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Randomized Controlled Field Trial of a Probiotics to Assess Its Role in Preventig Diarrhoea (Yakult)

Primary Purpose

Diarrhea

Status
Unknown status
Phase
Phase 3
Locations
India
Study Type
Interventional
Intervention
Probiotic (Yakult)
Sponsored by
Indian Council of Medical Research
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Diarrhea focused on measuring Probiotic, Prevention of diarrhoea, Nutritional status

Eligibility Criteria

12 Months - 59 Months (Child)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Children of either sex aged 1-5 years will be eligible for screening and parents will give and a written, informed consent form will be required from either of the parents/ guardians of each participating child.
  • Participating children should be free from any chronic illness and also any recent illness that may compromise the immune system. In general they will have good health without known underlying illness

Exclusion Criteria:

  • Children below -2SD of the National Center for Health Statistics (NCHS) reference median in the nutritional parameters will not be enrolled.
  • Children with history of diarrhoea in the preceding 2 weeks will not be eligible.

Sites / Locations

  • National Institute of Cholera and Enteric Disease

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

A,F,T,K

Arm Description

Two arms are for intervention and two are for control or placebo

Outcomes

Primary Outcome Measures

Diarrhoeal episodes in children

Secondary Outcome Measures

nutritional status in children

Full Information

First Posted
September 21, 2007
Last Updated
September 21, 2007
Sponsor
Indian Council of Medical Research
Collaborators
Yakult Honsha Co., LTD
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1. Study Identification

Unique Protocol Identification Number
NCT00534170
Brief Title
Randomized Controlled Field Trial of a Probiotics to Assess Its Role in Preventig Diarrhoea
Acronym
Yakult
Official Title
Randomized Controlled Field Trial of a Probiotics to Assess Its Role in The Prevention of Acute Diarrhoeal Diseases in Children
Study Type
Interventional

2. Study Status

Record Verification Date
June 2007
Overall Recruitment Status
Unknown status
Study Start Date
June 2007 (undefined)
Primary Completion Date
undefined (undefined)
Study Completion Date
January 2008 (Anticipated)

3. Sponsor/Collaborators

Name of the Sponsor
Indian Council of Medical Research
Collaborators
Yakult Honsha Co., LTD

