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Development and Field Testing of Ready-to-use-therapeutic Foods Made of Local Ingredients in Bangladesh for SAM Children

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ClinicalTrials.gov Identifier: NCT01889329
Recruitment Status : Completed
First Posted : June 28, 2013
Last Update Posted : August 31, 2016
Sponsor:
Collaborators:
UNICEF
Nutriset
Information provided by (Responsible Party):
International Centre for Diarrhoeal Disease Research, Bangladesh

Brief Summary:

Around 0.5 million under-five children are currently suffering from severe acute malnutrition (SAM) in Bangladesh and are at risk of death. Children with SAM and complications should be treated in a health care facility. It is imperative, however, to manage children with SAM but without any complications in the community. This requires a ready-to-use-therapeutic food (RUTF) that conforms to standard recommendations on its composition. The prototype RUTF is peanut based, made outside Bangladesh, and has to be imported. By developing a RUTF using local food ingredients, test it for acceptability and efficacy in the treatment of children with SAM, hopefully make the treatment of SAM cost-effective and sustainable.

Hypothesis: Does the locally developed ready-to-use-therapeutic foods (RUTFs) demonstrate similar or better acceptability and efficacy in the treatment of children suffering from severe acute malnutrition (SAM) when compared to the prototype RUTF (Plumpynut)?


Condition or disease Intervention/treatment Phase
Severe Acute Malnutrition in Childhood Dietary Supplement: RUTF-1 Dietary Supplement: RUTF-2 Dietary Supplement: Plumpynut Phase 2 Phase 3

Detailed Description:
Childhood malnutrition continues to be a significant public health problem in the world, especially in Asia. Acute malnutrition and more so, severe acute malnutrition (SAM) among children below five years of age remains a major embarrassment, and impediment to optimal human capital development in Asia. Without access to appropriate treatment, these SAM children are at high risk of death; there are only a few hospitals in Bangladesh and other developing countries with facilities for managing these children appropriately and their coverage is extremely low. In 2008, the Government of Bangladesh published National Guidelines for management of SAM at the facility level. However, these national guidelines have yet to become operationalized and there are very small exploratory initiatives that focus on community-based management of acute malnutrition (CMAM). Under the auspices of the Directorate General of Health Services, a 2007 national consensus meeting on the management of SAM resolved that CMAM along with scaling up facility-based management is essential for Bangladesh but that a local RUTF should be developed to ensure cost-effective and sustainable programs. Absence of a RUTF that is made of locally available food ingredients and hence, relatively inexpensive, is impeding the implementation of programs for community-based management of SAM in the country. The proposed project will develop new and improved recipes of RUTF based on established principles of dietetics and select at least two candidate RUTFs for treating SAM and testing their acceptability and efficacy. The experiments for development of RUTF will be done in ICDDR,B Food Processing Laboratory by the investigators. Experiments, including assessment of the composition of the local food ingredients and the presence of anti-nutrient factors, such as phytate, will be performed in the laboratories of Nutriset in France. Acceptability of the candidate RUTFs by the children as well as by the mothers will be assessed and compared among groups of children, who receive any new two RUTF products and the prototype RUTF (Plumpy'nut). For efficacy trial, the study population will be the children who will come to ICDDR,B hospital with SAM and complications. They will receive the standardized management during the acute/initial phase of treatment in the hospital. After completion of the initial treatment of associated medical complications an appetite test with the standard RUTF will be done. If the child passes the appetite test, the child will be enrolled in the study and subsequent alternate feeds of the child will be replaced with the assigned RUTF. The child will be further observed next day giving the total ration of the assigned RUTF and will be monitored for any possible adverse effects, e.g. skin rash, urticaria from food allergy, abdominal distension, pain abdomen, vomiting, diarrhea or any other significant change in clinical status. If there is no unwanted event and the child eats RUTF eagerly, then the child will be discharged from the hospital with RUTF ration for one week (7- 10 days' ration covering the weekends and any holidays). The RUTFs will be used in a partial double-blind manner. Complete blinding of the three RUTFs might not be possible because of distinctive smell of peanuts in proto type RUTF. Other two candidate RUTFs will be blinded. The code will be kept by the producer of the sachets (Nutriset) and Dr ASG Faruque, Senior Scientist, ICDDR'B, who will not be involved with the study. A team of ICDDR,B staff will be responsible for implementation of the study. All field personnel recruited will be full time for this study and will have prior experience in interview techniques, data collection, and assessment of nutritional status. Before starting field activities, an intensive 5-day training will be given to the supervisors and interviewers. The quality control team supported by investigator(s) will monitor the performance of field personnel through regular observation at the household level and regular checks of data for completeness. The quality control team will independently check the data collection. Errors detected will be corrected immediately in the field. The entire assignment including the report writing will be completed within 24 months after the IRB approval from ICDDR,B and signing of MOU between the UNICEF, Bangladesh, Nutriset and ICDDR,B.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 490 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary Purpose: Treatment
Official Title: Development and Field Testing of Ready-to-use-therapeutic Foods Made of Local Ingredients in Bangladesh for the Treatment of Children With Severe Acute Malnutrition
Study Start Date : April 2013
Actual Primary Completion Date : December 2015
Actual Study Completion Date : December 2015

