About this trial
Children in low- and middle-income countries who are hospitalized for diarrhea and also have malnutrition are at high risk for illness and death in the 6 months period following treatment for diarrhoea despite receiving current guideline recommended diarrhea management (such as oral rehydration solution, or "ORS"). This study will test whether nutritional supplements made from milk (lactoferrin or lysozyme) or a combination of the two (lactoferrin and lysozyme) will prevent children from having repeated diarrhea episodes and help improve their nutrition by improving their stomach health or preventing new disease during this 6-month period. The study is taking place at 7 hospitals in Western Kenya. Six hundred participants will be enrolled if they provide informed consent to participate, are aged 6-24 months, were hospitalized with diarrhea and malnutrition and have been managed by the facility nutritionists and ready to return home. Participation in the study will entail providing information on the child's health history, collection of stool samples, blood, and potentially urine. The caregiver will be provided sachets of the investigational product to take home and mix daily with their child's porridge or other complimentary food, and asked to return to the clinic 4 times in the subsequent 6 months, and also consent to having a community health worker visit their home every two weeks for a follow up visit. The risks to the participant and their caregiver are minimal. The information gained in this study will help us create new treatments and develop new strategies to treat sick children to prevent death and illness.
Eligibility criteria
This trial accepts healthy volunteersQualifiers
Age 6-24 months
Managed as an outpatient or inpatient for diarrhea at one of the recruiting sites
MUAC <12.5 cm at the time of screening
Plan to stay within the study area for the next 6 months or greater
Disqualifiers
Age younger than 6 months or older than 24 months
Caregiver does not provide consent to study participation
History of 2 or more blood transfusions in the past 12 months
Exclusively breastfeeding at the time of enrollment
Trial design
Factorial
Treatments tested in this trial
Lactoferrin
Dietary supplementCaregivers of children will be instructed to provide 1.5g of lactoferrin with 40g of unmodified rice powder daily mixed with 125 mL of porridge or other complimentary food.
Lysozyme
Dietary supplementCaregivers of children will be instructed to provide 41.5g of Lysosure daily mixed with 125 mL of porridge or other complimentary food.
Lactoferrin + Lysozyme
Combination productCaregivers of children will be instructed to provide 40g of Lysosure with 1.5 grams of lactoferrin daily mixed with 125 mL of porridge or other complimentary food.
Placebo
Other interventionCaregivers of children will be instructed to provide 41.5 grams of unmodified rice powder daily mixed with 125 mL of porridge or other complimentary food.
Treatment groups
Trial outcomes
Primary outcomes
Incidence of moderate-to-severe diarrhea
Defined as total number of new diarrhea episodes (\> 48 hours after a diarrhea-free period) deemed moderate-to-severe, divided by the child-time at risk during the 6-month follow-up period. Moderate-to-severe diarrhea will be defined as ≥ 3 using the CODA (Community DiarrhoeA) diarrhea severity score or dysentery (evidence or reported visible blood in stool).
Time to nutritional recovery
Defined as the number of days since enrollment to the date of the second of two consecutive MUAC measurements ≥ 12.5 cm.
Secondary outcomes
Incidence of diarrhea (any severity)
Diarrhea (any severity) will be defined as diarrhea (3 or more abnormally loose or watery stool) during follow-up, irrespective of severity, ascertained through follow-up visit questionnaires and a diarrhea diary. Episodes will be defined as per the primary outcome.
Incidence of severe diarrhea
Severe diarrhea defined by the CODA diarrhea severity score of 7 or more or dysentery. Episodes will be defined as per the primary outcome.
Incidence of dysentery
Dysentery will be defined as evidence or reported visible blood in stool. Episodes will be defined as per the primary outcome.
Incidence of medically-attended diarrhea
Medically-attended diarrhea will be defined as diarrhea that led to an outpatient or inpatient visit at a health facility or hospital that is typically attended by a nurse, clinical officer, and/or physician. Episodes will be defined as per the primary outcome.
Sponsors and contacts
Click on the lead sponsor to view all of their trials.
University of Washington
Lead sponsor
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Collaborator