Direct Observation of Treatment Provided by a Family Member as Compared to Non-Family Member among Children with New Tuberculosis: A Pragmatic,Non-Inferiority,Cluster-Randomized Trial in Gujarat,India

Background

The World Health Organization recommends direct observation of treatment (DOT) to support patients with tuberculosis (TB) and to ensure treatment completion. As per national programme guidelines in India, a DOT provider can be anyone who is acceptable and accessible to the patient and accountable to the health system, except a family member. This poses challenges among children with TB who may be more comfortable receiving medicines from their parents or family members than from unfamiliar DOT providers. We conducted a non-inferiority trial to assess the effect of family DOT on treatment success rates among children with newly diagnosed TB registered for treatment during June–September 2012.

Methods

We randomly assigned all districts (n = 30) in Gujarat to the intervention (n = 15) or usual-practice group (n = 15). Adult family members in the intervention districts were given the choice to become their child’s DOT provider. DOT was provided by a non-family member in the usual-practice districts. Using routinely collected clinic-based TB treatment cards, we compared treatment success rates (cured and treatment completed) between the two groups and the non-inferiority limit was kept at 5%.

Results

Of 624 children with newly diagnosed TB, 359 (58%) were from intervention districts and 265 (42%) were from usual-practice districts. The two groups were similar with respect to baseline characteristics including age, sex, type of TB, and initial body weight. The treatment success rates were 344 (95.8%) and 247 (93.2%) (p = 0.11) among the intervention and usual-practice groups respectively.

Conclusion

DOT provided by a family member is not inferior to DOT provided by a non-family member among new TB cases in children and can attain international targets for treatment success.

Trial Registration

Clinical Trials Registry–India, National Institute of Medical Statistics (Indian Council of Medical Research) CTRI/2015/09/006229     

Ecobiotechnological Approach for Exploiting the Abilities of Bacillus to Produce Co-polymer of Polyhydroxyalkanoate

Ecobiotechnological approach is an attractive and economical strategy to enrich beneficial microbes on waste biomass for production of Polyhydroxyalkanoate (PHA). Here, six strains of Bacillus spp. were used to produce co-polymers of PHA from pea-shells. Of the 57 mixed bacterial cultures (BCs) screened, two of the BCs, designated as 5BC1 and 5BC2, each containing 5 strains could produce PHA co-polymer at the rate of 505–560 mg/l from feed consisting of pea-shell slurry (PSS, 2 % total solids) and 1 % glucose (w/v). Co-polymer production was enhanced from 65–560 mg/l on untreated PSS to 1,610–1,645 mg/l from PSS treated with defined hydrolytic bacteria and 1 % glucose. Supplementation of the PSS hydrolysate with sodium propionate enabled 5BC1 to produce co-polymer P(3HB-co-3HV) with a 3HV content up to 13 % and a concomitant 1.46-fold enhancement in PHA yield. Using the principles of ecobiotechnology, this is the first demonstration of PHA co-polymer production by defined co-cultures of Bacillus from biowaste as feed under non-axenic conditions.     

Ecobiotechnological Strategy to Enhance Efficiency of Bioconversion of Wastes into Hydrogen and Methane

Vegetable wastes (VW) and food wastes (FW) are generated in large quantities by municipal markets, restaurants and hotels. Waste slurries (250 ml) in 300 ml BOD bottles, containing 3, 5 and 7 % total solids (TS) were hydrolyzed with bacterial mixtures composed of: Bacillus, Acinetobacter, Exiguobacterium, Pseudomonas, Stenotrophomonas and Sphingobacterium species. Each of these bacteria had high activities for the hydrolytic enzymes: amylase, protease and lipase. Hydrolysate of biowaste slurries were subjected to defined mixture of H₂ producers and culture enriched for methanogens. The impact of hydrolysis of VW and FW was observed as 2.6- and 2.8-fold enhancement in H₂ yield, respectively. Direct biomethanation of hydrolysates of VW and FW resulted in 3.0- and 1.15-fold improvement in CH₄ yield, respectively. A positive effect of hydrolysis was also observed with biomethanation of effluent of H₂ production stage, to the extent of 1.2- and 3.5-fold with FW and VW, respectively. The effective H₂ yields were 17 and 85 l/kg TS fed, whereas effective CH₄ yields were 61.7 and 63.3 l/kg TS fed, from VW and FW, respectively. This ecobiotechnological strategy can help to improve the conversion efficiency of biowastes to biofuels.