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Malnutrition

Arm Intervention/treatment
Experimental: RUTF-1
Made from local food ingredients
Dietary Supplement: RUTF-1
Made from local food ingredients

Experimental: RUTF-2
Made from local food ingredients
Dietary Supplement: RUTF-2
Made from local food ingredients

Active Comparator: Plumpynut
Made from peanut
Dietary Supplement: Plumpynut
Commercially made from peanut paste




Primary Outcome Measures :
  1. Weight gain (g/kg/d) [ Time Frame: Initially 3 months for the acceptability trial another 18 months will be required for the efficacy trial ]
    The primary objective of the proposed study will be to develop ready-to-use therapeutic food (RUTF) that will ultimately be used to treat childhood severe acute malnutrition which continues to be highly prevalent in Bangladesh. This will involve selection of candidate recipes of RUTF and testing them for acceptability and efficacy among children and caregivers. The successful candidate recipe of local RUTF is expected to have better weight gain (g/kg/d) in children suffering from Severe Acute Malnutrition (SAM).



Information from the National Library of Medicine

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Ages Eligible for Study:   6 Months to 59 Months   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Children aged 6 to 59 months (either sex)
  • Suffering from Severe Acute Malnutrition (SAM) defined by WHZ <-3 using WHO growth standards 2006 and/or having bipedal edema (nutritional), and/or MUAC <11.5 cm
  • Have completed acute (stabilization) phase management, are clinically well, and have an appetite
  • Additional enrollment criteria will be: no signs of concurrent infection, mothers/caregivers agree to stay in their current address for at least the next three months (for ease of follow-up of the children)
  • Informed written consent obtained from the parent or guardian.

Exclusion Criteria:

  • Failure to obtain Informed consent from parents or caretakers
  • Children without any fixed address
  • Children with tuberculosis (diagnosis based on WHO 2006 guidelines which have been incorporated in the national TB control guidelines of Bangladesh)
  • Any congenital/acquired disorder affecting growth i.e. trisomy-21 or cerebral palsy
  • Children on an exclusion diet for the treatment of persistent diarrhea
  • Having known history of soy, peanut or milk protein allergy.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01889329


Locations
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Bangladesh
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
Dhaka, Bangladesh, 1212
Sponsors and Collaborators
International Centre for Diarrhoeal Disease Research, Bangladesh
UNICEF
Nutriset
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Responsible Party: International Centre for Diarrhoeal Disease Research, Bangladesh
ClinicalTrials.gov Identifier: NCT01889329    
Other Study ID Numbers: PR- 11005
First Posted: June 28, 2013    Key Record Dates
Last Update Posted: August 31, 2016
Last Verified: June 2015
Additional relevant MeSH terms:
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Malnutrition
Severe Acute Malnutrition
Nutrition Disorders