across all groups—patients, clinicians, and community leaders alike—agreed on the need to standardize raw plant biomass into regulated pharmaceutical tablets.

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

Neither appropriate and clear nor inappropriate and unclear

Strengths Clear Conceptual Mapping (Tables 1 & 4): The analytical tables effectively link the integrated Health Belief Model (HBM) and WHO Behavioral and Social Drivers (BeSD) framework to qualitative themes and field data. This gives readers a clear structure for navigating complex socio-anthropological findings. Helpful Geographic Context (Figure 1): The map of the Kalima Health District provides crucial spatial context. Showing natural barriers like rivers and dense forests alongside conflict zones grounds the paper's claims about physical isolation and supply chain disruptions. Weaknesses & Methodological Disconnects: Mismatched Biochemical Visuals: Including diagrams of compound variability in raw infusions (like Figure 3) feels out of place. Because this is a purely qualitative study (N=30) without lab assays or pharmacological testing, these biochemical visuals sit outside the scope of the collected data. Limited Qualitative Visuals: The qualitative findings rely heavily on text and basic summary tables. The paper would be stronger with visual tools like thematic network diagrams or matrices comparing quotes across patients, healthcare workers, and local leaders to clearly highlight stakeholder differences. Focus on Theory Over Empirical Workflows: The figures prioritize theoretical mapping over empirical qualitative artifacts. Swapping abstract conceptual diagrams for concrete visual tools—such as participant flow charts, coding trees, or adoption heatmaps—would better demonstrate the depth of the data.

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

Neither clearly nor unclearly

While the findings are clearly analyzed and well-interpreted, the proposed next steps remain fairly high-level instead of detailing concrete future studies.

Is the preprint likely to advance academic knowledge?

Highly likely

This paper offers valuable insights for public health, medical anthropology, and policy in conflict settings: Rethinking Herbal Remedies: It reframes local plant use as a practical response to systemic failures—namely, widespread stockouts and fake medicines—rather than a mere cultural preference. Dual Theoretical Lens: Pairing the Health Belief Model with the WHO BeSD framework illustrates how environmental constraints override individual decision-making. Stakeholder Divide: It documents key tensions between end-users seeking accessible care and clinicians worried about dosing consistency and resistance. Policy Impact: It reveals broad consensus among patients, local leaders, and healthcare staff on transitioning raw plant material into standardized tablets to inform regional supply policy.

Would it benefit from language editing?

Yes

The manuscript's core arguments are clear, but frequent language and formatting errors weaken its delivery: Sloppy Syntax & Grammar: Typos and awkward phrasing—like repeating words in the abstract—distract from the content. Overused Buzzwords: Academic jargon ("structural survival," "quality vacuum," "epistemological friction") is repeated so often that it feels redundant. Formatting Flaws: Citations lack proper spacing ([4],[5]), hyphenation is inconsistent, and punctuation marks are occasionally left open. Dense Structure: Heavy noun phrases make the methodology harder to follow than necessary; active verbs would make it much more readable. Language Inconsistencies: British and American spellings are mixed, alongside unedited French translation artifacts.

Would you recommend this preprint to others?

Yes, but it needs to be improved

1. Linguistic and Stylistic Revisions: The manuscript needs thorough line editing to fix minor grammatical errors, improve sentence flow, and reduce reliance on repetitive jargon like "structural survival" and "epistemological friction." 2. Aligning Data Presentation: Including visuals on biochemical dynamics (such as active compound variability) feels out of place in a purely qualitative study (N=30). Replacing these figures with qualitative artifacts—such as coding trees or thematic comparison matrices across stakeholder groups—would strengthen methodological alignment. 3. Elaborating on Next Steps: Although the paper highlights a consensus on galenic standardization (converting biomass into calibrated tablets), it falls short of outlining concrete research protocols or policy pathways to turn these insights into practice.

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

No, it needs a major revision

Methodological and Visual Disconnects: The visual representations of pharmacological and biochemical dynamics—such as compound variability in raw infusions—do not fit the qualitative design (N=30). Replace or restructure these figures to showcase qualitative empirical data, such as coding hierarchies, thematic matrices, or participant flow charts. Linguistic Overhaul Needed: The manuscript relies heavily on repetitive jargon ("structural survival," "epistemological friction," "quality vacuum"), redundant phrasing, syntax errors, and translation artifacts from French academic prose. A comprehensive line edit is required to streamline the text and establish a concise, active academic style. Refining Recommendations: The conclusion jumps abruptly from qualitative findings to calling for a galenic transformation (standardizing raw biomass into tablets). To better guide future research, expand this section with concrete research frameworks, implementation protocols, or actionable policy pathways.

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.