A monk and his students volunteer to provide blood for the Targeted Malaria Elimination (TME) study in Pailin, Cambodia. The monks have come down from a nearby temple to show their support to the village chairman – who is also the local malaria worker.

Pailin is a small province in western Cambodia with around 70,000 inhabitants. It borders Thailand on the west and is surrounded by Cambodia’s Battambang Province. Pailin became a separate administrative division in 1996. This region is famous for its natural resources, namely precious gems and logging.

This Thai-Cambodian border region has been historically a cradle of anti-malarial drug resistance. In the 1960s resistance of Plasmodium falciparum to chloroquine emerged from here, before spreading to Asia and Africa. Resistance to sulfadoxine and pyrimethamine also seems to have originated here and then spread to other malaria-endemic countries.

MORU has a long-running collaboration with the Cambodian National Malaria Control Programme (CNM). In 2007, a group of investigators led by MORU Professors Arjen M Dondorp and Nick J White, CNM Director Dr Duong Socheat and Vice Director Dr Chea Nguon established a study site in collaboration with CNM at the Pailin Provincial Referral Hospital.

Since then MORU along with CNM and other partners has conducted a series of malaria research studies in Pailin, with an initial focus on artemisinin resistance and antimalarial drug efficacy against Plasmodium falciparum malaria. We work in partnership with the provincial health department, local NGOs and the village malaria worker programme.

Due to effective control measures by the Cambodian government and partners this area has witnessed a marked decline in malaria over the past decade. However, Pailin is also the site in which artemisinin-resistant falciparum malaria was first detected and has been at the centre of several waves of antimalarial resistance in the past.

At Pailin, MORU currently conducts clinical trials on triple artemisinin combination therapies (TACT)to compare these with the increasingly failing dual therapies in ACTs. In addition genetic epidemiological studies aim to understand the importance of the asymptomatic parasite reservoir, and studies on targeted malaria elimination (TME) – treating a whole village with mass drug administration – address how to target this asymptomatic reservoir in order to stop transmission. Major recent and on-going studies in Pailin include: artemisinin resistance in falciparum malaria efficacy study 2007-09, the TRAC study 2011-13, the micro-epidemiology of plasmodium falciparum malaria study 2013-14, and the targeted malaria elimination (TME) study 2015-17.

The Pailin field station is run by Rupam Tripura MD, a research physician, and Tom Peto PhD, a research scientist, with studies supervised by Professor Arjen Dondorp and Dr Lorenz von Seidlein. MORU maintains an office in Pailin, laboratory facilities at the Pailin Referral Hospital, and a satellite office in neighbouring Battambang from which our field team operates. Our aim is to conduct research that will help Cambodia to eliminate malaria.

Dr. Rupam Tripura, right, shows Bill and Melinda Gates medicines used in Pailin for targeted malaria elimination (TME) studies.