Research Activities

Image of mosquito

The Shoklo Malaria Research Unit (SMRU) was established in 1986 to study the epidemiology, the treatment and the prevention of multi-drug resistant falciparum malaria in the Karen refugee camps on the Thai-Burma border. At that time, malaria was the most serious health problem facing the displaced population living along the border - it was the primary cause of death and represented over 45% of out-patients consultations. Over the years SMRU has conducted the largest clinical trials on the treatment of uncomplicated malaria and pioneered the deployment of the artemisinin based combination treatments (ACT) now the world standard. Registration studies of the main ACTs (Arthemeter-lumefantrine, mefloquine-artesunate, DHA-piperaquine) were conducted at SMRU. Numerous studies on the treatment of malaria in pregnancy, as well as the impact of malaria on the mother and the fetus were conducted as well. SMRU documented for the first time, the impact of P.vivax malaria in pregnancy as well as the impacts of malaria and the artemisinin derivatives in the first trimester. The results of this operational research have directly benefited the population that we serve by guiding our humanitarian services and maximizing their positive impacts. The scope and breadth of the research activities of SMRU is evident from the list of over 500 publications.

Clinical Studies

SMRU's ongoing clinical studies include: 

1. Malaria studies:

  • P.falciparum: efficacy of mefloquine+artesunate compared to DHA-piperaquine. The pivotal factor leading to the decline in efficacy of the artemisinin-based combination therapy (mefloquine-artesunate) in routine use on the Thailand-Myanmar border to a clinically unacceptable level (from 100% in 2003 to 81.1% in 2013) is the increasing local prevalence of K13 mutations (increased from 6.7% to 83.4%) superimposed onto a longstanding background of Pfmdr1 amplification. Recent efficacy studies done in Kayin state and inside Myanmar displayed high cure rates (>90%) of DHA-piperaquine and Artemther-Lumefantrine combinations as well. However, high background of Pfmdr-1 is an imposing threat on the efficacy of Artemther- Lumefantrine and in addition to the recent emergence of piperaquine resistance in Cambodia with associated rising failure rates of DHA-piperaquine
  • Plasmodium vivax: Tafenoquine versus primaquine in the treatment of P. vivax malaria. This trial will assess hemolysis, safety and efficacy of tafenoquine compared to primaquine when used to treat acute P. vivax infections.
  • Treatment of P.falciparum malaria in pregnancy.

2. Studies in pregnant women and infants:

  • Interbio-21 study: a recently funded extension to the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) Project involving health institutions from seven geographically diverse countries. SMRU is one of the research centers. INTERBIO- 21st has two components: the Fetal and Neonatal Studies. In the Fetal Study, which is limited to certain settings, women are being monitored from early pregnancy onwards so as to capture very detailed information about fetal growth patterns; in the Neonatal Study, women are identified at delivery provided that gestational age has been confirmed by ultrasound < 24 weeks’ gestation. In summary, we aim to integrate pregnancy-related, molecular, biochemical and clinical data to improve the phenotypic characterisation of newborns, so as to develop targeted interventions and screening tools in pregnancy and early infant life.
  • Infant growth: studies aim at measuring and improving growth and neurodevelopment in neonates, infants and children. The research questions evolve around understanding the role of infections, nutritional status and anemia during the first 1000 days of life as well as the impact of maternal depression.
  • Neonatal jaundice: the Neonatal Jaundice study aims to identify the risk factors of moderate and severe neonatal hyperbilirubinemia, and related impaired development on the Thai-Myanmar border. This study will also help formulate how limited resources could be best allocated to reduce the risks and the negative outcomes of neonatal hyperbilirubinemia.
  • Molecular Signature in Pregnancy study: aims to identify biomarker signatures predictive of preterm birth. High throughput profiling technologies (i.e. a systems approach) will be employed; maximizing the amount of information that can be obtained and knowledge generated from each patient sample. Preliminary data will also be obtained for infectious complications in order to assess potential for a systems approach in detecting infectious events before onset or in absence of clinical symptoms. Identifying biochemical markers that are associated with preterm birth can guide in designing the most effective, targeted intervention strategies aimed towards women at risk. This project is realised in cooperation with the SIDRA Medical and Research Center based in Qatar.

3. ​Studies in tuberculosis:

  • Pharmacokinetics of anti-tuberculosis drugs: This study aims to describe the plasma drug levels of first line anti-tuberculosis drugs in newly diagnosed pulmonary TB patients among two different groups of adults with HIV co-infection and without HIV co-infection.

Laboratory Studies

The central laboratories at SMRU provide both diagnostic services and high profile research support to the investigations carried out in the fields of malaria and other infectious diseases. 

They include: microscopy, malaria in-vitro, entomology, haematology, and microbiology laboratories.