Malaria & Critical illness

The Malaria & Critical Illness Department focuses on the diagnosis, patho-physiology, prevention, elimination, and treatment of malaria. A critical issue for the department is the emergence and spread of antimalarial drug resistance. In addition, our research has a focus on improving critical care in resource limited settings.

© MORU. Photographer: Gerhard JørénMORU’s Malaria & Critical Illness Department, led by Prof Arjen Dondorp, integrates multiple teams to tackle malaria and critical care challenges. Their work spans treatment trials for falciparum and vivax malaria, drug resistance monitoring, vaccine evaluation, ICU care assessments, and novel interventions in low-resource settings. The department also supports malaria prevention and elimination strategies.

Collaborating with global partners and across MORU sites, the department conducts clinical trials, molecular studies, and behavioural research. Its Bangkok-based laboratories—led by Professors Kesinee Chotivanich, Mallika Imwong, and Olivo Miotto—contribute to understanding malaria pathophysiology, drug resistance, and epidemiology. In 2024, the department played a key role in major multinational projects: DeTACT and Critical Care Asia Africa (CCAA), and continues close collaborations in the DRC and across the Greater Mekong Subregion.

© MORU. Photographer: Gerhard JørénIn 2024, MORU achieved major milestones in malaria research and critical care. It completed the TACT-CV and DeTACT studies on triple artemisinin-based combination therapies (TACTs), advancing treatments for drug-resistant malaria. The results have led to a fixed-dose combination now set for multi-country trials in 2025. MORU also established the Critical Care Africa Asia (CCAA) ICU network across 15 countries, implementing registries, quality improvement initiatives, and clinical trials on COVID-19 and other critical diseases.

In malaria elimination, MORU supported eastern Greater Mekong Subregion (GMS) efforts through molecular surveillance and targeted interventions. Prof Dondorp chaired the USD $800m RAI steering committee, positioning MORU to support similar initiatives in East Africa, where artemisinin resistance has emerged. The team also progressed the Star Homes Project in Tanzania, evaluating health and environmental impacts of novel housing. In vaccine research, following immunogenicity studies of the R21/MM malaria vaccine in Thai volunteers, MORU completed preparations for a 2025 cluster trial combining the vaccine with mass drug administration in Bangladesh.

In 2018, MORU’s Malaria & Critical Illness Department completed the TRAC II study, a large multi-country effort that assessed the safety and effectiveness of triple artemisinin-based combination therapies (TACTs) for multi-drug resistant Plasmodium falciparum. This form of drug resistance poses a growing threat to global malaria control and elimination.

To address this, the DFID-funded DeTACT project builds on TRAC II by expanding TACT evaluation to African countries. Its goal is to have two optimised TACT regimens ready for deployment, offering a vital tool in the global fight against increasingly resistant malaria strains and helping to secure treatment effectiveness across regions.

DeTACT

DeTACT is a large, MORU-led clinical trial across 14 sites in Africa and Asia, evaluating the safety and effectiveness of two triple artemisinin combination therapies (TACTs) to combat drug-resistant Plasmodium falciparum. The project also explores ethical, commercial, and public health implications for deploying TACTs, especially in high-burden African settings.

TACT-CV

The TACT-CV study (2017–2020), funded by the Bill & Melinda Gates Foundation, evaluated the safety and efficacy of triple ACT (artemether-lumefantrine + amodiaquine) versus standard ACT in treating uncomplicated Plasmodium falciparum malaria in Cambodia and Vietnam. The trial included research, epidemiology, and public engagement activities in rural Cambodia.

Severe malaria

MORU conducts severe malaria research in Bangladesh and DR Congo. Key trials include SEAQUAMAT in Chattogram and the PERFuSE study on sepsis. In Kinshasa, a Wellcome-funded trial is testing paracetamol’s kidney-protective effect in children with severe malaria to reduce acute kidney injury, a major complication in paediatric cases.

Siem Pang

In Stung Treng, Cambodia, MORU established a research station at Siem Pang to support the Gates-funded TACT-CV study, evaluating antimalarial treatments. The site also hosts epidemiological research on forest malaria and public engagement initiatives that provide health education to rural communities, fostering collaboration between researchers, villagers, and national malaria authorities.

© MORU, Nicky AlmasyBuilding on the success of the TRAC II study, the DFID-funded DeTACT project is expanding the evaluation of triple artemisinin-based combination therapies (TACTs) to African countries. The goal is to develop two TACT regimens ready for deployment, addressing the growing challenge of multi-drug resistant falciparum malaria across multiple regions.

Looking ahead, MORU’s Malaria & Critical Illness Department will focus on antimalarial drug resistance biology, innovative drug testing, and malaria elimination strategies including vaccines and housing improvements. Additional research areas include optimising treatment for P. vivax, improving severe malaria care, and advancing critical care in low-resource settings through ICU training, registries, and adapted clinical protocols.