CoBRI – Community Based Research Initiative for Health, is a public-private initiative committed to public health conditions in low to middle-income populations and combines the skills of a variety of organizations to bring scientific research to communities.
As part of the initiative, SPRIM acted as the CRO to study a new diarrhea solution which could improve patient-reported outcomes in adults with dehydrating diarrhea in Indonesia.
SPRIM worked with the local government and chose PUSKESMAS and POSYANDU test sites to conduct the study.
PUSKESMAS are government-mandated community health clinics located across Indonesia. There are an estimated 9,754 PUSKESMAS in Indonesia, all of them overseen by a team of general doctors, dentists, nurses, midwives, nutritionists, pharmacist, sanitarians, laboratory staff, and non-medical staff appointed by the Indonesian Ministry of Health.
POSYANDU provide integrated services for health, nutrition, family planning and activities aimed at generating income for women as part of the poverty alleviation strategy.
The role of POSYANDU in this system is very important, especially to support the vaccination programme, mother and child healthcare (KIA), family planning programme, prevention of diarrhea, and community health education.
Between September 2016 and December 2017, a total of 380 adult patients with acute diarrhea were enrolled into the study and were equally randomized. The Enterade solution proved to resolve diarrhea 4 hours earlier than the WHO-recommended solution.
This was the first randomized controlled trial (RCT) that evaluated the efficacy of Enterade® in acute diarrhea so further studies are needed. However, the results provided evidence that there may be better interventions available for treating diarrhea in Indonesia. There is a growing body of evidence that glucose is the reason behind ORS’ lack of effect in shortening duration of diarrhea. In addition, study findings support previous observations that in the absence of glucose, intestinal fluid absorption, particularly that of Na+, can take place via amino acid-coupled transport. If proven to be efficacious, Enterade® would be a promising alternative to the standard reduced-osmolarity ORS.