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
A therapeutic as well as preventive role of probiotics has been suggested from results of different studies using different probiotics that have been tested, usually lactic acid producing bacteria such as lactobacillus, bifidobacterium and streptococcus species. The supplementation of probiotics to infants may also have a prophylactic effect against acute diarrhoeal diseases. In the present proposal, we plan to examine if daily intake of a probiotic beverage, which includes 15 billion probiotic Lactobacilli, has a beneficial role in protecting children from infectious diarrhea in Kolkata. OBJECTIVES Primary objectives: To assess the impact of probiotics in the prevention of acute diarrhoeal diseases in children To assess the impact of probiotics on nutrition and growth of the children Secondary Objectives: Reduction in duration, frequency of diarrhoea Identification of pathogens causing diarrhoea Examination of faecal microflora STUDY DESIGN It will be a double blind randomized controlled field trial involving 4000 children aged between 1 and 5 years in an urban slum of Kolkata, India. The 4000 children will be identified through demographic survey. The study will be double blinded where the study arm will receive Probiotic drink, which includes 15 billion probiotic Lactobacilli, one bottle (65ml) daily (under supervision of a Health Worker) for 12 weeks and the control arm will receive a similar drink without the lactobacilli (Nutrient drink) daily for 12 weeks. Randomization will be done in a ratio of 1:1, i.e., the study arm and control arm will include 2000 children each. All the children under the study will be visited daily by a health worker who will supervise intake of Probiotic drink or Nutrient drink by the children. All the children will be followed up daily for 24weeks for identification of acute diarrhoea cases.
Detailed Description
A therapeutic as well as preventive role of probiotics has been suggested from results of different studies using different probiotics that have been tested, usually lactic acid producing bacteria such as lactobacillus, bifidobacterium and streptococcus species. The supplementation of probiotics to infants may also have a prophylactic effect against acute diarrhoeal diseases. In the present proposal, we plan to examine if daily intake of a probiotic beverage, which includes 15 billion probiotic Lactobacilli, has a beneficial role in protecting children from infectious diarrhea in Kolkata. OBJECTIVES Primary objectives: To assess the impact of probiotics in the prevention of acute diarrhoeal diseases in children To assess the impact of probiotics on nutrition and growth of the children Secondary Objectives: Reduction in duration, frequency of diarrhoea Identification of pathogens causing diarrhoea Examination of faecal microflora STUDY DESIGN It will be a double blind randomized controlled field trial involving 4000 children aged between 1 and 5 years in an urban slum of Kolkata, India. The 4000 children will be identified through demographic survey. The study will be double blinded where the study arm will receive Probiotic drink, which includes 15 billion probiotic Lactobacilli, one bottle (65ml) daily (under supervision of a Health Worker) for 12 weeks and the control arm will receive a similar drink without the lactobacilli (Nutrient drink) daily for 12 weeks. Randomization will be done in a ratio of 1:1, i.e., the study arm and control arm will include 2000 children each. All the children under the study will be visited daily by a health worker who will supervise intake of Probiotic drink or Nutrient drink by the children. All the children will be followed up daily for 24weeks for identification of acute diarrhoea cases. METHODOLOGY Slum areas in Kolkata Municipal Corporation with approximately 60,000 populations (approximate 15,000 families) will be selected from ward 66 to reach a sample size of minimum 4,000 children (1-5 year age). Baseline anthropometric measurements will be taken. The diarrhoeal surveillance will be through regular household visit by CHW and stool container will be kept at each child's house to collect stool sample if diarrhoea occurs. INCLUSION/ EXCLUSION CRITERION FOR RECRUITMENT OF PARTICIPANTS Children of either sex aged 1-5 years will be eligible for screening and parents will give and a written, informed consent form (Appendix 7) will be required from either of the parents/ guardians of each participating child. Participating children should be free from any chronic illness and also any recent illness that may compromise the immune system. In general they will have good health without known underlying illness. Children with history of diarrhoea in the preceding 2 weeks will not be eligible. ADMINISTRATION OF STUDY AGENTS There will be a setup of 5 health outposts and 20 clusters (each cluster with 40 children) will be approximately of 800 children will be assigned for each health outpost. There will be 20 Community Health Workers (CHW), allocated in each health outpost will be responsible for administer of one agent code for 40 children. SAFETY EVALUATION Clinical monitor will evaluate adverse events due to intake of the drink. DATA MANAGEMENT PROCEDURES Data obtained from demographic survey (Appendix 4), daily reports and other proforma will be entered in a PC using suitable software. Data will be scrutinized for accuracy and consistency before it is entered into the PC. Data will be entered into computers in a dedicated area located at NICED, using data entry programs specially created for the project by programmer. STATISTICAL CONSIDERATIONS Endpoints Efficacy will be assessed by comparing the following between the probiotic and nutrient groups: i) Average duration of diarrhoea ii) Severity of the disease iii) Incidence of diarrhoeal disease iv) Nutritional gain v) Analysis of fecal microflora ETHICAL ASSURANCE FOR PROTECTION OF HUMAN RIGHTS Written informed consent will be obtained from the parent/guardian of each participating child for the Probiotic and Nutrition studies and for the safety and for permission to collect feces. The probiotic or nutritional drink is safe and has been administered to infant children, adults and the elderly. Storage conditions The probiotic and nutrient will be stored at 4 to 10C. Bottles taken to the field will be carried in carrying bags. Each box will have a single ice pack, and care will be taken not to freeze the contents of the bottle. MONITORING, AUDITING, INSPECTION Responsibilities of the investigator(s) The principal and co-investigators at NICED will be responsible for overall supervision and management of the project. Field investigators and other co-investigators will support the PI. The PI and co-investigators will supervise all activities at health facilities and in the sites (demographic surveillance, data collection, and samples collection and transportation). They will also visit the study sites regularly. ETHICAL AND REGULATORY STANDARDS Ethical principle The justification for using a nutrient in this study is that: 1) no probiotic is currently recommended for use for prevention of diarrhoeal diseases in public health programs in India and 2) a valid assessment of probiotic efficacy in Kolkata, which is endemic for diarrhoea, can only be obtained with use of a nutrient. The nutrient will consist of nutrient without lactobacillus, which will help for nutritional growth of the children. Potential benefits During both phases of the project, the potential benefits to participants include proper treatment and referral when needed, as well as free and accurate diagnosis of the causative agent of diarrhoeal disease. During the trial phase, the probiotic recipients are expected to benefit from the protection offered by the probiotic against diarrhoea. Potential risks The potential risk to the participants will be minimal, since there is extensive documentation for the safety of the probiotic to be used. Risk/benefit ratio The direct benefit the participants may expect from participating in this study will be free laboratory examination and treatment for diarrhoea diseases. The main benefit of obtaining data on the efficacy of the probiotic in Kolkata will be that these data will be crucial in guiding the decision of the Indian, and perhaps other developing country governments as to whether this probiotic will be alternative approach for growth of the children as well as prevention of diarrhoeal diseases. All recipients of the probiotic will potentially benefit from the probable protective effects against diarrhoea. The risks associated with the use of the probiotic or the nutrient and various other study procedures proposed to be used in this trial are expected to be minimal to nonexistent. Laws and regulations The study will be performed in accordance with the principles that govern biomedical research involving human subjects, specifically the ICMR Ethical Guidelines, the Declaration of Helsinki, and the International Conference on Harmonization's Good Clinical Practice Guidelines to provide assurance that the rights, integrity, and confidentiality of trial subjects are protected and that reported results are credible and accurate. Informed consent Individual informed consents from parents of eligible children between 1-5 years old will be obtained. Consent will be documented by signature or thumbprint of the parents/guardian on separate sheet. The privacy and confidentiality of all data and information collected from trial participants will be ensured both during and after the conduct of the trial. Individuals will not be identified in any reports and publications based on the trial data. Institutional review committee Before initiation of the study, the final protocol and the informed consent will require clearance Scientific Advisory Committee of NICED, Institutional Ethics Committee of NICED, Health Ministry Screening Committee of the Government of India. ADMINISTRATIVE ASPECTS Record retention The principal investigator and NICED will keep all trial documents for at least 5 years after the completion or discontinuation of the study. KEY PERSONNEL Name Professional Discipline/ Specialty Role in the Project 1. Dipika Sur Epidemiology PI in India 2. S.K. Bhattacharya Cholera and enteric disease Co-PI in India 4. Byomkesh Manna Epidemiology Co-I in India 5. S.K. Niyogi Microbiology Co-I in India 6 Anup Palit Microbiology Co-I in India 7. S.P. Mukhopadhyay Public health Controller 8. Ashok Chowdhury Clinician Clinical Monitor

