The PRoRota project is launching a new initiative to address childhood deaths from diarrhea in low and middle-income countries. The project will use probiotics, improved hygiene education, and mathematical modeling to reduce the incidence of diarrhea among children.
Diarrhea remains a leading cause of child mortality worldwide, claiming nearly two million lives each year. Rotavirus is identified as a major contributor to these deaths. While vaccines have reduced cases of rotavirus-related diarrhea, their effectiveness in some regions remains limited.
The PRoRota project recently received 5.3 million euros from the European Union for four years of research aimed at improving vaccine efficacy in low and middle-income countries. Sabrina Moyo leads the project, with Nina Langeland and Bjørn Blomberg as main researchers from the Tropical Infectious Diseases Group.
Researchers believe that the composition of gut microbiota may affect how well vaccines work in children. "In our guts we have both 'good' and 'bad' bacteria. The microbiota in our guts is affected by both hygiene and nutrition, and other factors," said Moyo.
Previous studies conducted by the group in Tanzania found high rates of antibiotic-resistant bacteria in infants under three months old. In follow-up research, they tested whether giving probiotics to infants could increase beneficial bacteria and decrease multi-resistant strains. "We observed that those who had received probiotics daily for one month, had a reduction of resistant bacteria in the gut, compared to the control group," said Moyo.
However, this effect was temporary; stool samples collected six months later showed that changes did not last long-term. The new study will examine if repeated probiotic doses before routine immunizations can improve rotavirus vaccine responses.
"Very few studies have looked at how probiotic affects vaccination. In PRoRota we will give probiotics from birth, and for longer periods," Moyo explained. "Our hypothesis is that probiotics can, through improving a destabilized gut microbiome, increase the vaccine immune responses."
To test this idea, researchers will conduct a double-blind, placebo-controlled trial involving 4,000 newborns across Tanzania, Malawi, and Ivory Coast. Infants will be randomly assigned to receive either probiotics or placebo during four-week courses at birth and again at 6, 10, and 14 weeks old. They will be monitored until six months of age for rates of diarrhea (the primary outcome), immune response to rotavirus vaccination, and levels of multidrug-resistant gut bacteria (secondary outcomes).
Five international partners are participating: University of Bergen (Norway), Muhimbili University of Health and Allied Sciences (Tanzania), National Institute for Medical Research (Tanzania), Association PAC-Ci CI IC (Ivory Coast), and Training & Research Unit of Excellence Limited (Malawi).
Another part of the project focuses on improving hygiene practices among caregivers through enhanced Water, Sanitation, and Hygiene ("WASH") education programs. "We know that hygiene and sanitation not optimal," said Moyo. She added: "In the study all groups will receive an enhanced 'WASH' education, and we will study what is needed to make the WASH-education work."
Researcher Amani Mori from the Department of Global Public Health and Primary Care oversees analysis on cost-effectiveness. Mori noted that caring for sick children increases time spent traveling to hospitals while reducing time available for work—a burden on families as well as health systems already under strain.
Additionally, Professor Iain Johnston from UiB’s Faculty of Science and Technology is developing a prediction tool using weather data combined with infection records from 2015-2025 in Tanzania, Malawi, and Ivory Coast to forecast future outbreaks: "The creation of early-warning systems for outbreak prediction could be an important tool for the Health Administration of these three countries," said Moyo.
Moyo summarized: "This funding means that we are able realize all our plans." The main objectives remain reducing diarrhea cases among children, lowering drug-resistant bacterial colonization in their intestines, and boosting immune responses to rotavirus vaccines.
