Overview Malaria & Critical illness

Our research focuses on the diagnosis, pathophysiology, treatment including the raising issue of drug resistance, prevention and elimination of malaria

Headed by Arjen Dondorp, MORU’s Malaria & Critical Illness Department consists of closely interacting teams that:

• Conduct treatment studies in severe and uncomplicated malaria;
• Investigate the growing problem of antimalarial drug resistance;
• Develop approaches to malaria elimination;
• Research the complicated pathophysiology of severe malaria; and
• Perform studies to improve critical care in resource-limited settings including training methods, adapting guidelines, and trialling novel interventions.

The clinical team is responsible for hospital-based malaria and critical illness studies within our network of study sites, where we work closely with our local collaborators.

The malaria laboratory in Bangkok, headed by Professor Kesinee Chotivanich, supports clinical research through a wide range of laboratory studies on the pathobiological mechanisms and antimalarial drug action in Plasmodium falciparum and P. vivax.

The molecular malaria laboratory, directed by Professor Mallika Imwong, focuses on molecular genetic correlates of antimalarial drug resistance and supports the large clinical and epidemiological malaria studies with sensitive qPCR detection methods.

© MORU 2019, Prayoon YuentrakulTRAC 2 study coordinator Rob van der Pluijm with Indian collaborators

Research carried out by MORU Malaria and SMRU underpins the current WHO guidelines for the treatment of severe malaria, uncomplicated falciparum and vivax malaria, and malaria in pregnancy.

In 2018 the Malaria & Critical illness Department completed the large multi-centre multi-country TRAC II study. This study continued tracking drug-resistant malaria and tested the safely and efficacy of triple ACTs (TACTs) to treat multi-drug resistant falciparum malaria, which is a major and worsening threat to global malaria control and elimination efforts. DeTACT, a large follow-up project funded by DFID will expand the evaluation of TACTs to African countries and aims to have 2 different TACTs ready for deployment by the end of the project.

We are currently undertaking the TACT-CV study in Stung Treng and Pursat, Cambodia to investigate TACTs in areas with multiple drug resistant falciparum malaria.

© MORU 2019, Gerhard Jørén.Malaria Lab Senior Post-doc Andrea Ruecker at work on the sexual stages of the malaria parasite

Our work on severe malaria includes study sites in Bangladesh and Kinshasa, DRC:

• Chattogram (formerly Chittagong), Bangladesh
• Kinshasa, DR Congo

These studies focus on the management of severe malaria, including fluid management. In addition, the studies identified haem mediated oxidative stress as an important contributor to renal failure in severe malaria. Paracetamol was shown to mitigate this important pathway in adult severe malaria and will now be trialled in African children with severe malaria.

© MORU 2019, Nicky Almasy.School children inside a classroom in Siem Pang

Work on critical illness includes the development and roll out of an electronic intensive care unit (ICU) registry as a starting point for quality improvement projects aiming to improve patient outcomes. This has been piloted successfully in Sri Lanka and Pakistan. We will now establish a large Asian ICU network with the aim to expand implementation of the registry and quality improvement activities, and to test new interventions.

In addition, the Malaria Department has an active, successful postgraduate student programme, with 22 students currently working on a DPhil, PhD or MSc. If you’re interested in doing a postgraduate degree with us, have a look at our Students page. Then, contact one of our principal investigators for a potential supervisor or Prof Stuart Blacksell, Post-Graduate Student Coordinator.