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diarrhea
Keywords
Probiotic, Prevention of diarrhoea, Nutritional status

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
4000 (Actual)

8. Arms, Groups, and Interventions

Arm Title
A,F,T,K
Arm Type
Experimental
Arm Description
Two arms are for intervention and two are for control or placebo
Intervention Type
Dietary Supplement
Intervention Name(s)
Probiotic (Yakult)
Other Intervention Name(s)
Yakult
Intervention Description
It is a dietary supplement ,65 ml containing 15 billion lactobacillus
Primary Outcome Measure Information:
Title
Diarrhoeal episodes in children
Time Frame
10 months
Secondary Outcome Measure Information:
Title
nutritional status in children
Time Frame
10 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
12 Months
Maximum Age & Unit of Time
59 Months
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Children of either sex aged 1-5 years will be eligible for screening and parents will give and a written, informed consent form will be required from either of the parents/ guardians of each participating child. Participating children should be free from any chronic illness and also any recent illness that may compromise the immune system. In general they will have good health without known underlying illness Exclusion Criteria: Children below -2SD of the National Center for Health Statistics (NCHS) reference median in the nutritional parameters will not be enrolled. Children with history of diarrhoea in the preceding 2 weeks will not be eligible.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Dr.Dipika Sur, MD
Organizational Affiliation
National Institute of Cholera and Enteric Diseases, India
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Institute of Cholera and Enteric Disease
City
Kolkata
State/Province
West Bengal
ZIP/Postal Code
7000010
Country
India

12. IPD Sharing Statement

Citations:
PubMed Identifier
20670468
Citation
Sur D, Manna B, Niyogi SK, Ramamurthy T, Palit A, Nomoto K, Takahashi T, Shima T, Tsuji H, Kurakawa T, Takeda Y, Nair GB, Bhattacharya SK. Role of probiotic in preventing acute diarrhoea in children: a community-based, randomized, double-blind placebo-controlled field trial in an urban slum. Epidemiol Infect. 2011 Jun;139(6):919-26. doi: 10.1017/S0950268810001780. Epub 2010 Jul 30.
Results Reference
derived

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Randomized Controlled Field Trial of a Probiotics to Assess Its Role in Preventig Diarrhoea

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